How to make a profession vanish into thin air

magicThere appears to be a push in the pharmacy world to expand residency programs so “that, by 2020, postgraduate year 1 (PGY1) residency training should be required for entry into practice for all pharmacists who will serve in direct patient care roles.” This according to a recent article in the American Journal of Health-System Pharmacy. In addition the article states that “ASHP conducted a survey to determine if health systems were requiring specialized residency training—now known as postgraduate year 2 (PGY2) residency training—for clinical specialist positions10; 15% of the respondents indicated that such specialized training was required, and 67% indicated that a lesser-trained pharmacist would be hired to fill a clinical specialist position only if a candidate with specialized training could not be found.”  Basically acute care pharmacies are looking for pharmacists with more education instead of looking for good pharmacists.

I would be left out in such a world. You see, I don’t have a residency of any kind under my belt. Lots of experience, but no residency. I’ve precepted pharmacy residents, some brilliant and some as dense as rocks. Their abilities to perform at a high level had more to do with their intelligence and common sense than their education. While I like to tease other pharmacists about their alumni status, I’ve found that true skill rarely cares what pharmacy school you went to.

One of the problems I see with the call for residency is a loss of pharmacy identity. Many pharmacists want to practice at the patient bedside. I think that’s a good idea. However, I believe we should be practicing pharmacy at the bedside. We’re drug experts. We know things about medications that few other professions know because we’re supposed to. Any monkey can pick out a drug to treat a disease state. It’s things that occasionally happen after that that requires specialized drug knowledge. Pharmacists are experts not only in the obvious, but the subtleties as well. Who else but a pharmacist would care about the structure activity relationship of a drug or its acid-base properties? Probably no one. While these things rarely matter in the routine care of a patient, when they do it makes a difference. Pharmacists are taught to think about the drug first, and last; everything about the drug. We’re the only profession that does that.

I agree that pharmacists have lots to offer to patient care, and I also believe that pharmacists shouldn’t be tied to the physical pharmacy. With that said, don’t let the fact that pharmacists are drug experts escape you. I fear that the push for residency and specialized residencies will drive pharmacists away from the very thing that makes them unique into a world already inhabited by plenty of would-be practitioners. Be careful what you wish for pharmacists, you just might get it.

3 thoughts on “How to make a profession vanish into thin air”

  1. I’m not sure we are anymore. My class has one semester of medicinal chemistry. Other than that, most of our classes were therapeutics, where we never saw a structure and never really learned acid/base chemistry (most drug it was more a cause effect relationship that was emphasized, not the depths of why like because this quinolone has this group, it does this. It was “this list of drug are respiratory quinolones.” We did have a class about receptor sites, but it was squeezed into half a semester, the other half being about physical examination. Pharmacology discussed the structural relationship of drugs a little, but that was considered a puff class (multiple choice tests, easy) as opposed to the massive SOAP notes and cases we had to workup in therapeutics, which took most of our time.

    I think pharmacy is heading in the wrong direction. It seems that the old guys are the only drug experts anymore. I had a newer pharmacist tell me the other day that I couldn’t mix an insulin drip in dextrose (the doc was using to lower triglycerides) because the sugar in the bag would react with the insulin and it would be like running straight dextrose. I was literally dumbfounded. She made pretty good grades too.

  2. Hi PharmD –

    I’m disappointed to hear what you have to say, but I’d be lying if I said I was surprised. I saw things headed this way when I was in pharmacy school back in the mid 90’s. Pharmacology a “puff class”. Who would have ever thought it would come to that. I believe in pharmacists understanding therapeutics because it makes them better clinicians, but we can’t lose sight of the medication in the equation. As I said in the post, most of the time things are straightforward, but on that rare occassion that they’re not, you need a drug expert in the room.

    Like you, I agree that pharmacy it headed in the wrong direction. I admire the enthusiasm, but I think we’re headed into a mine in the dark. Let’s hope it doesn’t come down to the profession completely losing its identity before someone wakes up. Thanks for stopping by and for commenting.

    -Jerry

  3. I’ll be at the back of the line, I’m not even a PharmD. As a manager, I typically sought critical thinking/people/organizational skills in pharmacists before I looked at academic accomplishments, credentials, etc. I found it much more difficult (if not impossible) to develop the former. Good topic, as always. Thanks.

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