- Email: [email protected]
World census of pharmacy
began conducting an annual census of pharmacists more than 20 years ago by collecting data on the number of registered pharmacists in good standing each year. This information has been published in the Proceedings of the National Association of Boards of Pharmacy annually and the census has been broadened from year to year as the secretary of NABP has requested additional information from the member state boards of pharmacy. This effort, which constituted the only authentic source of pharmacy manpower information to date, has been handicapped to some extent by the inability of individual state boards of pharmacy to collect necessary data, principally because of lack of funds and personnel with which to carryon the necessary state surveys. The NABP is a voluntary organization of state boards of pharmacy whose chief purpose is to provide for interstate reciprocity in pharmaceutic licensure, based upon a uniform minimum standard of professional education. It has no regulatory authority over the boards of pharmacy and cannot compel its members to supply information or to demand information from their respective registrants which is not required by the respective state pharmacy laws. It is all the more remarkable that NABP has been able to persuade its members to supply so much essential information annually as has been included in its annual census reports. The American Council on Pharmaceutical Education is currently giving thought to the possibility of requesting another survey of the profession and its activities to learn whether changes in pharmacal practice and pharmaceutical services require further consideration of possible changes in teaching curriculums and training procedures. A study of the manpower and other data in the Health Manpower Source Book on pharmacists seems to indicate the need for such a survey after a lapse of more than 12 years. Many of the data derived from the sample survey of 1962 by the Public Health Service are based on a censm~ sample which may not be thoroughly representative of all phases of professional practice encountered in the 50 states since 15 percent of those receiving the questionnaire did not reply. Both the sample and the questionnaire from which many of the data have been gathered and projected present certain limitations which can be corrected now that a relatively complete and current roster of pharmacists has been established. : The salary data assembled by the Health Manpower Source Book will serve as a basis for establishing professional fees and this is of particular importance to state welfare agencies and others endeavoring to provide fair remunera370
tion for the pharmaceutical services in medical care programs. The establishment of fair working hour schedules and remuneration based on extent of professional services provided has been facilitated by the assembly of data in this area, but more complete information and study of the procedure for gathering these data are indicated. The Public Health Service has rendered a distinct and invaluable service in the development of this manpower study. It not only will aid the pharmacal profession in its endeavor to pre-
• • •• J.t
'.' • '. '.' • • • • •
pare a directory of pharmacists with im- • portant basic information regarding • individual members of the profession, • but also will be of help to all segments • of the profession and drug industry in • studying the characteristics, employ- • ment status and related factors regard- • ing the profession. This, in turn, will • provide a sounder basis for indicating • trends, desires and service possibilities. • Study of the Health Manpower Source • Book will also lead to the development • of further information helpful in expand- • ing professional practice, professional • services and contacts with purveyors •• and recipients of pharmaceutical ser• vices. Having started the profession on its • • way to the improvement of its current • statistical sources and accumulation of • data which it should have prepared for • pUblication years ago and kept current, • the Public Health Service has indicated • that it is incumbent upon the profession, • acting in unity, to continue to collect· and supply information on its individual • • practitioners which will help to build a body of information about the profession • as a whole that will be of incalculable • value to all concerned. • • Obviously, the facts and figures con- • cerning individual pharmacists can be • kept current only through the co-opera- • tion of the members of the profession • and those who are engaged in industrial • pursuits growing out of the development • of drugs and medicines for better medi- • cal care. Periodic editions of a phar- • macal directory or manpower source • book will serve to keep the facts about • the profession before its own members, • related professions and others who may •• be interested. •
References 1.
2. 3. 4. 5.
r;!~~~;;r PS~~rc~ndB:a~nn;~.: ~"':a'; m~:i~lt':' PHS Publication No. 263 Sec. 15, U .S. Government Printing Office, Washington , D.C. , 1963. The general report of the pharmaceutical survey, 1946-49, American Council on Education, Washington , D.C., 1950. Elliott, E.C. , Address, Proceedings of the N ational Association of Boards of Pharmacy , Chicago , Ill. , 1947. Findings and recommendations of the pharmaceutical survey, 1948, American Council on Education, Washington, D .C ., 1948. Fischelis, R .P ., Manpower records (editorial), THIS JOURNAL 9, 595(October 1948).
