Choosing a course of study and career in pharmacy—student attitudes and intentions across three years at a New Zealand School of Pharmacy

Abstract
Factors influencing undergraduates’ selection of Pharmacy as a course of study, career, study and professional perspectives were evaluated by survey over the years 2004–2006 at Otago University, New Zealand. Altruistic intent emerged as a powerful motivator for choosing pharmacy and entrepreneurial career intentions were prominent. A sizeable though declining number
of students selected pharmacy secondarily to medicine or dentistry. Gender differences were found between intended areas of practice.

Introduction
Graduates from the National School of Pharmacy
(NSP) atOtago University represent just over half of all
Pharmacy graduates educated in New Zealand. In the
year 2006, these students constituted 45% of additions
to the practising register, with other significant
additions being from Auckland University (23%) and
UK/Ireland (21%; Pharmacy Council of New Zealand,
2005a). The motivations, career aspirations and
choices ofNSP studentswill therefore have a significant
influence on the future practice and culture of
Pharmacy both in New Zealand and on the work
overseas that many will pursue. Indirectly, selection
criteria used to admit students to the BPharm course
will also play a role in shaping the next generation of
pharmacists.
Choosing pharmacy as a course of study—demographics
and motivations
The choice by students of any undergraduate degree
involves many factors, including but not limited
to: socioeconomic variables, gender and ethnicity,
academic ability and academic self-concept, career
ambitions, personality, and prior educational attainment
(Van de Werfhorst, Sullivan, & Cheung, 2003;
Reay, Davies, David, & Ball, 2001; Pike, 2006; Porter
& Umbach, 2006; Abowitz, 2006). Recent studies in
the UK have indicated that there are increasing
numbers of women studying pharmacy, with almost
twice as many women as men qualifying as pharmacists
in 2005 (Hassell & Eden, 2006) leading to
pharmacy now being described as a “female-dominated”
profession (Hassell, 2003). The ethnic mix of
pharmacists in the UK is also becoming more diverse,
with around 25% of newly qualified pharmacists now
recorded as being “Asian British” (Hassell & Eden,
2006)—that is to say Indian, Pakistani or Bangladeshi—
compared with 4% of the population (Census,
1991/2001). Black British and Chinese ethnic groups
are also growing in representation (Hassell & Eden,
2006), though there is huge variability in the makeup
of course cohorts around the country (Willis,
Shann, & Hassell, 2006d).
Race or ethnicity has in a different way been shown
to be strongly associated with the pursuit of a
pharmacy degree and career. A US investigation into
whether individuals who had initially expressed an
interest in pharmacy subsequently pursued this field,
found that Hispanic or “other” ethnic group students
were 12 times more likely than White students to
continue with their plans to become pharmacists
(Cline, Mott, & Schommer, 1999). This study found
that those with higher grade point averages and career
commitments were also more likely to apply to study
pharmacy, suggesting that “despite pharmacy’s
uncertain future, it is still able to attract academically
qualified students” (P399). The role of ethnicity,
attitudinal traits and academic factors have been
found to interplay in other ways, for example with
family influence in choice of pharmacy as a career
reported to be particularly strong for non-White
students (Willis, Shann, & Hassell, 2006a).
The strongest motivating factor to study pharmacy
in the UK has recently been found to relate to its being
a science-based course, with other extrinsic and
intrinsic motivators also featuring—namely career
status and prospects, and a desire to help people and
to work with patients (Willis et al., 2006d). In
Australia, extrinsic factors relating to self-employment
and salary, and intrinsic factors relating to a liking for
science, interpersonal aspects and a desire to be socially
useful have all been found to influence students’ choice
of pharmacy as a degree (Roller, 2004). At the graduate
entry level, future employment prospects and a desire
to make a contribution to healthcare feature most
highly as factors influencing decision to study
pharmacy (Davey, Evans, & Stupans, 2006). Consistency
in motivations to study pharmacy across time and
cultures is indicated when it is considered that similar
findings relating to science, salaries and a “desire to
help humanity” were obtained in the US from the
1950s through to the 1970s (Cline et al., 1999; Pratt,
1956; Smith, Gibson, & Mikeal, 1974).
Around 75% of UK pharmacy students initially
chose pharmacy as their first course of study, with white
females most likely to take pharmacy as a first choice
(84%;Willis et al., 2006a). Ethnicity also emerged as a
factor in first degree selection, with almost four times as
many non-White students reporting pharmacy was not
their first choice of degree, compared with White
students. At the NSP, it is said to be “inevitable” that a
portion of undergraduates will not have opted first for
pharmacy, as the majority of students take a common
health sciences first year and subsequently compete for
entry to pharmacy, medicine, dentistry and physiotherapy
courses, for all of which they may apply at the end
of this year (Shaw, 2000).
Selection criteria
Admission to pharmacy at NSP is mostly based on
students obtaining a minimum of an average B grade
(70%) in the common health sciences first year.
