Q: A national pharmacy chain plans to open dozens of new outlets soon, but there is no one to staff them. Wages are sky-high already. Should managers boost wages further? Will that solve the staffing problem?

The French have a saying: "Be careful what you wish for; you may get it." As great demand for pharmacists continues, pharmacy chains and health systems bid against one another to staff their expanding facilities. It seems as if there has never been a better time to be in pharmacy, except for the patients: It's nearly impossible to get five minutes with a pharmacist.

What's wrong with the marketplace adjusting pay to keep pharmacies staffed? Doesn't this demonstrate the pharmacist's crucial role in health care?

Anecdotal information indicates that many pharmacists work more than one full-time job, while others have dropped out of the field entirely. The percentage of pharmacists who work part-time or who have left practice may be much larger than 20%.

In the past, many R.Ph.s were the sole support of their families and required a full-time job. Now, pharmacists often marry other professionals, and these dual-career families earn income from two or more positions. As the industry expands, and there is a corresponding increase in pharmacy outlets and career choices, the need for staff is critical, while pharmacists may choose not only where to work but also how much to work.

The marketplace has responded to the supply shortage by creating new pharmacy schools, licensing more foreign grads, increasing the tech ratio, and haggling over drug reimportation. Medicare Part D is the wild card in play; prescription volumes may increase the number of pharmacists needed or shift work to automated facilities. Part D could even bomb, if seniors can't decipher its rules and decide not to participate. No one can predict the total effect that these dramatic changes could have on manpower needs.

What impact does this free market approach have on the quality of professional services? Has the pharmacist's skill become nothing more than a commodity, like a box of prescription vials or a satellite transmission fee? Who represents the patients' interest in this economic model? What does the model tell us, when a commodity no longer has economic value?

We know that patients' needs cannot be met entirely by an automated dispensing system. As pharmacy demands grow in frequency and intensity, the R.Ph. who is an excellent educator will become increasingly uncomfortable with the pace. There will be less time to discuss medication therapy with prescribers. Fewer patient questions will be answered, and more adverse effects will occur. Patients will also be more likely to pick up conflicting OTCs or overdose themselves, since counseling may be reduced to little more than sending them to "look on aisle 22 B."

Is the economic model we now use to attract and keep pharmacists driving some of the best professionals right out of practice?

Some astute managers are experimenting with other kinds of compensation to retain staff. One hospital group is exploring remote inpatient order entry, which would allow R.Ph.s to work from home and more flexible hours. Another pharmacy manager, following discussion with his staff, traded pay increases for a saner workload and more patient contact. Clinical monitoring is now sometimes done by R.Ph.s working at home or by beaming files between work sites. Pharmacists who are physically challenged or simply unable to stand for long hours could also work in such arrangements.

Despite high wages, when pharmacists reduce their hours or quit because of the stressed-out work atmosphere, clearly it's not "all about the money."

Disclaimer: This column highlights ethical situations that often occur in pharmacy practice. It is designed to stimulate discussion on how to deal with these situations and is not intended as legal advice. Pharmacists who need immediate assistance should consult their attorneys, employers, state boards of pharmacy, and state and federal laws.

The Author has practiced long-term care and community pharmacy in Oregon for more than a decade and has served on numerous professional and community boards.