Pharmacy leader reflects on pharmacy reaching its full potential

Abstract

William (Bill) Zellmer, BSPharm, MPH, ScD (Hon), is a visionary in the pharmacy profession. He draws on many years of experience in leadership positions in pharmacy, both in the United States and abroad. In his previous roles, he focused on analyzing issues of strategic importance for hospital and health-system pharmacy at the American Society of Health-System Pharmacists (ASHP). He is now a consultant, a speaker, and a writer on professional and strategic issues in pharmacy. BZ: I grew up working on my parents’ dairy farm in Wisconsin, where I later attended pharmacy school. I graduated with my Bachelor of Science degree in pharmacy from the University of Wisconsin in 1967, and my initial aspiration was to become a community pharmacist. I remember, as a pharmacy student, becoming concerned that many pharmacists didn’t seem to be using much of their education to its fullest potential and they could have a much larger role in health care. As a student pharmacist, I had the opportunity to take a seminar course taught by Glenn Sonnedecker, PhD that focused on studies and commissions that looked at the profession of pharmacy, assessed the status of the profession, and made recommendations about how pharmacy could be contributing to a greater extent. The course made me realize that you don’t have to be satisfied with the “status quo”—you could, in fact, actively work on changing it, largely through pharmacy organizations. I completed a pharmacy residency at the US Public Health Service Hospital (PHS) in Baltimore, MD, where I was exposed to the hospital (or institutional) realm of pharmacy. I came to recognize that in the hospital environment, there was space for pharmacists to work with physicians and nurses to improve the use of medicines. After my service in the PHS, I applied for a position on staff of ASHP as an assistant editor of their journal. I got that position, and I ended up working for ASHP in various capacities for nearly 40 years. BZ: Some years ago, I gave a lecture entitled “Searching for the Soul of Pharmacy,” which drew on the writing of author Thomas Moore, who defined “soul” as a quality or dimension of experiencing life and ourselves. He said “it has to do with depth, value, relatedness, heart, and personal substance.” I argued in my lecture that pharmacy cannot become a true profession unless its individual practitioners have depth, value, relatedness, heart, and personal substance (i.e., soul) in how they approach their work. BZ: I believe that history has taught us there are certain prerequisites for making progress in pharmacy. One of those prerequisites is achieving a broad consensus about a vision for the profession—where do we want to be as a collective force in health care? Another prerequisite is setting our sights on a few, high-impact goals that will bring about constructive change and move us toward achieving that vision. Also, establishing appropriate minimum standards for pharmacy education and practice is important in making advancements in our field. Lastly, developing the resources through pharmacy associations [that help] practitioners make constructive change that will move the profession in the desired direction. Over the past 50 years, I think we have made wonderful progress in developing a deep and broad consensus within the profession about the primary patient-care role of pharmacists. We have changed our educational standards to shift from the science and technology of drug products to a focus on fostering appropriate use of medicines. Though we have more work to do, we have begun to develop a well-educated, well-trained corps of technical workers. This is very important to help give pharmacists the time they need to work with patients or other health care professionals to achieve appropriate, best use of medicines. BZ: I admire our profession for how it has stepped up. Vaccinations have been a tremendous innovation in our profession, because rather than the pharmacist being seen as somebody remote [and] behind a counter processing an order, we now have pharmacists across the country touching patients. By giving vaccinations, pharmacists have been able to have more conversations with patients, which has been a tremendous advance overall. I don’t think there is any question about it—the pandemic has caused great stress among essential workers, including those in health care such as pharmacists, physicians, nurses, and various technical workers. With respect to pharmacy, it’s been quite significant that federal emergency public health laws have been activated to expand the authority of pharmacists, often allowing pharmacists to go beyond their scope of practice in their state. This is a very positive advancement, and I hope that once the emergency is over, much of that role expansion will be continued. Overall, our profession is probably not yet achieving the full potential from the use of pharmacy technicians. We should work on bridging the gaps in education, training, and compensation for technicians to ensure their success. BZ: It’s notable that the accreditation standard for PharmD education calls for developing leadership abilities in student pharmacists. I think there are some facets of leadership development that are not getting enough attention; for example, being very clear about what we mean by “pharmacy leadership,” which I would define as working with others to achieve constructive change in the profession. Also, I don’t think we are paying enough attention to pharmacy history, because that’s a very vital component of leadership development. We need to study what lessons can be drawn from the history of the profession that will help guide us in making changes as we go into the future. Further, I think we need to emphasize the need to protect professional autonomy among pharmacists, and the need to not let the financial imperative override the ethical imperative in health care. BZ: APhA was the first professional organization I joined back in my student days. At the time, I was very impressed by the CEO of APhA, William S. Apple, PharmD, MBA, PhD. He was not afraid to challenge pharmacists to break out of the status quo and advance their level of service to the public. Apple’s message really appealed to me as a student and cemented my loyalty to APhA over all these years. After I became excited about the opportunities to advance the profession through hospital pharmacy work, it was natural for me to join ASHP. I believe strongly that knowledge of the history of pharmacy is an important component of leadership, so again it was natural for me to join and support and served as president for the American Institute of the History of Pharmacy (AIHP), which I have served as president. BZ: There is a difference between what I like to call “the short game” and “the long game” in becoming a successful leader in pharmacy. In the short game, it’s a matter of paying attention to the immediate demands in your particular practice site and trying to stay ahead of some of the apparent trends that are going to affect our profession in the near term. In the long game, by which I mean the span of a pharmacist’s entire career, I think success depends on the beliefs, the attitudes, and the habits of the pharmacist. So, my advice is don’t neglect the long game.