Aim
To identify the kinds of changes pharmacists had made to their work in the past three years and those changes that they intended to make in the next three years.
Design
Piloted postal questionnaire containing open and closed questions.
Subjects and setting
All registered pharmacists aged up to 65 years, together with those aged over 65 and still working, in the West Midlands region.
Results
The response rate was 68.8% after one reminder. There was a trend away from permanent community posts to locum work, with a net move to locum work of 58. Numbers switching between community and hospital sectors were small. Some 72 pharmacists had started work with a GP practice. Almost one in four pharmacists said they had cut their working hours. The most often reported reason for making a change was the wish to seek “more interesting work” or “greater job satisfaction”. Over half the working pharmacists planned to make changes in the next three years. Excluding career breaks and retirement, 25% of community and 12% of hospital pharmacists said they intended to reduce their hours. Interest in working with GPs was high, with 35% of working pharmacists stating they wished to do so. Almost one-fifth of working pharmacists said they would like to leave the profession (community and non-white pharmacists were over-represented in this group).
Conclusion
If the trends found continue and intentions regarding changes to work are implemented there will be significant implications for the pharmacy workforce, particularly for community pharmacy.
Pharmacy has traditionally been promoted as a profession which offers a range of career choices and flexibility in moving between different sectors as well as flexible working arrangements. In the context of recent reports of a shortage of pharmacists,1?6
shifts from one sector to another or changes in hours worked could have a significant impact on the available pool of pharmacist resource. However, there are no published data on the extent of employment moves between sectors or other changes in the pharmacy workforce. As part of a larger survey of work patterns and aspirations we asked pharmacists to tell us about changes they had made and planned to make in their careers.
In a previous paper we reported on current work patterns and profiles of pharmacists in the West Midlands.7
The findings showed that retention of pharmacists within the profession was very high (over 90 per cent) and that significant numbers of pharmacists had not left the profession. In this paper we address the effects of changes which pharmacists reported they had made or intended to make, and consider the implications for the workforce.
Objectives We set out to identify the kinds of changes pharmacists had made to their work in the past three years and those changes that pharmacists intended to make in the next three years.
More specifically, it was initially hypothesised that the following changes might have affected the pharmacy workforce:
- Pharmacists switching from hospital to community pharmacy (or vice versa)
- Pharmacists switching from permanent community pharmacy posts to locum work (or vice versa)
- Pharmacists taking up posts with GP practices
- Pharmacists reducing the numbers of hours worked
Methods
A postal questionnaire was mailed to all registered pharmacists up to age 65 in the Royal Pharmaceutical Society’s West Midlands plus those aged over 65 whose registration category indicated that they were still working as a pharmacist (2,568 in total). The first mailing was distributed in November, 1997, with a reminder to non-responders in January, 1998. The response rate was 68.8 per cent (1,767) after one reminder. Ninety per cent (1,590) were working as pharmacists, with 78 per cent (1,247) working in community pharmacy and 17 per cent (275) in hospital. The detailed methods, including the validation of respondents have been reported elsewhere.7
In the survey we sought to test our hypotheses by asking pharmacists to report on employment changes already made and those intended for the future.
The past – changes made in the past three years Pharmacists were asked if they had (i) switched from hospital to community pharmacy (or vice versa), (ii) switched from a permanent community pharmacy post to locum work (or vice versa), (iii) started to work as a GP practice pharmacist, or (iv) cut down the number of hours worked in the past three years.
An open question allowed them to describe any other changes they had made to their work during this period. Respondents were then asked to say why they had made changes.
The future – changes intended in the next three years Respondents were asked if they intended to make changes to their work, then if they planned to increase or reduce the hours they worked, take a career break or retire during this period.
Respondents were asked in an open question if they intended to make any other changes to their work and, if so, what these might be. They were then asked to say why they planned to make such changes.
Pharmacists were also asked whether they agreed or disagreed with a series of statements beginning “I would like to …” and then offering a series of options: move to another branch of pharmacy, work in the pharmaceutical industry, work in hospital pharmacy, work in community pharmacy, work with a GP practice, or leave the pharmacy profession to pursue a different career. These questions were intended to gauge the level of interest in staying in the same sector, switching between sectors, taking on the new role of working with GPs, and in leaving the profession altogether. The latter was intended to provide an indication of morale and motivation.
Results
Changes made in the past three years
(i) Switching between sectors of pharmacy The numbers of pharmacists switching between hospital and community employment in the past three years were relatively small and fairly similar: 45 moved from hospital to community and 39 moved from community to hospital. The numbers represent 3.1 per cent of community and 16.4 per cent of hospital pharmacist responders.
