Lucinda L. Maine, RPh, PhD

Lucinda Maine is executive vice president & CEO, American Association of Colleges of Pharmacy.

 by Dennis Miller, RPh, provides an incorrect picture of the scope and focus of contemporary pharmacy education. Perhaps Miller, as a retired pharmacist, has not had an opportunity to experience pharmacy school recently. And perhaps he is not aware of the accreditation standards that govern our institutions. 

	Today’s pharmacists are educated not only as medication experts, but also as the most accessible health and wellness providers. Approximately 15,000 new graduates enter practice each year, equipped with a broad and diverse range of knowledge and experience.

	The American Association of Colleges of Pharmacy (

) is the national organization representing pharmacy education in the United States. The mission of AACP is to lead and partner with our members in advancing pharmacy education, research, scholarship, practice, and service to improve societal health.

Related article: Why consumers trust pharmacists

	Pharmacy education has been changing progressively for the last 20 years. The Center for the Advancement of Pharmacy Education (

) Curricular Outcomes is the framework for the content of the Accreditation Council for Pharmacy Education standards. As far back at 1998, CAPE defined the scope of pharmacy education as encompassing pharmaceutical care, systems management, and public health.

	In 2013, AACP updated this framework and increased the emphasis on the components of pharmacists’ education and practice that address cultural competence and patient-centeredness. More recently AACP has published a set of Entrustable Professional Activities that communicate what employers, patients and others can expect pharmacy graduates to do, without direct supervision, upon completion of a doctor of pharmacy program.

	While the PharmD curriculum certainly prepares our graduates to be the most well-prepared medication use experts, it also provides students many opportunities to consider the people they serve holistically, taking into account patient concerns and preferences for disease prevention and treatment. 

	Indeed, today’s pharmacists deliver patient care through counseling in community and hospital settings, through home health visits, and through screening programs and community-based clinics that provide outreach to underserved communities. The entrustable professional activities also emphasize new graduates’ abilities in population health and practice management.

	As a result of their excellent education, pharmacists have many rewarding career paths, including ambulatory care clinics, specialty pharmacy, research, government agencies – and academia.

Articles

AACP offers a rebuttal to a Drug Topics opinion article. 

Pharmacy Education: Foundation for Providing Health

	It's been said that the move to the doctoral level of pharmacy education required a 60-year debate that ended just in time. When the provider status bill now moving through Congress is enacted into law, it will underscore the truth of that statement.

	The knowledge, skills, and attitudes pharmacists must have in order to meet the needs of Medicare beneficiaries are exactly those that graduates acquire in our colleges and schools of pharmacy today. It might be said that practice will finally catch up with education.

	The profession wrestled with questions about the level of education pharmacists needed across much of the last century. Before the establishment of an accreditation system in 1932, colleges awarded many different degrees for programs of varied lengths. The bachelor's degree became the standard in the traditional four-year model, but forward-thinking educators and practitioners argued as early as the 1940s that this level of education would not equip pharmacists to both manage drug distribution systems and provide the education and patient management services that the increasingly complex drug armamentarium required.

See also: Specialized training puts pharmacists front and center

	You might ask, "Why were pharmacists not included among the list of professionals when Medicare was enacted 50 years ago?" One simple answer is that at that time, the cost of processing the reimbursement outstripped the actual average prescription cost.

	In reality, there was no vision for pharmacists' patient-care services in this era. In fact, the American Pharmacists Association (APhA) code of ethics contained a provision that essentially said a pharmacist should not inform a "patron" regarding the composition of a prescription or its purpose. In many states, pharmacy practice acts forbade pharmacists from putting the name of the medication on the prescription label.

	In the decades following the introduction of Medicare, medication use has become increasingly complex. Pharmacists in every practice setting have demonstrated their ability to collaborate with prescribers to identify patients' drug-related needs; monitor response to therapy; adjust drug regimens and dosages; and educate patients and their caregivers to achieve intended therapy outcomes. Numerous studies have provided evidence of the return on investment from such services.

	In 2003 Congress enacted legislation to create Medicare Part D. Burdened with high out-of-pocket costs for pharmaceuticals, many elderly citizens had resorted to buying drugs out of the country or had been forced to choose between buying medications or other essentials, including food.The addition of Part D and improved access to medications has actually been shown to lower expenditures in Medicare Parts A and B.

	Pharmacy organizations lobbied successfully to include a modest provision for patient-care services in Medicare Part D, and medication therapy management (MTM) services are currently provided on a limited basis to some beneficiaries. The profession has the potential to offer much greater value, especially to those in medically underserved communities.

See also: How pharmacists can find jobs, get paid, and win provider status

	Are we prepared to deliver such services when Congress amends the Medicare law and adds pharmacists to the list of providers? I believe the majority of pharmacists stand ready to expand their patient-care services, as has been shown with the now ubiquitous availability of vaccinations, a variety of disease-management interventions, transitions-of-care programs, and other services. The integration of pharmacists into physicians' office practices and ambulatory care clinics is further evidence of recognized value and need for more proactive patient management.

