Introduction
“So now on top of everything else . . . we have to do this new expanded scope of practice work? Who makes these decisions? Don’t they know how busy we are already?”
“What, another school of pharmacy is opening?! Don’t they know they’re flooding the market. . . . Where will they get jobs?”
“They let us in as International Pharmacy Graduates saying there’s a shortage, but once we are in Canada . . . it’s next to impossible to get licensed. Aren’t these people talking to each other?”
The sentiments expressed in the illustrative comments above speak to the multiple, intersecting challenges faced by Canada’s pharmacists today. During a time of abundant opportunities and rapid change in the day-to-day work of pharmacists, there continue to be significant challenges and struggles. Many pharmacists experience a sense of overwhelming stress approaching burnout, brought on by heavy workloads and additional responsibilities (including scope of practice expansions), against a backdrop of inadequate staffing, increased demands for their time and abuse and harassment from the public. 1 Yet there is comparatively little data or evidence to confirm this perception or to quantify their scale and significance. 2 In response to severe health human resource shortages, pharmacist scope of practice across Canada has been expanding to improve access to some primary care services, yet there are little data on the impact of this expansion on the pharmacy workforce. It is often noted that the career trajectories of international pharmacy graduates (IPGs) do not necessarily follow those of Canadian graduates, raising concerns about systemic bias and underutilization of this large (and growing) part of the pharmacy workforce,3,4 yet there is comparatively little data or evidence to confirm this perception and quantify its significance. 5 After more than a decade since establishing the regulated pharmacy technician role, their integration into community practice and ability to work to their fullest potential and scope appears frustratingly limited and haphazard, 6 yet there is comparatively little data or evidence to confirm this perception and quantify its significance. 7 Currently, there are gaps after gaps in the data and evidence the profession and policy makers need to understand what is occurring in the pharmacy workforce across Canada.
Health workforce data for planning
The ability of our health care system to meet the health needs of Canadians depends on developing, deploying and sustaining a connected and collaborative network of health practitioners equipped with the skills, supports and resources to provide high-quality care. Health workforce planning has been defined as “the process of estimating the number of persons and the kind of knowledge, skills and attitudes they need to achieve predetermined health targets and ultimately health status objectives. Such planning also involves specifying who is going to do what, when, where, how and with what resources for what population groups or individuals so that the knowledge and skills necessary for the adequate performance can be made available according to predetermined policies and time schedules.” 8
This process involves the engagement of several “players” in the health workforce ecosystem—government and nongovernmental organizations, profession- and sector-specific organizations—that address the education, accreditation, funding, regulation and practice of health practitioners. Building data systems that accurately capture the nature and activities of the health workforce, including the scope of regulated and nonregulated practitioners and the outcomes of their work, is critical to maintaining a healthy and effective health system. 9
Knowledge into Practice.
Data are integral to effective health workforce planning.
Currently, data relevant to the pharmacy profession to support effective planning are limited.
Technological, competitive, economic, regulatory, and political barriers to collecting robust data for planning purposes limit governments, employers and the profession in undertaking comprehensive planning for the pharmacy profession.
A refreshed Minimum Data Standard (MDS) that assembles relevant data needed for planning purposes is being adopted across Canada by several professions, including pharmacy.
MDS elements include registration, demographics, geography, education and employment data and can help planners better understand current and project needs for the pharmacy professions.
The Canadian Institute for Health Information (CIHI), an independent, nonprofit, pan-Canadian health organization that focuses on the collection, curation and analysis of data to improve health system performance, 10 has recently refreshed its 2012 Health Human Resources Minimum Data Standard (HHR MDS) to better support evidence-based planning.9-11 This includes data on a range of health workers, including pharmacists. Briefly, a minimum data standard refers to the data elements to be gathered into a data set that would include the responses to those data elements. While the HHR MDS may sound like an abstract and academic concept, its impact on day-to-day work and practice for professionals—and the day-to-day care received by patients—is significant. Consequently, understanding the dimensions of the HHR MDS and how it will influence evolution of our health care system, as well as every individual pharmacist’s workflow and workload, is essential.
