Fred M. Eckel, RPh, MS, ScD (Hon) Pharmacy Times Editor-in-Chief

In 1986, I was asked by Ray Gosselin, the newly appointed publisher of 

. Irv Rubin had just retired from the journal, which he had nurtured for a large part of his career. Because I had admired the contributions that Irv had made to pharmacy, I, perhaps a little naively, gladly accepted the offer. What I thought would be a brief experience in pharmacy publishing became an important part of my own pharmacy career.

In 2002, Publisher Jim Granato asked me to become editor-in-chief of 

. Many saw me as a hospital pharmacist and/ or an academic pharmacist, so the question raised was could I focus on promoting community pharmacy, too? I remain grateful to both Ray Gosselin and Jim Granato for taking a chance with me and giving me an opportunity to become associated with 

, the leading massaudience pharmacy publication.

As editor-in-chief, I have tried to help advance the role of the pharmacist in all settings, especially community pharmacy. At times, my vision of pharmacy’s future was too far ahead of where most pharmacists saw their profession. I guess my academic side prevailed, and I was criticized for being too idealistic. I was not always right in my predictions, but I think my vision for pharmacy has mostly been on track.

Some of my editorial goals were to make pharmacists think, challenge them to get out of their comfort zone, and realize that pharmacists in all practice settings have most things in common. My readers can answer how well my commentaries made them think. I have written more than 300 commentaries in my 

 roles. Bringing a new perspective on a pharmacy issue each month turned out to be easier than I thought. Only once in my 30-year career did I experience writer’s block and need help. I am grateful to my Creator for endowing me with the ability to write so easily.

 is a team effort, and in my 3 decades with the publication, I have worked with great team members. Thank you all for your support and encouragement, but it is now time for me to put this part of my career in the past.

On a Saturday night many years ago, I was working in my community pharmacy, and Bernie Chernoff asked, “Fred, did you ever think of becoming a pharmacist?” Little did I know how blessed I would be to make that decision. Yes, pharmacy has been a great career, and I am proud that both my children followed me into the profession. Getting to work with my son as part of the 

Of course, I need to thank you, my readers, for supporting me. I would not have had 30 years as editor of 

 without the readers’ support. I particularly appreciated the criticisms because they made me think.

The new editor-in-chief is someone I worked with in my role as executive director of the North Carolina Association of Pharmacists, someone I worked for briefly as an employee of Community Care of North Carolina, and someone I taught as a faculty member at the University of North Carolina Eshelman School of Pharmacy; so, I am pleased to pass the baton to a part of my pharmacy family. I wish Troy Trygstad success in his new role as editor-in-chief of 

. I know he will continue to challenge our readers to become engaged in the roles that pharmacists are playing in bringing value to health care outcomes, improving chronic disease management, and taking responsibility for patients’ drug therapy outcomes. What a great time to be a pharmacist!

Articles

Thank you all for your support and encouragement, but it is now time for me to put this part of my career in the past.

It's Time to Say Good-bye

Sometimes changes occur so incrementally that they are hardly noticed until we eventually realize that drastic change has occurred. Ten years ago, no one thought of the community pharmacy as the place to go for most immunizations. I remember the fights in state legislatures regarding implementation of laws to give pharmacists the ability to administer immunizations. I remember complaints by some pharmacists who spoke against such a role for pharmacists. I also heard pharmacists’ concerns that administering vaccinations could affect their ability to safely fill prescriptions.

Today, these issues are distant memories because the community pharmacy is well established as the place where the public can get its flu shots quickly and easily. Pharmacists are a recognized health team member who can be trusted to deliver immunizations. The community pharmacy has evolved into the neighborhood health center, and society and the pharmacy profession accept this.

Right now, we are in the midst of a change in what pharmacists do and where they do it. Some innovative pharmacists are leading the way for the profession. The 2015 Pharmacy Benefit Management Institute reports that 57% of accountable care organizations employ or contract clinical pharmacists to help manage medication use. Perhaps in a few years, we will realize a similar drastic change when pharmacists are health team members in most community and ambulatory medical care practices. A recent article in the Business Insider (January 5, 2016) suggests that “pharmacists are trained to do much more than dispense medication, and they could help plug the growing gaps in chronic care management in the United States.”

