In recent years, the outlook of Pharmacy education has changed quite significantly. Obtaining a degree in a healthcare profession requires tremendous amount of preparation and dedication, not only due to the intensity and rigor of the curriculum but also due to the dramatic changes that occur in a student’s life. Companies that used to consistently hire all of their interns every year have now cut back in their hiring. Other companies have cut pharmacist hours and even changed their policies on working overtime. This uncertainty has created stress within some pharmacists and pharmacy students.
With more and more pharmacy schools opening up every single year, the number of new grad pharmacists continue to grow exponentially. Unfortunately, this number does not seem to be keeping up with the growth of new pharmacist jobs available.
This chart shows the PDI (Pharmacist Demand Indicator) for the last 10 years. If the value is above 3, it indicates that there is a demand for Pharmacy students. If the number equals to 3, it indicates the supply meets the demands. Late in the year of 2017 marked for the first time a drop in PDI below 3, which indicates that there is was a shortage of pharmacist jobs. Later the scenario stabilized for the year-end.
The above data shows how the demand for fresh graduates and experienced professionals may vary according to time and the demand has been consistently decreasing in the past couple of years.
This can be majorly attributed to the fact that there are increasing number of pharmacy institutions coming up in the country hence the number of Pharma graduates keep on increasing constantly. This leads to increase in the competition and there are not enough job opportunities to accommodate all.
On the other hand, heavy workloads and long hours make stress management a critical skill for pharmacists. A study of practicing pharmacists found that more that 68% experienced job stress and role overload. Almost half reported work– home conflicts. Respondents cited role ambiguity as a serious concern—they were often unable to provide ideal professional services because mundane tasks took priority. Among the functions they perceived got short shrift was not meeting their expectations, because they lacked either time or necessary skills.
What is Stress?
Stress is the “wear and tear” our bodies experience as we adjust to our continually changing environment; it has physical and emotional effects on us and can create positive or negative influence on us. As a positive influence, stress can help compel us to action. As a negative influence, it can result in feelings of distrust, rejection, anger, and depression, which in turn can lead to health problems such as headaches, upset stomach rashes, Insomnia, ulcers, high blood pressure, heart disease, and stroke. With the death of a loved one, the birth of a child, a job promotion, or a new relationship, we experience stress as we readjust our lives. In so adjusting to different circumstances, stress will help or hinder us depending on how we react to it.
Other studies identified interpersonal interactions, level of compensation and advancement, role stress, and career commitment as stress triggers. This research found that when management improves interpersonal interactions among staff members, they become more committed to the profession. Better interactions among staff reduces nonwork conflicts – and the work environment is more manageable.
A startling 15% of pharmacists are so stressed in their current job that they have considered finding a new job – a stressful process itself – although most wish to remain in the profession.
Among all pharmacy staff, uncertainty about continuing employment, heavy workload, short staffing, and inability to update and improve professional competence are significant stressors. Staff who report highest satisfaction, lowest stress, and plans to remain on their jobs cite supervisor support and managerial flexibility as key reasons. Recall the adage, “People don’t quit their jobs, they quit their supervisors.”
Sources of stress (stressors) in the undergraduate population include financial burdens, new and increased academic demands, increased independence, and adjustment to a new environment and culture. A limited number of studies have focused on the Health-Related Quality of Life (HRQoL) and perceived stress among the pharmacy students and noted that pharmacy students experience higher levels of perceived stress and lower levels of HRQoL compared to the general population.
While both these factors are significant, it is equally important to understand the Quality of Life (QoL) of pharmacy students. There are notable differences between HRQoL and QoL as defined by the World Health Organization (WHO). While HRQoL talks about the physical, mental, and social well-being, QoL is defined as the individual’s perception of his/her position in life in the context of the culture and value systems in which he/she lives and in relation to his/her goals, expectations, standards, and concerns. The QoL adds other dimensions such as environment, spirituality, and life in general to physical, mental, and social well-being.
