Teachers as Learners and Learners as Teachers: A Model for Sustained Prosperity

Over the course of a lifetime the average person will take on ~12 different jobs¹ and, according to the National Center for Education Statistics nearly ~20% of all college and graduate students in 2020 will be over the age of 35.

“If I have a license, I’ll have a job.” Think again.

Professionals have historically been somewhat immune to the market forces that require the type of job changes and lifelong learning that begs personal transformation. Doctors do doctoring. Lawyers do lawyering. Pharmacists do pharmacy. Professionals tend to evolve in small increments, but for the rest of the world, substantial reeducation and training on a regular basis is the norm. We’re not talking about continuing education or your mandatory bloodborne pathogens refresher at your workplace. Rather, the numbers referenced above speak to significant disruption and individual evolution. The kind that pharmacy may be entering headlong into over the next decade as the market for dispensers tightens and pharmacy schools graduate bumper crops of debt-laden and hungry, newly minted licensees.

“Yeah, we have lots of students and residents.”

I’ve had the great privilege over the past few years to lead a project to test and evaluate new ways of paying pharmacies and integrate them into the larger care team, principally with primary care clinics and nurse care managers that act as extensions of that clinic.

We attempted a natural experiment wherein we asked medical directors and care management leads to identify pharmacies that they thought might be good fits for a coordinated care model based in the community and buttressed by relationships both with the patients they jointly served, but also each other as care team members with shared performance goals related to patient outcomes.

After receiving 147 names of pharmacies from these providers, we sent out a solicitation to join us in Raleigh to launch the effort. Sixty-seven showed up. Our first question to them was, “what types of enhanced services do you provide for patients and other care team members that is focused on clinical and global outcomes improvement such as total cost of care and improved lab results?” What returned was a flood of descriptions for novel services (such as urine drug screening) and somewhat novel (medication synchronization). But most impressive was the willingness to learn and to try a host of new services meant to be integrated more closely with our primary care and care management infrastructures. I thought to myself—dang, this might actually work!

Then I became curious as to how it was that these pharmacies had become so unique and so agile and advanced, seemingly thriving in an increasingly difficult marketplace and I stumbled upon it (perhaps without surprise in retrospect). I asked “how many of you have either multiple students or residents in your pharmacies?”Nearly every hand in the room went up.

“I’ve been practicing pharmacy for 40 years and I’ve never enjoyed it so much.”

A lot of hard work ensued, both applying for, but also in the implementation of a large project across 14 care management networks, 2,000 primary care practices and more than 250 pharmacies. We have a leadership team that worked tirelessly to make it happen, but each of us is so grateful for the experience. It is an absolute joy to see the evolution of a close-to-retirement or “I’ll never retire” elderly pharmacist who, completely, will come up to one of us and thank us for the project and describe how it reoriented their view of what’s possible in the practice of pharmacy. One gentleman expressed later on in the project (after initially offering some skepticism about the value of changing their model of care) said, “I’ve been practicing pharmacy for over 40 years and I’ve never enjoyed it so much.” Initially not part of the project, his pharmacy now precepts student and collaborates with other pharmacies to develop new service lines.

Teachers as Learners and Learners as Teachers

As the project went along, our team began to realize the power of intergenerational learning in both directions. Turns out, learning can be bidirectional. Pharmacies can mostly certainly learn new service lines and new workflows and new ideas from other pharmacies, but also from students, even first year students with no therapeutics knowledge whatsoever. In fact, one might come to find that not having been contaminated by prior work experience in a pharmacy led to greater levels of innovation. Time and again, we ran across pharmacies whose transformational lifeblood was gained by either another pharmacy sharing their knowhow or a student or resident teaching the pharmacy a new way of doing business, whether through intention or osmosis.

Roughly 70% of our pharmacist workforce is over the age of 40, with ~ 50% greater than 50 years of age². We cannot rely solely on new graduates for filling the growing gap between customer and payer expectations and current standards of practice. Profession-wide transformations (and arguably sustainability) require whole workforce evolution in this new era of value-based care delivery. No longer can a pharmacist sit idly by and assume that they are protected by that piece of paper on the wall bestowed by the Board of Pharmacy.

Troy Trygstad, PharmD, PhD, MBA, is the Editor-in-Chief of Pharmacy Times.

References

• https://www.bls.gov/news.release/pdf/nlsoy.pdf
• http://www.aacp.org/resources/research/pharmacyworkforcecenter/Documents/FinalReportOfTheNationalPharmacistWorkforceStudy2014.pdf