Even as the profession works to (1) change laws to give pharmacists more authority to manage chronic disease and (2) promote provider status legislation to enable proper payment for this role, some pharmacists are already taking on an expanded role and branching out into different settings. A recent National Governors Association article (The Expanded Role of Pharmacists in a Transformed Health Care System) identifies some of the barriers and challenges that need to be addressed to allow the pharmacist’s role to expand. The article details how different states have addressed these barriers and challenges.

It has been encouraging to me that reports and articles such as these are coming from outside our profession. The important and expanding role that pharmacists can play is being championed for us by others outside pharmacy. When similar efforts were made 10 years ago regarding immunizations by pharmacists, incremental changes resulted in a major change. Ten years from now, things will be different: many more pharmacists will have an expanded role and will be practicing in many more settings. Current incremental changes are making this happen.

If my projection is accurate, it might affect many of you reading this today. You might disagree with me and, therefore, not feel a need to do anything different. But if you think there might be some merit to my observation, the question is: what are you doing today to get ready to take advantage of the new opportunities that will emerge tomorrow? Your future success in pharmacy will be determined by how you prepare today.

Mr. Eckel is professor emeritus at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He is also emeritus executive director of the North Carolina Association of Pharmacists. A lifelong advocate for the profession of pharmacy, Mr. Eckel has lectured on pharmacy issues and trends in all 50 states and has traveled to 6 continents to promote and educate audiences on the role of the pharmacist.

Sometimes changes occur so incrementally that they are hardly noticed until we eventually realize that drastic change has occurred.

Expanding Pharmacy's Role

I have always been interested in the science of futurism. This interest started when I was a pharmacy director. Someone once told me that you should always be interested in the future because you will spend the rest of your life there. Positioning my department for the future was my concern. If I could understand the forces that were producing changes in health care and pharmacy, I could prepare my department to take advantage of new opportunities as they emerged.

A good resource, that helps pharmacy directors gain insight on how health care and pharmacy may change is the annual 

 published by ASHP Research and Education Foundation, with 

 Although its focus is health-system pharmacy, any pharmacy leader would benefit from reviewing it and thinking about the strategic recommendations for practice leaders. The 8 topics (Table) selected for this fourth edition provide insightful, strategic recommendations for practice leaders, which can be a useful tool for preparing yourself and your pharmacy practice for the future. No matter where you practice pharmacy, each of these domains is impacting your practice setting at some level.

 would have been a helpful resource to me when I was a pharmacy director. With this resource, I would have been able to keep abreast of the literature on the future of pharmacy and health care, as well as test my perspective against that of the panelists, thereby making me feel more comfortable with my strategic decisions. This document could do the same for you.

 is that health care payment reform will have far-reaching effects on the health care system. Payment reform will affect all areas of pharmacy practice. Reviewing the section titled “Health Care Delivery and Financing” can help you think about the strategic decisions you might have to make personally or for your program to be prepared for the reimbursement changes coming.

The domain on ethics suggests that pharmacists and other health professionals will give more attention to issues related to professional autonomy and ethics. As we struggle to allow pharmacists to practice at the top of their license, the issues of professionalism and ethics will become more critical— another reason why 

 will help you become more of a pharmacist futurist, and the future should be important to you because, soon, you will be practicing there.

		Zellmer WA, ed. Pharmacy forecast 2016-2010: strategic planning advice for pharmacy departments in hospitals and health systems. American Society of Health-System Pharmacists Foundation website. ashpfoundation.org/pharmacyforecast. Published December 2015. Accessed December 16, 2015.

As we struggle to allow pharmacists to practice at the top of their license, the issues of professionalism and ethics will become more critical.

Future Trends Affecting Pharmacy Practice

Recently, I had the opportunity to experience the health care system as a patient. My experience was centered around my left total knee replacement this past fall. Six weeks after surgery, my orthopedic surgeon released me to assume my normal activities. I want to share some reflections on this experience as a way of saying thank you to many. I also hope to challenge you in your role as a provider.