	Some pharmacists have dedicated most of their careers to the essential service of drug distribution management and have had only a limited opportunity to render clinical services. As automation increases the efficiency of dispensing and as pharmacists expand their patient-management activities, continuing professional development programs offered by colleges of pharmacy and practice associations will provide opportunities for these pharmacists to build their knowledge and skills to meet the needs of patients and providers.

	Perhaps the highest priority for colleges of pharmacy will be to focus on the professional development needs of pharmacists who serve as preceptors, frequently volunteering their time to contribute to the education of the next generation of pharmacists. AACP is committed to supporting all the efforts in curricular and practice transformation, and to increasing our work with our valued preceptor colleagues.

	As pharmacy is recognized for its vital contribution to healthcare and wellness, pharmacy education will adapt to meet the needs of the pharmacists of today and tomorrow.

is executive vice president and CEO, American Association of Colleges of Pharmacy. 

A 60-year debate accompanied the elevation of pharmacy education to the doctoral level. When the provider status bill now moving through Congress is enacted into law, it will put paid to that particular conversation.

Pharmacy education and provider status

	As we consider how the profession of pharmacy has changed over the last 160 years – and how much it might change in the near future – I want to note the profound changes in pharmacy education over these 16 decades.

	Elements of our history seem to be coming full circle. Physicians played a key role in formalizing pharmacy education in the mid-19th century, because they were concerned with the quality of drug products. They recognized the importance of ensuring the integrity of medicines, and they took the initiative in molding a profession with the skills and knowledge needed to prepare and distribute high-quality medications. Today, physicians increasingly recognize the need to take advantage of pharmacists’ expertise when faced with the complexity of medication management - especially for patients with multiple chronic conditions.

	The changes in education over just the last 60 years underscore that we have, indeed, advanced as a profession. This becomes clear in the context of the APhA Code of Ethics, which from 1929 until 1969 stated: “Pharmacists should never discuss the therapeutic effect of a physician’s prescription with a patron or disclose details of the composition which the physician has withheld.”

See also: AACP, NCPA collaborate on adherence education challenge

	After decades on the front lines of patient care, pharmacists were told to stop “counterprescribing” - and state law even prohibited placement of drug names on the prescription labels.

	This was a challenging time in pharmacy practice, a time when more prefabricated medications were coming to market and when the effectiveness and actions of many medicinal products were often unclear.

	As pharmacists found their compounding duties shrinking, pharmacy educators began to reimagine the curriculum. And education and practice leaders began to accumulate evidence indicating that medication errors could harm patients when pharmacists’ roles were limited.

	A multiyear study of the profession, released in 1949, represented a turning point in thought leadership about pharmacy education and practice. The report recommended increasing the pre-pharmacy coursework to increase both scientific rigor and general education requirements. It also encouraged an evolution of the core pharmacy curriculum in keeping with changes in other professions. By the early 1960s, the degree advanced from a four-year BS to a five-year degree.

	In 1969, the APhA Code of Ethics revision markedly changed the profession’s ethical commitment to patients and society, stating, “A pharmacist should always strive to perfect and enlarge his knowledge. He should utilize and make available this knowledge as may be required in accordance with his best judgment.”

	The change from “should never discuss” to “should make available” was a 180-degree shift for the pharmacist and patient care. Fortunately, pharmacy education had begun to introduce important changes that would help prepare graduates for their new role.

	California schools did not make the four-year-to-five-year BS transition; instead, in the late 1950s they introduced the six-year Doctor of Pharmacy curriculum, thereby ushering in the clinical pharmacy movement.

	In the 1970s, fueled by federal funds to stimulate enrollments across the health professions, schools of pharmacy hired the first clinical faculty members and began to expand the focus on therapeutics within the curriculum. Many schools began to offer post-baccalaureate PharmD degrees as well.

	In the late 1990s, the issue of credentialing that had been raised in 1949 was finally resolved. A single degree standard affirmed that a doctoral level of education was necessary for 21st century pharmacy professionals. A more proactive patient management role for pharmacists was beginning.

	The last revision of the APhA Code of Ethics, released in 1994, stressed the evolution in education and practice: “Considering the patient-pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society. In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust.”

	Contemporary pharmacy education is grounded in this relationship and in the role of the pharmacist as a patient advocate. As we say, “Pharmacists help people live healthier, better lives.”

As specialized pharmacy education has evolved through the years, the value that pharmacists contribute to healthcare has increased exponentially.

Author | Lucinda L. Maine, RPh, PhD

Articles

Pharmacy Education: Foundation for Providing Health

Pharmacy education and provider status

Specialized training puts pharmacists front and center