Here is the stat: the U.S. Bureau of Labor Statistics projects about 13,400 job openings for pharmacists each year. In 2026, the number of people graduating with a Doctor of Pharmacy across the U.S. will be about 8,000 — only 60% of what we need.
That second estimation comes from Russ Melchert and Terri Warholak, deans of pharmacy at University of Missouri-Kansas City (UMKC) and University of Health Sciences and Pharmacy in St. Louis (UHSP), respectively. The two work together on the problem of low enrollment in pharmacy schools across the country.
"We’re not competing in this," said Warholak. "We know that this isn’t a me problem or a St. Louis College of Pharmacy problem. It’s not a UMKC problem. It’s a problem about making sure we have enough pharmacists to serve the public."
In a long conversation, they explained that, actually, we need way more than 13,400 graduates per year — that’s the number of pharmacist job openings, not jobs that require a PharmD.
"Our graduates go to work for drug companies, regulatory agencies, they go into the military, they go into post-graduate residency training. A lot of different things," said Melchert.
Coverage of the pharmacist shortage tends to focus on chain retail pharmacies within the past two or three years. But over the past decade, the pipeline feeding new graduates into the industry has started to dry up. It hit retail first. It’s beginning to hit hospitals, and it’s going to affect every sector where pharmacists work. The Doctor of Pharmacy is a four-year graduate program. Even if we turn things around right now, it’s going to get worse before it gets better.
Identifying the problem
A little more than 20 years ago, American pharmacy was in a similar position to the one it's in now. A 2001 New York Times article reported rising prescription volumes, vacant positions and an increase in mistakes made by overworked pharmacists. The response was an increase in pay and an expansion in enrollment. In fact, it wasn’t just enrollment that expanded — the number of schools did too, nearly doubling from 83 in 2001 to 142 as of two years ago.
Now, we’re seeing a lot of the same things: Pharmacists staged walkouts last year in response to years of overwork, and chains like Walgreens have offered sign-on bonuses in an attempt to hire. But issues in education preceded those more recent concerns. Applications have been declining for 10 years now, and since 2019, enrollment rates have been dropping too. To be clear, those numbers aren’t per school – that’s overall.
After students enter school, the problems don’t necessarily end:
"Really, you’re talking about 20% of students that go into pharmacy are not actually coming out and practicing pharmacy," Melchert explained. "There’s a 10% attrition [rate] and then another 8-10% not sitting for the board. So, the problem’s actually going to be a lot worse than I had originally modeled."
That portion of students not getting licensed goes up by 2% every year.
The issue isn’t just affecting community retail pharmacies. Hospitals are concerned too, first of all because there are just fewer people to hire.
"And then, number two, some of our partners, at UMKC anyways...I met with a couple weeks ago, and they told me they’re already feeling the impact of the salary increases in the community sector," said Melchert.
Daniel Good, Vice President of Pharmacy at Mercy, explained to KSMU how that affects his work.
"With this shortage, we’ve actually had to decrease hours per day and decrease days per week that we have our retail pharmacies open," he said. "In the hospital setting we don’t have that luxury because they’re open 24/7, but that does mean that we have to ask our pharmacists to work overtime, and sometimes things just don’t get done — we’re not able to optimize our formularies, we’re not able to optimize our inventory, we have less time to spend with patients, and we have less time to spend developing our own staff while we’re spending more time working on a scheduled shift."
"To me, it’s like a harbinger," said Melchert. "When you see it happen in one sector, you know it’s going to hit all the others, it’s just a matter of time. And we’ll be hit, too, in academia, in terms of being able to recruit and retain the faculty we need to educate the future pharmacists."
As the problem worsens over the coming years, Missouri is going to be hit especially hard.
"About 15% of pharmacists in Missouri will be at age 60 or near 60 in 2026. About 26% will be over the age of 50 by then," Melchert explained. "But, also, if you look at the number of applicants in Missouri and compare it to all the bordering states, we would rank eighth out of nine in terms of the number of pharmacy applicants that are in the system applying for pharmacy schools this year."
"It's multifactorial"
At this point you might be asking: Why is this happening? Well, we regret to inform you that the answer seems to be 'maybe a lot of things.'
The obvious answer is pay, and there’s some credence to that explanation. Between 2012 and 2022, pay adjusted for inflation went down in both hospital and retail. Statistics aren’t available for 2024 yet, but between ‘22 and ’23 they pretty much just kept up with inflation.
"We have seen increased competition from other health professions, particularly physician assistants, Melchert said, "and I would add in there certified nurse anesthetists."
So maybe pay explains that — sign-on bonuses can only do so much. But again, last year’s walkouts weren’t about pay, but conditions. According to Paul Gubbins, Dean of UMKC’s satellite pharmacy school here in Springfield, those conditions have a massive effect on the field’s pipeline.
"Usually the first place that a student gets interested in pharmacy is taking a technician job or working in a pharmacy as a clerk or something like that. And they’re going to walk in, and they’re going to see a very stressful environment," he explained. "Or perhaps another way that they get introduced to pharmacy is [that] their parents are pharmacists who are on the front lines and may say that that’s not the career they recommend for their children."
That’s pretty close to the experience of Joel Talley, a pharmacy student at UHSP:
"I’ve personally had a more-than-I-can-count-on-my-hands number of pharmacists that have told me not to go into pharmacy whenever I was an undergrad working as a technician," he told KSMU. "And even in high school, when I was thinking about it, I had a lot of people saying 'don’t go, pharmacy’s a dying profession.' Which is absolutely not true, because there’s so much to do with pharmacy that isn’t just community, and that’s something that not a lot of people get to see."
