Postponed exams spark concerns over pharmacist shortage

Hundreds of pharmacy graduates are forced to delay their entry into the workforce after their licensing exam was suddenly postponed for a second time this year. Students are blaming administrators for failing to plan during the ongoing COVID-19 pandemic.

Students received the cancellation notice less than two days before the scheduled Objective Structured Clinical examination (OSCE) on Nov. 8, after Toronto Public Health updated COVID restrictions to limit gatherings amidst record-breaking COVID-19 cases.

The OSCE is the last step for graduating students to become a licensed pharmacist. The exam evaluates grads as they interact with a standardized patient at a number of clinical stations. This is the second time Eric Tran, a University of Toronto (U of T) student, has had his test delayed this year.

“Myself and many of my colleagues really are in limbo,” Tran said, who currently interns at a pharmacy in rural Ontario. “We’re stuck with the title as a pharmacy intern. We can practice similarly to the scope of a pharmacist but not entirely the scope of a pharmacist.”

The 2020 class president representing graduating pharmacists at the University of Toronto, Michelle Wang, says that a total of 200 students across Canada, including 120 at U of T were impacted by the cancellations.

“It makes us feel like we’re not an appreciated healthcare provider, especially during this time of need,” Wang said. “There’s a lot of pressure on pharmacies right now and they’ve been able to handle this burden because of this new body of pharmacy interns”

This is the second time that the OSCE has had to be rescheduled for the 2020 grads.

In May, students across Canada, including Wang, were forced to delay their certification after the test was postponed due to COVID-19.

During this time, Wang and her fellow students have only been allowed to work as interns at pharmacies, unable to practice in the full scope or earn a full wage while facing student debt in the tens of thousands.

In the months following the first cancellation, Wang says she urged testing administrators to develop a contingency plan, expecting a second wave of COVID-19 to lead to more restrictions.

“The ball was dropped here,” Wang said. “We all knew that this was coming but there was no plan. We kept asking for a plan. I don’t know why there was no movement in wanting to support this body of new graduates who are eager to work.”

The Pharmacy Examining Board of Canada (PEBC) is the national body responsible for providing tests and licensing pharmacists and pharmacy technicians. The organization says approximately 200 candidates were “displaced” in November’s OSCE, while the exam was administered to another 1,000 candidates across the country.

“While this is no consolation to those who were unable to test, it is a testament to the hard work and dedicated efforts by the exam centre teams who worked tirelessly with PEBC staff to overcome each obstacle amidst rapidly escalating COVID health and safety restrictions,” a spokesperson from the PEBC told CityNews. “In fact, PEBC tested more than 200 candidates than previous November exam administrations.”

Prior to Sunday’s cancellation, The Ontario College of Pharmacists (OCP) tells CityNews they along with stakeholders attempted to find ways for the exam to proceed safely but were not successful.

Last week, the Canadian Association of Pharmacy Students and Interns penned a letter to the Board on behalf of their 3,000 members, saying administrators have failed to be transparent and develop a contingency plan during COVID-19.

“The decisions and actions that are made today have the potential to prevent a backlog in the system and allow the graduating class of 2021 to write their exams and become licensed on time,” the letter read. “This issue needs to be dealt with immediately.”

Concerns of a Pharmacist shortage

The delay in licensing students has created a ripple effect of concerns from pharmacists in Ontario, who have been on the front lines of COVID-19. Drug stores have played a crucial role in Ontario’s largest flu immunization campaign and select locations have also been administering COVID-19 tests, taking the burden off assessment centers.

The Ontario Pharmacists Association (OPA) argues that this delay in certification will have an impact on pharmacies in the province, many of which are already short-handed during the pandemic.

“We have front-line healthcare providers who are trying to practice, we do have a need in the pharmacy space for more labour, for more pharmacists because we’re doing things like COVID testing,” said Justin Bates, CEO of the OPA. “There is opportunity for them to get employment at a fair wage, but without the license, they’re caught in between.”

Bates adds that he’s planning on writing a letter to the Ministry of Colleges and Universities, asking the province to allow graduates in Ontario to receive conditional licenses.

Bates notes that Saskatchewan, Manitoba and Nova Scotia have all granted conditional or temporary licensure, which in some cases will enable the graduates to practice to the full scope and receive a ‘fair wage’, as long as a pharmacist is available to answer any questions if needed.

The OCP is participating in an upcoming board meeting to discuss the challenges graduates are facing in getting their licenses, also exploring possible solutions.

“The College has been actively engaged with the Ministry of Health throughout the pandemic on several matters related to supporting the safe delivery of safe pharmacy services, including the potential for temporary emergency registration, or conditional licensure,” the OCP tells CityNews. “Such emergency registration would be subject to the government’s approval and determination that it is necessary to ensure access to pharmacy services in the province is protected.”

In 2019, an estimated 6,800 pharmacist candidates participated in PEBC examinations, compared to 4,900 this year.

Like the college, the board notes that it is also looking for alternative delivery models, with a shift to virtual assessments. However, the PEBC adds that there are challenges, including technology requirements and constraints surrounding security of the exam and fairness to all the candidates, who would be required to move from one station to the next.

“After determining how to logistically administer the exams, PEBC would need to be assured of the validity and reliability of that delivery model in the assessment of competence. Much work needs to be done to support this initiative. However, PEBC has been in discussions with its partners at the other examining bodies about virtual OSCEs and is committed to exploring this alternative,” said a PEBC spokesperson.

Wang and Bates have also proposed re-defining how the OSCE is classified so that it isn’t considered an event, like a wedding or party, but is in a category of its own. Prior to Sunday’s examination, Bates says the OPA, along with PEBC were advocating for the government to overturn the public health definition, so that the event could go on.

“Even though it’s an educational session, it deemed it as the same category as a wedding and group setting,” Bates said. “We were cautiously optimistic because we were talking to multiple levels of government. Unfortunately, they stuck with the interpretation that it was a meeting or event and therefore prohibited under their restrictions.”

The Associate Medical Officer of Health tells CityNews the classification of exams depends on the specific circumstances, and tests organized at schools, post-secondary institutions and by licensing bodies, would all follow different regulations.

“It depends on the specific protocols of the organizations administering the exam, the type of facility and venue that is hosting the exam, and how these fit into the Reopening Ontario Act,” Dr. Vinita Dubey said.

CityNews also asked if Public Health has the power to reclassify events like the OSCE, Dr. Dubey notes that this would be provincially legislated, through the Reopening Ontario Act.

CityNews reached out to two provincial ministries to ask about the calls to grant conditional licenses for students and to redefine the exam event so it wouldn’t be canceled under public health guidelines.

The Ministry of Colleges and Universities deferred the questions to the Ministry of Health, who tells CityNews that it “relies on the Ontario College of Pharmacists”.