In this third installment of Dr. Tice's responses, you will find: discussion of lack of professional mobility between types of practice, board certification, age discrimination, calling out companies for abusive practices, traditional pharmacists and technician support.
PA:
While we are on the subject of competence, let's talk about another vast rift between members of our profession. Many of us working in the community are not "residency-trained", for any number of reasons, not the least of which is that some years ago, residency was touted as a kind of "spring board" - an intensive training course that would provide pharmacists with the equivalent of 3 to 5 years of experience. Today however, we have moved more towards "residency trained" and "non-residency trained" as two separate classes of pharmacists - leaving those who chose not to complete a residency upon graduation frustratingly stuck and "unhireable", no matter their aptitude and competency. What options exist for us as the job market increasingly narrows?
BT: APhA policy and all our advocacy work is based on the voluntary nature of residencies or specialty training. Pharmacists today graduate with a PharmD and are deemed ready for practice by their academic standards. We also recognize that our degree is only the beginning of lifelong learning. No pharmacist, nor any professional, should expect to grow stagnant and still prosper in their career. We have an obligation to stay up to date and prepare ourselves for the changing needs of our patients and emerging opportunities within the health care system.
It is true that many pharmacists seek additional credentials, and we are supportive of that, but not as a mandatory requirement. In the growing team-based care opportunities, special skills may be appropriate, so we will make every effort to provide them for those who want to differentiate themselves.
In every policy position APhA takes and with new services developed, we ensure a path for all pharmacists. We advocate for residencies to increase what pharmacists can do, but at the same time we work to create a path for non-residency trained pharmacists. There are times where we work with regulators outside the profession to establish a new service like immunizations, and the regulators authorizing the service have not seen pharmacists doing that before, so they want to require additional training. For example, as provider status passes in more states, we’re working to ensure a path for non-residency trained pharmacists to be able to participate.
APhA also created ADVANCE, a soon-to-be-released program that enables employers and pharmacists to create paths to continue their clinical competency. If an employer wants its pharmacists to be equipped to deliver a certain service, the training can be “served up” in that area and then pharmacists can work through it to get qualified.
In addition, Pharmacy Profiles was created to facilitate the verification of pharmacist credentials, networking, and system recognition and engagement of practitioners. When we say “verification of pharmacist credentials," that is the process of confirming that the person has an active, valid license, is in good standing (e.g., does not have any sanctions preventing them from being paid), and has a means to document of all of their special training in one location. It is not requiring extra training or residency training.
PA:
We know the option of certifications like the BCACP exist, but many have experienced that employers still do not consider community pharmacists who have achieved this distinction to be worthwhile hires, given the availability of desirable residency-trained pharmacists. How do you think APhA could impact the viability of role mobility for pharmacists? And while we're at it, why does it almost seem as if BPS actively tries to prevent community pharmacists from achieving such distinctions? (By this I mean requiring a letter from employers for eligibility, when the primary employers have made it abundantly clear that they have no interest in the advancement of patient care, or of their front-line employees).
BT: The eligibility criteria for BPS board certification examinations are developed by each respective Specialty Council and are reviewed and approved by the BPS Board of Directors. Historically, there have been two to three separate pathways—for example, PGY2 training, PGY1 training plus 1–2 years of specialized practice experience, or 3–4 years of specialized practice experience alone. This is because there are well-recognized barriers to completing postgraduate residency training, such as the limited number of residency positions available, and the lack of residency programs for certain specialized areas of practice (e.g., nuclear pharmacy, nutrition support pharmacy, and compounded sterile preparations).
Given the current gap between the demand for residency training and the availability of resident positions, it is unlikely that BPS eligibility pathways will change—meaning a residency will not be required to be able to sit for board certification—for the foreseeable future. Community practitioners are certainly eligible to sit for board certification. That could change in future years, depending on whether sufficient numbers of resident positions are available to meet the demand across the profession.
PA:
What do you have to say about the phenomenon of age discrimination in pharmacy, particularly in the community sector?
BT: APhA does not support any form of discrimination whether it be age, race, color, national origin, religion, sexual orientation, or disability. We recognize that the needs of the health care system and individual practices might shift, and we encourage employers and individual practitioners to reasonably provide or obtain the necessary skill sets to meet emerging needs.
