Good idea or overkill? Mandatory residency requirement sparks controversy

August 20, 2007

A recent resolution by the American Society of Health-System Pharmacists to require postgraduate one-year residencies for all pharmacists involved in direct patient care, has long-term consequences-and brings long-term controversy.

Perhaps it is an idea whose time has come. Or perhaps it's an overreaching attempt to prove professionalism.

"It is a lofty goal," said Sarah Ray, Pharm.D., clinical coordinator for ambulatory pharmacy services at Aurora St. Luke's Medical Center in Milwaukee. Aurora's residency program trains one community pharmacist and about eight health-system pharmacists every year.

Kasey Griffith, Pharm.D., sees the issue close up. Last year she was a resident in a community pharmacy program at Kerr Drug in Benson, N.C. This year she is a preceptor in the same program. "It is very valuable, and the experience is very practical," she said. "It can be scary your first year of hands-on practice, with a whole new set of responsibilities. This is a balancing experience, with a mentor in place to fall back on."

About 2,000 pharmacists are now participating in nearly 900 postgraduate year-one (PGY1) residencies in hospitals, clinics, community practices, and managed care settings. They generally receive stipends during their participation. That follows six years of rigorous-and expensive-education to achieve the doctor of pharmacy degree required of every licensed pharmacist since 2004.

ASHP's view

"Residencies are very valuable programs that offer hands-on training," said Janet Teeters, M.S., director of ASHP's accreditation services division. "We are recommending that people require this year of residency. It will be up to employers of pharmacists to determine whether this becomes a mandated policy." ASHP accredits residency programs through its Commission on Credentialing (CoC), but several professional organizations play a role in setting standards. Along with ASHP, the boards of the American Pharmacists Association (APhA) and the Academy of Managed Care Pharmacy (AMCP) approve standards for community pharmacy and managed care pharmacy residencies, respectively. The American College of Clinical Pharmacy (ACCP) also partners with ASHP to promote residency programs, but its board does not approve residency program standards. Representatives from all three organizations serve on the ASHP CoC.

"We believe strongly that residency programs provide the next generation of leadership in managed care pharmacy," said Mark Brueckl, R.Ph., AMCP assistant director of pharmacy affairs. "Participation in a residency program offers a leg up to someone seeking employment in a health plan or a pharmacy benefit management company, and we think it provides the potential for higher income. The hands-on experience in formulary design, network management, and pricing is invaluable."