A smaller number of students are admitted from
second or subsequent year of study, usually at Otago,
or as “competitive” graduates (of a New Zealand
university within the previous 3 years). An “alternative
applicant” category brings in a few others: those who
may have graduated from a New Zealand university
more than 3 years previously; those who have obtained
degrees, usually in medicine or pharmacy, from an
overseas university; and those who have worked as an
allied health professional (most often a pharmacy
technician or nurse) for 5 years or more. All such
applicants are required to have passed the subjects of
Otago’s common health sciences first year course (or
the equivalents) and to have demonstrated competence
in English. A certain degree of positive
discrimination exists in that students who are Maori
or Pacific Islanders may be brought into the BPharm
programme even if they achieve only an average of
65% or more during their pre-admission year(s). Only
about 1–2 students are admitted in this way each year,
however. Very few applicants for admission are
interviewed—only those applying as “alternative”
candidates and for whom English is not their first
language.
In the UK, A-level grades have been found to show
a small but significant correlation with grades at
pharmacy undergraduate level and thus it has been
argued that both teachers’ estimates of A-level
performance and actual A-level scores remain useful
in selection and forecasting (Foy & Waller, 1987).
A-level biology scores may perhaps be a stronger
predictor of performance in a pharmacy degree, and
English ability at entry level is also important as an
indicator of student success (Sharif, Gifford, Morris,
& Barber, 2003). Given that pharmacy undergraduates
must have the capacity to acquire diverse
scientific knowledge and skills, as well as developing
the knowledge and interpersonal skills of pharmaceutical
care, it is also reasonable to ask whether there
might be other selection criteria also applicable to
undergraduate admissions. With respect to the
contemporary focus of pharmacy practice as one
centred on patient care (Strand, Cipolle, Morley, &
Frakes, 2004), it has been suggested that formal
assessments of self-reported empathy be used in the
admissions processes of pharmacy schools. Similarly,
with reference to the scientific demands of the course,
that critical thinking skills and mathematical ability
should be taken into account, in addition to a range of
other non-academic and affective qualities (Duncan-
Hewitt, 1996).
The use of a variety of aptitude tests for pharmacy
admissions is now commonplace in the US (Chesnut &
Phillips, 2000), for example the Pharmacy College
Admission Test (PCAT; Duncan-Hewitt, 1996;
Chesnut & Phillips, 2000), which incorporates
measures of communication skills, reasoning ability
and chemistry- and biology-specific knowledge (American
Association of Colleges of Pharmacy, 2006).
Currently, no equivalent pharmacy admissions test
exists at the NSP; however, students pursuing entry
into medicine or dentistry from the common health
sciences first year are admitted in part according to
their performance on the UMAT (Undergraduate
Medicine and Health Sciences Admissions Test).
Given the potential relevance of various factors which
may be used in admissions, ranging from interpersonal
relations to problem-solving skills to ethical awareness
(Chesnut & Phillips, 2000), the novel step was taken
in this study to ask students themselves, what they
consider to be important and relevant selection
criteria for the pharmacy degree.
Career aspirations—professional intentions and influences
In the US, a study of eight Pharmacy Schools
indicated that the majority of students (71%) have
career aspirations that are strongly oriented towards
“direct patient care”, although concern is expressed
that this may be at odds with the realities of drug
distribution-based pharmacy likely to be encountered
in the professional workplace (Siracuse, Schondelmeyer,
Hadsall, & Schommer, 2004). This study also
found evidence that the more career-committed of
students will also be those aspiring to work in direct
patient care. Others have found that the “professional
subculture” of students entering pharmacy is comparable
to nursing and medical students as regards
their emphasis on patient care (Horsburgh, Perkins,
Coyle, & Degeling, 2006).
Pharmacy students in the UK apparently possess a
strong expectation that they will work very hard no
matter what pharmacy job they acquire—95% believe
this to be the case—and 80% state they are very
ambitious about their pharmacy career (Willis et al.,
2006a). Diverse factors have been shown to affect the
choice made by students about specific career paths,
including previous work experience, the influence of
sections of the undergraduate syllabus directed
towards pharmacy practice (Siverthorne, Price, Hanning,
Scanlan, & Cantrill, 2003) and practical matters
such as salary and work location, a desire for personal
fulfilment and to help patients (Carvajal & Hardigan,
1999; Carter & Segal, 1989).
As recently as 2000, concern has been expressed
that hospital pharmacy in the UK is said at the
undergraduate level to have an “image problem”,
being considered elitist, badly paid, dull and repetitive
(Hatfield, Marriott, & Harper, 2000). In contrast to
this (or perhaps evidence of a shift in attitude and
intention of students), more UK students stated that
they were at least “certain” that “in 10 years time”
they wanted a career in hospital pharmacy (60%)
compared to any other career option, although
significant interest was shown in community practice
(proprietor, 33%; employed by multiple, 51%),
working abroad (43%) and primary care (37%; Willis
et al., 2006a). Given that more than one option was
permitted in this survey, students do appear to be
hedging their bets to an extent, but these figures at
least suggest an open-mindedness about the practice
sites available to them.