I was surprised to learn that more than 670,000 total knee replacements are performed annually in the United States, most of which are to treat arthritis, which deteriorates cartilage in the joints. That was my diagnosis. I was able to delay the surgery for several years by using joint-lubricating injections, but they became less effective, resulting in the need for surgery. I join many who wonder why they didn’t get the procedure done sooner, but the literature suggests that the right choice is different for each patient, depending on the patient’s goals, overall health, and desire to have surgery.

Surgery can cause complications. I developed a deep vein thrombosis (DVT) after my surgery. I had a previous diagnosis of a clotting abnormality, so I wondered if my anticoagulation could have been better managed to prevent the DVT. If I have my other knee done, I plan to have an anticoagulation expert oversee my care. Fortunately, my DVT treatment was successful and I have had no residual effects, perhaps because of the body’s innate healing capabilities and the benefit of appropriate drug therapy. I share this part of my story to encourage anyone who becomes a patient. Recovery does happen, although it may be slower as you age.

I also want to share 2 observations about our health care system. It may need improvement, but it worked for me, and I am thankful for my outcome. During my several months of care, I met with many health care professionals who showed me they cared about my situation, treated me with respect, and provided the care I needed. For most of these interactions, I did not have a previous relationship with the provider, but a relationship was established immediately until another provider took over. The quality of many health care professionals is what makes our health care system outstanding. As pharmacists, we are part of this cadre, and we should feel privileged to be able to contribute to the health of others in such a special way.

At times I felt alone in my recovery, until I found a virtual group of patients who had experienced knee surgery. I found this group when I tweeted about my surgery. If interested, see @mykneeguide on Twitter. I received answers to my questions about my symptoms, much encouragement to persevere through the difficulties, and assurance that my problems were common. My virtual support group of fellow patients turned out to be an important part of my recovery, so I thank them all.

Pharmacists can play an important role in a patient’s life. Many of the health care professionals who took care of me were just doing their job. They probably didn’t even realize the important contribution they were making in my life. Yes, being a health care professional is a privilege.

As pharmacists, we should feel privileged to be able to contribute to the health of others.

A Personal Reflection on Our Health Care System

Medication reconciliation is being discussed frequently in the pharmacy literature because it has become an integral part of the care transition process. I had the opportunity to experience this process myself when I had a total left knee replacement this fall.

When I went to the hospital for my preoperation review, a pharmacist met with me to review the medications I was taking and to prepare a medication list. During that same visit, the pharmacy director reviewed the list and discussed it with me. She shared with me that her team considers medication reconciliation a priority and an important contribution the pharmacy department makes to the care process.

When I returned a few days later for my surgery, I was interviewed by another pharmacist about my medication use. In the course of my care, I had the opportunity to interact with 3 pharmacists about my medication use, demonstrating to me that at least at this hospital, pharmacists are an integral part of the health care team. I was encouraged about my profession’s future as I witnessed the important role pharmacists are playing.

In 2007, the American Pharmacists Association and the American Society of Health-System Pharmacists developed the following definition for medication reconciliation: “the comprehensive evaluation of a patient’s medication regimen anytime there is a change in therapy in an effort to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions, as well as to observe compliance and adherence patterns. This process should include a comparison of the existing and previous medication regimens and should occur at every transition of care in which new medications are ordered, existing orders are rewritten or adjusted, or if the patient has added nonprescription medications to [his or her] self-care.”

I include this definition to show how comprehensive this process should be and how frequently it may need to occur. This definition suggests that most pharmacists providing direct patient care need to engage in medication reconciliation. Perhaps the definition should be expanded to promote the engagement of community pharmacists in medication reconciliation when a patient’s medication regimen changes. Community pharmacists should pursue this with the same enthusiasm my hospital pharmacists had for managing my drug therapy.