Journal o(the AIYIERICAN PHARMACEUTICAL ASSOCIATION
WO rid -w I- de
census of pharmacy* by George B. Griffenhagen The Common Market has caused many European pharmacists to review their manpower requirements. Werner Klie, president of the pharmaceutical group of the European Economic Community and Hamburg pharmacist, presented a most thoughtprovoking address before the Pharmaceutical Society of Great Britain recently. Klie pointed out that one of the basic rights which citizens of the Common Market countries will obtain from the Treaty of Rome will be freedom of movement. Therefore a pharmacist will be free to select any country in which he wishes to practice, subject to the establishment of uniform education and standards. He then continuedIt also should be emphasized that it would be undesirable if the countries were to train too many pharmacists. I n France, for instance, there are too many holders of pharmacists' diplomas. The social position and economic security ofthe pharmacist must be ensured and action must be taken in time to avoid an excessive body of trained pharmacists resulting in social and professional tension.
• • • • •
The right to free selection of place by pharmacists differs in the six member-nations. An unrestricted right of establishment exists in Belgium, Germany and The Netherlands although practical experience in the latter country has resulted in a system of limitation of the number of pharmacies. Holland has about 800 pharmacies or one pharmacy for about 13,000 people. In
• • • • • •
• • • • •
*
Excerpts from an address entitled "A UN of Pharmacy" presented before the AMERICAN PHARMACEUTICAL ASSOCIATION Philadelphia chapter, February 14, 1963.
Belgium, where freedom of establishment exists, there are about 4,000 pharmacies, each one serving only about 2,000 inhabitants. That unfavorable situation is now under review and the introduction of restrictions is under consideration. Restrictions exist in France where a pharmacy serves about 3,000; in Italy where there are about 5,000 people to a pharmacy and in Luxemburg where a pharmacy also serves about 5,000 people. In Germany, a ruling of the Federal Constitutional Court in 1958 a bolished the traditional system of limiting the establishment of pharmacies. At the end of 1961 about 6,285 persons were being served by one pharmacy. In some districts, the ratio of inhabitants to one pharmacy is close to 5,000. In our opinion a still further reduction in that ratio would take it into the danger zone.
The ratio of pharmacies to population in the U.S.A. is one pharmacy for every 3,480 people. So perhaps we should take a longer look at this area as a possible cause of our present overcommercialization. But Klie speaks of pharmacies-·and not of pharmacists. Many European pharmacies have as many as six to a dozen pharmacists practicing in a single establishment. Recently someone asked me how many pharmacists there are in the world; I responded- "How do you expect us to know how many there are in the world when we don't know, with any certainty, how many pharmacists there are in our own country?" The Manpower Survey conducted by the U.S. Public Health Service provides the basis for a better estimate but, until a directory of all pharmacists is published, we shall never know the real answer. Since we have estimates of the number of pharmacists in our country that now are reasonably accurate, we should be able to determine similar estimates from other countries. Not only are figures for the number of pharmacists in most countires of the world available, but many countries (particularly European) have very precise data compiled from their national registry or national licensure board. The conclusion of my preliminary survey indicates that there are about one-half million pharmacists in the world (outside of Red China, for which we have no estimates). Of these 500,000 pharmacists, more than 100,000 are here in the U.S.A.; thus about 20 percent of all pharmacists in the world (outside of Red China) are serving less than eight percent of the world's equivalent population. The following figures ha ve been calculated from the latest (1962) edition of the World Health Organization Annual Epidemiological and Vital Statistics, Statistics of Health Personnel (Geneva,
1962). As one might expect from the large proportion of U.S. pharmacists to the total number of pharmacists, we have the largest number of any country in the world. The USSR ranks second in total number of pharmacists with 94,951. In decreasing order of pharmacist popUlation are the following countries- · Japan India Italy Federal Republic of Germany" Great Britain France
58,389 pharmacists 32,731 pharmacists 30,603 pharmacists 23,035 pharmacists 21,134 pharmacists 18,980 pharmacists
Perhaps more pertinent than the number of pharmacists is the ratio of inhabitants per pharmacist. In the U.S.A., there are about 1,500 people for every registered pharmacist. This same ratio is found in Finland, Israel, Japan and New Zealand and nowhere in the world is the ratio lower. Israel's figure is largely due to the influx of refugees, many of w hom are not practicing. t Japan's pharmacist/ population ratio might be expected to be low because of the tremendous competition that is reported by pharmaceutical observers and the influences of the U.S.A. following World War II. Among the Common Market countries, the lowest ratio is that of Belgium where the 5,266 pharmacists provide a ratio of one pharmacist for every 1,700 Belgians. This parallels the observation made by Klie that Belgium is presently over-populated with pharmacies. The following increasing ratios of pharmacists to population are worthy of notepharmacist/ population ratio Hungary Great Britain Denmark USSR France Canada Italy Paraguay Germany Chile Czechoslovakia Costa Rica Austria Sweden Greece Poland Romania Portugal Spain
1:2,000 1:2,100 1:2,200 1:2,300 1:2,300 1:2,300 1:2,400 1: 2 ,400 1: 2 ,500 1: 2 ,800 1:3,000 1:3,000 1:3,300 1:3,400 1:3,500 1: 3,500 1:3,600 1:3,800 1:3,900
From here on , the gap widens. Union of South Africa has a 1 :4,500 ratio (lowest in Africa); Peru has a I : 5,600 ratio; Yugoslavia a 1:6,000 ratio and
** Including 6,1 53 "pharmaceutical proba tioners and practitioners ;" al so includes West Berlin. t I srael 's 300 pharmacies provide one pharmacy for every 5,900 population.
