Leadership aspiration: An intersectional analysis of racial and gender equity in pharmacy.

BACKGROUND: The glass ceiling is a metaphor used to describe an invisible barrier that prevents an underrepresented group from rising beyond a certain level. Among pharmacists, underrepresented groups face various barriers and limitations to their successes. OBJECTIVES: The purpose of this study was to apply the intersectionality framework to data collected from the 2019 National Pharmacist Workforce Study (NPWS) to understand the association of gender and race with leadership aspiration among pharmacists, including differences in perceived barriers and attractors for pursuing leadership. METHODS: The 2019 NPWS was conducted using an electronic Qualtrics survey. Three e-mails containing the survey link were sent to a systematic random sample of 94,803 pharmacists through the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS had an overall response rate of 6% (5705/94,803). A total of 8466 pharmacists clicked on the survey link, resulting in a usable response rate of 67.3% (5705/8466). Data were analyzed in SPSS software using descriptive and Pearson's r and chi-square test statistics. RESULTS: Black, Indigenous, and People of Color (BIPOC) pharmacists reported holding 10.7% of all leadership positions. Leadership positions included manager, assistant manager, executive, dean, director, chief pharmacy officer, owner or partner, and other leadership position types. White men and women reported the lowest interest in leadership (38.8% and 37.7%), whereas Black men (65.1%), Latinas (59.2%), Black women (58.5%), and Latinos (57.1%) had the highest interest in leadership. "The ability to make an impact" was the most frequently selected attractor for wanting to pursue leadership, selected by 92.5% and 79.6% of Black men and women, respectively, 77.8% of Other women, and 76.9% of Latinos. At graduation from pharmacy school, the student debt loan average of all graduation years ranged from $63,886 (± $73,701) for Other men to $112,384 (± $105,417) for Black women. Higher student loan debt was positively correlated with wanting to pursue a leadership position (r = 0.22, P < 0.001). Black women graduating 2011-2019 had the highest student loan debt at graduation ($194,456 ± $88,898). CONCLUSION: Interest in leadership positions by BIPOC pharmacists compared with reported leadership roles were inversely correlated. Understanding the discrepancy in interest in leadership and reported leadership positions held, particularly with relation to race and gender, is essential to understanding equity in pharmacy leadership. Further research is warranted to understand the factors that impede the ascension of women and underrepresented pharmacists into leadership positions.

Identifying Services Provided in Community Pharmacy Practice Settings.

Background: To better address their patients' needs, community pharmacists are expanding from their traditional role of dispensing to managing medications and providing other care. Objective: This study characterized services reported by pharmacists practicing in community pharmacy settings in the 2019 National Pharmacist Workforce Study (NPWS). Methods: The 2019 NPWS was conducted via an online survey. E-mails containing survey links were sent to a systematic random sample of 96,110 U.S. pharmacists. The survey allowed tailoring of questions related to specific practice settings and for respondents in community pharmacies included reporting on delivery of twelve services. Other descriptive characteristic questions included community pharmacy type, staffing, monitoring activities, self-reported workload, and respondent demographics. An index was created by summing the number of yes responses for the service questions. This index served as the dependent variable in an ordinary least squares regression examining the association of work setting characteristics with the index. Results: Usable responses were received from 2,150 community pharmacists. The top four services were: administer vaccines (91.1%), patient medication assistance program (83.7%), naloxone dispensing (72.8%) and medication synchronization (67.2%). The regression model was significant, with supermarket pharmacies having a higher service index than large chains. Elevated service index scores were associated with more technicians on duty, CPESN participation, direct communication with primary care providers, practicing under a CPA and monitoring activities. Conclusions: Pharmacy operational characteristics were important influences on the delivery of services in community pharmacies. These findings can help inform the continuing transformation of community pharmacy practice.

Exploring the moderating role of job resources in how job demands influence burnout and professional fulfillment among U.S. pharmacists.

