HOSPITAL PRACTICE

Shortage of leaders a growing concern in hospital pharmacy

Should nonpharmacists manage pharmacists? It's not a theoretical question for Bruce Scott, pharmacist and corporate VP for Allina Hospitals and Clinics in Minneapolis. Allina's 11 hospitals and 42 clinics need more pharmacy leaders than pharmacy can provide. Last year, Scott brought in a nonpharmacist to manage a pharmacy technician unit. He has also hired nonpharmacists to manage pharmacy technology and other areas.

Too many pharmacists today lack four specific skills, Scott explained. They have no experience supervising employees, no program responsibility, no leadership experience, and no financial experience. His solution, bringing in nonpharmacist managers with the requisite skills, may be a growing trend. ASHP is hearing more anecdotal reports from members in the same predicament, said Doug Scheckelhoff, director of the association's pharmacy practice sections.

Nonpharmacists are running programs that are not directly involved in patient care, Scheckelhoff said. Typical areas include budget, purchasing, and informatics. "Often, it does not require a pharmacist to run the budget or the information technology program," he said. "Many health systems are using M.B.A.-types in pharmacy because of their specialized business training."

The growing demand for pharmacy leaders has been a problem for years. The shortage is particularly acute at the top. Pharmacy director positions typically go vacant for six months or longer. More health systems are turning to headhunters, a high-cost tactic that has traditionally been reserved for top business-related jobs, such as chief financial officer or chief information officer.

Part of the problem is demographic. An entire generation of pharmacy leaders is retiring as the baby boomers age, noted Harold Godwin, director of pharmacy at University of Kansas Medical Center. And health systems have eliminated middle management to trim costs. In the past, lower levels of middle management were the accepted entry into administrative and leadership tracks. As middle management disappeared, so did the leadership track.

At the same time, pharmacy schools moved to all-Pharm.D. programs with an increased clinical emphasis. Management topics got short shrift in revised curricula or disappeared entirely, Scheckelhoff noted.

Godwin said the shift in educational emphasis might have been the biggest single blow. Most healthcare professions deal with a relatively limited functional area and are almost entirely focused on clinical programs. Pharmacy involves everything from drug therapy policy to million-dollar purchasing budgets to information technology that links every clinical specialty to drug administration and patient education. "We have to be able to talk to the administrator, the CFO, the CIO, and the clinicians," he explained. "It's an extraordinarily broad scope, and it requires broad training."

Godwin is also chair of the Kansas University School of Pharmacy department of pharmacy practice. He runs one of only three residency programs nationwide that focuses on pharmacy administration. The University of Wisconsin and Ohio State University offer similar specialty residencies. The two-year programs combine pharmacy residency with a master's degree program.

"It's a supply issue as much as it is a demand problem," Godwin said. "We have a significant program, but it only graduates four or five new pharmacy leaders every year. You can't run a class of 300 residents."

ASHP is also trying to close the supply gap. The group is encouraging hospitals to offer administration residencies and pharmacy schools to offer more exposure to management topics. "Residency programs are trying, but everyone realizes that the number of graduates is not sufficient to meet the demand," Scheckelhoff said.

ASHP is also creating its own training programs. The group's annual summer meeting offers learning communities with 14 to 16 hours of leadership education. In the past, Scheckelhoff said, content has been focused on new managers or middle managers early in their careers. A second track for more advanced managers may be added. ASHP's annual Leadership Conference drew more 250 leadership development participants last year. The ninth annual conference is scheduled for next October.

The group also cooperates with Boston University's business school on a week-long Pharmacy Leadership Institute designed for experienced pharmacy directors.

"This issue isn't going to be solved quickly," Godwin said. "We have a whole generation of pharmacy leaders to replace, but we're all working in the same direction."

Fred Gebhart