Most health system pharmacy executives are looking to stay in their organizations, and a growing share want to run more of the enterprise, according to a national survey.
In a survey of 788 hospital and health system pharmacy leaders published October 2025 in the American Journal of Health-System Pharmacy, a majority of system-level executives said they want to lead service lines beyond pharmacy, from infusion and supply chain to the clinical lab, even though far fewer hold that kind of expanded portfolio today.
The researchers, David Chen of ASHP, Lindsey Amerine, PharmD, of Cleveland Clinic and William Kernan, PharmD, of Orlando (Fla.) Health, highlighted an underused leadership bench at a moment when health systems say qualified leaders are hard to find.
Among leaders who do not already oversee a non-pharmacy service line, 59% of system-level pharmacy executives said they were interested in doing so, along with 49% of hospital pharmacy leaders and 27% of managers. The appetite far outruns the current reality: just 18% of system-level leaders, 13% of hospital pharmacy leaders and 3% of managers currently lead a service line outside pharmacy.
The departments they want are the ones that sit closest to the medication enterprise. Infusion services topped the list of interest, followed by supply chain, the laboratory, home care and respiratory care — the same areas where the pharmacy department already manages drug spend, contracting and complex logistics.
Study authors framed the appetite as a natural extension of the job.
“The complexity and intersection of clinical, operational and financial oversight within pharmacy seamlessly translates to other areas of the health system,” they wrote, calling it “an area to continue exploration, promotion and advocacy for pharmacy leaders to facilitate growth and continued influence within their organizations.”
The growth signal sits inside a survey that is otherwise a warning about the leadership pipeline. While 79% of respondents said they were satisfied or very satisfied in their roles over the past 12 months, approximately three-quarters, 77%, said there is a severe shortage of qualified candidates for pharmacy leadership positions. More than 80% across every leadership group said those jobs are tougher and more stressful than in the past.
While systems worry about who will fill senior pharmacy roles, many of their current leaders are signaling they want broader operational scope, not the exit.
The survey, conducted in mid-2024, updates the most recent comprehensive assessments of pharmacy leadership conducted in 2005 and 2013.
In an accompanying editorial, AJHP Editor-in-Chief Daniel Cobaugh, PharmD, said the findings put the profession “once again, at a crossroads,” echoing a 2005 paper that asked whether the health system pharmacy industry faced a leadership crisis. The appetite to expand into other service lines suggests one answer pharmacy can pursue on its own terms: widening its reach rather than narrowing it.
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