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In the ideal health care system, there would be an abundance of resources to ensure timely and comprehensive patient care. However, it is a well-known reality that demands on Canadian hospitals and clinical pharmacy services are escalating because of increases in the number of elderly patients, the acuity of patients’ conditions, the complexity of drug regimens, and the length of stay in hospital. In addition, there continues to be a shortage of hospital pharmacists. Despite these challenges, patient care should not be compromised. Hence, we believe that there should be a cap on the number of patients under the care of a clinical pharmacist. We outline here the 4 main reasons for this position. First, not limiting the number of patients under the care of a clinical pharmacist may compromise patient care and may actually increase costs. The value of clinical pharmacy services is well documented in the literature, and certain interventions such as participation in patient care rounds and inservice education have been shown to decrease mortality. If individual pharmacists are each expected to take care of a large number of patients, it may not be possible for them to perform all of these mortality-reducing interventions for all assigned patients. Furthermore, Bond and Raehl have demonstrated an association between the number of pharmacists per 100 beds and mortality. In addition, when pressed for time, pharmacists may only deal with urgent issues or troubleshoot problems and may not consistently perform certain cost-saving activities such as development and management of drug protocols, making switches from IV to oral dosage forms, or changing therapy to less expensive alternatives. Second, a heavy patient load may be detrimental to the pharmacist’s relationship with other health care professionals. If the pharmacist has an excess number of patients to see, he or she may be forced to provide targeted services to patients at various locations in an institution and may thus be unable to develop consistent relationships with the other health care professionals on the patient care team. The value of the pharmacist is realized when he or she practises in a collaborative, integrated environment and when other health care professionals can place a face to a name. Pharmacists are more likely to be consulted if they are present in person than if they have to be paged or called. Scaling back services may suggest to other health care professionals that pharmacists are only capable of targeted tasks, such as recommending drug dosages, rather than being medication experts who are capable of comprehensive assessments of medication therapy. As a result, the level of trust between the pharmacist and other members of the health care team will be lower, which may in turn mean that the pharmacist practises at less than the optimal scope, hence jeopardizing the growth of the pharmacy profession. Third, other health care professions are using caps on patient numbers to deal with the strain of increasing demand for their services. It is well accepted that a general practitioner will stop accepting new patients or that patients will wait several months to obtain care from a specialist because the physician has capped the patient load to a prespecified number of patients per day. Physicians do not compromise the quality of their patient care through excess patient load, and neither should pharmacists. Patients and other health care professionals should be able to expect the same high-quality pharmaceutical care from any clinical pharmacist in any institution. To meet this expectation, we need to limit the number of patients under each pharmacist’s care, because each comprehensive assessment requires a finite period of time to perform, and each pharmacist has only a finite number of working hours per day. If other health care professionals were to limit themselves to “troubleshooting”, as pharmacists do when patient load is excessive, it would be the equivalent of a nurse only checking vital signs or a cardiologist only reading electrocardiograms when they see a patient, neither of which would be acceptable. For pharmacists to be utilized to their maximum scope, we need to align our work with all of the patient’s medication-related goals, not just some of them. Finally, not instituting a patient cap can have a detrimental effect on pharmacists’ job satisfaction. An increasing number of patients causes the pharmacist’s daily routine to be increasingly “task-oriented”. This is an ironic situation, given that the majority of pharmacists choose this profession because they want to help people. Not being utilized to their maximum potential will reduce job satisfaction, and pharmacists who choose to remain in such environments will eventually lose their holistic patient assessment skills, which is detrimental to both patients and the future of clinical pharmacy. We need pharmacists who are passionate about and actively engaged in patient care to advance the profession to its maximum scope of practice. In conclusion, it is a long-term goal of the profession for pharmacists to deliver consistent pharmaceutical care for each of their patients. In the presence of limited resources, it is imperative that the quality of patient care not be compromised in order to provide consistent but substandard care. There should definitely be a limit or cap on the number of patients under the care of a clinical pharmacist. Unlike other health care

Should There Be a Cap on the Number of Patients Under the Care of a Clinical Pharmacist?