Preparing Individuals for Provider Status

Many hospitals support pharmacy residency programs. Throughout the winter, pharmacists in those institutions are actively engaging with pharmacy students, giving them tours throughout their hospitals, sharing their departments’ educational and training philosophies, getting to know the students’ passions and career interests, and recruiting them to train in these institutions. It is a wonderful time for hospital staff to meet future graduates who are excited about becoming pharmacists.

Unfortunately, our profession continues to debate the role residencies play in our training spectrum. Many professional associations have adopted policies requiring graduates to complete a residency before going into direct patient care. The associations support their position by noting the lack of preparation by pharmacy schools for highly specialized positions in hospitals, and that hospitals require residencies as a prerequisite for these positions.

Other individuals are convinced that new pharmacy graduates are ready for these positions. This position is defended by noting that the accreditation standards for pharmacy schools are patient-focused, there are not enough residencies to accommodate all graduates, and many employers will hire pharmacy graduates without a residency.

Although many individuals continue to debate the definition of “direct patient care,” let us address the training needed for a pharmacist to have prescribing privileges under approved protocols. Implicit in this discussion is that provider status has been adopted and state pharmacy practice acts have been updated to allow for this practice. With collaborative practice arrangements already existing in many states, thinking about whether a new graduate is ready to practice in this setting is germane to today. We tend to use the term “direct patient care,” but I wonder if the discussion would change if we substituted it with “provider” (as in “provider status”) instead.

Here are a couple of thoughts on ensuring that our profession is ready for prescribing under protocol:

Pharmacy degree. It is hard for me to accept that a new pharmacy graduate is capable of fully assessing a patient, understanding all the lab results and medical history, and making a pharmacotherapy recommendation, while taking into account the published literature. My experience with pharmacy students is that they do not have the breadth of insight and experience needed to assimilate all of this information.

Continuing education. After attending and lecturing for many continuing education programs over the years, I can tell you that a minority of attendees pay close attention. We attend mostly because we need to renew our license. We prioritize timing, cost, and venue over content. Relying on passive education to keep a pharmacist current on treatment advances worries me, based on my observations over the years and questions I have received regarding my presentations. If these points cause concern regarding provider status for pharmacists, then additional safeguards need to be introduced to ensure that patients have access to competent pharmacists who can be providers.

Additional training beyond a pharmacy degree is necessary. The best and easiest way to obtain this training is through a residency. Although options, such as certificate programs or traineeships, might need to be developed due to supply issues, the best training program will always be a residency.

Portfolios should be used for relicensure. We need a much more active process to demonstrate individual competency each year. Continuing professional development is often referenced in this regard. I have had experience leading this in North Carolina, and have found it to be much better than the traditional method in ensuring ongoing competency. Whichever method a state board uses for collecting and reviewing this information, learning goals and the subsequent plan needs to be documented, and then examples of patient care should be submitted. Board certification is another option, but changes might need to be introduced to allow this to happen.

I do not think the debate over pharmacist preparation will end anytime soon. However, our profession has desired provider status for so long that we need to ensure that we have a competent workforce to provide the care our patients need. I am concerned that a pharmacy degree with our current relicensure process is not enough for the difficult patient situations that provider status could present. I would appreciate your insight and experience regarding this issue. Let me know your thoughts via e-mail (seckel@unc. edu) or Twitter (@stepheneckel).

Stephen F. Eckel, PharmD, MHA, BCPS, FCCP, FASHP, FAPhA, is associate director of pharmacy, University of North Carolina Hospitals, and clinical associate professor at the University of North Carolina Eshelman School of Pharmacy.