Formosa, a 1: 7,800 ratio. Ceylon, Korea and Egypt have a 1 :9,000 ratio while India, which has the fourth largest total pharmacist population, only has a 1: 13,000 pharmacist/ population ratio, about the same as Algeria, Ghana and Turkey. Some African countires (as Nigeria with 2,539 pharmacists) have a ratio 1 :55,000. It is interesting to compare the respective standing of the pharmacist in each country and the degree of governmental control over pharmacy with the given ratios and with popUlation densities. It is true that in many countries non-pharmacists can perform certain pharmaceutical duties which would lower the ratio but in many countries a larger percentage of pharmacists are engaged in other scientific and professional pursuits (as food and dairy chemists) which would increase the ratio of population to practicing community pharmacists. Since pharmaceutical practice is directly related to the number of prescribing physicians, another ratio that might be of interest is a comparison of physicians to pharmacists in each country. In this particular case, the U.S.A. is not low man on the totem pole. Japan has only one and a half physicians to every pharmacist. Again reports from Japan (several of which have been published in THIS JOURNAL) indicate that most physicians dispense their own medication, leaving the Japanese pharmacist to seek other areas of income and in this situation, the competition is tremendous. But the U.S.A. has the second lowest ratio with a ratio of almost twophysicians for every pharmacist. Other countries with a 1:2 ratio are Belgium, New Zealand, Ceylon, Korea and Nigeria. Countries with a 1 :2 1/ 2 ratio include Denmark, France, Italy, Great Britain, Union of South Africa, Canada, Chile, Peru, Tunisia and India. USSR has a 1:4 ratio as does Germany, Spain, Hungary, Lebanon and Egypt. About the highest ratio of major countries is a 1:5 ratio found in Austria, Greece and Yugoslavia. Thus we find that the U.S.A. has the most pharmacists, the lowest population per pharmacist and the second lowest pharmacist-physician ratio of any country in the world. If statistics of this world-wide survey are being correctly interpreted, it further supports the conclusions of the USPHS Pharmacy N[anpower Survey that there is a need to review carefully the proper utilization of pharmacists in the U.S.A. as well as around the world. I submit that these statistics provide "food for thought" and they certainly prove that we have much to learn through study of and collaboration with our half-millior, pharmacist-colleagues around the world. • Vol. NS3, No.7, July 1963
371
tion for the pharmaceutical services in medical care programs. The establishment of fair working hour schedules and remuneration based on extent of professional services provided has been facilitated by the assembly of data in this area, but more complete information and study of the procedure for gathering these data are indicated. The Public Health Service has rendered a distinct and invaluable service in the development of this manpower study. It not only will aid the pharmacal profession in its endeavor to pre-
• • •• J.t
'.' • '. '.' • • • • •
pare a directory of pharmacists with im- • portant basic information regarding • individual members of the profession, • but also will be of help to all segments • of the profession and drug industry in • studying the characteristics, employ- • ment status and related factors regard- • ing the profession. This, in turn, will • provide a sounder basis for indicating • trends, desires and service possibilities. • Study of the Health Manpower Source • Book will also lead to the development • of further information helpful in expand- • ing professional practice, professional • services and contacts with purveyors •• and recipients of pharmaceutical ser• vices. Having started the profession on its • • way to the improvement of its current • statistical sources and accumulation of • data which it should have prepared for • pUblication years ago and kept current, • the Public Health Service has indicated • that it is incumbent upon the profession, • acting in unity, to continue to collect· and supply information on its individual • • practitioners which will help to build a body of information about the profession • as a whole that will be of incalculable • value to all concerned. • • Obviously, the facts and figures con- • cerning individual pharmacists can be • kept current only through the co-opera- • tion of the members of the profession • and those who are engaged in industrial • pursuits growing out of the development • of drugs and medicines for better medi- • cal care. Periodic editions of a phar- • macal directory or manpower source • book will serve to keep the facts about • the profession before its own members, • related professions and others who may •• be interested. •
References 1.
