Schools are divided on mandated residency

August 6, 2007

After the leadership debated the issue of requiring residency for all new pharmacy school graduates by 2020, the American Association of Colleges of Pharmacy decided to delay action and voted to refer the policy statement, that the AACP backed an accredited residency program for all graduates providing direct patient care, for further study.

Debate over the issue clearly divided many of the members after the Council of Deans voted down a proposal that pharmacy schools should hire only faculty members who had residency training.

"We need pharmacists to step up now to provide direct patient care to their patients," said Marilyn K. Speedie, AACP president. "We don't want to send a message that we think they are unable to do so or place an artificially higher barrier to their being approved to do so. A full year of residency for all is definitely a barrier."

But John E. Murphy, Pharm.D., associate dean of the University of Arizona College of Pharmacy, supports required residency because "the primary benefit is to improve patient care." He said ASHP's house of delegates just passed a resolution supporting a one-year accredited residency for all pharmacy graduates who will be providing direct patient care in 2020. "The need for pharmacists who can manage patient therapy to ensure safety and effective drug use is undeniable," he said.

Even with the shortage of pharmacy faculty projected in the next 10 years, Murphy contended that it is time to be "creative and bold. In the short term, patients derive direct benefit through decreased adverse drug reactions, decreased drug interactions, and improved responses to prescribed drug treatment."

Speedie, who is dean of the University of Minnesota College of Pharmacy, said she backs voluntary residencies as well as developing specialists who deal with complex patients. "One premise for the proposal to require residencies is that current Pharm.D. education does not prepare pharmacists to provide direct patient care," she said. "I disagree. I cannot speak for the graduates of all colleges and schools of pharmacy, but certainly the graduates I see are not only able to provide medication therapy management, but are indeed taking positions where it is the principal practice."

Adding a residency requirement now is adding an extra layer of care that is not necessary, Speedie said. "We have to be bold, but sometimes being too bold actually works against what we want to accomplish."

However, Murphy argued that educational institutions don't change rapidly. A residency enables a student "to really mature and develop patient care skills because we can't do that in pharmacy schools," he said.

But Speedie contended that the group's intention to eventually require residency will discourage current practitioners. "It suggests they aren't able to change their practices to incorporate medication therapy management," she said.

"If indeed the graduates ... are missing some critical skills now, we must engage in educational improvement so that they are graduating with knowledge, patient care skills, and health improvement skills," Speedie said. "Individuals who think our graduates are lacking must let us know what additional skills are needed to meet their expectations."

Speedie also noted that graduating students have "significant debt" and a residency requirement would only increase that problem. "There is every indication that the federal government is less and less willing to support required medical residencies," she said. "I don't see this changing by 2020, and we wouldn't have until 2020 to start a significant building of new residencies to support the requirement at that time."

THE AUTHOR is a writer based in Florida.