The nature of health workforce information and its implications in pharmacy
Central to the collection of health workforce data are regulatory authorities who are mandated by provincial and territorial governments to create a registry of practitioners that are licensed to practise a health profession. 12 Regulation of health professions is a provincial or territorial responsibility, meaning each province or territory has its own regulatory authority (e.g., the Ontario College of Pharmacists) and registry of licensed practitioners. 13 Pharmacy, like many large health professions, also has a national coordinating regulatory organization (the National Association of Pharmacy Regulatory Authorities [NAPRA]). NAPRA is an umbrella group that facilitates communication, sharing of information and development of guidance around areas of common interest for provincial regulators but has no enforcement or direct role in licensure for individual pharmacists.
Mise En Pratique Des Connaissances.
Les données font partie intégrante d’une planification efficace du personnel de santé.
À l’heure actuelle, les données concernant la profession de pharmacien permettant une planification efficace sont limitées.
Les obstacles technologiques, concurrentiels, économiques, réglementaires et politiques à la collecte de données solides à des fins de planification entravent les gouvernements, les employeurs et la profession dans la réalisation d’une planification globale pour la profession de pharmacien.
Une norme minimale de données (NMD) actualisée qui rassemble les données nécessaires à des fins de planification est adoptée partout au Canada par plusieurs professions, y compris dans le secteur de la pharmacie.
Les éléments des NMD comprennent les données démographiques, géographiques, de licence, d’éducation et d’emploi, et peuvent aider les planificateurs à mieux comprendre les besoins actuels et futurs concernant les professions pharmaceutiques.
At the time of initial registration and each year with renewal of licensure, pharmacists are required to complete forms confirming a variety of different aspects of their professional and personal life. Examples of personal details (or data elements) may include age or self-identification with respect to certain protected demographic characteristics (including sex/gender and age). Professional details typically include site of practice, type of practice and typical hours worked in practice. In some jurisdictions, declarations regarding certain advanced practice skills (e.g., prescribing authorities, training to administer injections) are required. Since every member of the profession of pharmacy must, by definition, be registered with a provincial licensing body, these bodies have the most extensive data sets about the profession as a whole. The challenge that arises is that these data are collected in disparate ways across the provinces and territories. Moreover, these data sets tend to be focused on issues of relevance to regulators but could be leveraged for more robust health workforce planning. Indeed, guidance to be released shortly from the World Health Organization recommends leveraging registry data for planning.
Employers also maintain detailed human resource records about the pharmacy workforce. Often these records focus on employment-related legal issues. For example, large corporate employers in Canada maintain data sets regarding the type of practice of a pharmacist, workload measurement statistics and performance data related to billable nondispensing services. These have not been integrated with registry data that pharmacy regulatory authorities share with CIHI.
Private and public insurers may also maintain relevant health workforce data, particularly focused on administrative data (e.g., drug dispensing data, billings for nondispensing services) that could help planners understand the nature, frequency and intensity of some work in community pharmacy. Arguably these data are focused on the product (i.e., medications), rather than the services, pharmacists and their teams provide or the public receives.
Finally, educational institutions and providers have relevant data with respect to qualifications and education, postgraduate certifications (e.g., certified diabetes educators) and other data points that are important in understanding expanding scope of practice changes. These would also be important data to integrate with employment and registry data.
As can be seen, data elements describing individual pharmacists are distributed in an uncoordinated manner across multiple different organizations and jurisdictions. Each may maintain data in incompatible ways that do not facilitate easy consolidation, sharing or centralization, depending upon (for example) software that is used, who “owns” the data and regulations that govern privacy of personal information. In some cases, the accuracy of data themselves may be in question, particularly with high-volume transactional elements such as workload measurement systems.
