Requiring Residencies by 2020?

Several years ago the American College of Clinical Pharmacy approved a strategic plan that includes a vision statement suggesting that formal, postgraduate residency training will become mandatory before one can begin practice. The 2007 American Society of Health-System Pharmacists (ASHP) House of Delegates approved a new policy, which states that pharmacists "who have direct patient care responsibilities" should have an ASHP-accredited residency by the year 2020. The American Association of Colleges of Pharmacy will be considering a similar resolution at its annual meeting this month.

I have consistently encouraged professional students to consider completing a postgraduate residency program. These experiences supplement traditional education with intense collaboration with and supervision by expert practitioners who apply knowledge to practice. Residencies help new practitioners determine their practice interests and instill self-confidence in their practice capabilities. In addition, residency experiences include an emphasis on the importance of lifelong learning, expose residents to research and publication through completion of a major project, and launch the development of a personal professional network, as relationships with fellow residents, preceptors, and staff members are formed.

As an employer, I have learned that requiring residency is not essential for a given pharmacist to practice in any environment. I have employed many pharmacists without formal residency training who developed the essential skills themselves so that they could provide comprehensive services to even the most complicated patients.

I admit that doing so is more difficult now than 10 years ago, but anyone with enough self-determination and practice opportunity can eventually successfully practice in any environment. Learning on one's own is not an efficient process, and many employers cannot invest in training employees over the long periods of time that frequently are required to develop the necessary skills.

I believe that practice evolution in acute care and in hospital-based clinics will require residency training for assuming new positions in 2020. Based on the evolution and proliferation of practice in retail settings that offer more than dispensing services, residency training will be important as well. The expanded use of information systems and automated technology, coupled with a well-trained technical staff, will continue to remove the nonjudgmental tasks from practicing pharmacists. The need for pharmacists to more carefully and consistently interact directly with patients and monitor their pharmacotherapy to maximize therapeutic outcomes safely already requires more time than the workforce can accommodate.

Pharmacists should reflect on the shift from the old BS programs to the PharmD curriculum before they decide on the need for a residency by 2020. We have learned that mega-transitions require a long time to accomplish and that this transition will be largely market-driven. We also know that current practitioners will not be left behind, and innovative programs will emerge for practitioners who want to open new practice opportunities. Finally, this vision will help pharmacy practice and the profession to evolve.

What we do not know is how academia and employers will respond over time. If schools of pharmacy and their cadre of preceptors for the experiential portion of the curriculum are strengthened, perhaps a residency will not be essential. Similarly, if employers develop strategies to retool and/or supplement professional training, our current vision of the future could change. What do you think?