BACKGROUND: Job stress, burnout, and fulfillment can be modeled using the Job Demands and Resources model (JD-R). OBJECTIVE: This study explores the relationship between job demands and burnout and professional fulfillment in pharmacists, and the moderating role of job resources. METHODS: Data were obtained from the 2019 National Pharmacist Workforce Survey of a random sample of U.S. licensed pharmacists. The survey assessed pharmacist demographics (age, gender, and work setting), job demands (workload and work-home conflict), job resources (job control, time spent in various work activities, and social support), as well as burnout and professional fulfillment. Hierarchical regression analyses were used to assess the relationship between job demands-resources variables and pharmacists' professional fulfillment and burnout. Moderation was assessed by including interaction terms (job demands x job resources) in the regression models. The change in marginal mean burnout and professional fulfillment for different combinations of job demands and job resources was used to assess the salience of significant moderation effects. RESULTS: Women and community pharmacists accounted for 64.8% and 45.8% of the study sample, respectively. Age was negatively associated with burnout. Job demands were positively associated with burnout and negatively associated with professional fulfillment, and the converse was true for job resources. Significant moderation effects were observed for 7 out of 12 interaction terms assessed. The moderating effect of job resources was more salient under varying conditions of job demands in 5 out of 7 instances where significant interaction effects were observed. CONCLUSION: While pharmacist characteristics explained a significant amount of variation in burnout and professional fulfillment, also considering the moderating effects of job resources on the association of job demands with burnout and professional fulfillment identified additional information, such as the increased importance of job control and task variety in high workload environments.

Snapshot of unemployed pharmacists from the 2019 National Pharmacy Workforce Survey.

BACKGROUND: Prior national surveys have quantified unemployment in the pharmacy workforce, and recent surveys have occurred in a changing environment, with increased numbers of pharmacists in the labor market. OBJECTIVES: We sought to investigate the rate of unemployment and situations of unemployed pharmacists. METHODS: Data from the 2019 National Pharmacist Workforce Survey were analyzed, focusing on an initial question about employment status and follow-up questions for unemployed respondents about whether they were seeking a job, the reason they were unemployed, and how long they had been unemployed. RESULTS: Overall, 4.4% of the respondents were unemployed, with higher rates occurring for female pharmacists, older pharmacist cohorts, and respondents of color, with the highest rate occurring (9.3%) for Black pharmacists. Most (74.4%) of the unemployed pharmacists were seeking a job in pharmacy, but 16.6% were not seeking any job. Nearly two-thirds of the unemployed pharmacist respondents had left the workforce involuntarily, with men at higher rates than women. The youngest cohort of unemployed pharmacists was the least likely to be forced to leave and more likely to leave for workplace-related or personal reasons. Black pharmacists had the overall highest rate of leaving the workforce involuntarily. On average, the unemployed pharmacists had been out of work nearly 2 years (19.2 months), and the periods out of work ranged widely. Those seeking a job in pharmacy predominantly (75.7%) had been unemployed for 1 year or less. More than half of the pharmacists involuntarily unemployed had been unemployed for 6 months or less. CONCLUSION: An increased rate of unemployment and a higher proportion of those unemployed seeking work occurred in this most recent national survey of the pharmacist workforce. Differences in the extent of unemployment and whether leaving the workforce was voluntary or involuntary occurred in pharmacists of color and in some age cohorts.

Clinician burnout during the COVID-19 pandemic before vaccine administration.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has disrupted pharmacy practice. Little research has been done to assess how COVID-19 has affected pharmacists' employment, workload, and feelings of burnout. OBJECTIVES: The objectives of this study were to characterize the impact of COVID-19 on pharmacists' employment status, workload, and feelings of burnout, as well as to examine emotional health concerns related to COVID-19. METHODS: Wisconsin pharmacists were surveyed using an online instrument between August 25, 2020, and September 22, 2020. The data analysis, performed in December 2020, examined employment status, 3 common burnout risk factors (workload, rewards, and social depersonalization), and emotional health concerns related to COVID-19. RESULTS: Of the 1300 pharmacists, 439 completed the survey (33.8%). The study analysis included pharmacists in community (n = 127) and hospital or health system (n = 107) settings. With regard to employment changes and workload, hospital pharmacists (36%) were more likely to have their hours reduced than community pharmacists (13%) (P < 0.01), and, conversely, community pharmacists (19%) were more likely to have their hours increased than hospital pharmacists (8%) (P = 0.01). For the burnout domain of workload, 45% of the pharmacists reported increased feelings of physical exhaustion at work, and 53% reported increased feelings of emotional exhaustion at work, with no difference between settings. Regarding the burnout domain of rewards, 6% of the hospital pharmacists and 1% of the community pharmacists experienced a reduction in hourly wages or salaries as a result of COVID-19. For the burnout domain of depersonalization, 25% of the pharmacists reported that their ability to connect with colleagues and patients decreased during the COVID-19 pandemic. Additional emotional health concerns reported by the pharmacists included 40% experiencing more anxiety and 25% experiencing more sadness or depression during the COVID-19 pandemic, with no difference between settings. CONCLUSION: This study found that the burnout domains related to workload, rewards, and depersonalization were negatively affected by COVID-19. Pharmacy managers need to proactively combat burnout as well as be reactive when employees show signs of burnout to maintain their workforce and meet the COVID-19-associated challenges.