Of those intending to work in the community sector
in the UK, strong entrepreneurial intentions are
evident, with 44% of male students and 28% of female
students saying they are certain they want to own a
pharmacy (Willis et al., 2006a) and pharmacy
ownership reported as the top ambition for students
(Wilson, Jesson, Langley, Hatfield, & Clarke, 2006).
The proportion of these individuals who will attain
their ambitions, given the decline of the independent
pharmacy in Britain, remains to be seen, however.
Consequences of the “feminisation” of pharmacy relate
to the likelihood of women working part time once in
their 30s, and gravitating towards temporary community
work (Hassell, 2003). It has been suggested also
that this feminising shift may at least correlate with
pharmacy itself becoming a more attractive career for
women than men (Gidman & Hassell, 2005).
Attitudes and career intentions in pharmacy have
not been as clearly elucidated in New Zealand.
However, given that currently 2100 (82%) of
pharmacists work in the community sector and 300
pharmacists (10%) in the hospital sector (Pharmacy
Council of New Zealand, 2005b) it could be valuable
to assess students’ perceptions of these and other
career paths.
Aims of this study
This study evaluated factors influencing students’
decisions to study pharmacy and to work as health
professionals, aswell as the characteristics they consider
important for selection to the course and for practising
pharmacy. Also investigated were pharmacy students’
career aspirations and intentions, and the relative
importance and attraction of various professional
activities and incentives. NSP students across three
separate cohorts and years were surveyed to examine
for commonalities and trends in these areas.
Method
This study, approved by the University of Otago
Human Ethics Committee, was developed in December/
January 2002/2003 following a series of interviews
and focus group discussions with current and recently
graduated students. It was piloted in 2003 by a
group of student researchers on that year’s second year
intake, following which a number of minor adjustments
were made to ensure consistency and ease of
analysis. The questionnaire has since then been
administered routinely to each incoming second year
class at the start of their first lecture, in the School of
Pharmacy. This first lecture which introduces students
to the School and pharmacy profession, is attended by
most students, all of whom have just been admitted
into the BPharm programme. The results presented in
this paper relate to the second year students of 2004–
2006.
The (anonymous) questionnaires were distributed
around the lecture theatre before the start of the lecture.
Students were then given 15 min to complete the
surveys and were asked to do so in silence, without
reference to their neighbours. At the end of the allotted
time, class representatives collected the completed
questionnaires and handed them to the academic staff
member present (who was not one of the researchers).
The questionnaire consisted of 24 separate questions,
many of which were subdivided into further
categories of choice. Most questions were multiplechoice,
requiring respondents to rate statements on a
Likert-type scale of 1–5, with 1 being not at all
important/ not at all interested through to 5 as most
important/ very interested. Other questions asked
students to rate order of importance of factors (e.g.
order of priority of factors influencing decision to
study pharmacy) or to make selections from alternatives
(e.g. ethnicity).
The following areas from the survey questionnaire
were analysed for the period 2004–2006:
1. Why do you want to work as a health professional?
(rating scale 1–5, 17 statements)
2. Which three of these factors (statements from
Question 1) were the most important in your
decision? (Please list in order of priority)
3. What, in your opinion, are the most important
attributes that the School of Pharmacy should
consider when selecting people for the Bachelor of
Pharmacy programme? (rating scale 1–5, 12
statements)
4. When you applied for admission to the Health
Sciences, was Pharmacy your first preference?
(yes/no) If not, please state which programmes
were preferred.
5. At this stage in your BPharm programme, do you
want to become a pharmacist? (yes/no)
6. Community pharmacists are involved in many of
the following activities in their day to day work.
Which activities are of most interest to you? (rating
scale 1–5, 11 statements)
7. What aspects of being a pharmacist are most
important to you? (rating scale 1–5, 14 statements)
8. During my working life, I would like . . . (tick as
many phrases as you feel apply [12 statements])
9. If you had to choose a pharmacy career path today, in
what field would it be? (Please tick one [6 options])
Further questions were also asked about gender,
age, ethnicity, language spoken and residency status.
Data were collated and analysed for all student
responses over the 3 years (n = 351) and separately for
each year to examine for trends. Participants’
responses between questions were not linked for the
2005 data, so analyses linking responses from different
questions are only presented for 2004 and 2006.
In addition to reporting descriptive statistics,
participants were forced to rank only three factors in
Question 2. Thus ranking data in Figure 1 represent
the mean number of times participants ranked a factor
as primary importance (3), secondary importance (2),
and tertiary importance (1). A score of 3 would
indicate all participants said a factor was the most
important; conversely a score of 0 indicates a factor
was not ranked in the top 3 by any participant.
