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.
References
1. Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Accreditation Council for Pharmacy Education. Chicago; 2006.
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.
3. Knapp DA. The rocky road to educational change: Adopting the entry-level Pharm.D. at Maryland, 1989-93. J Am Pharm Assoc 2011; 51:712-719.