How the role of pharmacist has changed

The job of a pharmacist is not what it used to be.

Historically, a pharmacist’s primary responsibility was to fill and dispense prescription medications in community and hospital pharmacies. Today, pharmacists are providing more clinical services than ever before—in a role that more closely resembles a primary care provider.

“Over the last couple of decades of my career, the community pharmacy space in particular has changed quite a bit,” Alison Lum, VP of pharmacy services at Blue Shield of California and a pharmacist by training, told Healthcare Brew. “We’re seeing more and more pharmacists stepping away from the dispensing function and starting to focus more on the clinical care side, meaning working with patients to look at their overall medication profile, and working to make sure that people are taking their medications appropriately.”

Evolution of the pharmacist

One of the first shifts toward a more clinical role for pharmacists came in the ’90s, when pharmacists began routinely administering vaccinations.

“My class a couple of decades ago was one of the first classes to give immunizations,” Lum said. “That has been an amazing shift [...] We needed to increase the number of access points, and we’re seeing more and more vaccines being administered in a community pharmacy setting over other settings.”

Despite immunizing patients for just a few decades, pharmacists gave more vaccinations than physicians between 2020 and 2021, according to research from the Global Healthy Living Foundation and Iqvia, a life sciences research and analytics firm.

In recent years, states have started allowing pharmacists to prescribe medications, including birth control and HIV prevention medications. All 50 states now allow pharmacists to prescribe opioid overdose treatment naloxone and Covid-19 antiviral Paxlovid. Eleven states also allow pharmacists to prescribe medications to treat minor acute conditions, according to data from GoodRx.

Pharmacists now also have many more job options outside traditional community or hospital pharmacy settings, according to Lum.

“I see lots of pharmacists that are leading professional organizations and associations. I see pharmacists that are doing really great things at startup companies and pharmacy benefit managers […] We also see pharmacists that are getting employed in physician groups,” she said. “There are lots of roles for pharmacists.”

Educational changes

The role of the pharmacist isn’t just changing behind pharmacy counters.

Pharmacy schools are training the next generation of pharmacists to see themselves as part of a broader medical team that does more than “count, pour, and stick” labels on prescriptions, Kelly Ragucci, the American Association of Colleges of Pharmacy’s SVP of professional development and chief academic officer, told Healthcare Brew. And new continuing education standards aim to bring that mindset to pharmacists who’ve been working in the field for decades.

“There’s a lot more emphasis on how our professional identity fits into that team role within that interprofessional education piece,” she said in an interview, adding that the shift in the aughts to the doctor of pharmacy as the sole professional practice degree in the US highlighted the need for such training.

But, Ragucci said, more must be done to attract new pharmacy students—and retain existing ones—amid professional shortages that only grew worse during the Covid-19 pandemic.

Employers posted nearly 61,000 open pharmacist jobs in the first three quarters of 2023—nearly half of which were for retail pharmacy positions, according to the Pharmacy Workforce Center’s latest pharmacy demand report.

Just over 13,000 new pharmacists graduated in 2022—down from 14,000+ in 2021, AACP reported. The number of pharmacy school graduates is expected to dip below 10,000 by 2027, Ragucci said. Meanwhile, she added, fewer graduates are entering retail pharmacies, opting for hospital pharmacy jobs, post-graduate education and research positions, or other professions.

“At the same time, we’re trying to expand our services and do different things other than [fill prescriptions but] those numbers are going down,” she said. “We’re trying, especially in education at AACP, to see how we can increase influence even to [get] high school students and undergrad students to go into pharmacy school: How can we increase our enrollment and then retain those good students?”

AACP, for example, is considering adopting competency-based education for pharmacy students—a model that’s used in other medical professions and allows students to complete courses once they’ve demonstrated a certain skill set—helping some to graduate earlier and reduce education-related debt, Ragucci said. The association has also placed greater emphasis on mental health and well-being, she said, following research suggestions that pharmacists are at higher risk than the general public for suicide.

Still, there’s only so much pharmacy schools can do: Employers, particularly large pharmacy chains, are also looking at potential changes—like offering central fill services that free up pharmacists to spend more time on immunizations and direct patient care—to bolster recruitment and retention, she said.

“The chains are really asking us, ‘What can we do to turn things around so that your graduates are more likely to want to come work for us?’ They have to do some changes in their own companies to make that happen, as opposed to just giving them more staffing [support],” Ragucci said.