Beyond the incompatibility of data management software or questions regarding the accuracy and quality of data themselves, additional concerns regarding privacy and security of data holdings are a significant issue in generating an HHR MDS. Much of the “data” about pharmacists, pharmacies and regulated pharmacy technicians connect directly or indirectly to the services and care provided to patients, and as a result, many different legislative frameworks govern storage, use and access by others. For example, Schedule 1 of the federal Personal Information Protection and Electronic Documents Act (PIPEDA) contains important safeguards around patient confidentiality, and where data collected by employers, insurers or others may have relevance to HHR planning, they must be aligned with PIPEDA requirements. 14
The complexity involved in working towards an integrated and standardized HHR MDS across Canada is significant, despite the significant benefit such a data set would offer in terms of planning and management. Without timely, accurate and appropriate data, planning decisions related to how many schools of pharmacy should exist and how many students they should enrol, what numbers of IPGs are required and what skills/qualifications pharmacists need in order to meet patient and health system needs are difficult to make in an evidence-based manner. While some professions are more advanced in their work in this area (notably medicine and nursing)—albeit in an unstandardized and siloed manner, making integration of data challenging—most other professions (including pharmacy) have significant gaps and issues.
Understanding minimum data standards for a minimum data set
Central to the notion of health workforce planning is the importance of accurate, timely and sufficient data upon which to base decision-making. While this may seem self-evident, there are difficult choices to be made with respect to what these data elements should be. Perfect and complete data are neither realistic nor necessary to start to make evidence-based decisions; further, the cost and logistic constraints of trying to gather perfect and complete data make it impractical to consider.15,16 This is the reason why leveraging data already being collected for registration makes sense, to have census-level data of the whole population of practitioners. In developing a minimal data set, planners need to be conscious of overburdening practitioners with reporting requirements and potentially offending them by asking questions and requiring answers in areas that may not appear relevant to the objective of understanding the composition of the health workforce.
In the CIHI MDS, 5 core data elements have been identified that are relevant to pharmacy, along with subelements that provide richer details (see Table 1 for detailed composition). 15
Table 1.
Minimum data set (MDS) elements for pharmacy 14
| Category | MDS data elements | Comments |
|---|---|---|
| Registration | • Provider type • Provider registration status • Provider registration date • Provider registration number • Provider registration province/territory • Provider concurrent registration country • Provider initial registration province/territory • Provider initial registration year |
Key data gaps include: - Terms, conditions and limitations on registration imposed by the regulatory body - Collaborative practice agreements/arrangements - History of complaints, disciplinary actions and reprimands - Criminal or civil litigation - National unique identifier |
| Demographics | • Gender • Sex at birth • Birth year • Language—ability to provide service • Indigenous identity • Racialized group |
Key data gaps include: - Sexual identity/orientation - Ethnocultural identity/orientation - Disability and health status |
| Geography | • Residence province/territory • Residence country • Residence postal code |
Key data gaps include: - Locum practice - Multipractice sites |
| Education | • Basic education level • Basic education graduation year • Basic education graduation institution • Basic education graduation province/territory • Basic education graduation country • Highest level of education graduation year • Highest level of education graduation province/territory • Highest level of education graduation country |
Key data gaps include: - Postgraduate certification (e.g., board certification, CDE, CAE, etc.) - Cross-Canada comparability of degree requirements based on variable scopes of practice - International comparability based on variable scope of practice - Noncertificate continuous professional development/skills upgrading |
| Employment | • Employment status • Employed in profession • Seeking employment • Provider employment category • Employment full-time/part-time/casual status • Employment full-time/part-time/casual preference • Employment annual earned hours • Employment place of work • Employment position • Employment area of practice • Employment funding source • Agency health care provider flag • Multiple site flag • Primary site virtual care • Primary site organizational identifier • Primary site postal code • Primary site province/territory • Primary site country |
Key data gaps include: - Clinical/medication therapy management services provided frequency - Clinical/medication therapy management services provided intensity - Clinical/medication therapy management services provided quality - Collaborative practice arrangements - Scope of practice fulfillment based on provincial jurisdiction - Risk for occupational stress/burnout - Data silos between employers, regulators, professional associations and educators |
Registration data elements
Registration is often described as the foundation of the professional workforce. 12 Regulation of professions like pharmacy supports mandatory requirements for regulatory bodies to collect data points from every member of that profession (“registrant”). Typically, data will be collected during an educational program if a compulsory studentship or preregistration internship is required that involves regulatory oversight, at entry to practice when a license or registration is first awarded and annually as part of the renewal of registration requirement. Regulatory bodies collect data related to questions such as the registration status of the individual (e.g., Part “A” actively providing patient care vs Part “B” not actively providing patient care), where and in what year initial registration of a pharmacist occurred in Canada and whether the individual is simultaneously registered as a pharmacist in another country. There are, however, important gaps. In jurisdictions where collaborative practice agreements with other health professionals are possible, the existence of these arrangements is neither reported nor tracked through registration processes.
