What’s in a Title?

Academia just loves titles, initials, and degrees after names, but I contend that real-world experiences are what truly matter. I don’t care if you have 30 letters after your name. What practical knowledge do you have in patient care? It doesn’t matter to me whether you can draw the structure of naloxone if you don’t provide it to a patient at risk for overdose.

Robert H. Jackson is a stellar example of how on-the-job training is far more important than the degrees attained or the letters after your name. Jackson was born in Warren, Pennsylvania, a small town in rural northeastern Pennsylvania, approximately 1 hour from the small town I grew up in. Jackson was a lawyer who worked his way up to solicitor general, attorney general, and associate justice of the Supreme Court.

Although these titles are all impressive, Jackson is most renowned for being the chief prosecutor for the United States in the Nuremberg trials in 1945 and 1946. Although the other 3 Allied powers—the British, the French, and the Russians—thought a trial of the Nazi regime was not necessary, Jackson pushed for a trial that would eventually become the basis for international law.

It’s fair to assume that an attorney of such caliber would have been trained at Yale University, Princeton University, or Harvard University—but he was not. Jackson did not possess a degree from an Ivy League school; rather, he attended the University at Albany and enrolled in law school for 1 year. He went on to practice law and quickly rose to the top of his profession. With only 1 year of study at a university, this brilliant man went on to leave his fingerprints all over international law. I encourage you to watch his opening statement at Nuremburg on YouTube.

In the late 1990s, all schools of pharmacy switched from the 5-year BSPharm degree to the PharmD degree. We thought adding more letters to our profession’s degree would be of great benefit, but I believe that this has not worked out as planned. Students pay for another whole year of tuition for “exposure” to different elements of the profession. When I graduated in 1981, we had three 5-week rotations: hospital pharmacy, community pharmacy, and clinical pharmacy. After those 3 rotations were done, I was well satisfied with my choice to practice community pharmacy.

A few days ago, a young woman came to the pharmacy with a prescription for doxylamine/pyridoxine (Diclegis), which wasn’t covered by her insurance. Her husband piped up: “We’ll pay cash.” I explained that the brand name of this medication cost over $500, and the generic cost over $200. “Let’s take a walk out front,” I said. We walked to the sleep aids aisle and grabbed a box of doxylamine (Unisom SleepTabs), then went to the vitamin section and grabbed a bottle of vitamin B6 (pyridoxine). I explained to the couple how this combination of OTC medications would work—and for less than 10% of the generic prescription price.

A funny thing happened during our walk and discussion: They never looked at my credentials. This young couple just saw an experienced pharmacist, who didn’t need a phone or computer to help them. All this seasoned pharmacist needed was the desire to help this struggling woman who had been vomiting for 2 weeks.

Since graduating over 40 years ago, I have not added a single letter to my professional title. I will admit it has held me back from consideration for some academic opportunities. But watching the way an experienced pharmacist practices, it’s not clear that anything is missing. Like so many of my fellow bench pharmacists, individuals like Jackson exemplify the way that hard work and practical experience trump letters after your name, or the prestigious institution you graduated from.