As technology and science advance, pharmacists have the opportunity to take on new responsibilities, expand their role in health care, and meet society's needs.
Change is hard for people, especially if you ask someone to change who has been doing something a certain way for a while. So why should pharmacy leaders want to expand the role of the pharmacist? Sometimes those very patients we want to help through our expanded role do not want us to change either.
When discussing a more expanded clinical role for pharmacists with physicians, I have heard more than once, “If you want to practice medicine, you should have gone to medical school.” Conversely, I also have had pharmacists tell me the exact same thing: “If I wanted to practice medicine, I would have gone to medical school.” Some patients even get upset when we delay their picking up a prescription to offer consultation.
With all these negative reactions, why are we promoting an expanded role for pharmacists? Let me suggest several reasons. Can we be guaranteed that our current role will continue forever or at least throughout “my career”? The answer clearly is “no.” With the advancement in technology and its applications to health care, we are finding new ways to do old jobs. As science advances, we are creating opportunities for new roles which might require an expanded role for the pharmacist or the creation of a new type of health care worker. Look at what nurse practitioners and physicians assistants are doing in urgent care centers located in many pharmacies. I believe that pharmacists—with little or no additional training—could handle this role.
When discussing my interest in trying to get pharmacists more engaged in medication therapy management and monitor drug therapy outcomes with a colleague recently, I expressed my frustration with how difficult it is. He responded, “Well, some pharmacists still want to make buggy whips.” His point was that sometimes we hold onto tasks that are no longer needed when we should be willing to get engaged in new roles.
So, how much longer will pharmacists be able to primarily focus on making sure the right drug is in the container rather than making sure the drug is used correctly and desirable outcomes are achieved? When the idea of mandatory “unit of use” packaging was proposed by pharmacist Jere Goyan while he was the secretary of the FDA, I was opposed. I would not be today. Just think how pharmacy practice would change if we required all drugs to be dispensed in the manufacturers’ prepared “unit of use” containers? No more counting by pharmacy personnel.
If such a development occurred by a legislative change, what would happen to today’s pharmacists? They might find themselves on unemployment while training for a new career. Such a system would be safer than our existing system because of bar codes and other technologic improvements. However, if pharmacists were already engaged in managing drug therapy outcomes, we would have a brighter future.
This scenario suggests that another reason to push for an expanded role for pharmacists is to fullfill an unmet societal need. From poor adherence to preventable side effects, drugs are not being used adequately right now—and this misuse costs the health care system and society plenty. Since professionals really serve at the pleasure of society to help society meet a need that can’t meet itself, we have an obligation as health care professionals to meet societal needs—if we don’t want to be put out to pasture.
A final reason we should want to see our role expanded is to enhance our professional value. Scientific advances seem to be creating an opportunity for personalized medicine. Yes, the profession has heard a lot about this for some time, but practicing pharmacists have seen little application of it in practice. There is usually a lag between when scientific discoveries occur and when they find application in practice. Personalized drug therapy based on your genetic profile is now here. The tests required to implement this make financial sense.
Do we want our profession to take the lead in this new area or leave it to another profession to assume the role? To me it makes sense to make this a pharmacist’s role because today’s students in many schools of pharmacy are being prepared to assume this role. Additionally, insurers are giving thought to paying for this activity because it improves care and lowers cost.
An expanded role for pharmacists will not happen unless pharmacists become excited by the opportunity it offers them. When practitioners want to change—and leaders provide direction for change—both society and the profession benefit.
Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.
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