PLEI Perspectives: What are the Pharmacy Profession’s Two Biggest Problems?

The pharmacy profession’s 2 major problems are misbranding and anonymity.

As we transitioned from the 5-year bachelor’s degree to the all doctor of pharmacy degree (PharmD), a great shift happened to the prepharmacy curriculum. To fit greater experiential parts into the PharmD curriculum in the first 3 professional years, many pharmacy schools pushed more of the biological and physical sciences into prepharmacy. These programs then expunged the communication, humanities, and social science classes from prepharmacy or integrated them into the professional curriculum.

How can applicants at one school of pharmacy possibly see themselves as well-rounded, impactful health professionals with a single undergraduate semester of introductory composition, speech communication, and economics, 9 credits, and more than 50 credits of biological and physical science classes? The academic literature clearly shows the first undergraduate chemistry course as a derailing point for the pipeline. How does a fifth semester help recruitment? Can students really believe that pharmacy is right for them if prepharmacy even seems wrong for them?

Prepharmacy Prerequisites Misbrand Pharmacy Practice

Potential applicants’ first meeting with a pharmacy school is usually with the posted prerequisites. A political science major sees science classes, but not positions in congress and state pharmacy associations. A computer science major sees that computer languages don’t count toward admissions, but they don’t see the informatics field they could enter. A business major sees that accounting, entrepreneurship, finance, or marketing classes do not count for a single prerequisite credit toward pharmacy school. Yet, pharmacy school graduates far and wide own pharmacies and run businesses. A liberal arts major sees introductory composition and speech, but no opportunity for foreign language study. In short, applicants’ first interactions with the pharmacy profession are the rigid, prescriptive, science-heavy prerequisites of a prechemistry major. A close look at section 16 of the Accreditation Council for Pharmacy Education’s Guidance Document clearly outlines a possible source of the problem.

16c. Preprofessional curricula: To better prepare prospective students, preprofessional educational programs include chemical and biological sciences (including general chemistry, organic chemistry, biology, and other foundational sciences that focus on human biochemical and physiological processes and diseases); mathematics; information and communication technologies; physical sciences; economics; and general education (defined as humanities, behavioral sciences, social sciences, and communication skills). Elements of general education also may be attained concurrently or integrated within the professional degree curriculum (16.3).

Like a hospital pharmacist in the basement or a long-term care pharmacist in a closed pharmacy, the extended opportunities in leadership, technology, business, and language in pharmacy escape connection with prospective students. Pharmacy school educators are experts in teaching the biological and physical sciences, so why only move the general education requirements to the professional curriculum? Academicians will meet this fall to talk about holistic admissions, but the problem isn’t how schools view the student applicants. The problem is students’ realities in gaining admission through archaic prepharmacy curricula. Our prepharmacy prerequisites misbrand our profession as a group of inelastic physical and biological scientists without the depth and breadth of the social sciences, humanities, technology, and entrepreneurship prevalent in our practitioners. A quick fix is to rename generic prepharmacy “pharmacy orientation” classes using monikers that reflect our profession. For example, semester 1, Pharmacy Clinicians; semester 2, Pharmacy Entrepreneurs; 3, Pharmacy Innovators; 4, Pharmacy Leaders; and so forth.

Although I can only offer the prerequisite problem as a thought experiment, it’s clear the pharmacy profession has communicated poorly with its potential applicants. Applications to pharmacy school fell 3% over the past 5 years while applications to nurse-practitioner and physician assistant programs rose 60% and applications to medical school 20%. Pharmacy needs humanities-trained voices, loud and lucid, to counter this misperception. We need orators who feel comfortable communicating one-on-one with patients, but who also advocate for pharmacy through podcasts and other social media to this generation of applicants. We need writers to articulate the profession’s value to other health professionals and the public.

Pharmacist as Oral Communicator

I read once that often a company CEO will spend only 5 minutes with his or her child a day, and 4 of those minutes are prescriptive, telling the child what he should do. The child doesn’t see the 14-hour day that parent put in for them, rather he or she only sees the company gets 14 hours, the child gets 5 minutes. Patients only see the few minutes of counseling we do, not the hour that we spend adjudicating their prescription.

Our profession wants provider status to spend time with our patients. But the public sees us hurriedly communicating to them through a plate-glass, drive-through window or over a countertop. We work behind the scenes in basements and small offices reviewing charts. At the doctor’s office, patients sit down with no barriers because insurers pay physicians, nurse practitioners, and physician’s assistants for this face-to-face interaction. We wait until provider status creates a model for our payment. Now, patients only see us face-to-face with an immunization needle in hand. The order is backwards.

