Ambulatory care specialty certification under study

March 5, 2007

A new specialty certification may be on the horizon. The Board of Pharmaceutical Specialties (BPS) could offer ambulatory care certification as early as 2008. "BPS got the ball rolling, but we have not committed to the development of this specialty," said BPS executive director Richard Bertin. "It is up to the profession to present arguments, pro and con, before that decision can be made."

The arguments have already begun. Cynthia Brennan, Pharm.D., president of ASHP, supports ambulatory care certification. She sees a practical distinction between research and inpatient-oriented pharmacotherapy and more clinical and outpatient-oriented ambulatory care. Brennan also sees the certification as a major step toward obtaining reimbursement for pharmacy services. "We need to help payers understand that pharmacists are specialists," she said. "We need a rational, defensible credentialing system beyond licensure."

Opponents insist that periodic changes to the skill assessment that defines pharmacotherapy are evolving to include ambulatory care. "Pharmacotherapy represents the core of pharmaceutical therapy as practiced across a broad range of care and settings," said Joseph Saseen, associate professor of clinical pharmacy, University of Colorado at Denver School of Pharmacy.

BPS is trying to keep the debate from spinning into acrimony. "We are engaged in a task analysis to bring some definition to the discussion," said Bertin. "You can't hold a reasonable discussion without common definitions about the parameters of the practice. We are all still speculating when it comes to a new certification in ambulatory care."

The five existing specialty certifications (nuclear pharmacy, nutrition support pharmacy, oncology pharmacy, pharmacotherapy, and psychiatric pharmacy) emerged from petitions submitted by one or more pharmacy groups, starting with nuclear pharmacy in the 1970s. BPS reviewed arguments and data before accepting the specialties and created tests to evaluate professional competence. The last new specialty, oncology pharmacy, was approved in 1996. Instead of waiting for new petitions, BPS itself raised the topic of an ambulatory care certification in an attempt to be more proactive in shaping the future of pharmacy. In 2005 and 2006, it sponsored focus groups with members of ACCP, the American Pharmacists Association, and ASHP. The idea was to spur the submission of a formal petition for the creation of an ambulatory care pharmacy specialty.

The focus groups found widespread support for the concept of the certification but also widespread confusion and disagreement over what should be included. "Opinions were all over the map because of different views about what the ambulatory practice is and isn't," Bertin said. Earlier this year, BPS launched an electronic survey of ACCP, APhA, and ASHP members who practice in ambulatory settings. The results will become part of a task analysis to help define ambulatory care pharmacy.

BPS and other interested groups plan to evaluate the task analysis in April. If the analysis suggests that ambulatory care is a practice distinct from pharmacotherapy, Bertin expects one or more pharmacy associations to petition BPS to create a new specialty.

"We have had discussions with several groups on this issue," Brennan said. "We are practicing in a model dominated by medicine. Buyers understand board certification, pharmacists understand it, physicians understand it, and patients understand it. I'm not sure how we will benefit by fighting that model."

For practicing pharmacists, simply being board certified may be the key. Kaiser Permanente Colorado is one of a growing number of health systems that require board certification for pharmacists in patient care roles. Incoming pharmacists must become board-certified within three years. While there is no pay increase, Kaiser picks up the expenses associated with testing, continuing education, and recertification every three years, said Beverly Kroner, Pharm.D., chief of primary care clinical pharmacy services at Kaiser Colorado.