Talley's sentiment is one pretty much everyone quoted in this story emphasized over and over: Pharmacy is not just community pharmacy. That’s the biggest sector, but there’s hospital work, there’s research work, there are all these different routes. But the inevitable PR problem is that the person working behind the counter at CVS — quite possibly with not enough support — is the only exposure to the profession that a lot of people have.
As Mercy's Daniel Good explained, "some of the students say, 'well, I want to go do healthcare, I want to go help people, but I don’t want to be in a profession that’s going to have this kind of negative reception,' which is in [contrast] to where we were literally 12 years ago, where according to one of the Gallup polls, pharmacy was one of the top-rated professions as far as respect goes in the country. I don’t think it’s there anymore."
The optics problem worsens as pharmacies close at an alarming rate, particularly in rural and majority Black and Latino neighborhoods. Independent pharmacies, where you’re most likely to have a one-on-one interaction with a pharmacist, are doing particularly poorly: A National Community Pharmacists Association survey found that about a third are on the brink of closing this year.
"I grew up in a smaller town in far southwestern Kansas," Melchert said, on the topic of closures. "And my mom would see the pharmacist on a regular basis, and it was the pharmacist providing advice when she couldn’t get to a provider right away. She was a single mother of three boys, and she was trying to get us care, and if one of us had a problem the first person she’d talk to was the community pharmacist. And I’m here because my mom said when I was in college and I was studying chemistry 'you should really think about going into pharmacy.' "
The cause of the closures is also the result of a lot of factors, but one of the biggest is pharmacy benefit managers or PBMs. PBMs act as middlemen between insurance companies and pharmacies, but over time the big ones have consolidated not just with each other, but also insurance companies and pharmacies. The biggest PBM is called “CVS Caremark.” According to an FTC report (which several PBMs refused to cooperate with), their practices include, among other things, imposing contractual terms designed to disadvantage independent pharmacies.
Dean Warholak noted that "there [are] a lot of medications which they dispense, [and] they’re actually losing money every time they dispense it. And that has implications, of course, on the number of pharmacies that might need to close and also the amount of help they can afford to pay.”
The experience of working in a pharmacy, the public perception of what a pharmacist is and the sometimes lack of interaction between patients and pharmacists all rub up against a pretty fundamental motivation for going into any healthcare field: Helping people. Melchert said that’s a particularly strong factor among this generation of college graduates.
"It’s not all economics, right? I mean, economics will drive some of this," he said. "But I think some of the employers are finding out 'wait a minute, these graduates, they want more than just money, they want to make sure they have the best environment to care for the patients' — these are becoming the number one things. And I think that’s a very optimistic sign for the future."
And why is Missouri’s enrollment especially low? Well, the answer is even more unsatisfying.
"We don’t know the answer to that," said Warholak. "And I don’t know if it’s just that people don’t realize what a wonderful impact you can make as a pharmacist. Like, I always tell my students, 'pharmacists save lives every day, and they know that that is true.' So, I don’t know if it’s an awareness issue, if it’s an education issue — I’m not sure.”
Reversing the trend
Luckily, pharmacy organizations in Missouri seem to be pretty united on the issue of low enrollment. Dean Warholak mentioned one effort, the Coalition to MOve Pharmacy Forward, consisting of both pharmacy schools, the Missouri Pharmacy Association the Missouri Society of Health-System Pharmacists along with some reps from the state board of pharmacy.
One major priority is just getting the word out in the field. Russ Melchert is getting a paper published in the Missouri Pharmacy Association Journal with a lot of the statistics discussed so far. The hope is that, with enough urgency around the issue, they can get pharmacists in schools promoting the profession to middle and high schoolers.
In the short term, the two schools are both running pharmacy technician programs aimed at high schoolers. UMKC is offering a class in the Blue Springs School District, and STL has a collaboration with the Boys & Girls Club. The hope is to strengthen one of the pipelines by which a lot of people enter the field.
"That will have a more immediate impact on pharmacists currently practicing and their desire to continue practicing in a community setting," Melchert added
But some level of government action is probably necessary to address the problem. So far, the track record indicates that Jefferson City isn’t particularly aware of that. Melchert cites HB 1898 and 1925, which feature an incentive program for a list of healthcare professionals, not including pharmacists.
"Neither one of them passed, is my understanding," he noted. "But if those bills are reintroduced, one easy thing to do would be to add pharmacists to that list."
Melchert also said that the state could implement 'test and treat' legislation, which allows pharmacists to prescribe drugs themselves based on the results of, say, a positive influenza or COVID test.
"Does it make a lot of sense to then have the patient leave the pharmacy, COVID-positive, to go somewhere else to see a physician to get a prescription for Paxlovid to treat the COVID? No. What kind of worries me is, if we don’t keep pace with other states," he said, "our graduates are going to start leaving Missouri to go to states like Idaho, where today pharmacists can independently prescribe a large number of medications — almost anything (except for a controlled dangerous substance) as long as they have the practice expertise to do that."
Laws regulating Pharmacy Benefit managers would do a lot, not only for pharmacy education, but the pharmacy industry as a whole – not to mention drug prices. The state of PBM legislation could be its own story, but there are proposals on both the state and federal level with a chance of passing.
Still, it’s important to remember that it takes a minimum of six years total to become a pharmacist. The basic problem right now is there just aren’t enough people entering the labor pool, and it’s going to take years to turn that trend around. However, much is being done to address the problem now, and educators are doing a lot. The deficit between the number of pharmacists we need and the number of pharmacists we have is going to keep growing for a least a little while.
Dean Warholak summed it up well.
"I’ve always been about the underserved, and that’s who this is about," he said. "Even people who are in cities, even the people who have the resources to buy medications, are getting ready to all be 'the underserved.' "