By Gina Shaw
A growing number of pharmacy residents are not completing their PGY-1 residency programs, and PGY-2 pharmacy residency matches are also on the decline, according to new data presented at the ASHP Pharmacy Futures 2025 meeting, in Charlotte, N.C.
In 2025, 345 PGY-2 pharmacy residency positions went unmatched, according to ASHP figures, compared with just 43 in 2020.
“We and I think a lot of other program directors have noticed that there appears to be a decline in the number of residents finishing their first year and also in those going on to pursue a PGY-2 if they do finish that first year,” said Beth Phillips, PharmD, the Rite Aid Professor of Clinical and Administrative Pharmacy and an assistant department head for residency programs at the University of Georgia (UGA) College of Pharmacy, in Athens. “We wanted to understand why that is, to address some of the contributing factors, ensure that residency programs are giving their residents the tools and support they need, and get people excited about advanced training and specialty practice again.”
In an effort to answer these questions, Dr. Phillips and Chelsea Keedy, PharmD, a clinical assistant professor of pharmacy at UGA Pharmacy, who are part of the school’s Ambulatory Care Collaborative research group, collaborated with ASHP and Utah-based tech company Qualtrics to develop the first large-scale survey (posters 38-S and 42-S) to address concerns over declining completion rates and PGY-2 applicants.
The survey, sent from ASHP to all PGY-1 program directors of accredited residency programs, yielded 428 respondents spanning a variety of practice settings, with 196 (47%) from community hospitals, 120 (29%) from academic medical centers and the remainder from other institution types.
Dr. Keedy attributed the high response rate to widespread concern about the issue. “These are questions that everyone is really interested in: residents, residency program directors, health systems and administrators. This affects everyone,” she said.
One section of the survey (poster 38-S) dug into program directors’ perceptions of reasons that their residents might not have completed their programs. More than half of the respondents (n=214; 51%) indicated having at least one PGY-1 resident who did not complete their residency in the last five years.
Key themes identified by the survey included:
• inability to pass licensing exams (34%);
• inability to complete program requirements (27%); and
• resident medical reasons, including mental health (12%).
Less commonly cited reasons included:
• family obligations (7%);
• not needed for career goal (6%);
• family member medical reason (4%);
• financial hardship (2%);
• work environment or culture (1%);
• student loan debt (1%);
• the COVID-19 pandemic (1%); and
• other (4%).
The survey also gave program directors the opportunity to elaborate on their responses in free text sections. On the issue of PGY-1 non-completion, the comments coalesced around the larger theme of difficulty passing licensure exams and lack of preparedness for the requirements of residency programs, especially after the pandemic.
“I have seen an overall increase in the amount of educational remediations on an annual basis, as incoming residents do not seem as prepared for the workload of residency as they once did,” one respondent said. “We have had two-thirds of our most recent residents require multiple exam attempts,” reported another.
When program directors were asked about any decline in residents pursuing PGY-2 training (poster 42-S), 110 (26%) reported noting that fewer of their residents were pursuing PGY-2 training over the past five years. Top reasons included:
• no interest in further training (19%);
• perceived lack of need for career goals (15%);
• concern over salary (11%);
• workload perception/time commitment (11%); and
• geographic restrictions (9%).
Other, less commonly cited factors included:
• student loan debt (6%);
• family obligations (6%);
• competitive application processes (5%);
• current work environment or culture (4%);
• resident medical/mental health reason (9.2%);
• the pandemic (<1%);
• competitive early commitment process (< 1%);
• family member medical reason (< 1%); and
• other (3%).
In this section of the survey, comments centered on the idea that trade-offs around completing a PGY-2 year outweighed the potential benefits, and the lack of need for specialization to enter the pharmacy work-force.
“Burnout is consistently a concern expressed by residents. PGY-1 is harder than they expected, and they are not enthusiastic about continuing to work that hard in a PGY-2,” one respondent said.
“Ambulatory care, in particular, has been a struggle for our system as PGY-1 residents interested in that field commonly seek (and secure) jobs in it without PGY-2 training,” noted another.
Residents are somewhat older in recent years, Dr. Phillips noted. “So with all the training they’ve already gone through, they are looking to get into their careers. They have student loan debt, they want to get married, and they’re looking at this a bit differently than they may have in the past.”
An additional survey focuses on the attitudes of pharmacy residents themselves. The first phase of that survey was sent out in 2024, to PharmDs at the beginning of their PGY-1 year. That same group will be consulted again in a survey to go out by the end of June, assessing how their attitudes may have changed over the course of the year.
“What do they think now about pursuing a PGY-2, compared with a year ago? Has their experience in PGY-1 shaped their inclination either towards or away from specialty training through an additional year of residency?” Dr. Keedy asked. “That, I think, will be the final piece of the picture in terms of data.”
Next Steps
Based on the results of the program director survey, Drs. Keedy and Phillips suggested that logical next steps could be specific support surrounding licensing exams for graduating students and/or incoming PGY-1 residents, as well as ensuring that residents have the support they need in their individual residency programs to complete the requirements of that year.
“Another thing to touch upon, although it may be more abstract and challenging, is the question of how we are incentivizing people to continue to pursue these advanced or specialized areas of pharmacy. It’s important to ensure people feel like these career paths are worth the investment that they are putting in, so we can continue to attract competitive and committed candidates.”
The sources reported no relevant financial disclosures.