Analysis of the data by age shows that over half of the pharmacists (53 per cent) moving from hospital to community pharmacy were aged 30 or under (Table 1). A similar picture emerges when looking at pharmacists moving from community to hospital, with just over half of the 39 pharmacists who made this switch being aged 30 or under. Thus, switches in both directions between community and hospital work were predominantly made by pharmacists in the earlier stages of their careers.
(ii) Switching between permanent community posts and locum work Many more pharmacists reported leaving a permanent community pharmacy post for locum work (154) than had made the opposite change (97). Almost two-thirds (98) of those switching to locum work were male compared with 43 per cent (41) making the opposite change.
Analysis of the data by age showed that 31 per cent (51) of the pharmacists switching from permanent community pharmacy posts to locum work were aged 50 or over, with the majority (86, 56 per cent) aged 40 or under. Most (63) of the 97 pharmacists switching from locum work to permanent community posts were aged 40 or under.
In all age groups except 41-50 there was a net move to locum work (Table 1). Thus younger pharmacists and those approaching early or traditional retirement ages were moving to locum work.
(iii) Starting work with GP practices Seventy-two pharmacists (4.5 per cent) reported that they had started to work with one or more GP practices within the past three years. All but one were undertaking this work part-time, and for most this was up to one day per week; the single pharmacist worked full-time with the practice. Thus most pharmacists continued to work in traditional pharmacy roles in addition to their work at the GP practice; the primary sector of work was community for the majority (52, 72 per cent), followed by hospital (11, 15 per cent). Working with GP practices appeared to be a role taken up by relatively experienced pharmacists (Table 3), with almost three quarters aged between 31 and 50.
(iv) Changes in hours worked Almost one in four (23.8 per cent, 378) pharmacists said they had cut down the hours they worked in the past three years. The majority of these (336) were from community pharmacy, with 30 from hospital and 11 “other”.
Table 4 shows the age and gender profile of pharmacists who reported having reduced the hours they worked.
Some of the reductions in hours worked are accounted for by permanent retirement or pharmacists moving into semi-retirement and working fewer hours in preparation for retirement. A greater number of women than men reported having reduced their hours in the 21?30 and 31?40 age groups (roughly two-thirds women to one-third men).
Respondents were not asked directly if they had increased the hours they worked but, in answer to the open question about other changes made, 40 pharmacists reported an increase.
| Table 1: Switches between community and hospital pharmacy posts by age | ||
|---|---|---|
Age range | Hospital to community | Community to hospital |
21-30 | 24 | 22 |
31-40 | 9 | 10 |
41-50 | 8 | 6 |
51-60 | 4 | 1 |
Over 60 | – | – |
Total | 45 | 39 |
| Table 2: Switches between locum work and permanent community posts by age | |||
|---|---|---|---|
Age range | Locum to permanent community | Permanent community to locum | Net move to locum work |
21-30 | 27 | 48 | +21 |
31-40 | 36 | 38 | +2 |
41-50 | 25 | 17 | ?8 |
51-60 | 7 | 28 | +21 |
61 and over | 1 | 23 | +22 |
Total | 96 | 154 | +58 |
| Table 3: Age profile of pharmacists starting work with GP practices | |
|---|---|
Age range | Number of pharmacists |
21?30 | 16 |
31?40 | 29 |
41?50 | 22 |
51?60 | 4 |
Over 60 | – |
Total | 72 |
| Table 4: Reduction in hours worked by pharmacists’ age and gender | |||
|---|---|---|---|
Age | Number of pharmacists reporting reduced hours | ||
| Male | Female | Total |
21?30 | 24 | 44 | 72 |
31?40 | 44 | 75 | 119 |
41?50 | 31 | 27 | 58 |
51?60 | 34 | 21 | 55 |
Over 60 | 54 | 19 | 73 |
Total | 191 | 186 | 377 |
Reasons for changes made A total of 330 respondents gave reasons for the changes made in the past three years and these are summarised in Table 5.
