Item 11 of the 2000 Appropriations Act directs the Joint Commission on Health Care (JCHC) to continue its study of the various health workforce programs and initiatives related to improving access to care in underserved areas. Specifically, the Appropriations Act states that the Joint Commission's continuing work shall:

(i) assess the impact of the programmatic and administrative changes enacted by the 2000 General Assembly on the various workforce programs;

(ii) recommend any further improvements to the existing programs and identify additional cost-effective initiatives; and

(iii) assess the need for and feasibility of establishing a pharmacist scholarship and loan repayment program for pharmacists who agree to practice in underserved areas of the Commonwealth.

A copy of Item 11 of the 2000 Appropriations Act is provided at Appendix A.

Based on our research and analysis during this review, we concluded the following:

• The Virginia Department of Health (VDH) has taken steps to increase the number of underserved areas designated as health professional shortage areas (HPSAs) which will help increase the number of providers locating in these areas. However, provider recruitment and retention efforts are still hampered by limited staff at VDH. (Virginia assigns .5 FTE to recruitment; North Carolina devotes 5 FTE.)

• In FY 2000, only 8 providers were placed in underserved areas in Virginia.

• Budget language adopted by the 2000 General Assembly to consolidate the scholarship and loan repayment funds into one amount has provided needed flexibility to VDH in making awards. However, forfeited amounts revert to the general fund rather than staying within the respective scholarship/loan repayment program. Retaining these funds in the program would increase the number and amounts of the awards.

• Various pharmacy groups believe there is a national shortage of pharmacists. Some indicate the shortage is critical. Shortages are reported in urban as well as rural areas. The National Association of Chain Drug Stores estimates that their member stores have a continuing unmet need of 5,000 pharmacists. A 2000 survey by the American Society of Health Systems Pharmacists found that 70% of pharmacy directors report that there is a critical shortage of pharmacists.

• Several reasons are offered to explain the shortage of pharmacists: (i) expanding job opportunities; (ii) increasing number of prescriptions; (iii) increasing number of chain drug stores; (iv) increasing administrative demands on pharmacists; (v) greater number of pharmacy graduates wanting to work only part-time; and (vi) the number of pharmacy graduates not keeping up with demand. The Federal Health and Human Resources Administration is studying the national shortage of pharmacists.

• A preliminary analysis of where pharmacists practice in Virginia indicates that several rural counties have much higher population-pharmacist ratios than the state average. (Analysis was very limited due to available data; further study is needed to assess ratios throughout the Commonwealth.)

• A pharmacist scholarship and loan repayment program could help underserved areas. However, such a program may not fully address pharmacist supply issues. Scholarship/loan repayment programs typically are used to correct a maldistribution of an adequate number of providers. However, there is general agreement that there simply are too few pharmacists to meet demand. A scholarship and loan repayment program may only re-distribute an insufficient number of pharmacists.

• VCU/MCV typically graduates about 90 Pharm.D. students per year. The total number of pharmacy graduates in Virginia will increase by 95 per year beginning in 2004 when Hampton and Shenandoah University graduates enter the marketplace. However, many students are from out of state and may not practice in Virginia. Consideration should be given to increasing the class size at VCU/MCV.

A number of policy options were offered for consideration by the Joint Commission on Health Care regarding the issues discussed in this report. These policy options are listed on pages 33-34. Public comments were requested on a draft of this report. A summary of the public comments is attached at Appendix B.

On behalf of the Joint Commission on Health Care and its staff, I would like to thank the Virginia Department of Health, the Department of Health Professions, the Virginia Board of Pharmacy, the Virginia Pharmacists Association, the VCU/MCV School of Pharmacy, the Hampton University School of Pharmacy, the Shenandoah University School of Pharmacy, and the other organizations and individuals who provided input and information during this study.

Patrick W. Finnerty
Executive Director
December, 2000