Key Contributing Factors of Stress Among Pharmaceutical Professionals
With a drastic increase in the number of Pharmacy colleges in almost every part of the country, the intake of pharmacy students has increased to leaps and bounds in the colleges. In aspiration of a good future, students have opted the pharmacy profession. But as their graduation comes to an end, they are now finding themselves in a state of dilemma about what they should do now because it is becoming increasingly difficult for a fresher to land a promising job in the Pharma Industry. And luckily if someone gets a job, he is bound to work in a very low salary for initial years which is even not sufficient to earn his livelihood. The other option left for the student is to go for higher education, for which again he has to pay a huge amount to the colleges.
A study conducted by Ammar Ihsan et al showed possible correlation between perceptions of stress and HRQOL among MPharm students. MPharm students reported relatively lower levels of perceived stress than non-pharmacy students; however, MPharm students reported relatively lower mental HRQOL than non-pharmacy students. In addition, higher levels of perceived stress were negatively correlated with mental and physical HRQOL.
The most common stress triggers reported by M.Pharm students were related to the curriculum (examinations, case presentations and clerkship reports).
Most students employed positive lifestyle strategies in order to alleviate stress. Strategies should be developed in order to alleviate perceived stress and to promote the mental and physical HRQOL of these students. Again, go for PhD, which has also become a money game by some of the universities offering PhD as just a degree. In this curriculum, the students doing their degrees from reputed institutes are also treated at par with the students doing degrees with such universities giving degrees just for money.
According to a study conducted by Jennifer Beall et al, class assignments and completing electronic portfolios are the top stressors reported among student pharmacists. There was a higher percentage of female participants that selected the items in the survey as stressors compared to males in all surveyed stress trigger items but one. Males had a higher percentage of stress than females concerning completing survey(s) from faculty or administration. A majority of students perceived IPPEs as a major stressor. Tables below illustrate the stressors analyzed between genders and among age groups, respectively.
The PharmD Situation
The Pharm.D program in India can be a major support for the Indian health care system and can help to address many loop holes and issues persisting in India if utilized properly however a tough and bumpy road is ahead for the Pharm.D graduates. There are 233 colleges approved by the PCI to run Pharm.D programme in their premises so far they have produced overall 20,000 graduates and approximately 9000 are graduating each year. They are facing the challenge of getting placed after completion of their course. Though initially introduced and regulated by Pharmacy Council of India (PCI) but the programme is now being controlled by both All India Council of Technical Education (AICTE) and Pharmacy Council of India (PCI).
The profession of PharmD is facing serious lack of recognition and underutilization, especially in India.
Only handful of private hospitals are now offering job as a clinical pharmacist on low pay grade. This forces them to work in non-conventional fields such as medical writing, medical coding instead of practicing their profession due lack of opportunities in government hospitals. The course of Pharm.D is of Six years duration and is considered as a postgraduate doctoral degree. Even the fees structure for a PharmD course is much higher compared to the B.Pharm course. Students get quite frustrated due to lack of opportunities even after they dedicate six years of their precious time into training themselves.
This happens majorly due to reasons like the PharmD graduates are still not legally allowed to prescribe in India although they possess better knowledge about drugs and the possible side reactions/adverse reactions that they might cause.
The state of Hyderabad has already scraped out the course due to scarcity in job prospects after completion of the course. “The role of a Pharm D graduate is not defined unlike that of a doctor, dentist, or an engineer. It is not clear he or she can open a clinic as a pharmacist”, said N Yadaiah, registrar, Jawaharlal Nehru Technological University. He said that the students have even moved the court asking why there are very few jobs for PharmD graduates.
In the year 2017-2018, the Pharmacy Council of India made the semester system of education mandatory for B.Pharm and M.Pharm colleges. This move was taken in order to bring a dynamic change in the pharmaceutical educational system, since the syllabi needed revision with the latest and upcoming trends in the industry. These changes came with their own advantages and disadvantages.
