December 16, 2011

Pharmacists Education: B.S.Pharm to Pharm.D. — the Evolution of a Profession

by Ashley McCabe, PharmD, PGY1 Community Pharmacy Resident, University of Maryland School of Pharmacy 

If you or someone close to you has recently graduated from pharmacy school, you know the Doctor of Pharmacy (Pharm.D.) degree is the degree that all pharmacists now earn.  However, not every pharmacist in the pharmacy world has a Pharm.D.  In fact, the education of pharmacists has evolved as the profession has transformed.  The Pharm.D. degree is a relatively new standard in the profession.  As someone who works in a community pharmacy setting, where more pharmacists have a Bachelor of Science in Pharmacy (B.S.Pharm) rather than a Pharm.D., I am intrigued by the differences between the two degrees and how professional education has changed over the years.  I intuitively understood that the doctorate required more years of school but, why did the doctorate become the standard? As a student of education, I wondered what drove educators to alter the curriculum so drastically.  More importantly, as we are undergoing another phase of healthcare reform, it is vital to look at that process, in the event that education will need to transform again based on the needs of the profession and the patients we serve. 

Through my investigation, this is what I discovered.  The B.S.Pharm degree was the norm until 1997 when the Accreditation Council for Pharmacy Education (ACPE) re-evaluated the needs of entry-level pharmacists and patients.1   The changes made were based on recommendations for healthcare provider competencies identified by the Institute of Medicine (IOM).  In 2000, the new ACPE standards went into effect.  Therefore, if you graduated pharmacy school in 2003 or later, the doctorate became the entry-level degree.  As the profession and medical care in general evolved, so did the education of the pharmacist.  The doctorate of pharmacy put more emphasis on medication management – and this proved important when the Medicare Modernization Act passed in 2003.1 Pharmacists needed to employ their cognitive skills to an ever expanding population in need.

 Pharmacy practitioner Paul W. Abramowitz clarified this concept perfectly in his Harvey A. K. Whitney Lecture by describing the transition of pharmacy practice throughout his career.2 He painted a picture of pharmacy practice in 1974, the start of his career, as more humble clinically with limited inter-professional exchanges.  He continued with how the profession morphed as pharmacists became more involved in acute care settings and as the repertoire of medications expanded along with medication-related problems and the pressure to make cost-effective decisions.  Moving into the current practice model, he expanded his story by describing how curriculums now require one year of advanced practice experience in order to fit into the new healthcare model of inter-professional care.  Thus, Mr. Abramowitz helped answer how the doctoral degree evolved, but there is definitely more to it than that.  What were the educators thinking? 

In a recently published article by former dean of the University of Maryland School of Pharmacy, Dr. David A. Knapp, highlighted the thoughts of educators, policy makers, alumni and other stake holders at the time of the transition.3 The article illustrates the lengthy debate and political upheaval that the all-Pharm.D. inspired.  Support from research studies and practice analyses done by both sides of the debate exemplified how difficult the transition really was.  Faculty and staff members at the school were burdened by trying to put additional requirements into a 5 year program.  Adding 2,000 supervised practice hours and 6 months of externship into a packed course load with limited elective opportunities stressed an already bloated curriculum.  However admirable it was, an all-PharmD was despised by many employers, pharmacists, and state legislators who saw a doctoral education as costly and unnecessary, amongst many other perceived undesirable characteristics. But as we all know, in the long run, the all-Pharm.D. transition occurred. 

From an educator perspective, the necessity of transitioning from 5 years to 6 years of education was related to a needs analysis.  The transformation was inspired by the evolving advance clinical roles pharmacists were taking on.  These roles were first explored by practitioners and educators in the 1960’s, 70’s, and 80’s.  In the current economic and political climate, the pharmacy profession is facing different challenges.  Educators and practitioners are sure to have opinions on the topic, but none are as potentially influential as the current students who will become the future of the profession.  Therefore, a needs analysis of the current students could hold the key to where professional education needs to go. 

With the transformation of pharmacy education in mind, as highlighted by Mr. Abramowitz and Dr. Knapp,2,3 I believe it is fair to question where this evolutionary trend in pharmacy education will lead.  This is especially vital when considering the perceived needs of current students as they begin their careers in pharmacy.  Will it be residencies for everyone in order to enhance the retention and transfer of the advanced knowledge and skills first taught in school?  I believe that assessing the needs of the learner, in this case pharmacy students, as well as the needs of our patients should provide the data we need to make informed decisions about the future of pharmacy education and training. 

