Shaping the Future of Health Care

I know that many of our readers and colleagues commit long hours and great effort to care for patients, despite overcoming challenges every day in our individual practices and at the global level of the entire profession. Board of pharmacy regulations, limitations imposed at the institutional and departmental levels, and federal and state government bureaucracies impose barriers that threaten the achievement of our full potential. In fact, sometimes we limit ourselves when we resist change or avoid risk.

Despite these challenges and barriers, thanks to the early efforts of pharmacist pioneers and the continuous persistence of many of our colleagues, I am amazed at the progress we have made since my career began in the 1970s. Our collective success results from not being members of the "silent majority," taking personal risks as we challenge the status quo, building rapport with our extradepartmental peers, and personally committing to our professional responsibilities even when we are rebuffed, as we shape the future practice of pharmacy.

I recently reviewed a list of the "100 Most Powerful People in Health Care," published August 22, 2005, in Modern Healthcare. I was pleased to see on the list the chief executive officer of the University of North Carolina Health Care System, William Roper, MD, MPH. I was even happier to see Michael Cohen on the list as well. Mike is a long-time friend and colleague. I can assure you that he made the list because of his personal convictions regarding medication errors, his perseverance, and his unwillingness to be silent or to worry about his personal popularity among all the people he has influenced. Shockingly, however, no other practicing pharmacists were on the list. Others on the list included non-pharmacy health care association executives, corporate executives of the health care industry, and government leaders.

At the recent National Association of Chain Drug Stores meeting, I was buoyed by the seminars regarding the Medicare Modernization Act and the opportunities it may encompass. Representatives of corporate health care enterprises have threatened to control and influence medication-use processes and the role of pharmacists. I also was thunderstruck by the rapid evolution of technologies to increase the efficiency of basic prescription services that threaten the ability of pharmacists to provide personalized pharmaceutical care services to individual patients. These trends made me contemplate the "100 most powerful people" list and wonder why more pharmacists were not on the list, especially our thought leaders and association executives.

Are we, as a profession, positioned to shape the future of health care? Are our associations and their staff and leaders working collaboratively and taking risks to shape the future of pharmacy as change occurs? Are we individually supporting our associations and willing to take risks, sticking to our convictions, and insisting on being part of our proactive evolution, or will we be relegated to being reactive to changes others make? We must have leaders who are influential. Where are they and what are they doing?

Mr. McAllister is director of pharmacy at University of North Carolina (UNC) Hospitals and Clinics and associate dean for clinical affairs at UNC School of Pharmacy, Chapel Hill.