The Real Crisis Behind Indiana's Pharmacist Shortage: Why Working Conditions, Not Licensing Exams, Are Driving Pharmacists Away

A recent article from The Statehouse File attributed Indiana's pharmacist shortage partly to the state's requirement of the Multistate Pharmacy Jurisprudence Examination (MPJE). However, this analysis fundamentally misdiagnoses the problem. The MPJE is not the barrier preventing pharmacists from practicing in Indiana. Rather, the exodus from the pharmacy profession stems from deteriorating working conditions in chain drug stores that place impossible demands on pharmacists while compromising patient safety. Evidence from neighboring Ohio provides a stark illustration of the real crisis facing the profession.

The MPJE: A Red Herring in the Shortage Debate

The claim that eliminating the MPJE will solve Indiana's pharmacist shortage ignores a critical fact: the vast majority of states require this examination. According to the National Association of Boards of Pharmacy, 45 states currently require the MPJE for initial licensure. Only a handful of states have eliminated this requirement entirely.

States that do not require the MPJE include Alaska, Idaho, Michigan, and Vermont. Additionally, Arkansas, California, and Puerto Rico have developed their own state-specific jurisprudence examinations rather than using the standardized MPJE. This means that out of 50 states and U.S. territories, only four have completely eliminated a pharmacy law examination as a licensure requirement.

If the MPJE were truly the primary barrier to pharmacist employment, we would expect these states to have significantly better pharmacist staffing levels. However, there is no evidence that Alaska, Idaho, Michigan, or Vermont are immune to the nationwide pharmacist shortage. Michigan, despite eliminating the MPJE in recent years, continues to face the same workforce challenges as states that retain the examination.

Furthermore, the article's suggestion that the MPJE is outdated because pharmacies now have computerized access to current laws misses the point entirely. The examination tests a pharmacist's fundamental understanding of legal and ethical frameworks governing practice, not their ability to memorize specific regulations. Professional competence requires more than the ability to look up information; it demands the judgment to apply legal principles appropriately in complex, time-sensitive situations.

The Real Crisis: Unsustainable Working Conditions in Chain Pharmacies

While Indiana debates licensing requirements, a far more pressing crisis is driving pharmacists out of the profession entirely. Nationwide, chain drug stores have implemented business models that prioritize profits over patient safety, creating working conditions that experienced pharmacists describe as unsafe and unsustainable.

The situation in Ohio provides compelling evidence of the true nature of this crisis. In 2020, the Ohio Board of Pharmacy conducted a comprehensive survey of 4,000 pharmacists to assess working conditions across the state. The results were alarming: roughly half of all pharmacists reported that they did not have adequate time to complete their work safely. The concerns were most acute among pharmacists employed at large chain retail pharmacies.

Pharmacists surveyed identified three primary obstacles to safe practice: inadequate support staff relative to workload, pressure to meet corporate metrics such as the number of prescriptions filled per day, and an overwhelming burden of non-clinical duties including administrative phone calls. These conditions created an environment where medication errors became inevitable rather than exceptional.

"One Ohio pharmacist wrote in the survey: "I feel like there are at least 1-2 dispensing errors every month in my pharmacy. If we were allowed to work at a safe pace, this would be completely avoidable." Another pharmacist with 20 years of experience at the same retail pharmacy explained their decision to leave the profession: "My MAIN reason was because I did not feel safe — the environment was set up for me to fail and it was only a matter of time before I would make a horrific mistake."

Corporate Metrics Over Patient Care

The Ohio survey revealed a disturbing pattern at large chain pharmacies: the vast majority of pharmacists reported feeling pressured to meet corporate metrics that interfered with patient care. Pharmacists working at standalone chain drugstores and grocery store pharmacies consistently reported insufficient staffing for patient safety and were least likely to receive adequate breaks or lunch periods.

Ten percent of pharmacists working at large chain drugstores reported working shifts longer than 13 hours. These extended shifts, combined with inadequate support staff and relentless productivity demands, create conditions where even the most competent pharmacist cannot maintain safe practice standards.

The problem extends beyond Ohio. A national survey by NBC News in 2021 found that overworked, understaffed pharmacists at chain drug stores across the country were reaching a breaking point. Pharmacist Jessica Awad, who left a major pharmacy chain, explained:

"I feel like a big dilemma that a lot of pharmacists deal with is that they go into pharmacy wanting patient care. But a really big issue is that we deal with a very high workload, a very high volume of scripts that we deal with daily. And so as a result, a lot of patient care kind of gets put on the back burner."

Regulatory Response: Ohio's Attempt to Address the Crisis

Recognizing the severity of the situation, the Ohio Board of Pharmacy took unprecedented action. In response to the 2020 survey findings, the board established the Pharmacist Workload Advisory Committee, bringing together representatives from retail chains, independent pharmacies, hospitals, and practicing pharmacists.

