The Evolution and Equity of China’s Pharmacist Workforce in Healthcare Institutions: A Provincial Panel Data Analysis, 2007– 2023

In the complex machinery of modern healthcare, doctors diagnose illnesses and nurses provide care, but there is a third, often quieter group of professionals who ensure the medicines themselves are safe and effective. These are the pharmacists. In many parts of the world, the role of a pharmacist has expanded beyond simply counting pills and handing them over; they are now expected to be active partners in a patient's treatment, reviewing prescriptions for safety and helping doctors choose the best drugs. However, for a healthcare system to function properly, the number of these specialists must keep pace with the growing needs of the population. If there are too few pharmacists relative to doctors and nurses, the system can become unbalanced, leaving patients without the full benefit of expert medication management. This balance is not just about having enough people; it is also about where those people are located and whether they have the right training to handle complex medical cases.

A new study by researchers at the National Institute of Hospital Administration in China takes a long, hard look at this specific group of workers over a period of sixteen years. The team analyzed data from healthcare institutions across the country from 2007 to 2023, a time that covers a major era of reform in Chinese healthcare. Their goal was to track how the number of pharmacists changed, how their skills and backgrounds evolved, and whether they were distributed fairly across the vast and diverse landscape of the nation. By examining official government records, the researchers painted a detailed picture of a workforce that is growing, but perhaps not growing fast enough to meet the demands of a modern medical system.

The findings reveal a story of slow growth that is struggling to keep up with the rest of the medical team. Between 2007 and 2023, the total number of pharmacists working in hospitals and clinics in mainland China did increase, rising from roughly 357,700 to 569,500. This represents an average annual growth of 2.2 percent. While this sounds like progress, the researchers found that this rate is significantly slower than the growth of other health professionals. During the same period, the number of doctors grew by 4.6 percent each year, and the number of nurses grew even faster at 7.4 percent. Because the pharmacist workforce is expanding so much more slowly, the balance of the medical team has shifted. In 2007, there was one pharmacist for every 5.15 doctors. By 2023, that ratio had worsened to one pharmacist for every 8.39 doctors. This means that as the healthcare system has expanded, the relative size of the pharmacist team has actually shrunk compared to doctors and nurses.

This shortage creates a heavy burden on the pharmacists who are there. The study highlights that institutional pharmacists are responsible for managing nearly 70 percent of the nation's drug sales, which are mostly prescription medications used in hospitals and clinics. Yet, there are actually 175,000 fewer pharmacists working in these healthcare institutions than there are licensed pharmacists working in retail pharmacies. This disparity suggests that the professionals tasked with the most complex medical decisions and the highest volume of drug usage are the most understaffed. Consequently, many of these pharmacists are forced to spend the majority of their time on the repetitive, high-intensity work of dispensing medicine, leaving them with little time to engage in the more advanced clinical care that patients need.

The study also looked at who these pharmacists are and how their professional makeup has changed. The workforce has become increasingly female, with the proportion of women rising from about 60 percent in 2002 to nearly 71 percent in 2023. At the same time, the workforce is aging. The share of pharmacists under the age of 25 has dropped significantly, while the number of those over 55 has grown. This suggests that fewer young people are entering the field, which could lead to future shortages. While the education levels of pharmacists have improved, with more holding bachelor's degrees and a small but growing number holding master's degrees, the overall level of senior expertise remains low. Only about 6.6 percent of pharmacists hold senior professional titles, which are typically required to lead complex clinical services or conduct research. This lack of high-level talent could limit the ability of the healthcare system to move toward more advanced, patient-centered care.

When the researchers examined where these pharmacists are located, they found a mixed picture of fairness. On the surface, the distribution of pharmacists across China's 31 provinces has become more equal over time. A statistical measure of inequality, known as the Gini coefficient, dropped from 0.145 in 2007 to 0.093 in 2023, indicating a more even spread of resources from one province to another. The study also found that, contrary to what one might expect, the density of pharmacists in rural areas is actually higher relative to the population than in urban areas. This shift appears to be the result of national policies aimed at strengthening healthcare in the countryside. However, the researchers discovered that the main source of inequality is not between cities and the countryside, but rather between different provinces within those same categories. In other words, the gap between a wealthy province and a poorer province, even if both are urban, remains a significant challenge.

The spatial analysis of the data shows that the way pharmacists are clustered across the country has changed. In the early years of the study, pharmacists were heavily concentrated in specific regions, creating distinct "hotspots" of high density and "coldspots" of low density. Over time, these extreme clusters have faded. By 2023, the distribution of pharmacists looked much more random, with no strong pattern of clustering remaining. This suggests that the resources are spreading out more evenly, though the study notes that this does not necessarily mean every local area has enough staff, only that the extreme gaps between regions have narrowed.

Despite these improvements in how resources are spread out, the core issue remains the structural shortage of the workforce itself. The study concludes that while China has made measurable progress in expanding the number of pharmacists and making their distribution more fair across provinces, the workforce is still lagging behind the growth of the rest of the medical team. The aging demographic, the shortage of senior experts, and the heavy workload caused by the relative lack of staff all point to a system under pressure. The researchers suggest that future policies need to focus not just on hiring more people, but on optimizing the structure of the workforce and enhancing the clinical skills of pharmacists. Without addressing these structural gaps, the healthcare system may struggle to fully realize the benefits of modern, patient-centered pharmaceutical care.