Using the two smallest cohorts (2004 and 2006), it
was estimated using G*Power 3 that with 80%power, a
two-tailed pairwise comparison would be able to detect
an effect of d ¼ 0.38. By convention, values of 0.2 and
0.5 are considered to be small and medium respectively,
meaning that where differences were not found,
any real differences are likely to be close to small in size.
Results
A total of 351 students completed the survey (2004,
n ¼ 103; 2005 n ¼ 125; 2006, n ¼ 123) representing
98% of the total of three cohorts. All students in 2005
and 2006 completed the survey; 103 of 110 students
did so in 2004. There was a small level of nonresponse
on some questions, but this appears to be a
student accidentally omitting a question rather than
systematically not responding.
Motivations to study pharmacy
The left-hand panel of Figure 1 shows a strong degree of
consistency between years as to the primary ranked
motivations of students to work as a health professional
(Question 2). By far, the most highly ranked motivation
was a desire to work in a job where they “care for/
help people”, which was twice as highly ranked as
the next highest motivation, an “interest in human
biology”. A job involving interaction with people, a high
salary, a desire to work in the community, a desire to
own a business and a number of other aspects also
featured as important motivators. University publicity,
friends studying in the health sciences, family tradition
and “having high grades but not knowing what else to
do” were the least reported reasons for wanting to work
as a health professional.
The right-hand panel of Figure 1 presents mean
rating data for the same factors. Few trends across the
surveyed years were evident in students’ motivations to
work as a health professional, with the exception of a
desire for a “career in research”. Over the 3 years,
there was an approximately 15% increase in the
importance placed on this factor. It would seem
therefore that students coming into the pharmacy
course are increasingly explicitly considering a research
career at an early stage. It is also interesting to note the
difference in responses between the ranking and rating
data. For example, students were clearly interested in
learning new technology, but it was not a top priority.
Admissions criteria
Figure 2 shows that students rated being a good
communicator with good English (language skills) as
the top attributes that they considered the School
should considerwhen selecting people for the pharmacy
programme. Highmarks in health sciences first year and
in science at schoolwere also highly-rated, aswas having
an “orderly/controlled mind”. Those attributes considered
least important fromthe options presented were
a previous tertiary qualification, being an older student
and high marks in arts subjects at school.
Study and career commitment
A large, but slightly decreasing number of students
opted first for medicine or dentistry on application
from health sciences, with those opting for pharmacy
as their first choice ranging between 38 and 50%.
2006 was the first year of the three that more
students selected pharmacy as their first preference
than did not (50% (CI: 42–59) in 2006, vs. 38%
(CI: 30–47) in 2005 and 46% (CI: 36–56) in 2004).
One notable trend is the decreasing numbers of
students opting for medicine as their first preference,
from 38% (CI: 29–48) of applicants in 2004 to 33%
(CI: 25–41) in 2005 and 24% (17–32) in 2006.
There appeared to be an increasing conviction
among students that they wished to become “a
pharmacist”. In 2004, 82% (CI: 75–90) of students
stated they “want to become a pharmacist”, in 2005
this rose to 89% (CI: 84–95) and 2006 to 98% (CI:
95–100). Of the 3 students in 2006 who said they
did not, one stated they would prefer to go into
research.
Matters of interest and importance in a pharmacy career
There appeared to be a sharp division in interest in
aspects of the role of the community pharmacist,
between the “generic” work of selling products,
arranging staff duties and administration, and health
care-specificwork such as offering health promotionand
compounding drugs. Students rated the eight health
care-specific activities presented as being of similar
interest (each receiving an average rating of around 4 out
of 5) and the three generic items at around 3 out of 5
(Figure 3). Out of the eleven activities presented for
rating, students rated “listening to patients” and
“interviewing people” most highly, suggesting a
particular enthusiasm for the interpersonal aspects of
pharmacy work.
“Reliable employment” and “steady job” were the
highest-rated aspects of being a pharmacist followed
closely by “ability to travel” (Figure 4). A number of
other factors were also rated, including professional
status, a good salary and working in the health sciences
and in the community. The least-rated aspect is
“working in a retail shop”.
Looking at trends evident in Figure 4, there was a
slight decrease in importance placed on the “ability to
travel with my qualification” as an important aspect of
being a pharmacist over the years (though it is still
rated highly), a similar decline in the importance
placed on salary, and a corresponding increase shown
in the importance of “owning my own pharmacy”.
Career aspirations
Looking to the future, an overwhelming majority of
students (87% averaged over 2004–2006) stated that,
during their working life they would like to be able to
live and work outside New Zealand (Figure 5). There
is some evidence of this declining in later years. A high
proportion of students (62%) would like to find work
in New Zealand, however, and only 11% say they want
to move away from New Zealand permanently.
Over two-thirds of students, stated they would like
to own a business at some point during their working
life. Furthermore, when asked separately to indicate
what pharmacy career path they would choose “if they
had to today” the majority chose “owner, community
pharmacy (urban)”. This choice has remained
relatively constant over the years (Figure 6). There
has been a decline in the number of students stating
they would choose a career in hospital pharmacy. Only
small numbers of students each year (around 4%)
indicated they would choose a career as a lecturer or in
public administration.