2.  Abramowitz PW. Harvey A. K. Whitney Lecture: The evolution and metamorphosis of the pharmacy practice model.  Am J Health-Syst Pharm. 2009; 66:1437-46.


Shell said...

What I don't understand is why there is not some sort of equivalency program or addendum course work that can be completed after the fact for the pharmacists who graduated with a B.S. in pharmacy. If you are a currently licensed pharmacist competing with pharmd graduates for positions, it creates a significant loss of value in the education and degree that was originally the one offered.
There should be some sort of allowances made for people who's livelihood is being impacted during this period of transition. Where is the option to graduate from a program designed to change a B.S.Pharm to a Pharm.D for the older pharmacists who have been gaining work experience all this time and are now being devalued?

John Scott said...

Very much agree with Shell. As a 1986 Pharmacy graduate from Auburn University (Rho Chi Honor Society) - I resent that I am not given an easy pathway to quickly gain the PharmD degree - it is not an easy prospect to return to school once you are in the work place and have family obligations. There are a few external non traditional PharmD programs available to BS Pharmacists - but they are expensive and they are NOT convenient to most Pharmacists. I think if you are going to mandate an increased degree standard - at the very least each state should be required to offer a workable pathway to the pharmacist's that did everything that was required of them to gain the necessary requirements to be a fully licensed Pharmacist at the time they entered the profession. My resident state of Alabama toyed with the idea of having a non traditional program through Auburn University - but quickly abandoned this approach because of alack of organization and participation. I am 55 years old and am hoping like everything that I can slip on into my golden years with my BPharm - which I am very proud of ..... the only analogy that I can even remotely compare to the BPharm vs PharmD is a 2 year RN vs BSN - which if the BSN ever becomes the std Nursing degree than 2 year RN's will be in the same boat as BS Pharmacist's. - but with one major difference - BS Nursing programs are plentiful and they have long ago designed a convenient pathway for Associate RN'sto upgrade their degree's

quite capable said...

I agree as well. Traveling out of state, required campus visits, and no credit for 20 years of experience makes no sense. Of course, a B.S. R.P. will be passed up for most jobs in favor of the Pharm.D. R.Ph. I think that the academic world is afraid to include us because they are afraid we will disprove their theory that we are inferior in education and capabilities as the degree mill turn-outs.

Bill Sutherland said...

There have been a lot of interesting posts. I was never concerned about my RPh. in the past. I went through a clinical pharmacy program out of state. At the time they required 3 more years to get a Pharm D. My program was similar to USC , but no Pharm D.The state of California Pharmacist license has no distinction concerning Pharm D or RPh. At one time pharmacists were always needed. It was never hard to find work. Recently I applied to work for an insurance company. They only hire Pharm D. Many hospitals have similar requirements and usually also require a year residency. I had been a Clinical Pharmacist in Home care for over 20 years. This turned out to be a dead end job after Walgreens & CVS bought most of the Homecare Pharmacies. I had been a hospital pharmacist before this. It has been hard to get back into hospitals without the Pharm D. It would really be nice if there was a way to grandfather some of us in. Maybe something like a bar exam. If a procedure was adopted, there would be pharmacists with a lot of experience ready to go.
Journymen experience in other professions counts for something, why not pharmacy. Pharmacy does not take care of their own like some professions. We have been diluted by lackluster Pharmacy Schools on every corner. What does the Pharm D mean anyway for most of the new Pharmacists.

Grace said...

I'd like some more specifics "The changes made were based on recommendations for healthcare provider competencies identified by the Institute of Medicine (IOM)" (which were what?)
"From an educator perspective, the necessity of transitioning from 5 years to 6 years of education was related to a needs analysis...inspired by the evolving advance clinical roles pharmacists were taking on."

The problem here is that the bachelors degrees serve very little purpose in this area now! You take away the vocational BS you take away the point of the bachelors. This is money grab on the part of universities which treat the undergraduate level as a "holding period." We get some remedial/repeat high school education, a lot of irrelevant courses, and a lot of political indoctrination.

I don't blame Pharmacy from "breaking away" from these increasingly inefficient systems. Am I right that you don't HAVE to get the bachelors to attend Pharm D?

If that's the case BY ALL MEANS, focus on the prereqs and go straight for PharmD.

--to the other posters--yes they NEED an online degree bridge BPharms should to transition at a low cost online. MOOCS should be a FRACTION of the cost of brick and mortar. BPharms have been educated and working for YEARS already!! There is NO sense in punishing them like this!