Every area of health care has evolved by necessity over the past century to align with the expansion of how technology and techniques change as well as how patients are cared for. The evolution of pharmacy, as a practice and profession, is unique in that its evolution has quickened exponentially in just the past 20 years, such that the industry as it was when I began my career more than 2 decades ago is in some ways hardly recognizable. It is a remarkable shift, as new pharmacists today have a myriad of fascinating and fulfilling ways to utilize their hard-earned PharmD degrees.
The Community/Retail Pharmacy
When I began working in retail pharmacy as a clerk, then a technician, and then an intern, naturally my primary task was supporting the pharmacist in the dispensing of medication. At that time, and early in my career when I had completed my PharmD and became a practicing pharmacist myself, every step of a patient’s care was performed manually, with physical elements crucial to nearly every task. The process typically began with the slip of paper a patient would carry into the pharmacy on which their physician had written the prescription. We would type up the prescription on a typewriter and then eventually input it into a computer system. Before dispensing the medication, however, it was necessary to make multiple phone calls in order to follow up and affirm the patient’s care. And the pharmacists themselves had to touch every bottle of pills that was distributed, to correctly verify the dosage and amount.
Of course, like so many other aspects of our lives, technology has driven the evolution of retail pharmacy. The process of fulfilling a prescription begins before a patient ever steps foot in the pharmacy, as the physician’s orders are communicated automatically via electronic scripts the minute the patient leaves the medical office. Pharmacy technicians can prepare the medications, taking digital photos or videos every step of the way, and those prescriptions can be verified remotely by a pharmacist who does not need to be present. Besides the efficiency benefits, this change allows pharmacists to extend their capacity to serve patients in their communities as well as allowing them to extend their reach into underserved communities that may not have a retail pharmacy present.
The other major evolution of the retail pharmacy space is the expansion of the clinical services the pharmacist can provide the community. Although pharmacists have been able to provide vaccinations for years, the COVID-19 pandemic did much to normalize the practice, and now, to take one example, more than 60% of flu vaccines were administered in a pharmacy versus a doctor’s office.1 Retail pharmacists are also able to collaborate more closely with physicians on medication therapy management (MTM) services, providing patients easy access to questions or clinical information. Finally, there is point-of-care testing, where some outpatient pharmacies will provide services to help monitor a patient’s diabetes, cholesterol, thrombolytics and/or blood pressure.
The Hospital Pharmacy
For a very long time, hospital pharmacists were literally down in the basement, because, like retail pharmacy, their role was seen as primarily about dispensing medications. In the context of the hospital, that meant there was little expectation for the pharmacist to interact with people; all they had to do was send the medications up to the correct floor. There were very few clinical roles for pharmacists in hospitals, and very few specialized residency opportunities.
Now, the pharmacist’s role in the hospital has expanded a great deal, and one of the most visible ways is in the areas of specialties. There are nearly as many areas that a pharmacist can specialize in as there are for a physician; a person can be an oncology pharmacist, an acute care pharmacist, a pediatric pharmacist, and more. This allows the pharmacist to partner with a physician specialist to deliver the absolute best clinical care from a medication standpoint. It also brings a tremendous amount of value to the health care system, as we have seen decreases in hospitalizations, morbidity, and mortality because the patient can have the right pharmacist helping lead their medication management for their individualized diseases both in hospital and when they transition their care to home after leaving the hospital.
Technology has played a major role in the evolution of hospital pharmacy as well. Of course, there’s the enormous shift to digital records and electronic charts, and the way this allows the pharmacist to instantly access a patient’s relevant data with respect to medications. There is also technology that performs a crucial function in ensuring that certain medications are always available on the floor. We also have the same camera technology that allows a pharmacist to remotely monitor technicians as they work to mix medications in the infusion preparation room, for example.
The Expanded Roles
The last major evolution in the profession of pharmacy when we compare the field now to how it used to be is the many positions and roles a pharmacist can perform that quite simply did not exist before. There are, for example, informatics pharmacists, who work with pharmaceutical data. There are consultant pharmacists who deal with nursing homes and surgery centers. There are pharmacy benefits managers (PBMs) who work to administer prescription drug programs for employee plans.
As I mentioned above, specialty pharmacy has exploded incredibly, as there are so many more specific medications that need to be monitored with the patient more closely. Complex cancer drugs or biological drugs are just 2 examples where a pharmacist needs to be more routinely involved with patient care to ensure safety. Personalized medicine is another face of this, in which pharmacists have the opportunity to look at patients’ personalized medical care and make recommendations based on genetics, drug metabolism, new drugs, new clinical trials, or new opportunities to find the best therapies for different types of diseases.
About the Author
Monica Trivedi, PharmD, is an Assistant Professor and the Associate Dean of Clinical Affairs and Community Outreach at Marshall B. Ketchum University. She received her Doctor of Pharmacy degree from the University of Southern California School of Pharmacy in 2002. Throughout the years, Trivedi has been focused on patient-centered care with the implementation of expanded Immunization programs, Medication Therapy Management, leadership development for pharmacists, and expanding health care services.
Finally, there are so many fascinating examples of how health care professionals with a PharmD can utilize their didactic knowledge from pharmacy school to become a specific kind of expert that also serves the health system. They can work on the political advocacy side, the industry side, or the regulatory side in the field of, for example, pharmacogenomics, developing, testing, and approving gene therapies. There are positions in pharmacoeconomics in which the pharmacist is analyzing the cost effectiveness of drugs with respect to overall effects and adverse effects. These are just a few examples of the many roles available to pharmacists as the field has evolved to serve the needs of society and communities, far beyond simply dispensing medications.
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