Undergraduate demographics
New Zealanders of European descent made up the
largest proportion of students at NSP at 39% with
sizeable other groups being ethnic Chinese (19%),
Korean (9%), Taiwanese (7%), Malay (6%), (Fijian)
Indian (6%) and Middle-Eastern (5%), though it is
worth noting that there are 25 separate ethnic
groups/nationalities listed in responses.
The male to female ratio of students studying
pharmacy has been consistent since the mid 1970s, at
about two-thirds female to one-third male students
(64–36%). This contrasts with the university student
profile as a whole, which is 55% female and 45% male.
The majority of students beginning the course are 18
or 19 years old (around 80%), with around 15% aged
20–22, and less than 5% aged 23 or over.
Gender and ethnic differences
Gender differences were found to exist in the career
aspirations of students (Figure 7). Only 2004 and 2006
datawere able to be analysed for effects, and across both
years female students were more likely than males to
indicate that they would choose hospital pharmacy “if
you had to choose a pharmacy career path today”
(females 37% versus males 20%; p = 0.006). There
were no significant differences between male and female
students in their preferences for an urban pharmacy or
rural pharmacy career. However, male students were
twice as likely as female students to opt for research as a
career path (females 13% versus males 31%,
p , 0.001). When asked whether during their working
life students wanted to own a business, 89% of male
students indicated this as a careerambition,with 81%of
females saying they did, though this difference was not
significant.
Students’ ethnicity appeared to be one determinant
of whether they studied pharmacy as a first choice, with
New Zealand/European students far more likely to have
done so than students from other ethnic groups (63%
NZ European versus 37% all “others”; p , 0.001). It
was not possible to separate out different ethnicities in a
fully satisfactory manner because of issues with data
collection (changing census classifications) over the
years of study. Of those students who identified
themselves as “Chinese” (n = 38) or “other” Asian
(n = 42), however, less than half had selected
pharmacy as a first choice (n = 27) and one of the
eleven Taiwanese students (all of whom are Chinese by
ethnicity if not by politics) had done so. Differences by
ethnicity were found in terms of influences of parents.
None of the 2006 New Zealand European students
rated parental influence most highly in their decision to
become a health professional, indeed 70% gave it the
lowest possible rating. Parental influence on non-
European New Zealanders was more evenly spread
with 18% of students rating it as the most important
factor in their decision-making and only 33% rating it
as being least important.
Discussion
Motivations to study pharmacy
We have examined themotivation to study pharmacy in
a novel way, by asking students to rank which three
(of seventeen) factors had most influence upon their
choice, in addition to asking students to rate separately
the importance of the range of factors. This enables a
differentiation between factors that might appear at first
sight similarly salient (ratings), and those thatweremost
important in actually influencing a decision (factors
scored by rank). Using thismethod, themost important
motivation given by students in this study for choosing
pharmacyemerges as an intrinsic, altruisticone: that of a
desire to “care for/ help people”.
These findings are probably more pronounced than
those fromother research in this area but do correspond
with other studies of pharmacy students’ study choices.
These studies have consistently reported high prominence
of motivations to study broadly describable as
altruistic, such as “a desire to help humanity” (Pratt,
1956), aspiring to be “socially useful” (Ferguson,
Roller, & Wertheimer, 1986), a desire to make a
contribution to healthcare (Davey et al., 2006) and “a
desire to help people” (Willis et al., 2006a).
These and the current study’s results might seem to
imply that much of students’ motivation to study
pharmacy is in large part a deferred one, that is to say
directed towards their professional life after graduation;
however, other research has indicated that intrinsic
factors influencing the selection of a pharmacy degree
also relate to the course of study itself. Roller (1993)
found that the most important intrinsic or extrinsic
influences on Australian pharmacy students were that
the course was perceived to be “intellectually satisfying”;
however, students’ belief that pharmacy was
socially useful was also important. Willis et al. (2006d)
in the UK similarly identified the science-based nature
of pharmacy as the primary draw for students, but again
with the desire to help people also strong among
intrinsic factors. The current study did not ask directly
whether the course of study was inherently appealing,
although our finding that the second most important
reason why students selected the coursewas “an interest
in human biology” indirectly indicates this is likely to
have been relevant.
Extrinsic factors of most importance to students in
choosing to study pharmacy relate to a desire to earn a
high salary and to own their own business and, to a
lesser extent the status of the profession. Previous work
has also found that students are motivated to study
pharmacy for financial reward and the opportunity for
self-employment (Roller, 1993, 2004; Willis et al.,
2006d) with the most recent research in this area
claiming pharmacy ownership is the “top ambition for
students” (Wilson et al., 2006). Seston, Shann, Hassell
and Willis (2006) found that just under half of all UK
students report the prospect of ownership as having
some influence in their decision to study pharmacy,
with the effect particularly strong among male students
and ethnicminority students. Crucially, they also found
a strong link between the prospect of owning a
pharmacy as a reason for choosing pharmacy as a
degree, and career intentions after three years of study.