On the bright side, the syllabus of undergraduate and postgraduate courses in pharmacy were updated to a great extent which became a crucial part of upgradation. One key problem that the Pharmacy Council failed to address initially was to implement Continual Pharmacy Education programs (CPEs) to train the professors and lecturers before the change took place. As a result, the efficiency of deliverance of knowledge from teachers to students became affected because of lack of preparation. This greatly affected the quality of education in the pharmacy colleges, especially in non-government colleges. Students are not being mentored up to the requirements which lead to a situation where the students are not competent enough to get good industrial jobs.
This is a very dangerous situation because if the student does not put sufficient effort from his side, he knows the reason behind the success in his professional career is the product of his efforts. But if the mentoring itself does not meet expectations, it leads to a huge amount of stress because they are under a false impression that they did their best in the training stage but when they come to the professional world reality hits like a train and their ambitions are crushed. Most students assume that they will never be competent enough and resort to switch their profession or chose to work at the most basic jobs available.
The most common source of stress among the pharmacy students was academic-related stress. The students also frequently reported personal life issues such as inadequate time for rest and recreational activities, lack of time for family and friends, interpersonal conflicts and environmental events as their sources of stress. This is not surprising as pharmacy training is a rigorous and strenuous endeavor which takes place in a competitive vocational environment.
After a student graduates from high school and moves away from home, he or she is often out of their comfort zone. Stress develops during this transition as the student tries to adjust to the new situations and adapt to a new college environment. Learning to cope properly with distress and eustress is important, as the behaviors established in college can continue for years or even a lifetime. If behaviors and habits resulting from stress management are maladaptive, they may have both psychologically and physiologically detrimental effects on the body and mind.
According to a study conducted by Sue Hui Sun to assess the stress among the undergraduate students of pharmacy, it was reported that the stress levels among the students varied with time. At the time of during the period where students needed to complete assignments, laboratory reports and also facing end of semester exams, stress levels were expected to be higher compared to that which was at the beginning of a semester. This suggests those students’ stress levels were not constant throughout the year but that students experienced higher stress at the time where assignments and examinations are near.
Vivek B. Waghachavare conducted a study of Stress among Students of Professional Colleges from an Urban area in India and found that gender was found to be one of the most important factors in the development of stress, with the results indicating a female predominance. The amount of stress in the students of pharmacy and medical profession was significantly high as compared to those of engineering students. This can be attributed to the fact that in India there has been a huge change of scenario in the past decade. In the earlier days, sending female children for education were not as widely encouraged as of today. This taboo still exists in certain communities of India which creates a mental stress on the female students because they are more likely to be a victim of criticism on failing to meet the expectations in terms of results.
Lack of Vision – The Career Killer
The major error that a pharmacy student makes in today’s world is that he lacks vision and that is where his professional life starts tumbling down the stairway. Most graduates begin their career in Pharmaceutical Industry with an idea of joining the company or post which gives them the best salary negotiation. Those who join a job role only for the money involved are not actually either qualified for the job or not interested in the role and thus they undergo huge amount of stress – as a result they burn-out more quickly than expected. This creates too much stress in the individual and also leads to the creation of a false notion in his mind about the Pharmacy Profession.
Let’s face it, the majority of pharmacy workplaces have developed a system of metrics in which a pharmacist’s performance is measured. Depending on the company, these metrics are created to determine the company’s success. Even if you as an individual disagree with these metrics, these are what the company values, and it’s up to you to identify and create a plan on how to execute without causing distress to yourself and sacrifice your passion or happiness. This plan will require you to audit yourself and your abilities and determine what will be needed in order to get the job done.
Although there are various other ways to becoming indispensable, by focusing on this key aspect, one can grow their career beyond ways that they could imagine. It is going to be crucial for pharmacists to develop these skills moving forward. Their job security will depend on it.
An optimal level of stress enhances learning, while excess of stress can cause health problems. This results in reduction of students’ self-esteem and affects their academic achievement. A high level of stress may have negative effect on cognitive functioning and learning of pharmacy students. The young student population is vulnerable to stress of higher professional education due to competitive environment.
