Experts Discuss the Future of Pharmacy

SEPTEMBER 01, 2008
Barbara Sax

Ms. Sax is a freelance writer based in Chevy Chase, Maryland.

Pharmacy Times held a roundtable for pharmacy students and pharmacy professionals at the American Pharmacists Association?s Annual Meeting and Exposition in San Diego this past March.

Students from 5 pharmacy schools and pharmacy executives from 4 national retail chains, including Pharmacy Times Strategic Alliance Partners Kmart, Wal-Mart, Rite Aid, and CVS, talked about the future of pharmacy. Topics ranged from how well prepared panelists felt pharmacy students were when they graduated to how broad a role pharmacy technicians should have.

Conrad Bio and Mike Peerson

Conrad Bio and Mike Peerson

The discussion moderator was Fred Eckel, RPh, MS, editor-in-chief of Pharmacy Times and professor of pharmacy practice at the University of North Carolina at Chapel Hill?s School of Pharmacy.

Panelists felt that students were leaving pharmacy school very well prepared for the technical aspects of pharmacy practice, but they could benefit from more leadership development. Mike Peerson, director of talent services and campus relations at Wal-Mart Stores Inc, said he felt students are well prepared for the practice of pharmacy and direct patient care in the community practice setting, but that the leadership development component in the curricular model can be improved. ?Many students actually graduate with all the science and the knowledge base to pass on their level of knowledge to the patient, but when you get in the practice environment, many times you have conflicts requiring resolution,? he said. ?Pharmacists must be able to delegate responsibility and empower others to perform their roles, in order for the pharmacist to leverage what they have learned in the education process.?

Howard Kramer, director of pharmacy human resources and government affairs for Sears Holding Corp?s Kmart Pharmacy agreed. ?Today?s students are better educated than any students in the past,? he said, but they have ?a lack of leadership development.?

Conrad Bio, college relations director of Rite Aid, said that the chain has created a California Pharmacy School Leadership Conference for that purpose. Last year, 10 representatives from California pharmacy schools attended to learn leadership skills to bring to the workplace. The chain is preparing to roll out the conference to additional states.

Sara Newton and Howard Kramer

Sara Newton and Howard Kramer

Student panelists felt that preceptors could help them gain invaluable leadership ability. ?Preceptors are one of the most vital portions of a student?s education,? said Madelyne Cearley, a pharmacy student at Texas Tech University. ?We have business portions of our curriculums, but it is very difficult to put those into practice, unless you have a good example to show you how to implement those ideas.? One challenge is finding enough qualified preceptors and adequate sites to provide the training the students need.

Panelists also weighed in on mandatory residencies. Eckel said that while most professionals would agree that an additional year of experience would create better practitioners, whether the additional year should be mandated is cause for debate. Eckel also raised the question of whether an improvement in the experiential part of the pharmacy education program could eliminate the need for an additional year.

Some panelists felt that more standardization in pharmacy education was needed in general. ?Requiring a residency may fundamentally be inevitable at some point,? said Samantha West, a student from Ohio State University, ?but I think we have to make sure that the experiential programs across the board are equal.?

Kimberly Andrews, a student at Medical University of South Carolina, felt that students should have a financial interest in becoming more involved with medication therapy management (MTM) services in the community, so community residencies that helped them prepare for those roles are a good idea.

Kimberly Andrews and Samantha West

Kimberly Andrews and Samantha West

Eckel asked students how they felt the profession was using automation to advance practice opportunities. Jenifer Young, a student at Loma Linda University, does not think the profession is using automation to its fullest capacity. ?In one of the stores I work at, we have our top 200 drugs in the robot, but that top 200 was done 4 years ago, and [the list] has changed. When we finally took the time to update everything, we have more than three quarters of our drugs coming out of the robot,? she said. ?Most pharmacies I work at do not utilize automation fully, and they could hugely increase their patient care if they did.?

One panelist said that even when technology enables pharmacists to have more free time, many are not using that time for patient care services. ?I feel it is all coming down to the bottom line and instead of using that time for patient care, they are just filling more and more prescriptions,? said Sara Newton, a student at Drake University.

?Automation should enable the pharmacist to spend more time with the patient, period,? said Wal-Mart?s Peerson. ?Our patients tell us they want to spend more time with the pharmacist.?

Technicians also can be a big benefit to the profession. Eckel asked panelists if the profession is using them to the fullest extent and mentioned a move toward standardized training for technicians, certification for technicians from the Pharmacy Technician Certification Board, and licensure for technicians.

Some panelists expressed concern that more training might deter people from becoming technicians. Others felt that technicians should be offered the opportunity to step up their training. Drake University?s Newton said that changing technician positions from a short-term job to a career by increasing pay and responsibilities could benefit the profession.

?Technicians play an important role in the pharmacy, and will continue to play an important part in the dispensing/filling process, primarily to free up the pharmacist to be able to do more professional functions,? said Eckel.

The panel discussed whether the profession makes adequate use of generic drugs. Most students said that they were taught to view generics as equivalent to branded drugs, and they believe in substituting to save patients money, except with medications that have neurotherapeutic indexes.

In those cases, students believe that stabilizing patients on one drug is most important, and they worry that switching off generics to conform to a health plan?s formulary can be harmful to a patient?s health.

For the majority of patients, panelists support the use of generics. ?It is pretty evident that patients who stop taking medications in some cases do it because they cannot afford the medicine,? said Papatya Tankut, vice president of pharmacy professional services at CVS. ?As the pharmacist?s role continues to evolve, we can suggest generics that are more costeffective to a patient so that patients can be compliant. Pharmacists can do a much better job continuing to educate all parties about generics.?

Panelists unanimously agreed that the future of pharmacy is dependent on pharmacists? continued activism in support of their profession. ?We have to take a big stand on getting legislation passed that can allow us to be reimbursed for [MTM],? said Cearley. ?We could have a much more limited role unless we are very active right now in ensuring that we can do those activities in the future.?

West spoke about the Immunization Bill recently passed in Ohio that allows not only pharmacists, but interns, to give flu shots. ?Pharmacists have to take it upon themselves to define what their role is going to be in the health care team,? said Andrews.

Kmart?s Kramer urged students to get involved in the legislative part of the profession and to work with the American Pharmacists Association, the National Community Pharmacists Association, and the National Association of Chain Drug Stores to effect change that is good for pharmacy. ?Pharmacy has always been a very highly regulated profession?one of the most regulated in the medical field?and I do not foresee that changing,? he said. ?In several states where we have pharmacists and other medical professionals involved in the legislature, there have been some big wins because the Boards of Pharmacy and the pharmacists were able to work with individuals in the legislature who really understand the profession. It is critical that pharmacists get involved in the regulation of the profession.?

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