Should Pharm.D. still be required for retail pharmacy

Since the Accreditation Council for Pharmacy Education (ACPE) is currently reviewing revised guidelines for the Pharm.D. degree, now is a good time to take a look at whether the switch to the Pharm.D. as the entry-level degree has been a boon or bane for the profession.

The conversion to the Pharm.D. degree came with great hope, great expectations, and great fanfare. But I believe these expectations have not been realized in the community pharmacy setting. I've never worked in a hospital, so I am unqualified to offer an opinion on the impact of the Pharm.D. on hospital pharmacy.

In my opinion, there is no greater contradiction in pharmacy than the position of pharmacy schools, which promote the Pharm.D. degree, and that of big retail employers, many of which would like to replace pharmacists with technicians and robots. The views of these two parties are diametrically opposed.

Proponents of the Pharm.D. degree argue that with the increasing complexity of drug therapy, today's pharmacists need to be armed with more education. In my 25 years' experience as a pharmacist, I have found that I needed more time and more staffing far more than I've needed more education. From my perspective, understaffing and (let's be honest) simple pharmacist carelessness are the main causes of drug errors.

All the errors I recall have been caused by mundane things like simply putting the wrong pill in the bottle, typing the wrong directions on the label, giving the pills to the wrong patient, and so on. I don't recall a single instance of an error caused by failure to understand a drug interaction, contraindication, precaution, or warning.

I suspect that the majority of B.S. pharmacists would say that they're just as good in the retail setting as Pharm.D.s. In fact, many B.S. pharmacists believe that their years of experience in retail give them an advantage over freshly minted Pharm.D.s.

In many ways, the pharmacy computer has leveled the playing field between B.S. pharmacists and Pharm.D.s. The pharmacy computer is a powerful tool to screen for drug interactions, contraindications, warnings, precautions, high/low dose alerts, and drug allergies. The pharmacy computer can be like providing all B.S. pharmacists with a Pharm.D. degree. That is, if we only had time to properly address all the information that the pharmacy computer is capable of giving us.

Pharmacy schools want their graduates to increase their interaction with patients. Many employers want just the opposite because they think that counseling slows down production. Schools train students for an environment in drugstores that all too often simply does not exist. Upon being licensed, pharmacists often go through a period of culture shock and bruised egos when they find themselves running the pharmacy cash register and ringing up Doritos, Chiclets, and suntan lotion along with patients' prescriptions.

The big employers view pharmacy as mainly a business that deals with the distribution of products, whereas pharmacy schools regard pharmacy as primarily a cognitive enterprise. I seriously doubt that these two concepts can coexist in the McDonald's version of pharmacy.

In any culture, there are many subjects that are taboo. Some people say you can understand a culture best by examining the questions that are routinely avoided. In our profession, a taboo question is whether the Pharm.D. degree is needed in retail pharmacy. I think it's time we addressed this controversial issue.

The purpose of a Pharm.D. degree is to ensure pharmacist competence and improve patient outcomes. If the Pharm.D. degree has not translated to fewer errors and better counseling for patients, is it time for pharmacy schools to set up a separate degree for community pharmacy?

The Author, a community pharmacist in Delray Beach, Fla., encourages feedback at dmiller1952@aol.com
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