Stressors can impact students either in a positive or negative manner. Majority of students display the effects of stress, as evidenced by their decreased academic performance and extra-curricular activities. The most predominant stressors were theory and practical examinations (both mid-sem and final), viva-voce and familial issues, among the others. While having a national and international leadership role we must also build on our local engagement. PCI and AICTE should also take some concrete decisions on ensuring that the students are gaining sufficient training in the educational institutes so that they become industry ready. With a basic knowledge of coping strategies, pharmacists can overcome stress to achieve their personal best.
One of the best ways to move forward would be to seek mentorship from experts or join an internship program which provides hands-on training in the actual industrial setup. This will help the students make better decisions for their future. There are few organizations in India that provide such training programs and internships. One such organization is Pharma Knowledge Centre® in Ahmedabad that focusses on bridging the gap between industry and the students by providing hands-on training, interactive sessions and internship programs – that makes the student confident for industry jobs which leads to a more sustainable workforce. This happens because such initiatives develop competence in the student, hence they perform better in their job roles.
- Votta RJ, Benau EM. Predictors of stress in doctor of pharmacy students : Results from a nationwide survey. Curr Pharm Teach Learn [Internet]. 2013;5(5):365–72. Available from: http://dx.doi.org/10.1016/j.cptl.2013.06.014
- Sam AT, Muttusamy B, Yee SM, Ayapanaido T, Parasuraman S. Investigation of Stressors Affecting a sample of Pharmacy Students and the Coping Strategies Employed using Modified Academic Stressors Scale and Brief Cope Scale : a Prospective Study. 2016;8(2):122–7.
- Awadh AI, Aziz NA, Yaseen SN, Abdulameer SA, Sahib MN, B OQ. A comparison study of perceived stress and quality of life among Master of Pharmacy and non- pharmacy master ’ s students. 2013;13(1):22–8.
- Basak SC, Sathyanarayana D. Pharmacy Education in India. 2010;74(4).
- Hirsch JD, Do H, Hollenbach KA, Manoguerra AS, Adler DS. Students ’ Health-Related Quality of Life Across the Preclinical Pharmacy Curriculum. 2009;73(8):1–6.
- Review AS, Pharmacy ON, In E. of Biomedical AND Pharmaceutical sciences A STRATEGIC REVIEW ON PHARMACY EDUCATION IN INDIA WITH FUTURE. 2016;3(10):180–2.
- Beall JW, Dehart RM, Riggs RM, Hensley J. Doctor of Pharmacy Students. 2015;344–54.
- Behere SP, Yadav R, Behere PB. Original Article A Comparative Study of Stress Among Students of Medicine , Engineering , and Nursing. 2011;33(2).
- Gallagher CT, Mehta AN V, Selvan R, Mirza IB, Radia P, Bharadia NS, et al. Perceived stress levels among undergraduate pharmacy students in the UK. Curr Pharm Teach Learn [Internet]. 2014;6(3):437–41. Available from: http://dx.doi.org/10.1016/j.cptl.2014.02.004
- Sun SH, Zoriah A. Assessing Stress among Undergraduate Pharmacy Students in University of Malaya. 2015;49(2):99–105.
- Jishnu V, Rm G, Dn M. Pharmacy Education in India : Strategies for a Better Future. 1932;3(4):334–42.
- Assaf AM. Stress-induced immune-related diseases and health outcomes of pharmacy students : A pilot study. Saudi Pharm J [Internet]. 2013;21(1):35–44. Available from: http://dx.doi.org/10.1016/j.jsps.2012.02.006
- Deepak K, Gaur A. Current scenario of pharm.d program of india. 2018;(March).
- Waghachavare VB, Dhumale GB, Kadam YR, Gore AD. دنلها في ةيرضح ةقطنم نم ةينهلما تايلكلا بلاط ينب رتوتلا نع ةسارد. 2013;13(August):429–36.
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