FACTORS INFLUENCING THE DEMAND FOR

PHARMACISTS AND PHARMACEUTICAL CARE: DEMAND FOR PHARMACISTS IN RURAL AREAS

The demand for pharmacists for practice in rural areas is, as elsewhere, a derived demand based on
consumer demand for prescription medication and other services of these providers. Factors which
differentiate rural consumers' demand include demographics (age, education), general health status,
and economics (income and health insurance). In addition, access to other health care providers,
especially primary care physicians, is a factor. A lack of access to routine and specialized medical care
would reduce the level of prescription demand by rural residents. Shortages of medical personnel that
prevail in rural medically underserved areas (MUAs) force residents to seek care elsewhere and, most
likely, this would include their medication purchases. The employment sectors for pharmacists in rural
areas are primarily retail pharmacy outlets, comprised of independent and chain stores, hospitals and,
to a lesser extent, long term care facilities, and a limited number of others (prisons). Rural employers
face substantial competition from others in their efforts to hire and retain pharmacists. This competition
has translated into higher compensation and other bonuses being offered; these may disadvantage
smaller independent rural retail outlets and hospitals. Characteristics of the rural population.
Differences between the population base of rural areas and non-rural areas have implications for the
demand for pharmacy products. One component is age because the elderly tend to use more health
care products and services, including prescription medicines. The median age of the non-metropolitan
population is nearly two full years greater than those in metropolitan areas, and the proportion of those
over age 65 is 15.0%, compared with 12.8% (Ricketts, Johnson-Webb & Randolph, 1999). Health status
of rural residents, a factor in the demand for services, has been well documented as generally worse for
rural residents compared with those elsewhere. Analysis of this factor is complex due to its relationship
with economics, education, and other variables. In rural areas there are higher rates of chronic disease;
injuries, especially those related to occupation; and age-adjusted mortality (ibid.) Economic factors,
including earned income and insurance coverage, are important variables in the demand for pharmacy
products and other health care services. The long period of sustained economic growth experienced
throughout the country has not offset the lag in incomes for rural residents due to downturns in mining,
timber, agriculture and other rural industries. In Illinois, the discrepancy between earnings from similar
jobs in metro and rural areas is growing.
In 1980 the average earnings per job was $5,203 less per year for rural workers than for those in metro
areas. This gap had widened to $7,589 by 1998 (Straub, 1999). Employment is less likely to come with
health insurance when located in a rural setting. A national household survey found that 54 percent of
rural residents were covered through employment, while this figure was 63 percent for urban residents
to have public insurance or to be without any insurance. Other features of insurance further
differentiate by location; private coverage for rural residents increases with proximity to a more
populous county. A study of Nebraska residents found that the lengths of time without insurance
coverage has increased and those without insurance in rural areas experienced longer spells than those
in urban areas (Mueller 1997). These and other characteristics of the rural population suggest their
demand for pharmacy products may differ from that elsewhere, although the pattern is not
straightforward. A higher percentage of elderly and persons in poor health status indicate more demand
for prescriptions, while the income and insurance factors mitigate this demand.
Research certifies that rural residents in Illinois use alternative medicines and therapies; these may
serve as substitutes for prescription drugs and alter demand (Straub & Henley, 2000). Consumers may
also elect to purchase their prescription through mail order outlets and the Internet. The dynamics of
these characteristics and behaviours of the population affect the accuracy of predictions about the
demand for pharmacists in rural communities. Demand variables. Compensation is a main variable in
employer demand for workers. The ability to pay higher rates of pay and benefits to attract pharmacists
varies among types of rural employers. Small rural hospitals, already in jeopardy regarding profit
margins, have difficulty competing with large retail pharmacy chains that are currently in a growth
mode. These outlets are fueling their demand for pharmacists with offers of generous starting salaries
and bonus packages. Smaller independent outlets and hospitals cannot back up their demand in this
way. All rural employers are competing with those in non-rural settings as well. A comparison of average
earnings for pharmacists in Illinois in 1996 shows those in rural areas earn less than the Statewide
average at entry level and at the median, but slightly more if experienced. Pharmacist earnings,
Statewide, are slightly higher than those for dentists at entry level, but the differential is reversed at the
median and experienced levels. When employers are unable to meet their demand for pharmacists, this
can be offset by initializing substitute resources. Potential options include: pharmacy technicians and
aides, automated and centralized dispensing, and contract services. The ability to use pharmacy
technicians and aides varies among States according to the scope of practice designation for these
positions. There is some evidence that pharmacy technicians are not utilized as extensively by rural
pharmacists as by those in urban areas. One study of Nebraska pharmacists found that pharmacists in
urban areas, versus rural areas, felt that technicians were useful in freeing up the pharmacist;s time for
patient counseling and questions. A recent study of rural pharmacists in three Midwestern States found
that 83 percent of rural retail pharmacies had at least one pharmacy technician on staff. The most
common pattern (in 58 percent of the outlets) is for three to four technicians. The study also found that
use of these technicians varied among the three States, from 92 percent in Minnesota pharmacies
reporting at least one technician, to 68 percent in North Dakota. Staffing patterns varied by ownership,
with chain pharmacies much more likely to employ pharmacy technicians than independents. Barriers
that inhibit the use of pharmacy technicians include lack of time by pharmacists, limited clinical skills or
pharmacists, and employer and public acceptance. Another factor affecting the demand for local
pharmacists is consumer substitution, such as consumers’ use of other outlets for drug purchases;
primarily, these are retail stores located elsewhere, mail order, and the Internet. Mail order shopping,
traditionally a standard for rural residents, is now used for prescriptions. Internet access continues to
increase in rural areas. When residents of rural Illinois were surveyed in 1996, 37 percent of
respondents had a computer and 17 percent had Internet access but its use for precscription drugs was
negligible (Straub & Tripp, 2000). Results of the 2000 survey of these residents show that 57 percent had
a computer and 72 percent of these had Internet access. For those, 34 percent use it for health care
information, but only 4 percent do so for drug purchases. Mail order purchases of drugs were made by
16 percent of respondents (ibid)
Department of Health and Human Services Health, Resources and Services Administration &
Bureau of Health Professions. (2000). Factors influencing the demand for Pharmacists
and Pharmaceutical Care: Chapter 2, Demand for pharmacists in Rural Areas. Retrieved
on September 5, 2013 from
http://bhpr.hrsa.gov/healthworkforce/reports/pharmaciststudy.pdf