2. 3. 4. 5.
r;!~~~;;r PS~~rc~ndB:a~nn;~.: ~"':a'; m~:i~lt':' PHS Publication No. 263 Sec. 15, U .S. Government Printing Office, Washington , D.C. , 1963. The general report of the pharmaceutical survey, 1946-49, American Council on Education, Washington , D.C., 1950. Elliott, E.C. , Address, Proceedings of the N ational Association of Boards of Pharmacy , Chicago , Ill. , 1947. Findings and recommendations of the pharmaceutical survey, 1948, American Council on Education, Washington, D .C ., 1948. Fischelis, R .P ., Manpower records (editorial), THIS JOURNAL 9, 595(October 1948).
Journal o(the AIYIERICAN PHARMACEUTICAL ASSOCIATION
WO rid -w I- de
census of pharmacy* by George B. Griffenhagen The Common Market has caused many European pharmacists to review their manpower requirements. Werner Klie, president of the pharmaceutical group of the European Economic Community and Hamburg pharmacist, presented a most thoughtprovoking address before the Pharmaceutical Society of Great Britain recently. Klie pointed out that one of the basic rights which citizens of the Common Market countries will obtain from the Treaty of Rome will be freedom of movement. Therefore a pharmacist will be free to select any country in which he wishes to practice, subject to the establishment of uniform education and standards. He then continuedIt also should be emphasized that it would be undesirable if the countries were to train too many pharmacists. I n France, for instance, there are too many holders of pharmacists' diplomas. The social position and economic security ofthe pharmacist must be ensured and action must be taken in time to avoid an excessive body of trained pharmacists resulting in social and professional tension.
• • • • •
The right to free selection of place by pharmacists differs in the six member-nations. An unrestricted right of establishment exists in Belgium, Germany and The Netherlands although practical experience in the latter country has resulted in a system of limitation of the number of pharmacies. Holland has about 800 pharmacies or one pharmacy for about 13,000 people. In
• • • • • •
• • • • •
*
Excerpts from an address entitled "A UN of Pharmacy" presented before the AMERICAN PHARMACEUTICAL ASSOCIATION Philadelphia chapter, February 14, 1963.
Belgium, where freedom of establishment exists, there are about 4,000 pharmacies, each one serving only about 2,000 inhabitants. That unfavorable situation is now under review and the introduction of restrictions is under consideration. Restrictions exist in France where a pharmacy serves about 3,000; in Italy where there are about 5,000 people to a pharmacy and in Luxemburg where a pharmacy also serves about 5,000 people. In Germany, a ruling of the Federal Constitutional Court in 1958 a bolished the traditional system of limiting the establishment of pharmacies. At the end of 1961 about 6,285 persons were being served by one pharmacy. In some districts, the ratio of inhabitants to one pharmacy is close to 5,000. In our opinion a still further reduction in that ratio would take it into the danger zone.
