Rethinking the Pharmacy Workforce Crisis by Exploring Unconventional and Emerging Career Pathways and Training

DISCUSSION

Pharmacists bring a broader set of skills beyond the expertise for patient-focused medication management. Although it is not widely recognized or discussed among pharmacy educators, programs already train students for employment in a broad range of unconventional positions by developing students’ nontechnical skills (soft skills) as a part of many curricular and cocurricular activities. While there is no one universally accepted definition of soft skills, they are generally defined as nontechnical skills that may be difficult to measure but define a person as a mature, responsible, cognizant, and creative human being. Some of these skills are contained in Standards 3 and 4 of the Accreditation Council for Pharmacy Education (ACPE) Standards 2016: problem-solving, interprofessional collaboration, cultural sensitivity, communication, self-awareness, leadership, innovation, and entrepreneurship. ¹ These are transferable skills needed to make one a good leader and conflict manager, and they are also essential to help advance one’s career. They align with the most sought-after skills by employers of many professions and include creativity, persuasion, collaboration, adaptability, and emotional intelligence. ² Studies have found that some of the most useful soft skills are a positive attitude, communication, teamwork, and strong work ethics. ³

A PharmD education provides students with many opportunities in which they can develop and actively demonstrate these soft skills, and students’ creativity and adaptability allow them to articulate how these transferable skills apply to different contexts. The soft and transferable skills provide keywords for PharmD graduates to search in unconventional pharmacy job postings, and having these skills make them well suited for many of the new areas of pharmacy and health care that may not have been considered avenues for pharmacists in the past. Graduates who look beyond the degree requirement line of a job posting will find interesting, dynamic, and fulfilling work that uses their entire skill set. Recognizing and articulating these skills can help graduates in searching for both conventional and unconventional career paths. Students who do not readily find a role in a typical community or hospital pharmacy setting may discover a perfect fit in another health-related or marketplace setting that values their transferable skills and attain job satisfaction. Yet, making this leap will require students to think outside the box and beyond the limited options presented to them upon graduation.

Pharmacists entering the workforce continue to overlook several conventional pharmacy roles that, according to position forecasting, are worth pursuing. As a prime example, ambulatory care is a sector of pharmacy practice that has steadily grown over the past 20 years, and around 15,400 pharmacists currently work in these settings. ⁴ This role is expected to grow as much as 20% to 18,600 jobs by 2029. ⁴ Another area of growth is the provision of pharmacy services online; this newer role is projected to grow from the current 5500 jobs to 7100 jobs (31%) by 2029. Recent changes in nonurgent health care to virtual delivery is a golden opportunity for pharmacists to take on a broader role in telehealth or telemedicine. ⁵

The pharmaceutical industry continues to expand, and pharmacy graduates are well positioned for employment in this sector with their research and clinical backgrounds. ⁶ According to the 2019-2020 fellowship report, 79 pharmaceutical companies offer fellowship programs, ⁷ whereby the top three areas for fellowships are medical affairs, clinical research and development, and regulatory affairs. Fellowship programs increased by 111% over the last six years, and other fellowship areas that are currently being offered include pharmacovigilance, medical information, market access, clinical supply, drug safety, clinical development, and marketing. Another group supporting pharmacists in this area is the Industry Pharmacists Organization which helps advance pharmacists’ professional careers by advocating for their role in drug development and medication use. ⁷

The COVID-19 pandemic and the opioid crisis have also created opportunities for pharmacists in areas such as public health, substance abuse treatment, and immunization. Other positions that graduates could consider are in more unconventional areas where both their technical and soft skills are highly relevant: nonprofit association leadership or management; academia; federal government agencies, such as the Federal Emergency Management Agency (FEMA) or the Centers for Medicare & Medicaid Services; state and regional health organizations, such as departments of health or public service; research in academia or the biotechnology industry; supply chain and distribution management; specialty pharmacy distribution and management; managed care, such as health management organizations; and quality improvement in health systems or pharmaceutical companies (Appendix 1).

While PharmD graduates possess skills that are both universal and transferable to the health care sector and the global marketplace, one shortcoming of PharmD programs is that students are undereducated on self-advocacy, such as how to integrate their strong clinical backgrounds and transferable skills into tomorrow’s practice models and market the skills they have and become aware of long-term opportunities. Schools and colleges of pharmacy can leverage cocurricular and interprofessional education opportunities to help students see the wider transferability of their skills into unconventional practice models and areas of employment. To help students see the value of cocurricular activities, pharmacy schools need to move beyond unstructured activities, which currently comprise many cocurricular plans. ⁸ Pharmacy graduates would benefit from intentional incorporation of how cocurricular activities can prepare them for positions as medication experts outside patient care. In addition, structured interprofessional education opportunities in innovative practice models need to be explored to help students in all professions learn how to become innovators in their professions.

