Divisions in the pharmacy profession's collective opinion on what the optimal future would entail is actually fairly systemic.
My colleagues and I recently conducted a strategic analysis of some major projects that our organization has committed to pursuing.
As part of the process, the facilitator for the meeting prompted us to explore questions about our motivations, goals, concerns, and beliefs, and then tied those perspectives to how we selected and approached professional opportunities.
Common themes quickly emerged from the discussion. Among them was a frequently repeated phrase: “advancing the profession of pharmacy.”
This was to be expected. After all, “advancing the profession” has been a strategic focus area of our organization’s operational plan for more than a decade.
What was slightly surprising, however, was that our vision for what this phrase would entail was not always consistent.
On certain issues, our visions for progress actually conflicted with one another. Barring the conclusion that one of the folks in the room secretly sought to undermine our efforts, there had to be some explanation for our sources of disagreement.
As it turns out, divisions in the pharmacy profession’s collective opinion on what the optimal future would entail is actually fairly systemic. Differences of opinion on this matter are fairly common, and in most cases, both sides of the arguments are conceivably valid depending on the worldview in which certain problems are approached.
Let’s take a closer look at some of the points of contention related to this subject matter.
1. The Role of Technology
As a young pharmacist, computer technology has always been present to some degree in the pharmacies where I have practiced. When more experienced pharmacists talk about using typewriters and “lick-and-stick” labels, I feel a sense of wonderment as I contemplate a world that seems so completely alien to any Millennial pharmacist out there.
My point in bringing this up is to note that pharmacy as a profession has been generally quick to adopt changes in technology. This is particularly true for community and retail practices that were using computerized recordkeeping long before meaningful use programs started to incentivize the rest of the medical community to catch up.
With that in mind, it is strange to see the profession’s resistance and apprehension towards some of the newer technological interventions. One issue I’m referring to is telepharmacy.
I experienced this issue firsthand during my first year at the Michigan Pharmacists Association, when we advocated for the passage of Michigan’s Senate Bill 373, which is now Public Act 267 of 2013.
The bill proposed to allow the Michigan Board of Pharmacy to conduct time-limited pilot projects that may require board-promulgated administrative rules to be waved for the purpose of exploring new technology. It was introduced with telepharmacy in mind, but those aspirations were derailed in subsequent discussions regarding pilot project capabilities.
Pharmacists in Michigan were heavily divided on the issue. Advocacy on both sides of the proposal was so heavy that I still remember a certain state representative outside of the House Chamber accusingly questioning me on whether pharmacists were “going to be for or against the bill today.”
When considering implementation of new technology in any medical setting, there are real issues that need to be contemplated, the foremost of which is patient safety. Leaps in technology require careful research and scrutiny.
The issue of telepharmacy in North Dakota has significant research supporting its implementation. This research has demonstrated that telepharmacy could benefit the state’s citizens by providing access to care in rural areas, and there have even been instances of quality-related events at remote sites that are consistent (albeit different in nature) from central sites.
Other concerns on the minds of pharmacists with more dystopian views towards technology have to do with being replaced by automated dispensing technology. While I would love to write an entire article on this point of view, let’s move to an issue that deals with job security more closely to home for many pharmacists.
2. The Role of Pharmacy Technicians
In order for pharmacists to move into more “clinical” roles, other individuals are required to play greater roles in the nonclinical aspects, such as dispensing. Pharmacy technicians are the obvious choice to fill this void.
We should keep in mind that when the pharmacist shortage was originally predicted in the early 2000s, it was assumed that there would be an increased demand for pharmacists in more clinical roles. Unfortunately, this prediction has not materialized to the extent that was originally anticipated.
Now, as training and education for pharmacy technicians continue to progress, what does this mean for pharmacists?
Few would argue that pharmacists—particularly those in the retail setting—don’t need the help. According to the National Association of Chain Drug Stores, roughly half of a pharmacist’s time is spent on dispensing activities.
Whenever a new clinical initiative is trialed, I can tell you from personal experience that one of the first questions the pharmacist asks is, “How do I find the time?”
In certificate training programs for services such as immunizations and point-of-care testing, appropriate utilization of pharmacy technicians in the workflow is a core component of the managerial teachings. In general, most pharmacists would likely argue that well-trained and qualified technicians are worth their weight in gold when operating a dynamic practice.
Yet, the question remains: where does the role of the pharmacy technician end and the role of the pharmacist begin? Textbook answers of “activities that involve clinical judgment” do not adequately define what this means in practice.
For instance, I continually receive questions about pharmacy technicians conducting medication histories (under the supervision of a pharmacist, of course) for patients admitted to the inpatient setting. Multiple stakeholders question the appropriateness of this, given that the medication reconciliation process derives much of its value from the accuracy of information obtained from the patient.
An even more controversial subject is technician verification, or the use of tech-check-tech programs. This concept sparks concerns on 2 fronts: 1) how truly safe and effective are these practices, and 2) what does this mean for pharmacists who currently participate in relatively few clinical patient care services?
Appropriate qualifications are necessary to ensure that practice innovations are implemented regardless of the pharmacy personnel discussed. Defining the term “qualified” leads us to our final area of discussion.
3. The Role of Credentialing
Michigan recently joined the vast majority of states in requiring some type of certification, licensure, or registration of pharmacy technicians. In witnessing this transition, I have personally seen the strain that minimum training expectations place on the pharmacy technician workforce.
When the Michigan Pharmacists Association pursued a minimum requirement of a high school education, we had no idea about the impact it would have on the current tech workforce. Shortly after the bill was passed, we were quickly pressed to develop a path for individuals without a high school education (or equivalent credentialing) to keep the positions in which they had worked in years.
Now, consider the announcement made by the Pharmacy Technician Certification Board (PTCB) about its new expectations for individuals who will be eligible to take their certification exam in the future. By 2020, PTCB intends to require prospective technicians to complete an accredited pharmacy technician education program in order to sit for the certification exam.
While this is exciting news for those seeking to “raise the bar” when it comes to a pharmacy technician’s practice capabilities, it is also reasonable to wonder how this will affect the job market for pharmacy technicians. In a world where health care costs and pharmacy practice sustainability are heavily scrutinized, what is the impact of increasing training expectations for entry-level pharmacy personnel?
Questions related to training expectations are not solely relegated to pharmacy technicians. Pharmacist training expectations continue to escalate not only within PharmD programs, but also after graduation.
Many pharmacists and organizations want to make postgraduate residency training a requirement to practice as a pharmacist at some point in the future. However, in 2015, just 3081 positions for postgraduate year 1 programs were available in the American Society of Health-System Pharmacists’ residency match program.
Compare this with statistics from the American Association of Colleges of Pharmacy on the number of PharmD programs and graduates, and the current shortfall in the number of residency programs poses frightening possibilities should a mandatory residency requirement be implemented.
That doesn’t even take into account the additional training and certification questions that new graduates from pharmacy schools and residencies face.
The inflation of minimum training expectations, particularly in light of the ever-increasing sums of student debt, is understandably concerning. Even so, you could argue that this may just be the price that the profession as a whole must pay in order to establish the pharmacy practices of tomorrow.
Although there are certainly many questions and uncertainties tied to the changing pharmacy profession, it isn’t all doom and gloom. Increased educational opportunities, new roles for all levels of personnel, and advances in technology mean that pharmacy professionals can touch the lives of patients in ways that were previously impossible.
At the center of all we do is the concept of “patient care.” We must take strategic steps to ensure that regardless of whatever changes are made to the system in which we operate, we keep that focus in mind.
When leveraged appropriately, the matters discussed here have the potential to improve health outcomes and change the lives of patients like never before.