The Evolution and Equity of Chinas Pharmacist Workforce in Healthcare Institutions: A Provincial Panel Data Analysis, 2007-2023 Evolution and equity of China's pharmacist workforce

BackgroundChina has implemented policies to strengthen its pharmacist workforce since the 2009 healthcare reform, yet a comprehensive evaluation of their long-term systemic effects is lacking. ObjectiveTo systematically analyze the evolution of Chinas pharmacist workforce in healthcare institutions from 2007 to 2023 across four dimensions: quantity, quality, structure, and distribution, providing an empirical foundation for policy optimization. MethodsA retrospective analysis was conducted using longitudinal data from the China Health Statistics Yearbooks. Trends were delineated via descriptive statistics. Equity and spatial evolution were assessed using the Gini coefficient, Theil index decomposition, and spatial autocorrelation analyses (Global Morans I and hotspot analysis). ResultsFrom 2007 to 2023, the total number of pharmacists increased from 357,700 to 569,500 (average annual growth: 2.2%). This growth lagged behind physicians (4.6%) and nurses (7.4%),causing the pharmacist-to-physician ratio to decline from 1:5.15 to 1:8.39. The workforce showed trends of feminization (female proportion rose from 59.7% to 70.8%) and aging. While quality improved, 51.1% still held an associate degree or below, and only 6.6% held senior titles. Equity analysis revealed the provincial Gini coefficient improved from 0.145 to 0.093. Theil index decomposition confirmed intra-provincial disparities as the primary inequality driver. Spatial analysis showed a non-significant global Morans I by 2023 (0.154, P*>0.05), down from 0.254 (P<0.01) in 2007. Hotspot analysis confirmed this transition, revealing a contraction of high-confidence clusters and a trend toward balanced distribution. ConclusionsChina has made measurable progress in expanding pharmacist workforce size and improving inter-provincial equity since 2007. However, persistent structural challenges remain: relative workforce contraction compared to other health professions, an aging demographic, a shortage of senior talent, and significant intra-provincial inequity. Future policies must prioritize optimizing workforce structure and enhancing clinical service capabilities to catalyze a shift toward patient-centered pharmaceutical care. HighlightsO_LIFirst longitudinal study (2002-2023) tracking Chinas institutional pharmacist workforce post-healthcare reform, revealing a critical structural shortage. C_LIO_LIPharmacist growth rate (2.2% annually) severely lagged physicians (4.6%) and nurses (7.4%), causing the pharmacist-to-physician ratio to plummet from 1:5.15 to 1:8.39. C_LIO_LI69.2% of Chinas drug market (prescription drugs) is managed by only 569,500 institutional pharmacists--175,000 fewer than retail pharmacists, exposing a critical workload imbalance. C_LIO_LISpatial disparity paradox: Gini coefficient improved to 0.093 (high equity), yet Theil decomposition revealed intra-provincial (urban/rural) gaps as the primary driver of inequality. C_LIO_LIHigh-level talent deficit: Despite quality gains, only 6.6% hold senior titles and 6.1% have masters degrees--a bottleneck for advancing clinical pharmaceutical care. C_LI