Another area for student development is the innovative use of technology. In this era of digital transformation, how can new graduates market and promote their skills as medication experts in ways that make pharmacists accessible to patients outside the traditional hospital, community, or clinic setting? Some changes that the field of pharmacy has experienced but which have not been made known to our graduates are in the areas of technological inventions (eg, medication dispenser, 3D printing), store-to-door convenience (eg, Amazon Pharmacy), social media (eg, medication “influencers”), artificial intelligence (eg, precision medicine), telemedicine (eg, home care), and digital disruption (eg, app creation). ^9-12 Cultivating human connection in a digital world is vital, and how this is taught and delivered in pharmacy curricula needs focus. For example, we may consider incorporating communication via social media into curricula to focus on content creation, podcast production, designing effective websites, and ethics for digital patient care (Figure 1, Appendix 1). These basic technical skills can help graduates create, innovate, and influence online communities that have a broader reach than typical pharmacy settings. By demonstrating their value as health care professionals on online platforms, graduates can contribute to practice transformation. ¹³

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Figure 1.

Graphic of the diverse career opportunities available for pharmacist innovators. Abbreviations: HMOs=health management organizations; PBMs=pharmacy benefit managements

In addition to furthering team development and technology skills, schools should address specialized didactic content that may further enhance students’ unique skill sets. This content could take the shape of certificates and dual degree programs. ¹⁴ Potential curricular topics include personalized medicine, pharmacogenetics, and patient education related to these areas. ¹⁵ Knowledge gained through certificates and dual degree programs also helps students become aware of unconventional careers early in their education. ¹⁶

To help students learn how to market more than their patient care skills, faculty members must discuss the unique skill sets that their student pharmacists are developing and how students can use them to their advantage when competing for unconventional positions. Faculty should become more aware of what is taught in their curricula and cocurricular activities and how that can translate to conventional and unconventional workplaces for pharmacy graduates. Faculty should serve as role models and mentors on how to be innovative and entrepreneurial; they should guide students on how to read job descriptions and market themselves for jobs that are not necessarily looking for a PharmD but could become rewarding careers.

For faculty to be these messengers and role models for students, schools should dedicate resources to help faculty raise awareness of new and unconventional areas of practice and to help minimize their perceptions, biases, or judgments stemming from their lack of knowledge and awareness about such career paths. Brown and colleagues ¹⁷ evaluated faculty perceptions of postgraduate training and found that faculty had greater awareness of community-based (95%) and hospital-based residency programs (94%) than of community-based fellowships (59%) and independent pharmacy ownership residencies (31%). Respondents showed preferential bias toward hospital-based pharmacy residencies, with 83% rating them “very valuable” compared with community-based residencies (59%) and fellowships (61%). In a changing workforce, faculty need to consider their own biases and messaging to students. Faculty should learn about residency programs that have a practice-expansion focus and engage with alumni having unconventional roles. Connecting with a career development center on campus or teaching students to effectively use platforms such as LinkedIn or other job search applications may be beneficial. Another strategy is for schools to enhance alumni mentorship programs so as to expose students and faculty to pioneering innovators and unconventional positions in pharmacy. ¹⁸

Creating opportunities for students to engage in professional mentorship and leadership development is beneficial to students as they prepare for their careers. A mentorship program for PharmD students with highly effective external pharmacy leaders can help prepare student pharmacists early on, potentially leading to higher rates of individualized career success. One such comprehensive, longitudinal hands-on mentoring program launched at the University of Wisconsin–Madison developed an innovative pharmacy leadership certificate and mentor (LCM) program (noncredit) that cultivates students’ leadership skills through a course, targeted activities, specific self-reflection questions, community service opportunities, and leadership conference opportunities, and it offers a mentoring relationship that connects students and practicing pharmacist mentors. ¹⁹ Most of the LCM program takes place outside the classroom, so students are building their skills on their own time. Overall, the goal of these professional development opportunities is to help students envision themselves in aspirational positions and cultivate their mindsets to see beyond perceived limits. They can become pharmacist clinicians or innovators, or both.