A severe shortage of pharmacy directors and assistant directors could put a damper on progress made by pharmacists at a time when they are poised to take commanding ownership of medication and patient-safety leadership positions in hospitals.

According to the results of a recent survey conducted by ASHP, 36% of pharmacy directors surveyed believe there are severe shortages of health-system pharmacy directors and assistant directors. In addition, the survey found a 5% average vacancy rate for pharmacists in 2004, a downward trend since 2000 when the mean vacancy rate was 8.9%.

Smaller hospitals seem to be particularly hard-hit by staffing shortages, with facilities under 100 beds reporting a higher vacancy and staff turnover rate than large hospitals. In facilities with one to 99 beds, the turnover rate is 12.5%, compared with 5.4% in hospitals with 400 or more beds. Small hospitals make up 44% of all hospitals nationwide. According to survey results, the mean turnover rate decreases as the average daily patient census increases.

Douglas Scheckelhoff, M.S., director, ASHP Pharmacy Practice Sections, said the survey findings show that there are some challenges in leadership in hospital pharmacy. "Pharmacy directors are stepping up and taking on more responsibility as it relates to medication-use process, including safety and utilization." But because pharmacy schools and residency programs are focusing more on clinical areas and patient care, there is less emphasis on developing managers and leaders. "As these positions become vacant," he said, "it's more difficult to find a qualified person to move into that role."

According to the survey, the average turnover rate in 2004 for pharmacists is 7.5%—equal to the rate in 2003. For technicians, however, the 2004 turnover rate is slightly lower—11.8%, compared with 13.3% in 2003. Scheckelhoff noted that staff shortages were clearly more problematic in the area of management, while the pharmacist shortage is continuing to ease overall.

On the recruitment side, the findings show an encouraging trend. Employers reported that it took 5.3 months to hire a pharmacist and 1.8 months to recruit a pharmacy technician.

Survey data indicate that it took longer to recruit R.Ph.s in rural settings (6.9 months on average), compared with suburban facilities where it took 4.4 months. In urban facilities, recruiting time is 4.8 months.

The 2004 vacancy rate for pharmacy technicians is 3.7%, compared with 4.6% in 2002—also indicating a downward trend. The vacancy rate for pharmacy technicians is lower in rural settings (2.0%) than in suburban settings, where it is 4.4%. In urban areas, the vacancy rate for pharmacy technicians is 3.9%.

The survey also revealed that the percentage of pharmacy technicians certified by the Pharmacy Technician Certification Board (49%) is similar to the percentage reported in 2003 (47%). Only 14% of the directors reported that none of their pharmacy techs were certified, and 22% said all of their techs are certified.

Survey results show that, according to pharmacy directors, 14% of their pharmacists are residency-trained. When asked if they had completed a pharmacy residency, 28% of the directors said they had done so. In the hospitals where the pharmacy directors had completed a residency, the percentage of staff with residency training was significantly higher (29%) compared with staff at facilities where the director had not completed a residency (8%).

ASHP's survey results show that pharmacy-staffing shortages have a negative impact on the job satisfaction of pharmacy directors. Directors were asked to rate their level of satisfaction with their current job position, using a five-point scale. Survey data indicate an inverse relationship between satisfaction levels and pharmacy vacancy and turnover rates. For instance, directors reporting that they are "very satisfied" with their current position (31% of responders) also report a pharmacy vacancy rate of 3.3%. Directors who are very dissatisfied with their current positions (3% of responders) report a vacancy rate of 8% that is more than double that of "very satisfied" directors.