The reason most frequently mentioned for making a change was the wish to do “more interesting work” or seeking “greater job satisfaction”, mentioned by 70 pharmacists, almost three times as many as those wanting more money (25) or better working conditions (24). Making changes because of family commitments was the second most common reason and was cited by 47 pharmacists. For most of the reasons given, the proportions of community, hopspital and “other” were as would be expected from the total sample. Exceptions to this were “move to better working conditions” and “less stressful work”, where community pharmacists were over-represented.
| Table 5: Respondents’ reasons for changes made in the past three years (n=330) | ||||
|---|---|---|---|---|
Reason | Total number of pharmacists | Community | Hospital | Other |
Seeking more interesting work/greater job satisfaction | 70 | 49 | 14 | 7 |
Family commitments | 47 | 38 | 9 | – |
Nature of job dictated (eg, longer hours) | 25 | 16 | 8 | 1 |
More money | 25 | 20 | 4 | 1 |
Move to better working conditions | 24 | 22 | 1 | 1 |
Less stressful work | 22 | 21 | – | 1 |
Retirement/semi-retirement | 21 | 20 | 1 | – |
Children reached school age | 19 | 16 | 3 | – |
Opportunity to change occurred | 17 | 12 | 3 | 2 |
No prospects of change/no long-term future in previous post | 10 | 8 | 1 | 1 |
Other | 50 | 43 | 4 | 3 |
Total | 330 | 265 | 48 | 17 |
Changes planned for the future Over half the pharmacists in the total sample who were currently working (52.7 per cent, 838) reported that they planned to make changes to their work in the next three years (Table 6).
Over one in three (593, 37.3 per cent) said they intended to reduce their hours. Respondents could select more than one option and, excluding those who intended to reduce their hours due to a career break or to retirement, 362 pharmacists reported planning to reduce their hours. These 362 pharmacists account for 25.1 per cent of community pharmacists and 11.6 per cent of hospital pharmacists.
The intention to reduce hours by sector was 86.5 per cent (313) “community”, 8.8 per cent (32) “hospital” and 4.4 per cent (16) “other”. Table 7 shows the intention to reduce hours by age.
Analysis of the data shows that, once career breaks and retirement are excluded, there is a substantial number of pharmacists below the age of 50 who are planning to reduce their hours. The majority are working in community pharmacy. In our previous paper we hypothesised that the high number of hours worked by significant numbers of community pharmacists might lead pharmacists to seek to reduce their working hours.7
This speculation appears to be confirmed inasmuch as 58 per cent of pharmacists (210) who want to reduce their hours are working over 40 hours per week.
In comparison, the figure for all working pharmacists in the survey who reported working over 40 hours per week was 36.1 per cent (Table 8).
Analysis of respondents wanting to reduce hours by community pharmacy status (owner, employee, locum) was conducted. Owners and employers were much more likely to want to reduce their hours (41.0 per cent compared with 25.1 per cent overall for community pharmacists).
| Table 6: Respondents’ planned changes in the next three years | |
|---|---|
Change | Number of pharmacists (%) |
Increase hours | 149(9.4) |
Reduce hours | 593(37.3) |
Career break | 173(10.9) |
Retire | 163(10.3) |
| Table 7: Pharmacists reporting plans to reduce hours worked by age (excluding career breaks and retirement) | |
|---|---|
Age | Number of pharmacists (%) |
21-30 | 86(23.8) |
31-40 | 112(30.9) |
41-50 | 87(24.0) |
51-60 | 53(14.6) |
Over 60 | 23(6.3) |
Total | 361 |
| Table 8: Comparison of weekly hours worked by all pharmacists and those wanting to reduce hours | ||||
|---|---|---|---|---|
Weekly hours worked | Number of pharmacists (%) | |||
| All working | Want to reduce hours | ||
Less than 10 | 99 | (6.4) | 4 | (1.1) |
11?20 | 157 | (10.1) | 17 | (4.7) |
21?30 | 171 | (11.0) | 26 | (7.2) |
31?40 | 568 | (36.5) | 97 | (26.8) |
41?50 | 432 | (27.7) | 147 | (40.6) |
51?60 | 106 | (6.8) | 51 | (14.1) |
Over 60 | 25 | (1.6) | 12 | (3.3) |
Total | 1,558 |
| 354 |
|
Changes pharmacists would like to make Pharmacists were offered a list of potential changes and their responses are summarised in Table 9.
While most pharmacists were planning to remain in their current work sector, 14.4 per cent (228) said they would like to work in a different sector of pharmacy, indicating the possibility of future switching. Of these 228 pharmacists, 173 (75.8 per cent) were working in community pharmacy and 43 (18.6 per cent) in hospital and these figures are proportional to the overall percentages of pharmacists in these two sectors. Forty-one hospital pharmacists (14.9 per cent) said they would like to work in community pharmacy. Eighty-eight community pharmacists (7.1 per cent) said they would like to work in hospital pharmacy.
