DRUGTOPICS© FOR THE HEALTH-SYSTEM PHARMACIST

Pharmacy titles expanding:
Do you know what they all mean?

Once upon a time, everyone knew the pharmacist, the one with R.Ph. behind his or her name. Then came Pharm.D., which also indicated pharmacist. Now there's P.D. and D.Ph. for pharmacist, plus CPP, CGP, FCCP, BCNSP, and an alphabet soup of other possible titles, designations, certificates, and specialties. So who's the pharmacist now?

"We're all pharmacists," said Peggy Kuehl, Pharm.D., FCCP, BCPS, director of education and member services for the American College of Clinical Pharmacists. "Too many initials after a name can create confusion. But when those letters come from degrees, licenses, specialty certificates, and honors, they are very acceptable ways of recognizing people who have something special."

In some cases, a new title means new knowledge or professional skills. And sometimes, a new title is nothing more than a name change. That's what happened in Oklahoma, where the state board of pharmacy recently changed the official designation given to pharmacists licensed to practice in the state from R.Ph. (registered pharmacist) to D.Ph. (doctor of pharmacy). More than half of Oklahoma's 3,500 licensed pharmacists have already applied for a new license showing the new title, said Oklahoma Pharmacists Association executive director Phil Woodward.

With the proliferation of pharmacist titles, confusion over these designations is a definite possibility, agreed Richard Bertin, executive director of the Board of Pharmaceutical Specialties. BPS generally gets credit for the first widely accepted add-on titles from its nuclear pharmacy certification, which appeared about 25 years ago. BPS now offers six specialty certifications and titles.

"There is a growing number of titles," Bertin cautioned. "We all need to be careful that all are clearly identified when dealing with the public and with other healthcare providers. We need to work on common definitions."

Proliferating titles and designations is hardly unique to pharmacy. Medicine has been granting supplementary titles to physicians for more than 150 years, Bertin noted. Nursing and other healthcare professions have also developed specialty practices and designations.

Decades of public education have taught patients to accept board certification as an indicator of higher-quality physician care, he said. It is less important that patients recognize the precise set of initials than look for advanced certification among pharmacists as well as other providers.

Pharmacy has a long way to go in terms of board certification. Among U.S. physicians, more than 80% are board-certified in at least one specialty, said David Witmer, director of professional practice and scientific affairs for ASHP. Among pharmacists, less than 2%, fewer than 3,000 R.Ph.s, have a BPS certification.

"Physicians have long had special skills and credentials," said Lucinda Maine, senior v.p. for policy planning and communication at the American Pharmaceutical Association. "Medicine, as a profession, is much further along this road than pharmacy has gone. Part of our confusion stems from the fact that we have not used any designation except R.Ph. for so long, even in specialized practice settings."

Although BPS has been certifying specialty practices for 25 years, the real growth in pharmacy titles began in the 1980s and 1990s, said Michael Martin, executive director of the Commission on Certification of Geriatric Pharmacy (CCGP). That's when significant numbers of pharmacists began to specialize.

"There was a real potential for each pharmacy organization to go off in its own direction," said Tom Clarke, director of professional affairs for the American Society of Consultant Pharmacists. "We needed consistency across the profession."

Pharmacy needed consistency, but pharmacists also needed recognition. In some cases, a new certification is a matter of professional advancement or pride. In other cases, a new certification is the key to reimbursement for specialized services.

"You want to let the world know that you have skills and expertise that not everybody else has," Martin said. "It demonstrates a special set of skills that can help you qualify for better salaries, better benefits, and faster promotions. But you can also confuse the public and practitioners themselves." By the late 1990s, he said, pharmacy organizations were beginning to recognize the potential for confusion over a growing number of professional titles and designations.

The answer was the Council on Credentialing in Pharmacy, a group of 11 professional organizations focused on creating uniform standards for pharmacy credentials and certifications. A CCP white paper published in 2000 laid out a three-part framework for pharmacy credentials.

Education-based credentials such as the Pharm.D. recognize basic education. State boards of pharmacy issue credentials such as R.Ph., P.D., D.Ph., and similar designations that allow entry into practice. Practice credentials such BPS or CCGP certification indicate advanced training or practice specialization.

"The number of titles could get ridiculous, especially if there were different designations and certificates for every disease state one could specialize in," said Robert Elenbaas, executive director of the ACCP. His solution: When dealing with patients and the general public, use earned titles such as BPS certification that indicate special professional knowledge, but tread lightly with fellowships that carry less obvious meaning. It makes more sense to use fellowship titles such as FCCP or FASHP when dealing with other healthcare professionals who are more likely to recognize the significance, he added.

The National Association of Boards of Pharmacy takes a similarly practical view. "If you hang all those degrees and certificates on the wall, it looks impressive," said NABP executive director Carmen Catizone. "But I'm not sure that the public knows, or even cares, what they all mean. The crucial moniker is the one that says the pharmacist is licensed to practice."

Fred Gebhart

Fred Gebhart. Pharmacy titles expanding: Do you know what they all mean?.

Drug Topics

2002;6:hse1.