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Could Making Pharmacy More Mobile Help Address Rising Tensions Among Pharmacists?

Considerable public attention and legislative action have been devoted to addressing and identifying the causes of burnout and turnover in various health professions that experienced workforce shortages following the COVID-19 pandemic. While pharmacists have not often been the focus of policy solutions centered around bolstering the healthcare workforce, they are the most recent profession to exhibit public tension with one of their main employers–chain pharmacies. In late 2023, pharmacists working for CVS and Walgreens staged a three-day walkout over working conditions and lack of support in meeting performance metrics.¹ Yet, according to MHC’s Michigan Healthcare Workforce Index, pharmacists are one of the healthiest professions in Michigan. These walkouts illustrate that even the most healthy occupations are working through their own tensions and issues. One potential way to reduce the current strain on Michigan pharmacists is to lean into the rising telehealth industry, which would allow pharmacists in neighboring states to serve patients in Michigan.


According to the MHC Pharmacist Survey, 66 percent of pharmacists who complete their residencies in Michigan and 70 percent of pharmacists who complete their pharmacy school education in Michigan also practice in the state. These results indicate that pharmacists are a less mobile population, and with three pharmacy education programs in the state, finding new ways to draw pharmacists to Michigan presents an opportunity to grow this workforce. Indeed, licensing boards and national organizations have worked to increase the mobility of pharmacists during the COVID-19 pandemic as other professions like nurses and physicians have seen a greater push to become more mobile professions in the last decade.

Currently, the National Association of Boards of Pharmacy (NABP) utilizes the Electronic Licensure Transfer Program (eLTP) to provide reciprocity for actively licensed pharmacists looking to practice in another state. The eLTP has made some strides in expediting the process for pharmacists to obtain licensure in another state. Additionally, for PharmDs who are not yet licensed the NAPLEX exam is available where graduates can submit exam scores to multiple jurisdictions for additional fees, which is costly. However, compared to the Nurse Licensure Compact (NLC) that allows nurses to seamlessly practice in participating states, the eLTP and NAPLEX are more expensive for pharmacists, and pharmacists are required to hold separate licenses for each state of practice or complete a legal examination dependent on state licensing requirements. A new policy in Idaho utilizes a mutual recognition model, similar to the NLC, that reduces the administrative burden for pharmacists to practice in Idaho by recognizing cooperating states’ licenses. The Idaho policy and the groundwork established by the NAPLEX licensing process and the NABP eLTP have started to erode the resistance to mutual recognition policies in the pharmacist profession.²


Other states have been slow to consider the Idaho model of mutual recognition and none have adopted the model but it represents a departure from the more cumbersome emergency passport model that the NABP used at the height of the COVID-19 pandemic. While standards of licensure remain a critical point in legislative considerations of mutual recognition of state pharmacy licenses, the creation and implementation of mutual recognition models could significantly increase the mobility of pharmacists and open the door for states to actively recruit pharmacists to their region.

¹ Chappell, Bill. 2023. “CVS pharmacist walkout in Kansas City area reflects problems across U.S.” NPR, September 29, 2023.


² Adams, Alex J. 2021. “Toward Multistate Pharmacy Practice: Enhancing Mobility and Portability of Pharmacist Licensure.” Annals of Pharmacotherapy 55 (3): 409-412.

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