PA:
Many have asked why APhA does not openly "call out" the biggest culprits of the mentioned infringements on the practice of pharmacy and the safety and well-being of both employees and patients. What do you have to say to that?
BT: They know who they are. Our goal is to do our best to promote constructive dialogue instead of lobbing missiles. That approach isn’t satisfying to some and we understand that. This has been discussed many times in the House of Delegates and in other settings. Typically, what happens is that policy is intended to be longstanding where it is better to address the issue than get engaged in name-calling. It is a small world and we often end up working with people we have disagreed with in the past, so naming specific entities is generally not done except in unique circumstances. The recommendations from this summer’s consensus conference do call for greater transparency and dialogue, and APhA and other organizations and individuals across the profession will be using the recommendations to address identified concerns.
PA:
Does APhA care about community pharmacists? Many have accused the organization of either abandoning traditional pharmacy roles or even actively working to harm those who work in the community. Can you tell us if APhA cares more about the "clinical" (ugh, sorry, I hate that descriptor in the way it is currently used, I have to choke on it a little) pharmacists than the others?
BT: This is one of the most interesting questions because it really speaks to the disconnect between APhA members and non-members. APhA and state associations are the leading advocates for community pharmacy practice. APhA specifically advocates that those using the term “clinical pharmacist” to differentiate from those practicing in community pharmacy are flat wrong! Community pharmacists ARE clinical pharmacists and provide direct patient care every day to real patients. There are residencies in community pharmacy because of APhA and pharmacists working through APhA to establish them, for the specific reason that APhA values community practice. Unlike other residencies where a pharmacy organization receives significant funding and fees, there is zero revenue to APhA. Our support of community pharmacy residencies is on our own dime. Additionally, the pharmacies that offer these residencies are not compensated. Yet, these residencies are a real cauldron of innovation and are essential for the long-term health of community pharmacy. We will continue to support them. Additionally, new clinical services have been established with and for community practice to broaden the clinical reach of community pharmacy. The APhA Foundation has and continues to highlight the value of community pharmacy and pharmacists through its demonstration projects.
APhA’s academies and House of Delegates have called for the development of mechanisms for referral between pharmacy practitioners and between pharmacists and other health practitioners. We have created resources to support this work, and our work on transitions of care have also supported the removal of actual or perceived barriers between pharmacy practitioners.
PA:
What does APhA offer to pharmacy technicians? Is there any consideration towards advocacy for these often under-appreciated folks who bear much of the brunt of an increasingly dissatisfied public for meager wages?
BT: APhA is one of the founding organizations of the Pharmacy Technician Certification Board (PTCB), created to provide recognition and consistency for technicians, who play an important role on the pharmacy team. Through PTCB certification, we have seen enhanced salaries and advanced roles for technicians, and increased confidence in the knowledge of the technicians they work with for pharmacists. While pharmacy technicians are not a major proportion of APhA’s membership, we do provide education, resources, recognition, and networking opportunities for pharmacy technicians.
Interview continues in:
Part 1: background, introduction, pharmacy working conditions
Part 2: oversaturation, regulatory capture, PBM/DIR abuse, and the practices and number of pharmacy schools, resident pay
Part 4: CEO compensation, provider status, "too little too late", Dr. Tice's blogging and social media involvement, and Dr. Tice's new opportunity, Aspen RxHealth
Part 5: The Cynical Pharmacist came to play! Read about compensation for services, corporate abuse of scope of practice, polling and scientific studies on the state of the profession
Footnote from Dr. Tice:
"Thank you for the opportunity and taking the time to read the responses. If there is something missing, that you do not like, or even better yet, that you do like and what to get more engaged, please feel free to reach out to me directly at bptice@gmail.com or text me at 615-574-9638."
As a note from PA to my readers: PLEASE, help with providing constructive feedback and represent our community well. Dr. Tice spent a great deal of time to provide us with these answers to questions I curated from site member feedback. If you take issue with his answers, please say so in a respectfully dissenting manner. Dr. Tice's contact information is listed at the bottom of each installment and he is listening to your feedback. I would love to see the conversation continue in the blog comments below each installment.