As noted earlier, regulatory authorities are required by provinces and territories to collect registry data. They choose to share data with CIHI through data-sharing agreements, with the goal of providing consolidated information about the Canadian health workforce. 17 This presents several challenges. First, this data pathway is time and resource intensive, as regulatory authorities collect different information and the definitions of their data elements (e.g., definition of what constitutes a full-time equivalent status). Further, the data are siloed by province and may not provide a full picture of the profession. For instance, the 27-year-old pharmacist who starts their education in Nova Scotia moves to Ontario for a postgraduate residency, then finds an initial first-time clinical position in Alberta, is not followed across the years from education and postgraduate training to professional practice and ultimately retirement, nor can they be easily tracked across provinces or between groups if in later life they switch professions but maintain dual registration and continue to practise occasionally as a pharmacist. One important element of a national HHR approach to registration is to detect registration patterns across multiple jurisdictions. In the meantime, a unique identifier for pharmacy professionals would assist in understanding these mobility patterns.
Demographic data elements
Demographic data describe the composition and characteristics of the health workforce and can be useful for planning purposes in projecting the future trajectory of the workforce. Key demographic characteristics of interest to planners include gender, year of birth, languages in which an individual can provide service, Indigenous identity and self-identification as a member of an ethnic or racialized group.
Some individuals may express concern or surprise at this information being collected, stored and analyzed, preferring to keep some matters private and wondering how it is relevant to professional work. Indeed, the notion of collecting data related to ethnicity and gender may be uncomfortable for some but is essential for understanding contemporary phenomena in practice, including an increase in abuse and violence directed towards increasingly feminized and racialized professions like pharmacy. Without these data elements that allow for understanding of the workforce itself, trends that directly impact on workplace safety, satisfaction, occupational stress, burnout and workforce retention are difficult to track and interpret.
From a health workforce perspective, demographic data are useful for many reasons. First, the demographic characteristics of the health workforce are themselves an equity issue: in Canada, professions need to be accessible by all Canadians regardless of gender, ethnic or Indigenous identity or age. Ensuring professions do not become the purview of only certain privileged individuals is an important social policy goal. There is also general acceptance of the notion that a more diverse health workforce that more closely approximates the general population will be better equipped to serve patients, and this in turn will improve accessibility, enhance patient–provider relationships and ultimately improve health care for patients. A particularly relevant demographic characteristic of importance for planners involves birth year, as this enables calculation of age-related workforce indicators and can help project age-related workforce trends such as retirement and family planning.