The ratio of pharmacies to population in the U.S.A. is one pharmacy for every 3,480 people. So perhaps we should take a longer look at this area as a possible cause of our present overcommercialization. But Klie speaks of pharmacies-·and not of pharmacists. Many European pharmacies have as many as six to a dozen pharmacists practicing in a single establishment. Recently someone asked me how many pharmacists there are in the world; I responded- "How do you expect us to know how many there are in the world when we don't know, with any certainty, how many pharmacists there are in our own country?" The Manpower Survey conducted by the U.S. Public Health Service provides the basis for a better estimate but, until a directory of all pharmacists is published, we shall never know the real answer. Since we have estimates of the number of pharmacists in our country that now are reasonably accurate, we should be able to determine similar estimates from other countries. Not only are figures for the number of pharmacists in most countires of the world available, but many countries (particularly European) have very precise data compiled from their national registry or national licensure board. The conclusion of my preliminary survey indicates that there are about one-half million pharmacists in the world (outside of Red China, for which we have no estimates). Of these 500,000 pharmacists, more than 100,000 are here in the U.S.A.; thus about 20 percent of all pharmacists in the world (outside of Red China) are serving less than eight percent of the world's equivalent population. The following figures ha ve been calculated from the latest (1962) edition of the World Health Organization Annual Epidemiological and Vital Statistics, Statistics of Health Personnel (Geneva,
1962). As one might expect from the large proportion of U.S. pharmacists to the total number of pharmacists, we have the largest number of any country in the world. The USSR ranks second in total number of pharmacists with 94,951. In decreasing order of pharmacist popUlation are the following countries- · Japan India Italy Federal Republic of Germany" Great Britain France
58,389 pharmacists 32,731 pharmacists 30,603 pharmacists 23,035 pharmacists 21,134 pharmacists 18,980 pharmacists
Perhaps more pertinent than the number of pharmacists is the ratio of inhabitants per pharmacist. In the U.S.A., there are about 1,500 people for every registered pharmacist. This same ratio is found in Finland, Israel, Japan and New Zealand and nowhere in the world is the ratio lower. Israel's figure is largely due to the influx of refugees, many of w hom are not practicing. t Japan's pharmacist/ population ratio might be expected to be low because of the tremendous competition that is reported by pharmaceutical observers and the influences of the U.S.A. following World War II. Among the Common Market countries, the lowest ratio is that of Belgium where the 5,266 pharmacists provide a ratio of one pharmacist for every 1,700 Belgians. This parallels the observation made by Klie that Belgium is presently over-populated with pharmacies. The following increasing ratios of pharmacists to population are worthy of notepharmacist/ population ratio Hungary Great Britain Denmark USSR France Canada Italy Paraguay Germany Chile Czechoslovakia Costa Rica Austria Sweden Greece Poland Romania Portugal Spain
1:2,000 1:2,100 1:2,200 1:2,300 1:2,300 1:2,300 1:2,400 1: 2 ,400 1: 2 ,500 1: 2 ,800 1:3,000 1:3,000 1:3,300 1:3,400 1:3,500 1: 3,500 1:3,600 1:3,800 1:3,900
From here on , the gap widens. Union of South Africa has a 1 :4,500 ratio (lowest in Africa); Peru has a I : 5,600 ratio; Yugoslavia a 1:6,000 ratio and
** Including 6,1 53 "pharmaceutical proba tioners and practitioners ;" al so includes West Berlin. t I srael 's 300 pharmacies provide one pharmacy for every 5,900 population.
Formosa, a 1: 7,800 ratio. Ceylon, Korea and Egypt have a 1 :9,000 ratio while India, which has the fourth largest total pharmacist population, only has a 1: 13,000 pharmacist/ population ratio, about the same as Algeria, Ghana and Turkey. Some African countires (as Nigeria with 2,539 pharmacists) have a ratio 1 :55,000. It is interesting to compare the respective standing of the pharmacist in each country and the degree of governmental control over pharmacy with the given ratios and with popUlation densities. It is true that in many countries non-pharmacists can perform certain pharmaceutical duties which would lower the ratio but in many countries a larger percentage of pharmacists are engaged in other scientific and professional pursuits (as food and dairy chemists) which would increase the ratio of population to practicing community pharmacists. Since pharmaceutical practice is directly related to the number of prescribing physicians, another ratio that might be of interest is a comparison of physicians to pharmacists in each country. In this particular case, the U.S.A. is not low man on the totem pole. Japan has only one and a half physicians to every pharmacist. Again reports from Japan (several of which have been published in THIS JOURNAL) indicate that most physicians dispense their own medication, leaving the Japanese pharmacist to seek other areas of income and in this situation, the competition is tremendous. But the U.S.A. has the second lowest ratio with a ratio of almost twophysicians for every pharmacist. Other countries with a 1:2 ratio are Belgium, New Zealand, Ceylon, Korea and Nigeria. Countries with a 1 :2 1/ 2 ratio include Denmark, France, Italy, Great Britain, Union of South Africa, Canada, Chile, Peru, Tunisia and India. USSR has a 1:4 ratio as does Germany, Spain, Hungary, Lebanon and Egypt. About the highest ratio of major countries is a 1:5 ratio found in Austria, Greece and Yugoslavia. Thus we find that the U.S.A. has the most pharmacists, the lowest population per pharmacist and the second lowest pharmacist-physician ratio of any country in the world. If statistics of this world-wide survey are being correctly interpreted, it further supports the conclusions of the USPHS Pharmacy N[anpower Survey that there is a need to review carefully the proper utilization of pharmacists in the U.S.A. as well as around the world. I submit that these statistics provide "food for thought" and they certainly prove that we have much to learn through study of and collaboration with our half-millior, pharmacist-colleagues around the world. • Vol. NS3, No.7, July 1963
371