There was a high level of interest in working with GP practices, with 35.1 per cent of respondents (557) saying they wanted to do so. The percentage was higher (35.9 per cent, 448) for community pharmacists than for hospital pharmacists (29.8 per cent, 82).
| Table 9: Pharmacists’ future preferences (n=1,587) | ||
|---|---|---|
Career preference | Number of pharmacists | (%) |
Move to another sector of pharmacy | 228 | (14.4) |
Work with a GP practice |
| (35.1) |
Work in the pharmaceutical industry | 80 | (5.0) |
Work in community pharmacy | 832 | (52.4) |
|
|
|
Work in hospital pharmacy | 295 | (18.6) |
Leave the profession to pursue a different career | 298 | (18.8) |
Pharmacists who want to leave the profession Almost one in five pharmacists (18.8 per cent, 298) said they would like to leave the profession to pursue a different career. Information on current work sector was given by 289 of these pharmacists, with 248 (85.8 per cent) working in community and 37 (12.8 per cent) in hospital. Thus community pharmacists were over-represented and hospital pharmacists correspondingly under-represented among the potential leavers. Data on the extent of hours worked showed that 51.6 per cent of pharmacists who said they wanted to leave the profession were working more than 40 hours a week and 14.7 per cent over 50 hours. These figures compare with 31.8 per cent and 7.4 per cent for the sample as a whole. The age profile of pharmacists saying they would like to leave pharmacy showed the percentages were relatively higher in those aged under 50 than in older age groups (Table 10).
We hypothesised that those pharmacists who were thinking of leaving the profession would be more likely to be planning to make changes to their work. This was found to be the case, with a higher percentage saying they intended to make changes (71.8 per cent compared with 56.1 per cent of the total sample of working pharmacists). Their planned changes are shown in Table 11.
The planned change most frequently indicated was to reduce hours worked, which 162 respondents (54.4 per cent) reported. Interest in moving to another branch of pharmacy was twice as high as among the overall sample of working pharmacists. The level of interest in working with GP practices was similar to that among the total sample of working pharmacists.
Analysis by ethnic group showed that 162 white (11.5 per cent) and 64 non-white pharmacists (19.8 per cent) said they would like to move to another branch of pharmacy. It also showed that 14.6 per cent of all working white pharmacists (206) and 26.6 per cent of all working non-white pharmacists (86) said they would like to leave. Again, non-white pharmacists were over-represented.
| Table 10: Age profile of pharmacists who want to leave the profession (n=298) | |
|---|---|
Age range | Percentage of pharmacists |
21?30 | 21.9 |
31?40 | 17.8 |
41?50 | 20.3 |
51?60 | 11.8 |
Over 60 | 4.0 |
Total | – |
| Table 11: Planned changes of pharmacists saying they want to leave the profession (n=298) | |
|---|---|
Change planned | Number of pharmacists (%) |
Increase hours worked | 16(5.4) |
Reduce hours worked | 162(54.4) |
Take a career break | 61 (20.5) |
Retire | 23(7.7) |
Move to another sector of pharmacy | 85(28.5) |
Work in industry | 36(12.1) |
Work in hospital | 47(15.8) |
Work with GP practice | 108(36.2) |
Discussion
The level of switching between community and hospital pharmacy was found to be low. It was occurring mainly in younger age groups. Although there is little published work in this area, one study has demonstrated that young pharmacists are highly mobile in the workforce up to at least four years after registration, perhaps because they are experimenting with different career options before making a final choice.8
It is also possible that pharmacists feel more able to change sectors relatively soon after qualifying compared with later in their career.
The data on switching between permanent community posts and locum work appear to confirm previous anecdotal reports that greater numbers of pharmacists are opting out of “traditional” community pharmacy posts. While it might be expected that pharmacists preparing for retirement or semi-retirement would move into locum work, the only age group in which there was not a net move into locum work was pharmacists aged 41-50. This is the first survey to have indentified the net movement of pharmacists between these types of work and without a baseline it is difficult to know whether the number of pharmacists opting for locum work has increased, as has been suspected by some.
Overall, one in four working pharmacists reported having reduced their hours during the past three years, with a disproportionately large percentage (89 per cent) from community pharmacy. Scrutiny of the figures shows that around two-thirds of these pharmacists were aged under 50. While part of the explanation is likely to be women pharmacists reducing hours to allow flexibility in relation to family commitments, it is also possible that the figures reflect active moves by community pharmacists in response to long working hours. Certainly, in relation to the future the number of pharmacists reporting plans to reduce hours worked far exceeded those planning to increase them.
