There’s more to the lack of pharmacists than a simple numbers game, writes Fintan Moore
The subject of pharmacist availability, or the lack thereof, has been an issue for the last 40 years. I did my Leaving Cert in 1985 when the country was in the economic doldrums — watch the movie Small Things Like These to get an idea of the grimness — and part of the appeal of doing Pharmacy was that it guaranteed a job at the end without needing to emigrate because of the shortage of pharmacists.
Back then, the only course in the Republic was in TCD, but many travelled north or to Britain, and it took years before RCSI and UCC opened their schools of pharmacy. Even with these extra options, there is still a chronic shortage of pharmacists, and there can be periods with acutely low levels of locum cover.
There’s more to this picture than a simple numbers game, because many recent graduates don’t stay in community pharmacy due to the long hours, late finishes, weekend working, sometimes stressful conditions, lack of career advancement opportunities, etc. However, the picture is also clouded by factors such as Brexit, because pharmacists from the EU are moving here in bigger numbers due to the UK no longer being an easy option.
We are a small country relative to the size of the EU, and it’s reasonable to think that the margin between an undersupply and oversupply in this jurisdiction could probably tip quite quickly. So the news that three new schools of pharmacy are opening in the near future is something that I welcome with a bit of a health warning.
The three schools will be located in Sligo, Waterford and Galway, and when fully up-and-running, will respectively have 35. 40 and 70 students. Collectively, that will add 145 graduates a year to the existing output from TCD, RCSI and UCC, and the inflow from the EU.
I’ll assume that better-informed minds than mine have crunched the numbers on this, but my back-of-an-envelope figures run as follows. There are about 5,000 pharmacists on the register, spanning ages from approximately 25 to 65, ie, a spread of 40 years. If one-fortieth of these retire every year, then that’s 125 pharmacists that need to be replaced. The figure of 125 is probably slightly low when you correct for population growth, but as against that, more of the existing 5,000 pharmacists are under 45 rather than over 45, so 125 could well be an over-estimate. So it’s possible that we’ll have an oversupply of home-grown graduates before we add in overseas entrants.
I stand to be corrected on this, and indeed would be very happy to be proved wrong.
Sudden deafness
An under-recognised but vital role played by community pharmacists is our ability to act as an early-warning system for conditions where early treatment is critical. We’re often the first port of call for people who can’t get an appointment with a doctor, or who aren’t even sure that they need medical attention.
Collectively we see shingles rashes, herpetic eye infections, cellulitis or other skin infections, dangerously high or low blood pressure readings, heart attack and stroke symptoms, meningitis rashes, and other conditions where time is of the essence. Occasionally, we have to argue with the patient that they need to find a doctor ASAP rather than wait two days to see their GP.
There’s a new one to add the list which I had never heard of before until it was mentioned by pharmacist Nicola Cantwell in her speech at the recent Pharmacy Excellence Awards, namely Sudden Deafness (Sensorineural Hearing Loss).
If somebody reports a sudden and severe loss of hearing, they should get to a hospital immediately to see an ENT consultant, because early treatment with steroids can be vital. Causes can vary, but include viral illness and trauma. If treatment with steroids is delayed, then hearing loss can be profound and permanent. It’s worth flagging this condition with your staff also.
Power trips
Every year when winter approaches, I think to myself that I should probably invest in a portable back-up generator for the pharmacy in case of a prolonged power-cut due to storm damage, ESB strike action, or some construction worker with a JCB chopping though a major cable.
Then I get busy with the winter and Christmas rush, and never follow up on it, and the winter passes without any incident, and I forget about it until the following October and the cycle repeats itself. Some year, my luck will probably run out, and then I’ll most likely buy a generator after that so I don’t get caught again.
We’re often the first port of call for people who can’t get an appointment with a doctor
If anybody is thinking about doing something similar, pharmacies don’t use a lot of power, so a relatively small generator will keep the fridge, computers and some lights running. You can get a petrol or diesel option for as little as €300, but storing either fuel can be a problem for safety reasons, and they degrade over time. You will probably be able to buy fuel if needed unless your local filling station is also blacked out!
For about €1,000 you can get a gas-powered generator which uses a gas cylinder, so that’s easier to store. Another possibility nowadays is that many EVs can be used as a power source, so a cable can be run from the car to power a premises. The EV needs to have bidirectional charging and not all of them do, but if you’re thinking of buying an EV, it’s worth checking what models have it. Fingers crossed you never need it.
Fintan Moore graduated as a pharmacist in 1990 from TCD and currently runs a pharmacy in Clondalkin. His email address is: greenparkpharmacy @gmail.com.
