Schools, advocacy groups edging pharmacists toward life support

If the Dean [Ronald P. Jordan] of the Chapman University School of Pharmacy sees no issue with the nationwide explosion of schools of pharmacy, then I suggest that the university personally invest in its graduates by providing pharmacy students with low interest, dischargeable, education loans. After all, I see  the word “entrepreneurial” sprinkled throughout his interview (Too many pharmacy schools? One dean says no).

Bruce Kiacz, BS PharmAnd speaking of “entrepreneurial,” I certainly hope there is a heavy  business school emphasis on developing graduates that will be able to create their own practice, because early indicators suggest that the traditional practice  of pharmacy will soon be on life support, thanks in a large measure to the policy positions of the American Association of Colleges of Pharmacy (AACP) and the American Society of Health-System Pharmacists (ASHP).

A few of the early indicators that our professional organizations,  universities included, continue to sell us down the river are:

Technician programs

The National Association of Boards of Pharmacy in its 2012 Survey of Pharmacy Law noted that at least 10 states permit tech-check-tech programs. Why would a business not want to hire more, lower-paid workers who can be supervised by a single, expensive, “responsible pharmacist?” We all know the resistance to establishing pharmacist/technician ratios, so why not have six, eight, or 10 technicians per pharmacist? Better still, why not create an environment where there is one “operational” pharmacist manager to oversee the “dispensing” technicians and one “business” pharmacist manager who handles contracts, policy, personnel, and committee responsibilities?

While clinical programs might be supervised by an additional “clinical” pharmacist, we are already seeing advanced pharmacy technicians (whose training is another university revenue stream) performing admission medication reconciliation and other tasks, rather than pharmacists.

Automation and telepharmacy

Modern, error-free, robotics will continue to displace pharmacists from the drudgery of “traditional” practice. Robots prepare IV solutions, count and package medications, and where state  law still requires a final pharmacist check, telepharmacy review from a remote location allows a single pharmacist to verify technician work at  multiple locations.

Studies funded by our pharmacy organizations and  often performed at university hospitals, have supported these changes while suggesting a broader, yet legally undefined, role for the profession.

Healthcare information systems

Today, many physicians prefer to speak to the pharmacist regarding drug selection, drug therapy, and other clinical  issues. However, will this communication continue as older physicians leave practice to be replaced by younger graduates, who are comfortable using advanced information systems?

Automation has already made huge inroads to reduce “traditional” workloads. What will happen if IBM's Watson cognitive computing engine, currently being tested at Cleveland Clinic, becomes more universal in the delivery of personalized medicine? Will it be easier for a physician to click the “Optimize Drug Therapy” button in the EHR, than have a conversation with a pharmacist?

Pharmacy has lost control of it's future. Universities see the profession as a “cash cow” by promoting to students a record of historically high salaries during a time of pharmacist shortages.  However, by employing those same shortage statistics, AACP's Pharmacy Workforce Center and the Pharmacy Manpower Project, Inc., have encouraged the construction of dozens of new schools of pharmacy, which will ultimately result in an  oversupply of pharmacists at a time when technology and business interests seek to reduce the expense of pharmacy services.

For many years, pharmacy practice was more or less “protected” by state regulations that defined pharmacist responsibilities to a very granular level. Gradually, these protections have been eroded as our own organizations have advanced changes, such as expanded roles for pharmacy technicians, without addressing the potential ramifications on job security in an environment where pharmacist clinical services do not generate any revenue to support their relatively high salaries.

While I support may of the changes described in these papers, such as ASHP's Pharmacy Practice Model Initiative, I believe that we may be on the verge of a radical change wherein pharmacists will truly have to be “entrepreneurs” to retain their positions.

Bruce Kiacz is the former director of pharmacy (retired) of a community hospital in northwest Ohio.

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