An intersectional review of discrimination and harassment experiences in pharmacy: Findings from the 2019 National Pharmacist Workforce Survey.

BACKGROUND: Most pharmacists in the United States are women, and the profession is becoming more racially diverse. The recent increase in political and social movements in the United States has heightened our awareness of the importance of better understanding the experiences of underrepresented individuals and groups. Little is known about discrimination and harassment in the profession of pharmacy in the United States. OBJECTIVES: The purpose of this study was to provide evidence that discrimination and harassment exist in the pharmacy profession and explore differences in discrimination and harassment using the intersectionality of race and sex. METHODS: The 2019 National Pharmacist Workforce Survey (NPWS) utilized an electronic survey that was distributed using a 3-contact Dillman approach by email to a randomized sample of 96,110 licensed pharmacists from all 50 U.S. states using the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS included a new battery of questions to assess the prevalence of discrimination and harassment in pharmacy. RESULTS: The most common bases of discrimination experienced were based on age (31.2%), sex (29%), and race or ethnicity (16.6%). The most common type of harassment experienced was "hearing demeaning comments related to race or ethnicity" at 15.6%. The intersectionality analysis revealed different experiences among sex or race combinations. Black and Asian male pharmacists had the highest rate of "hearing demeaning comments about race or ethnicity." Nonwhite pharmacists were more likely to experience harassment from customers or patients compared with their white colleagues. Black female pharmacists had the highest rate of being "very unsatisfied" with the results of reporting discrimination and harassment to their employer. CONCLUSION: Discrimination, including harassment and sexual harassment, is illegal, immoral, and unjust. As the profession of pharmacy continues to become more diverse, there must be a conscious, systemic, and sustained effort to create and maintain workplaces that are safe, equitable, and free of discrimination.

National Pharmacist Workforce Study (NPWS): Description of 2019 Survey Methods and Assessment of Nonresponse Bias.

National Pharmacist Workforce Studies (NPWS) have been conducted in the U.S. every five years since 2000. This article describes the online survey methods used for the latest NPWS conducted in 2019 and provides an assessment for nonresponse bias. Three waves of emails containing a link to the online survey were sent to a random sample of about 96,000 pharmacists licensed in the United States. The survey asked about pharmacist employment, work activities, work-life balance, practice characteristics, pharmacist demographics and training. A total of 5467 usable responses were received, for a usable response rate of 5.8%. To assess for nonresponse bias, respondent characteristics were compared to the population of U.S. pharmacists and a benchmark, while a wave analysis compared early and late respondents. The pharmacist sample-population comparison and the benchmark comparison showed that the NPWS respondents had a higher percentage of female pharmacists and a lower proportion of young pharmacists compared to the population of U.S. pharmacists and the benchmark sample. In some contrast, the wave analysis showed that the early respondents had a higher percentage of males and older pharmacists compared to the late respondents. Both the wave analysis and the benchmark comparison showed that the NPWS respondents (and early respondents) had a lower percent of pharmacists with a PharmD degree than did the late respondents and the benchmark group. These differences should be considered when interpreting the findings from the 2019 NPWS.

Informal learning processes in support of clinical service delivery in a service-oriented community pharmacy.

The evolving health care system necessitates pharmacy organizations' adjustments by delivering new services and establishing inter-organizational relationships. One approach supporting pharmacy organizations in making changes may be informal learning by technicians, pharmacists, and pharmacy owners. Informal learning is characterized by a four-step cycle including intent to learn, action, feedback, and reflection. This framework helps explain individual and organizational factors that influence learning processes within an organization as well as the individual and organizational outcomes of those learning processes. A case study of an Iowa independent community pharmacy with years of experience in offering patient care services was made. Nine semi-structured interviews with pharmacy personnel revealed initial evidence in support of the informal learning model in practice. Future research could investigate more fully the informal learning model in delivery of patient care services in community pharmacies.