Community-based pharmacists performed mightily at a cost-efficient scale and safety record that rivaled any in the history of health professions.
It was uncommon for a patient in the mid-20th century to have more than a few medications prescribed each year. What started the century as a fledgling profession entered the midcentury as manufacturers based on Latin-laden, handwritten prescriptions with drams, grains, and sometimes permission to tell the patient what the medication was for. The profession grew to large factories producing small-molecule oral medications on a massive scale. Pharmacists largely became retailers, and as good pharmacies went, so did providers of counseling, advice, and services for prescriber and patient. Polypharmacy was born alongside the increasing complexity of treatment and decreasing coordination for medications that sought to cure or ameliorate ailments for conditions such as hypertension and diabetes, which do not often render symptoms that prompt adherence.
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The Move to the PharmD Model
The turn of the 21st century brought the first waves of PharmD graduates as the norm instead of the exception. It also started the provider status movement as the realization of an eventual commoditization of the retailing model, where reimbursement would become so little that providing services for free alongside medications would become unsustainable. The PharmD degree attempted to provide additional training for students to become effective practitioners and a political statement to care team members, policy makers, and health insurers. It was time to pay for services deemed necessary to safely treat patients as well as coordinate, dispense, and follow up on those now billions of prescription fills.
Popularity of Residencies Grows
In preparation, residencies ascended from “student gunner” status to mainstream adoption among graduates of schools and colleges of pharmacy, with the American Society of Health-System Pharmacists placing great emphasis on proximity to medical providers and prescribers of medications, desiring institutionally employed pharmacists to stand on their own as billable providers. The closer to the point of diagnosis and prescribing decisions, the more care team members would be accepting of the pharmacist as indispensable and worthy of a longer white coat, or so it seemed.
Troy Trygstad, PharmD, PhD, MBA, is executive director of CPESN USA, a clinically integrated network of more than 3500 participating pharmacies. He received his PharmD and MBA degrees from Drake University and a PhD in Pharmaceutical Outcomes and Policy from the University of North Carolina. He recently served on the board of directors for the Pharmacy Quality Alliance and the American Pharmacists Association Foundation.
All Dressed Up With Nowhere to Go
But provider status languished during the first 2 decades of this century as the business of medicine conflicted with the aspiring new business model of pharmacists as service providers. Internecine battles ensued between health-system and clinical pharmacists and their siblings in community-based pharmacy who represent more than two-thirds of the licensed and active pharmacist workforce, all in an effort to gain recognition.
Arriving Just in Time for Gen Z
Ultimately, patients are winning. The COVID-19 pandemic saw community pharmacists providing vaccines and COVID-19 tests through emergency authorizations by the federal government, not waiting for state legislators or governors to make decisions. Community-based pharmacists performed mightily, at a cost-efficient scale and safety record that rivaled any in the history of health professions. Some adult vaccines are now ordered by a pharmacist in a community pharmacy, point-of-care testing is commonplace, and the ability of pharmacists to prescribe is emerging. Multiple states now allow and encourage (or outright mandate) the credentialing and enrollment of pharmacists as providers, regardless of setting. There is still a long way to go, but Generation Z will have a career experience unlike any of the previous generations. And I’m happy for them.