The committee developed new regulations that took effect in May 2024, establishing minimum staffing standards, requiring mandatory breaks for pharmacy workers, and mandating that prescriptions be filled within five days. Cameron McNamee of the Ohio Board of Pharmacy explained the urgency: "We don't want that level of stress to then burn out and then we're dealing with issues where we don't have enough pharmacists to staff our stores and people are having issues getting access to medication."

The regulations require pharmacies to be appropriately staffed at all times to minimize fatigue and distraction that could interfere with safe practice. Pharmacies must also develop policies for limiting hours or services when the pharmacist determines they cannot be offered safely, and employers cannot override these professional judgments.

These rules came on the heels of a significant enforcement action: in February 2024, CVS agreed to pay a $1.5 million fine to resolve 27 cases of understaffing and delays in Ohio. This penalty underscores that the working conditions crisis is not merely a matter of employee dissatisfaction but has reached the level of regulatory violations with direct implications for patient safety.

The Workforce Crisis: Shortage of Willing Workers, Not Qualified Candidates

A critical distinction often overlooked in discussions of pharmacist shortages is the difference between a shortage of licensed pharmacists and a shortage of pharmacists willing to work under current conditions. Shane Jerominski, a practicing pharmacist in Southern California who helped organize walkouts at major chains, explained this distinction clearly: "It's not a shortage of pharmacists or a shortage of pharmacy technicians, but a shortage of pharmacists and technicians willing to practice in these settings. There's a lot at risk for a pharmacist when a medication error occurs. And after all of that education, you don't want to put your license at risk working for a company where you don't feel like you're supported."

This insight reveals why eliminating licensing examinations will not address Indiana's pharmacist shortage. The state is not struggling to attract pharmacists because the licensure process is too difficult. Rather, licensed pharmacists are choosing to avoid positions that place their professional licenses, reputations, and patients' wellbeing at risk.

According to the American Pharmacists Association, the industry has approximately 7,500 job openings for pharmacists and more than 25,000 openings for pharmacy technicians nationwide. Major chains like CVS and Walgreens have thousands of open positions, often with substantial sign-on bonuses. Walgreens has offered signing bonuses as high as $75,000 in some markets. Yet these positions remain unfilled.

The problem is not a lack of financial incentives or a shortage of licensed professionals. The problem is that experienced pharmacists refuse to work in environments where they cannot safely serve patients. When a pharmacist with two decades of experience chooses to leave the profession entirely rather than continue working under current conditions, no amount of signing bonuses or relaxed licensing requirements will retain talent.

What Indiana Should Learn from Ohio

Ohio's experience provides a roadmap for addressing the pharmacist shortage that Indiana lawmakers should follow. Rather than focusing on licensing requirements, Indiana should:

1. Conduct a comprehensive survey of working conditions at Indiana pharmacies, particularly chain retail locations, to document the scope and nature of workplace stress, staffing inadequacies, and safety concerns.

2. Establish minimum staffing standards based on the full scope of services offered, not merely prescription volume, to ensure pharmacists have adequate support to perform all aspects of their role safely.

3. Require mandatory breaks and reasonable shift limits to prevent the fatigue and distraction that lead to medication errors.

4. Prohibit corporate metrics that interfere with professional judgment and patient safety, allowing pharmacists to prioritize quality of care over quantity of prescriptions filled.

5. Create mechanisms for pharmacists to report unsafe working conditions without fear of retaliation and require timely management responses to these concerns.

6. Enforce these standards through regulatory oversight with meaningful penalties for violations, as Ohio demonstrated with the CVS settlement.

Conclusion: Addressing the Root Cause

Indiana faces a genuine pharmacist shortage, but the solution does not lie in eliminating professional licensing requirements. The MPJE is a standard requirement in 45 states, and the handful of states that have eliminated it continue to face the same workforce challenges.

The real crisis, as Ohio's experience demonstrates, is that chain drug stores have created working conditions so untenable that licensed pharmacists are either leaving the profession entirely or refusing to accept positions in retail settings. Pharmacists report inadequate staffing, excessive workloads, pressure to meet corporate metrics at the expense of patient safety, and shifts so long they cannot maintain concentration.

These are not minor complaints about workplace preferences. These are fundamental patient safety issues. When pharmacists consistently report that they cannot perform their duties safely, when they document regular medication errors that could be prevented with adequate staffing, and when experienced professionals leave the field because they fear making "a horrific mistake," the profession faces a crisis that no change in licensing requirements can address.

If Indiana wants to solve its pharmacist shortage, it must look beyond superficial fixes like eliminating the MPJE. The state must confront the business practices that have made retail pharmacy an unsustainable career choice for many professionals. Only by ensuring safe working conditions, adequate staffing, and protection of pharmacists' professional judgment will Indiana attract and retain the pharmacy workforce its citizens need.

The choice facing Indiana policymakers is clear: they can follow the path of meaningful reform that Ohio has begun, addressing the root causes of pharmacist burnout and unsafe working conditions, or they can pursue the false solution of relaxed licensing requirements while the real crisis continues to worsen. The evidence from across the country points unequivocally toward the former approach as the only viable path forward.