Career intentions and expected benefits
In the current study, there appeared to be an early
explicit intention expressed by students to pursue
a career in pharmacy: 121 of 123 respondents in
2006, stated that they want to become a pharmacist,
a proportion that has increased over the three
surveyed years. This result is striking for its being
obtained at a very early stage in students’ course of
study, where one might reasonably expect some
ambivalence towards the degree (though it should be
noted that students were not given the option of
expressing uncertainty). These high rates of commitment
to a career as a pharmacist may relate to other
findings which indicate pharmacy students are careercommitted
(Willis et al., 2006a) and the finding in this
study, that in 2006 for the first time more students
selected pharmacy than any other health profession as
their first choice of study. In 2004 and 2005, as many
of those surveyed had wished to study medicine as
pharmacy, whereas in 2006 over twice as many
students opted for pharmacy as medicine. Despite
this, large numbers (almost half) of NSP students
would have preferred to follow another profession,
usually dentistry or medicine, as has been noted
previously (Shaw, 2000). The tendency for European
New Zealand students to be more likely than ethnic
minority students to have chosen pharmacy as a first
choice is in keeping with other studies which have
found similar ethnic differences in application
priority. This result is curious though for its being
apparently robust across courses, countries and
cohorts (Ferguson et al., 1986; Willis et al., 2006a),
despite the very different actual mix of ethnicities
studying pharmacy between New Zealand, Australia,
Canada, the US and the UK. It may be of concern to
educators that ethnic minority, foreign-born or
overseas students appear to be those most likely to
be studying pharmacy as a second (or lower) choice,
particularly considering the high, and in many
instances increasing, proportion of these students on
pharmacy courses.
Since over two-thirds of students indicated that they
would like at some point in their working life to own
their own pharmacy, New Zealand students’ entrepreneurial
intentions seem as strong as their UK
counterparts (Seston et al., 2006). Interestingly, there
was a decline in the proportions selecting hospital
pharmacy as a desired career path over the years
surveyed.
With so many students wanting to own their own
pharmacy, the question should be asked to what extent
these ambitions are realisable. In theUK, they may well
not come to fruition “given the steady decline of
independent pharmacies through competition from
multiples over recent years and an economic climate
that is not favourable to small pharmacy business”
(Seston et al., 2006). The potential for proprietorship is
higher in New Zealand, which has a long tradition of
individual ownership. Recent changes in legislation,
however, have enabled pharmacists to have a share in
up to five pharmacies, with the consequence that
groups of pharmacists have banded together to form
some small chains of pharmacies, run by manager
pharmacists rather than owners. It will therefore be
important for educators in New Zealand and elsewhere
to be aware that students’ ambitions for individual
ownership may not remain viable.
That hospital pharmacy sector suffers an “image
problem” (Hatfield et al., 2000) is also not so much an
issue in New Zealand, where anecdotal evidence
suggests that pre-registration hospital placements are
more sought after than community internships. The
tendency for females to be significantly more interested
in hospital work than males found in this current
study is in keeping with UK findings (Willis et al.,
2006b) and findings spanning the US, Canada and
Australia (Ferguson et al., 1986). These findings seem
likely to be borne out by students’ career trajectories in
the UK, where three times as many women as men
work in hospitals (Hassell, 2003).
This well-documented gender difference may relate
to hospital pharmacy offering more flexible hours and
institutional benefits (Cockerill & Tanner, 2001), and
also be related to gender differences in entrepreneurial
ambitions, given the generally lower salaries pertaining
in the sector. Other research looking at UK
pharmacy students’ perceptions of hospital pharmacy
suggests that it is perceived by students to offer poor
salaries but more opportunities to interact with
patients and better career progression (Silverthorne
et al., 2003). However, Hassell (2003) identified
concerns among some UK pharmacists that a “glass
ceiling” exists for female hospital pharmacists,
resulting in them being under-represented in senior
positions in this field. This is not the situation in New
Zealand; however, where, in 2006, almost 70% of the
chief pharmacists working in the country’s main
hospitals were female.
As for student aspirations to pursue a career in
research, New Zealand differs from Europe or the US
in that it has only a small pharmaceutical research
industry and only two Schools of Pharmacy, which
may explain the relatively low numbers of NSP
students interested in this career pathway. Interest in a
research career, though still quite limited, is growing
and may increasingly be considered by students to be a
viable career option.
In the current study, students perceived from an
early stage the associated benefits of a pharmacy
career, foremost among these being reliable employment
and the ability to travel with their qualification.
Aspects such as being a professional, working in the
community and earning a good salary also feature as
important facets of being a pharmacist. These and
other factors—such as undergraduate practice and
work experiences (Silverthorne et al., 2003)—are
likely to play a part in influencing the particular career
trajectories of students. Perhaps contrary to expectations,
Carvajal and Hardigan (1999) have also
suggested that females are more likely than males to
experience job satisfaction from high salary and retail
work. This finding did not emerge in the current study
but would be worthy of future attention.
