Pharmacotherapy Part IV. The Future of Specialization and Certification in Pharmacy

Abstract

THE DEVELOPMENT OF PHARMACY SPECIALTIES is not completed with nuclear pharmacy, clinical nutrition, and pharmacotherapy. There will be two prominent pressures coming to the forefront. One already exists within pharmacotherapy: the pressure to fractionate pharmacotherapy into pediatrics, geriatrics, oncology, infectious diseases, adult medicine, family medicine, and so forth. The other pressure will be the dissatisfaction of the large number of pharmacists who will not be eligible for specialty status in the three current specialties. A similar dissatisfaction occurred in medicine among the thousands of general practitioners who did not qualify to be internists or pediatricians. This disenfranchisement resulted in the creation of the family medicine specialty, now the largest of medical specialties. Professional organization aspirations and politics will play a key role in the eventual specialty lineup. With the pharmacotherapy specialty now in the hands of the American College of Clinical Pharmacy, the American Society of Hospital Pharmacists (ASHP) will be even more anxious to see narrow clinical specialties approved, i.e., those it can reasonably sponsor. The ASHP has a difficult course ahead. The Board of Pharmaceutical Specialties (BPS) has already declared that specialties will not be based on administrative functions or location of practice. This apparently leaves out hospital pharmacy directors and supervisory personnel and the thousands of pharmacists working in drug-distribution services and lower-level clinical activities. The old camaraderie within hospital pharmacy in the pre-1975 era has eroded and will be even more stressed when most practitioners are still left out of a few new specialties to come. This disparity has been widened by the employment of thousands of entry-level pharmacists (those with B.S. or Pharm.D. degrees with no residency) to perform largely technical and low supervisory functions in drug-distribution control. There is no clear way out of this without a quick and thorough dedication to meaningful education and career development for pharmacy technicians. As long as high school graduates are hired one day and put in the sterile compounding service the next, the university education of pharmacists will be wasted and professional growth thwarted. The American Pharmaceutical Association (APhA), with some 50 000 members, curiously has no strategic plan to encourage specialization. Its flagship group, the Academy of Pharmaceutical Sciences, was badly torpedoed by the new American Association of Pharmaceutical Scientists in 1986. The APhA is in a struggle with NARD for community pharmacy, has lost hospital pharmacy, and never had clinical pharmacy. With thought to this confused background, I will speculate liberally on the future of specialties and certification in pharmacy. My thoughts are not constrained by the current policies of the BPS, organizations' status quo, or educational shortcomings; this analysis is concerned only with where we could go, not exactly how we can get there. These are my assumptions about the future of specialization in pharmacy: 1. Practice specialties will be built upon the Pharm.D. degree as the educational base (this can be entrylevel Pharm.D., or Pharm.D. after B.S. in pharmacy). 2. By implication above, new B.S.-degree pharmacists have no specialization future unless they enter a Pharm.D. program or recognized graduate program in the specialty area, i.e., M.S. program in nuclear pharmacy. The five-year B.S. could be reduced to four years to train pharmacists to function as drugcontrol supervisors. These graduates could not be heads of institutional or clinical services, but would have to report to a pharmacist with the Pharm.D. degree or other certified specialist. 3. M.S. programs would still be feasible, but hospital pharmacy and other practice-oriented programs would be only for pharmacists holding the entry Pharm.D. degree. 4. Current practitioners with B.S. degrees will be needed to do what they now do in the transition period of several decades.