We must first give more, then ask the public to stand behind us. With telemedicine, there is little reason we can’t be face-to-face with patients after they get home by video. Why don’t we keep OTC medications behind the counter so when a patient comes back we can just hand the right medicine to them? Patients should expect to see a pharmacist with an OTC medicine every time.

Do we help parents trying to find the right medicine for their child on their own? Newborns exhaust parents and data show that tired new parents try to shop in one store—one trip. A pharmacist checks the prescriber, but no one checks the new mom or dad. We can avail ourselves to them through telehealth 24-7 to avoid the ridiculous number of pediatric errors that happen in this country, 1 every 8 minutes. We can gain loyalty through above-and-beyond service.

Why are pharmacy schools prescriptive about the classes pharmacy students need to take if admissions committees assess their competency through the Pharmacy College Admissions Test, the PCAT? Outside of a full bachelor’s degree, there is no room for the 20 academic credits it takes to get through the first 4 semesters in a foreign language. Yet pharmacists will find that the biochemistry, immunology, and genetics undergraduate courses they had to take don’t help much when the patient speaks another language. How can pharmacy students develop the race/ethnic/socioeconomic sensitivity they need to help as health practitioners if they don’t have the freedom to take coursework in sociology and ethics? How will pharmacists argue for their profession without training in argumentation, rhetoric, and formal logic? If pharmacy schools continue to put so much emphasis on a student’s science PCAT scores, then it’s time to do away with the STEM-heavy prepharmacy curriculum. Allow students to become articulate orators of science knowledge and bring in a flood of new applicants who offer a diversity of talents and perspectives outside of biologists and chemists.

In a recent 10-minute podcast entitled “How Pharmacists Can Improve Their Working Relationship with Physicians,” Joseph Muench, PharmD, BCPS, “Pharmacy Joe,” a critical care pharmacist, speaks to how we can communicate with doctors. But he also writes about working on a health care team in his recently released book a pharmacist’s guide to inpatient medical emergencies: how to respond to code blue, rapid response calls, and other medical emergencies. He provides the best of “Free Open Access Meducation” and an academically sound resource.

Pharmacist as Written Communicator

In chapter 1, Muench writes in the “Be a Pharmacist” subsection about a pharmacist’s role in pharmacotherapy. Communicating that role in a best-selling book helps not only the other pharmacy professionals, but also other health professionals in the critical care arena.

Pharmacy Times has collected weekly updates from contributors for a long time, increasing the visibility of pharmacy professionals to not only the profession, but also other health care providers and the public. Patients want to know what’s going on with our profession and receive the advice we provide.

I published a book this year as well, called Memorizing pharmacology: a relaxed approach, in audiobook form. The uptake didn’t match my expectations. My intent was to communicate pharmacology etymologically to students who haven’t taken chemistry. I break down 200 drug names noting prefixes, infixes, and suffixes to help students learn drug classifications. My pharmacy technician students and many other allied health students do not take organic chemistry or even physical chemistry. I thought current students were my primary audience.

Instead, I saw messages from dyslexic students who felt a health professions career was possible. I got e-mails from patients who now understand their medications in context of the whole drug class. I thought only a health professions student would ever want to listen to what a pharmacist has to say for 7 hours of audiobook. I was wrong. Our patients want to hear from us. And to say that lack of provider status prevents us from communicating with them more is a weak argument with the available technology. A few pharmacy podcast episodes can get someone up to speed with today’s telehealth technology. We need to communicate with our patients now in multiple settings.

When my father worked for the now-defunct Control Data Corporation (CDC), he saw his job evaporate. I remember he had this red T-shirt that had a tombstone and “CDC Rest in Peace” on it. Mainframes used to need skilled workers to diagnose and repair the computers to keep them running, but gradually with self-diagnostics and modular parts, the computer could tell the technician what needed to be repaired. Similarly, pharmacy is less about hardware—the filling—than it is about the software, or soft skills—working within a practitioner network and getting face-to-face with our patients. We are not solely chemists, we are medical information communicators, coordinators of care, and patient advocates to patients’ insurers.

My favorite 2 words in Pharmacy Joe’s book are “Pharmacy’s Here.” If we accept pharmacy as a humanities-based profession with a STEM foundation, we can change our brand and open up our doors to a diverse pool of new applicants. When we help a patient holding 2 different medicines in the OTC aisle, go to a patient’s bedside, or talk through social media, I hope we internalize that “Pharmacy’s Here.”