The diminishing importance given by students to an
ability to travel as pharmacists from 2004 to 2006 may
be a consequence of the recent ending of direct
reciprocal employment agreements between the UK
and New Zealand, which has traditionally been a
popular route for New Zealand pharmacists to engage
in their “overseas experience”. Despite this decline, it
should be noted that almost 90% of students still say
they would like to be able to live and work outside
New Zealand at some point in their lives. This finding
may be particular to New Zealand where it is
especially common for university graduates to travel
and live abroad for a few years, usually within the first
10 years post-registration.
Admissions criteria
When asked to consider what might constitute
appropriate admissions criteria for the BPharm
programme, students report that “being a good
communicator” was more important as a selection
criterion than any other of the hypothetical admissions
criteria presented to them, more so even than high
marks in the health sciences common first year
or school science subjects. Speaking English well was
rated highly, and this aligns with research that has
found English skills to correlate highly with final
pharmacy exam marks for non-native English speakers
(Sharif et al., 2003). Science marks and the critical
thinking/scientific capacity indicator “having an
orderly and controlled mind” also featured highly in
students’ opinion of appropriate admissions criteria.
These results regarding student appraisal of what
might be important admissions criteria taken together
are an interesting indicator of students’ own perceptions
about what constitutes a good pharmacist and a
capacity to do well in the degree course: a combination
of good communication skills and cognitive ability. It
has been argued in the pharmacy education literature
that empathic and other non-traditional measures
should be used in student selection (Duncan-Hewitt,
1996; Wright & Miederhoff, 1999). At the university
where this study was conducted such measures are not
currently used in student selection for pharmacy,
though they are in medicine and dentistry. Whether to
use such measures in pharmacy admissions is likely to
arouse continuing controversy, not least because it is
now possible for students to be coached in how to
perform well in these tests in such a way that may be
construed as “faking” their true attitudes.
Aspects of interest in pharmacy practice
Interpersonal/empathic aspects again emerged as
aspects of being a pharmacist of most interest to
students, with “listening to patients” and “interviewing
people” receiving the highest ratings. There appears
overall to be a pronounced division in opinions of the
two facets of professional pharmacy practice: students
perceive non-patient-centred aspects of work, such as
administration and selling products, to be less attractive
than the range of patient-centred work. This may be a
sign that students are already conceptualising pharmacy
work as comprising two different types of
activity—indirect and direct patient care—and that
they are inherently more interested in the latter. This
result is perhaps not surprising, and matches other
research indicating students aspire more to involvement
in direct patient care than indirect patient care, with the
latter described as being “product-focused” or involved
with “drug distribution” (Siracuse et al., 2004). Such
attitudes on the part of students would seem to be in
keeping with the altruistic, patient-centred motivations
expressed for studying pharmacy in the first place.
The current study’s results may in a positive way be
placed in the context of Davey et al.’s (2006) remark
that “as pharmacy practice continues to emphasise
patient interface it is encouraging to see that a
contribution to health care is of more significance (to
students) than the status of the degree”. A cautionary
note may also be added though, that in light of these
findings it will be important to consider in future
research the extent to which students’ expectations and
aspirations are matched by the realities of the workplace,
where “for many pharmacists, there is a clear
disconnect between what pharmacy leadership says
pharmacists should be doing and the reality faced by
practising pharmacists on a daily basis” (Siracuse et al.,
2004) especially in terms of the administrative and
bureaucratic demands of small business management.
Undergraduate demographics
The approximate 2:1 ratio of female:male students at
the NSP corresponds with what seems now almost to
be becoming an education standard for this increasingly
female-dominated profession (Hassell, 2003).
Whilst registers of practising pharmacists consist at
present of 53% females in the UK and New Zealand
(Hassell, 2003; Pharmacy Council of New Zealand,
2005b) this seems destined to change. There are
implications for workforce supply, as the current UK
register shows a far greater degree of part-time hours
worked by women in their 30s and 40s thanmen of the
same age group, which in part is due to family building
(Willis et al., 2006c). A similar trend towards
feminisation has been observed in other health
professions, including medicine and dentistry, in the
US, the UK and Australasia, where similar consequences
have been predicted as a result.
The student body at the NSP is noteworthy in that it
is very diverse and unique to this pharmacy school.
Whereas, well-represented ethnic minorities in pharmacy
in the UK are “Asian British”, that is to say
British students of Indian, Pakistani and Bangladeshi
origin, in New Zealand the ethnic origin of (mostly
New Zealand-resident) minority students are mostly
represented by Chinese, Taiwanese, Koreans and
Malaysians, with those from Arabic and other backgrounds
also rising in numbers. Given the high
diversity, there is likely to be consequent variability in
the learning behaviours of students that educators
may increasingly need to take into account (Miranda,
Bates, & Duggan, 2002).