Geography of provider residence data elements
The minimum data set elements include data regarding residential locations of health care professionals in Canada to better understand how professionals are distributed across the country. Anecdotally, it is believed that most professionals like pharmacists prefer to live and work in larger urban or suburban regions, leading to skill shortages in rural and remote areas of the country. Various incentive programs have been developed to incentivize relocation to these areas. Until the mid-1980s, professions like pharmacy specifically admitted students to competitive university degree programs based on the postal code of their high school, to ensure geographic representativeness of a pharmacy class. In some cases, policy levers have been used (such as “return of service” requirements for internationally educated health professionals, requiring them to live and work in rural communities for a specified period as a precondition for Canadian licensure). Such incentives and policies were implemented prior to the development of minimum data sets and have had a very mixed history of success: in the short term, they appear to encourage some inter- and intraprovincial migration of professionals, but in the mid to long term, structural misalignments continue to persist. This minimum data set can help HHR planners better account for and adjust to “boom-and-bust” employment prospects in different parts of the country (or within a specific province).
Education data elements
The minimum data set elements for education capture details for education level, as well as graduation year and location where professional education was received. Over the past several decades, there have been significant changes in pharmacy education in Canada, with the adoption of the entry-level PharmD degree program by all Canadian universities, in alignment with the United States, but at odds with the entry-level pharmacy degree in most other parts of the world, including the United Kingdom, Australia and most of Western Europe. For a profession like pharmacy, there may be concerns that the minimum data set is not comprehensive enough: for example, postgraduate work (e.g., a postbaccalaureate PharmD or clinical master’s degree), postgraduate clinical training (e.g., a hospital pharmacy residency) and professional upgrading programs (e.g., Certified Diabetes Educator) are not captured in the minimum data set, meaning the actual complement of skills within the pharmacy profession is not clearly known. In some professions with more formalized specialization systems (e.g., medicine), these data can be invaluable in understanding shortages in some fields (e.g., family medicine) and surpluses in others (e.g., cardiac surgery).
In its current formulation, the minimum data set elements for education can only provide planners with limited information regarding the capacity of the overall pharmacy workforce to address emergent needs of the health care system. For example, as prescribing authorities become more widespread across Canada and individual provinces take different approaches with respect to formal certification/qualification as an independent prescriber, the educational requirement associated with this scope-of-practice evolution may not be adequately tracked or monitored. Further, in a profession like pharmacy that is highly reliant upon the contributions of international pharmacy graduates, differences in the basic education level across the workforce are not captured or monitored. The implications of the limitations of this minimum data set are not fully understood at this point, nor are the potential impacts on HHR planning decisions.
Employment data elements
The data elements for employment are particularly relevant for planning. Conceptually, this minimum data set aims to include where individuals work, how many hours they work per week, the kinds of positions they hold, the locations of practice and communities served and services provided. This data set can be cobbled together from various sources, including regulatory bodies, employers and self-reporting by professionals. As a result, it may not be the most timely or accurate, and there are significant opportunities for over- and undercounting of hours worked.
One particularly important issue for the pharmacy profession relates to service capacity (i.e., the amount of services that pharmacy professionals can collectively provide, which gets us beyond simple head counts), the nature of practice, especially in the community pharmacy sector. Unlike professions that work largely in the public sector, such as nursing, but like professions such as physiotherapy or dentistry, many pharmacists work in private for-profit sector workplaces. This sector itself is highly fractionated, representing independent pharmacies, large corporations, grocery and big-box stores and franchise structures. The impact of the business model of the pharmacy on the actual practice of the profession and the impacts/outcomes on patient care have been speculated on within pharmacy for decades but with minimal research and data to make informed decisions.
The current minimum data set may not provide sufficient, clear, timely or accurate data to better understand this important issue for the pharmacy profession, as a pharmacist’s “capacity” to deliver services in current structures is not well defined. It is unclear what specific data would be needed or helpful to address planning questions with respect to the structure of pharmacy businesses. Further, it is not clear how the necessary data could even be collected, as these data themselves have competitive value for these businesses, are localized within the businesses themselves and are unlikely to be freely accessible or shared.
The “minimum” data set and its implications for pharmacy workforce planning
As can be seen, the minimum data set indeed represents only a minimum amount of data regarding the health workforce. Recognizing that, going forward, this minimum data set will be highly impactful on planning decisions in pharmacy, it is imperative that pharmacists and the pharmacy profession understand some of the implications and issues that may arise, including insufficient data regarding education, training and specialization within the profession and incomplete data regarding the ways in which different corporate structures impact the profession.