After excluding planned retirement and career breaks, one in four community pharmacists reported planning to reduce the hours they work during the next three years. We believe this reflects the long hours that many are currently working, mainly in community pharmacy.7
The extent to which these long working weeks might be themselves at least partly caused by shortages of pharmacists is unknown. Another possibility is that owners and proprieters have more of a personal incentive to put in the hours required by the business. Even so, over 40 per cent of this group want to reduce the hours they work. In a situation where the percentage of employee pharmacists continues to rise, willingness to work long hours might be reduced. It is possible that community pharmacists’ plans to reduce the hours they work might not be realised for a number of reasons.
Among those pharmacists who said they wanted to leave the profession there were disproportionately high numbers of those working longer hours. While it can be argued that stated intention does not always match action, these findings, when considered in the context of the current working hours of many community pharmacists, provide a plausible basis for assuming reductions will occur.
Community pharmacists and non-white pharmacists were over-represented among pharmacists who said they would like to leave the profession. Non-white pharmacists were also over-represented among pharmacists who wanted to switch sectors. The data show a consistent pattern indicating higher levels of dissatisfaction and a greater desire to make changes among community pharmacists and among non-white pharmacists. Further data on morale and motivation in the workforce will be presented and their implications discussed, in a forthcoming paper.
An interesting result was that the most often reported reasons for having made a change to work was the desire to seek more interesting work and/or greater job satisfaction. Although the number of pharmacists who reported having started working with GP practices (72) was relatively small in the context of the overall sample, interest in taking up such work was strong. Since the survey the numbers of pharmacists undertaking such work (and, more recently, working with primary care groups) have increased. A review of job advertisements in The Pharmaceutical Journal in the first half of 1999 shows that significant numbers of new pharmacist posts have been created by PCGs.
Our findings show that, in the West Midlands, practice-based pharmacist work up to the beginning of 1998 drew pharmacists from community and hospital backgrounds roughly in proportion to their percentages within the overall workforce. The future workforce implications are likely to be significant, since more PCG level posts are on a full-time basis than has been the case with practice-based posts and there will be approximately 60 PCGs in the West Midlands and some 400 in England.
The West Midlands is only one of the English NHS regions, and employment conditions may vary between regions. Nevertheless our findings provide a marker for relevant developments and are likely to be of wider interest.
Conclusions
Overall, our findings indicate that switching between sectors of the profession is unlikely to occur to a significant extent in the next three years. The trend away from permanent community pharmacy posts to locum work could, if sustained or increased, have significant implications. Interest in working with GPs is high among pharmacists and demand for newly created prescribing adviser posts with PCGs, if sustained, will also be significant. Community pharmacists’ expressed intentions to reduce their working hours could lead to a substantial reduction in the available pool of pharmacist resource. There are indications of dissatisfaction with current work, particularly among community pharmacists and non-white pharmacists.
This survey is a useful benchmark against which to measure trends. We believe that these findings send important signals to employers about the working intentions of pharmacists and the issues that need to be addressed.
Acknowledgment We are grateful to the NHSE West Midlands, which funded the study, to our “user group” pharmacists and to our respondents.
Ms Boardman is research assistant and Professor Blenkinsopp is professor of the practice of pharmacy in the department of medicines management at Keele University. Dr Jesson is research fellow and Dr Wilson is head of the pharmacy practice group in the department of pharmaceutical sciences at Aston university, Birmingham. Correspondence to Ms Boardman at the Department of Medicines Management, Keele University, Staffordshire ST5 5BG
References
1. February Council Meeting: manpower supply and demand. Pharm J 1997;258:233.
2. Manpower planning, pay and preregistration training. Ibid 1996;256: 835-6.
3. Rees JE. Is early retirement creating a problem? (letter). Ibid 1997;258: 132.
4. Vacancies for hospital pharmacists are becoming harder to fill. Ibid 1997;258:184.
5. IPMI survey highlights recruitment problems. Ibid 1997;258:502.
6. Manpower: is the problem getting worse? Ibid 1997;258:602.
7. Blenkinsopp A, Boardman H, Jesson J, Wilson K. A pharmacy workforce survey in the West Midlands: (1) Current work profiles and patterns. Ibid 1999;263:909-13.
8. Rees JA, Clarke DJ. Employment, career progression and mobility of recently registered male and female pharmacists. Ibid 1990;245(Suppl): R30.