Limitations and suggestions for future research
A social desirability effect on the self-report measures
in this study may be pronounced because the survey
asked about explicitly socially desirable factors such as
“desire to care for/help people”. A strength of this
study is the very high response rate (98%) obtained,
largely through our distribution of the survey during
compulsory course elements. Although the questionnaire
used in this study was based in part on surveys
used in previous research into pharmacy student
choices, its reliability and validity were not separately
tested. Indicators of reliability and validity however
include the emergence of dual factors from questions
pertaining to direct and indirect patient care and the
congruence of certain career- and study-related
motivators emerging in separate areas of the survey,
for example in the intention and aspiration to own a
business. It is the authors’ intention to use a followup
questionnaire in longitudinal research with the
cohort surveyed in 2004–2006, which may give
further indications of its validity and reliability.
A particular point for concern for this and similar
studies is the apparently limited extent to which
physicians have accurate retrospective recall of the
causes of their own behaviour in relation to career
choice (Pathman & Agnew, 1993).
Future work might focus on extending knowledge of
intrinsic and extrinsic factors in choice of profession by
placing the choice of pharmacy as a degree and career
against a wider social context. The extent to which
socioeconomic factors and family background influence
students’ decisions might be further considered, for
example. Large-scale work has indicated that “professional”
class background can have a particular
positive effect upon the choice of prestigious degrees
such as medicine and law (Van de Werfhorst et al.,
2003). These authors also presented evidence that
educational systems are institutionally biased towards
students who possess “cultural capital”, which makes it
difficult for working-class students to succeed in the
education system. Furthermore, because of differential
costs and benefits between class backgrounds, professional
career trajectories are less easily attainable for
working-class students. In the health sciences, differences
in career choice have been found between lowand
high income family backgrounds of medical students
(Cooter et al., 2004). It is not known whether such
influences are as important in New Zealand, where
social systems are perhapsmore fluid. Neither has there
been any examination of whether the cost of study—
which ranged in 2006 from US$3300 per annum for
physiotherapy toUS$3850 for pharmacy andUS$7400
for medicine/ dentistry—influences students’ choice of
career. Nevertheless, it is a matter for concern that the
proportion of BPharmstudents who identify asMaori is
well below the proportion of Maori in the general
population (1–2% compared with 12%).
A further limitation of this study is that it was
focussed to a large extent on students’ intentions,
which may vary over their course of study and may
also not manifest in reality. Edwards, Lambert,
Goldacre, & Parkhouse, (1997), for example, reported
that ten years after graduating only two-thirds of
medical students end up working in the field they
intended to during study. It will be of value in future
research therefore to ascertain the extent to which
students follow through with their intentions, which
will better inform the reliability and validity of this and
similar survey tools and, more importantly, to what
extent expectations and aspirations of pharmacy
students are realised in the workplace. This would
have significance for those promoting pharmacy
degrees and admitting students to their courses, as
to what character of advice is most appropriate and
honest to offer to these aspiring professionals.
Summary and conclusions
This study, as well as previous research across a range
of cohorts, courses and countries, offers a generally
consistent view of the motivations of students to study
pharmacy and work as a health professional. Whereas
other research has suggested that altruistic intent may
be similar in importance to other factors, this study’s
results point to a clear prominence for this particular
factor.
Scientific aspects inherent to pharmacy as a course
of study also act as attractors to the subject area and
pharmacy is perceived in favourable terms as offering
good employment prospects with considerable entrepreneurial
potential. A tendency still exists among
many first year pharmacy students to have selected
medicine or dentistry as a first choice, particularly
among ethnic minority students, a tendency which
may be declining but is likely to be to an extent
inevitable, particularly with a system in which all
students take the same first year curriculum. The
picture among the undergraduate cohort, nevertheless,
is of committed individuals who intend to
pursue a pharmacy career. Gender differences
were shown to emerge between aspirations to work
in the different sectors, and in pharmacy
ownership intentions. The perceived value of a
pharmacy “passport”, and intention to travel with it
is very high among NSP students and will see many
working overseas. Students perceived that good
communication and English skills are of greatest
importance when considering potential entrants to the
course, a belief borne out by the literature. Yet the
Pharmacy School’s admissions process does not place
a greater emphasis on this requirement (which is
currently assessed by means of a paper on Effective
Communication, provided by the University’s English
Department) than any of the other papers of the
compulsory health sciences first year course, despite
the fact that many of its students have English as a
second language.
There is some concern about the extent to which
students’ desire and intentions to own a pharmacy
will be realisable in the future and also the extent to
which students’ experience in community pharmacy
after registration will match their expectations and
preferences.
Future focus for research that elucidates the wider
range of factors likely to influence students’ pursuance
of pharmacy, such as that which relates to family, class
or cultural background is suggested. Also of importance
will be work that better investigates the link
between students’ education and ambitions and the
realities of their professional life.