Our profession has demonstrated that pharmacists can consistently and effectively provide medication reconciliation for patients during care transitions by standardizing the delivery of medication therapy management (MTM). Our profession needs to bring MTM to all patients throughout their care process, even when a care transition has not occurred.

I admit that many ambulatory patients may not perceive the value to this activity, although a few enlightened payers do. As community pharmacists begin interacting directly with patients by engaging them in MTM, especially when a new medication is added, we should be able to improve patients’ perception of the value of interacting with a pharmacist. This will require a change in how we practice, but isn’t that the reason we are experiencing health care reform? Patients and payers are saying, “We want you to do things differently to achieve improved outcomes.”

Change is not easy, but unless you are beginning to incorporate medication reconciliation into your practice, you have some quality improvements to make.

Medication reconciliation is being discussed frequently in the pharmacy literature because it has become an integral part of the care transition process.

Medication Reconciliation: It's Time

Perhaps it is my age that causes me to reflect frequently on my career as a pharmacist. I have held a number of different jobs as a pharmacist, but I have had only 1 career. Age gives you the perspective to see how these jobs fit together to make a career. I challenge you to think about how your current job will contribute to your career.

Let me share some career-building observations I have gleaned from my time in the pharmacy profession. As I look back on my own career story, these 10 observations seem to have led to success. I hope you find in pharmacy all that you want and more. I did.

 Maybe there was a time when a job or career never changed, but that no longer holds true today. Although many of us in pharmacy prefer stability, change is occurring in every aspect of the field. Find a way to embrace change. Learn to see it as an opportunity to grow professionally. Look for trends that are occurring in health care so that you can begin to anticipate the future and prepare for the changes.

 As part of our training, we are taught the way a pharmacist should think and act. When we enter into practice, that training is reinforced. As the practice of pharmacy evolves, however, laws change and roles expand and we need to embrace new practice models.

 Pharmacists have been given a special role by society to protect patients from harm. As we accept change and grow professionally, we must keep in mind that the changes must benefit patients first. Yes, professional growth may enhance our role, but unless we put the needs of our patients first, we are not acting as true professionals.

4. Vision for the future makes today’s practice easier.

 Change does occur, but sometimes it seems to come too slowly. We enter practice excited by what we know and what we can do. However, sometimes our job doesn’t give us enough opportunities to do all the things we are trained to do. What can sustain us is to keep a clear vision of the future. We can better handle today’s job because we realize that change will come tomorrow.

 Even in pharmacy, we realize that we can no longer successfully practice alone. Pharmacists depend on pharmacy technicians to help get the job done. Physicians also depend on pharmacists to help manage drug therapy. See yourself as a team member, even if it is a virtual team. Take time to meet other team members. Call on the physicians in the area and introduce yourself.

6. Collaboration is necessary to advance pharmacy.

 Too many pharmacists practice in a silo and think that they do not need to work with, support, or understand what pharmacists do in other practice settings. This needs to change. We can only advance the profession in ways that include obtaining provider status by collaborating across the profession.

7. Pharmacy association membership facilitates collaboration.

 There are a lot of ways we can collaborate, but I have found membership in a pharmacy association to be best. Become a member, volunteer for a committee, and attend meetings. I found that the more I gave, the more I received and the better I became as a pharmacist.

8. Advancement occurs when you think like an entrepreneur.

 Most of us will be employees, not owners of our own pharmacy. We can still think and act like entrepreneurs, however. Successful entrepreneurs have traits such as passion and selfdiscipline. When we think and act like we are in charge, our job grows and we grow.

 For some, getting a diploma means that learning is finished, but pharmacists must be engaged in a lifelong learning process. Some call this continuous professional development: determine what you need to learn in order to improve and then figure out how to learn it. When you have completed the learning process, make an assessment of how well you did and start the process over with new learning goals.

10. Self-discipline is key to career success.

 In order to have a successful career, you must take responsibility for your growth. If you can’t manage yourself, how can you manage others? Growth requires self-discipline. When you have selfdiscipline, you will not only know what you should do, but do what you should do.

I have held a number of different jobs as a pharmacist, but I have had only one career. 