Experts Discuss the Future of Pharmacy

Ms. Sax is a freelance writer based in Chevy Chase, Maryland.

Pharmacy Times held aroundtable for pharmacystudents and pharmacyprofessionals at the AmericanPharmacists Association?s AnnualMeeting and Exposition in SanDiego this past March.

Students from 5 pharmacy schoolsand pharmacy executives from 4nationalretail chains, includingPharmacy Times Strategic AlliancePartners Kmart, Wal-Mart, Rite Aid,and CVS, talked about the future ofpharmacy. Topics ranged from howwell prepared panelists felt pharmacystudents were when they graduatedto how broad a role pharmacy techniciansshould have.

Conrad Bio and Mike Peerson

The discussion moderator wasFred Eckel, RPh, MS, editor-in-chiefof Pharmacy Times and professor ofpharmacy practice at the Universityof North Carolina at Chapel Hill?sSchool of Pharmacy.

Panelists felt that students wereleaving pharmacy school very wellprepared for the technical aspects ofpharmacy practice, but they couldbenefit from more leadership development.Mike Peerson, directorof talent services and campus relationsat Wal-Mart Stores Inc, saidhe felt students are well preparedfor the practice of pharmacy anddirect patient care in the communitypractice setting, but that the leadershipdevelopmentcomponent in thecurricular model can be improved.?Many studentsactually graduatewith all thescience and theknowledge baseto pass on their levelof knowledgeto the patient,butwhen you get inthe practice environment, many timesyou have conflicts requiring resolution,?he said. ?Pharmacists must be able todelegate responsibility and empowerothers to perform their roles, in orderfor the pharmacist to leverage whatthey have learned in the educationprocess.?

Howard Kramer, director of pharmacyhuman resources and governmentaffairs for Sears Holding Corp?sKmart Pharmacy agreed. ?Today?sstudents are better educated thanany students in the past,? he said,but they have ?a lack of leadershipdevelopment.?

Conrad Bio, college relations directorof Rite Aid, said that the chain hascreated a California Pharmacy SchoolLeadership Conference for that purpose.Last year, 10 representativesfrom California pharmacy schoolsattended to learn leadership skills tobring to the workplace. The chain ispreparing to roll out the conferenceto additional states.

Sara Newton and Howard Kramer

Student panelists felt that preceptorscould help them gain invaluableleadership ability. ?Preceptorsare one of the most vital portions of astudent?s education,? said MadelyneCearley, a pharmacy student at TexasTech University. ?We have businessportions of our curriculums, but itis very difficult to put those intopractice, unless you have a goodexample to show you how to implementthose ideas.? One challenge isfinding enough qualified preceptorsand adequate sites to provide thetraining the students need.

Panelists also weighed in on mandatoryresidencies. Eckel said thatwhile most professionals would agreethat an additional year of experiencewould create better practitioners,whether the additional year shouldbe mandated is cause for debate. Eckelalso raised the question of whetheran improvement in the experientialpart of the pharmacy education programcould eliminate the need for anadditional year.

Some panelists felt that more standardizationin pharmacy educationwas needed in general. ?Requiring aresidency may fundamentally be inevitableat some point,? said SamanthaWest, a student from Ohio State University,?but I think we have to makesure that the experiential programsacross the board are equal.?

Kimberly Andrews, a student atMedical University of South Carolina,felt that students should have a financial interest in becoming moreinvolved with medication therapymanagement (MTM) services in thecommunity, so community residenciesthat helped them prepare forthose roles are a good idea.

Kimberly Andrews and Samantha West

Eckel asked students how they feltthe profession was using automationto advance practice opportunities.Jenifer Young, a student at LomaLinda University, does not think theprofession is using automation toits fullest capacity. ?In one of thestores I work at, we have our top 200drugs in the robot, but that top 200was done 4 years ago, and [the list]has changed. When we finally tookthe time to update everything, wehave more than three quarters of ourdrugs coming out of the robot,? shesaid. ?Most pharmacies I work at donot utilize automation fully, and theycould hugely increase their patientcare if they did.?

One panelist said that even whentechnology enables pharmacists tohave more free time, many are notusing that time for patient care services.?I feel it is all coming down tothe bottom line and instead of usingthat time for patient care, they arejust filling more and more prescriptions,?said Sara Newton, a student atDrake University.

?Automation should enable thepharmacist to spend more time withthe patient, period,? said Wal-Mart?sPeerson. ?Our patients tell us theywant to spend more time with thepharmacist.?

Technicians also can be a big benefitto the profession. Eckel askedpanelists if the profession is usingthem to the fullest extent and mentioneda move toward standardizedtraining for technicians, certificationfor technicians from the PharmacyTechnician Certification Board, andlicensure for technicians.

Some panelists expressed concernthat more training might deterpeople from becoming technicians.Others felt that technicians shouldbe offered the opportunity to stepup their training. Drake University?sNewton said that changing technicianpositions from a short-term jobto a career by increasing pay andresponsibilities could benefit the profession.

?Technicians play an importantrole in the pharmacy, and will continueto play an important part in thedispensing/filling process, primarilyto free up the pharmacist to be ableto do more professional functions,?said Eckel.

The panel discussed whether theprofession makes adequate use ofgeneric drugs. Most students saidthat they were taught to view genericsas equivalent to branded drugs, andthey believe in substituting to savepatients money, except with medicationsthat have neurotherapeuticindexes.

In those cases, students believe thatstabilizing patients on one drug ismost important, and they worry thatswitching off generics to conformto a health plan?s formulary can beharmful to a patient?s health.

For the majority of patients, panelistssupport the use of generics. ?It ispretty evident that patients who stoptaking medications in some casesdo it because they cannot afford themedicine,? said Papatya Tankut, vicepresident of pharmacy professionalservices at CVS. ?As the pharmacist?srole continues to evolve, we cansuggest generics that are more costeffectiveto a patient so that patientscan be compliant. Pharmacists cando a much better job continuing toeducate all parties about generics.?

Panelists unanimously agreed thatthe future of pharmacy is dependenton pharmacists? continued activismin support of their profession. ?Wehave to take a big stand on gettinglegislation passed that can allow usto be reimbursed for [MTM],? saidCearley. ?We could have a muchmore limited role unless we are veryactive right now in ensuring that wecan do those activities in the future.?

West spoke about the ImmunizationBill recently passed in Ohiothat allows not only pharmacists, butinterns, to give flu shots. ?Pharmacistshave to take it upon themselvesto define what their role is goingto be in the health care team,? saidAndrews.

Kmart?s Kramer urged students toget involved in the legislative part ofthe profession and to work with theAmerican Pharmacists Association,the National Community PharmacistsAssociation, and the NationalAssociation of Chain Drug Stores toeffect change that is good for pharmacy.?Pharmacy has always been avery highly regulated profession?one of the most regulated in themedical field?and I do not foreseethat changing,? he said. ?In severalstates where we have pharmacists andother medical professionals involvedin the legislature, there have beensome big wins because the Boards ofPharmacy and the pharmacists wereable to work with individuals in thelegislature who really understand theprofession. It is critical that pharmacistsget involved in the regulation ofthe profession.?