Clinical Infectious Diseases Pharmacists in the United States: A Problem of Both Supply and Demand

TO THE EDITOR—The importance of antimicrobial stewardship (AS) to the future of healthcare is emphasized by recent statements of the US government calling for widespread implementation of robust AS programs, which applies to >5700 US hospitals [1]. The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance AS identify a clinical pharmacist with infectious diseases (ID) training as 1 of 2 core AS team members [2]. The Society of Infectious Diseases Pharmacists (SIDP) and Infectious Diseases Practice Research Network of the American College of Clinical Pharmacy (ACCP) recommend that future pharmacists seeking a clinical ID position complete a postgraduate year 1 (PGY-1) pharmacy practice residency and postgraduate year 2 (PGY-2) ID specialty residency [3]. Today, concern exists over the shortages of adequately trained ID pharmacists [4, 5], and as such, the future supply of clinical ID pharmacists is dependent on the availability of postgraduate ID training opportunities. The purpose of this correspondence is to objectively describe the current state of (1) postgraduate training opportunities for pharmacists looking to specialize in ID and (2) demand for clinical ID pharmacists. To quantify and characterize postgraduate training opportunities, we accessed pharmacy residency and fellowship directories of SIDP, American Society of Health-System Pharmacists (ASHP), and ACCP. Site information was crossreferenced to account for duplication, and available data points were collected for analysis. To assess the demand for clinical ID pharmacists, we utilized Web-based searches (eg, www.monster. com, www.usajobs.gov) and accessed employment postings provided by relevant pharmacy organizations (eg, ASHP, SIDP). These were compiled using Microsoft Excel software and evaluated individually to prevent duplication. We performed this snapshot assessment in October 2014, identifying 89 postgraduate ID training programs and 32 clinical ID pharmacist employment listings. Collected data are presented in Table 1. For training programs, none focused specifically on AS, although by nature AS concepts are incorporated into training and accreditation standards for PGY-2 ID residencies mentions AS briefly [7]. For employment, 23 (72%) mentioned AS within the job description and 29 (91%) were inpatient positions. In addition to the 32 clinical ID pharmacist positions, 5 academic and 10 industrybased (eg, medical science liaison) ID pharmacist jobs were found. If AS programs are destined to become part of the healthcare landscape and clinical ID pharmacists are essential for such a transition, the data presented here represent cause for substantial concern. Quantitatively and geographically, current opportunities for training and employment are considerably inadequate to fulfill the anticipated future needs for thousands of US institutions. Indeed, alternative educational programs such as certificate programs [8, 9] may assist in filling some existing gaps, but are limited in their scope. As healthcare continues to evolve and the role of AS grows, early recognition of existing barriers by stakeholders is essential to future success. The impact of the current clinical ID pharmacist supply and demand deficiencies within the United States noted here requires consideration during this AS program implementation and expansion period.