By Annette M. Boyle

WASHINGTON—According to job site Glassdoor, clinical pharmacists in the U.S. make about $113,000 on average. At the VA, they do a little better, averaging nearly $115,000, based on salaries reported to the site. And, in some regions of the country, clinical pharmacists working in the VA make considerably more.

Even so, the VA acutely feels the pay pressure caused by significant competition for these professionals, particularly at leadership levels.

“While VA has the ability to offer competitive salaries and benefits, challenges exist,” according to Debra Doty, Title 38 Compensation Program Manager, and Carmen Montgomery, director of Compensation and Classification Services, both of the VA’s Office of Human Resources Management. “VA facility directors are authorized to adjust pharmacist rates, based on recruitment and retention difficulties and other labor market factors, to include rates being paid to comparable private sector pharmacist positions within the local labor market, with the understanding that VA may never be the pay leader in the local labor market.”

Still, clinical pharmacist salaries within the VA stack up fairly well against many competitors, based on a review of posted jobs and salary surveys. The Bureau of Labor Statistics reports a median salary of $121,500 per year, or $58.41 per hour, based on 2015 figures; says the average salary as of June 24, 2016, was $109,112, with pay usually falling between $100,726 and $117,852; and pegs annual salaries at about $112,000, with hospital pharmacists making about $104,000 and hospital pharmacy directors pulling down $126,000.

Pharmacy residents at the VA North Texas Healthcare System. Competitive salaries and a broader scope of practice make working at the VA a popular career for newly-minted pharmacists. Photo from the VA North Texas Healthcare System.

Pharmacy residents at the VA North Texas Healthcare System. Competitive salaries and a broader scope of practice make working at the VA a popular career for newly-minted pharmacists. Photo from the VA North Texas Healthcare System.

Pay compression between pharmacy leadership and entry-level pharmacists in many areas across the country has made recruiting and retaining pharmacist positions more challenging, the VA said. The problem is most keenly felt in the upper ranks.

“Leadership positions outside VA are in high demand, resulting in a dramatic rise in salaries, and VA is unable to compete,” Doty and Montgomery told U.S. Medicine.

Geography makes the biggest difference in salary for clinical pharmacists, within or outside the VA. The Pharmacy Times survey found the lowest pay in the Midwest, with clinical pharmacists in Nebraska making $112,000 and those in Iowa bringing home $114,000. In Nevada and Alaska, the averages exceed $130,000, while California leads in pay at nearly $147,000.

Job postings for VA positions show similar variability. Salaries for starting positions (GS-12) range from $89,000 to $107,000 in Louisiana to $122,000 to $141,000 in California. Advertised salaries for clinical pharmacist specialist jobs (GS-13) start at $96,000 to $118,000 in Pennsylvania compared to $115,000 to $149,000 in South Carolina and $120,000 to $143,000 in Texas. The high end of the salary range for a GS-14 in South Dakota, $139,000, is close to the starting range for that level position in California, $131,000.

Several commentators on job websites for clinical pharmacists mention that working for the VA comes with a significantly better benefit package than most other employers provide. Low-cost health and life insurance are particularly notable, as are the generous sick and annual leave policies.

According to the American Association of Colleges of Pharmacy, the average new pharmacist graduated in 2015 with $149,320 in debt, making the education debt reduction program offered for some positions especially appealing. Jobs in the VA also qualify for the Public Service Loan Forgiveness Program.

Scope of Practice

If not pay, the most notable difference between working for the VA and working in the private sector for clinical pharmacists likely lies in the scope of practice. “VA pharmacists have had advanced practices with prescriptive privileges for approximately 20 years,” according to a Pharmacy Benefit Management (PBM) statement. In the past five years, clinical pharmacists have “assumed important roles in providing medication and disease management services collaboratively but independently within the [Patient Aligned Care] team framework.” These changes allow clinical pharmacists to fully integrate into the comprehensive disease state management for patients, rather than focusing on a single disease state or medications.

Currently, about 41% of clinical pharmacists have an active scope of practice. “From 2010 to present, the number of clinical pharmacists working under a scope of practice has risen an astonishing 63% primarily due to focused promotion on this role coupled with the VHA movement toward team-based care,” according to the PBM statement.

Their scope of practice enables clinical pharmacists to work in all practice settings, including ambulatory, acute and residential care environments and to treat a vast array of conditions. “Clinical pharmacists perform over 5 million patient care encounters annually within the VHA and play a key role in improving access and quality of care,” the PBM reported.

The number of clinical pharmacists and their role in providing care is likely to grow in importance “with the increasing recognition of their value in increasing access to primary and specialty care, improving clinical outcomes, and lowering overall healthcare costs,” according to the PBM statement. The VA’s aging patient population, high burden of chronic disease and the rapid development of new pharmaceutical agents have made the clinical pharmacist’s role increasingly critical.

The VA’s 7,747 clinical pharmacists represent an increase of 19.3% in the department’s onboard strength since FY 2011, or an increase of 1,135 employees. Despite the significant increase, Doty and Montgomery noted that the VA still faces recruitment and retention challenges in multiple markets, particularly for pharmacy managers and clinical pharmacy specialists. On the positive side, they said that “in recent years, the growth in the number of graduate pharmacists with Doctor of Pharmacy degrees has been beneficial to VA’s training programs, where we see high demand for VA residency training programs.”