Equally important is the recognition that the minimum data set represents a necessary, yet insufficient, step forward in building a more robust foundation for understanding the pharmacy profession than has ever existed before. The challenges in assembling even this minimum data set should not be underappreciated: while there may be gaps and deficiencies, this approach represents an important first step towards better, more systematic, data-driven understanding of pharmacy to facilitate more effective health human resource planning.
Presently, a Canadian Institutes for Health Research–funded team of investigators at the Canadian Health Workforce Network (including 2 of the authors here) are developing a more inclusive and enhanced health workforce data standard that attempts to address some of these limitations and to better support more integrated health workforce planning. Other examples of interprofessional approaches have also been proposed in other jurisdictions, including the United States.
Developing a culture of planning within the pharmacy profession building on more standardized data is a necessary step. As the profession of pharmacy becomes more deeply integrated in health and primary care systems and as more pharmacists become aware of and more deeply invested in planning, the unique issues and concerns of the profession can be more accurately represented in defining and developing an evolving minimum data set. To this end, planning that focuses on multiple professions within a sector will be necessary, as will standardized data on pharmacy across jurisdiction but also across professions within employment sectors.
Thus, every pharmacist should familiarize themselves with the processes and tools of health workforce planning to better understand how they can more effectively contribute to ensure the right and best possible data points are collected and used for decision-making. The current silos within which health workforce data are collected (regulatory, employment, academic, professional associations) and the difficulty of melding data across these silos will be a significant challenge moving forward to truly capture planning needs for the pharmacy professions as part of the broader health workforces across Canada.
Summary
Health workforce planning relies on integrated workforce data across all players in the health care system. Access to these data is critical to inform issues such as health workforce shortage areas, educational program planning and forecasting employment demands. The multiple, intersecting challenges faced by the pharmacy workforce affects the day-to-day life and work of pharmacists, influencing their ability to practise safely and effectively, as well as their morale and professional satisfaction. With the current climate of extreme stress on primary care services across Canada, expansion of scope of practice and roles for pharmacists has emerged as an important tool to ensure continuing access to quality care. The success and sustainability of this approach will depend entirely on the ability of the pharmacy workforce to absorb and fulfill new responsibilities effectively and efficiently and to plan for continuing evolution of the pharmacist’s role. Currently, there are insufficient and fragmented data to help planners, educators, employers, professional associations and regulators understand the current state of the pharmacy workforce, service capacity and future demands and needs.
Health workforce planning and the minimum data set it requires may seem like esoteric and uninteresting bureaucratic terms of little relevance to pharmacists, their patients and the profession. As health systems across Canada undertake more rigorous and evidence-based approaches to planning, the minimum data set will take on significant importance in the day-to-day life of pharmacists. These data will be used to make a wide variety of decisions about the profession, ranging from the number of schools of pharmacy needed in Canada to the readiness of the profession to assume expanded scope of practice responsibilities, to the ways in which policies need to change to protect pharmacists from violence and abuse. As a profession and as individual professionals, it is important to be invested in this process and in this data set: if pharmacists and pharmacy are not meaningfully contributing to and leading health workforce planning, decisions regarding the future of our profession will be made by others who may have less of an investment in and awareness about the past, present and future of pharmacy. ■
Footnotes
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Author Contributions: All authors approved the final version of the article.
Funding: Funding for this work was provided in part by a grant from the Canadian Institutes for Health Research.
ORCID iD: Zubin Austin 
https://orcid.org/0000-0001-6055-2518
Contributor Information
Natalie Crown, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario.
Ivy Bourgeault, University of Ottawa, Ottawa, Ontario; Canadian Health Workforce Network, Ontario.
Zubin Austin, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario; Institute for Health Policy, Management and Evaluation—Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario.
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