Association Perspective
Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP, Executive vice president and CEO of APhA
My columns in Pharmacy Today and my CEO blogs all share one common thread: truth spoken honestly and sincerely, even if it isn’t easy to write or easy to read. And I’m going to write today about something that I feel deep down needs to be said: pharmacists, be careful what you ask for from your state regulators and legislators.
I don’t know who first coined the term, but there is without question a “law of unintended consequences,” referring to the unexpected results of an action taken. Here’s one prime example. Pharmacists in a state want the authority to prescribe HIV PrEP and PEP after conducting an HIV test and providing counseling on that test. In the process of negotiating with the legislature for this authority, the pharmacy association says “Look, we are so confident that our pharmacists will do a good job no matter what; however, we’ll go ahead and put a provision in the law that requires pharmacists to complete a certificate program in order to provide the service.” Also, nothing in the law that was passed addressed payment for the services of the pharmacist. The unintended consequences: pharmacists aren’t interested in providing a service for which they can’t get paid, and we’ve created an unnecessary hurdle to patient access to care by requiring pharmacists to jump through one more educational hoop.
My longtime friend and former APhA President Marialice Bennett, BSPharm, RPh, FAPhA, famously said “the profession of pharmacy is just one CE course away from being able to do anything!” She’s right! What other health profession places condition-specific or situation-specific educational requirements on the health care professionals licensed in their state? Can’t think of one? Neither can I!
We’ve done this to ourselves. And APhA and other national and state pharmacy associations are largely to blame for it.
Yes, I said it. We are to blame for it.
It was a good idea 30 years ago when immunizations became the first large-scale attempt at engaging pharmacists in nondispensing services in the community practice setting. At that time, you’d have been hard-pressed to find a pharmacist with any training in vaccines and immunization practice.
Unfortunately, by putting requirements that pharmacists need to complete certificate training in vaccines into state practice acts, we’ve set a precedent of expectation among lawmakers, physicians, and health systems that pharmacists need additional training anytime they plan to take on added responsibilities beyond our stereotypical dispensing activities.
If you don’t believe this to be true, just look at the recent efforts to expand pharmacists’ scope into point of care testing, HIV testing and prevention, primary care prescribing, etc. Several states have adopted laws adding more training requirements for pharmacists, discounting the professional education and training provided by schools and colleges of pharmacy and ignoring the professional responsibilities of pharmacists themselves.
Pharmacy is a profession. Professionals self-regulate their provision of care to those things they know they are competent to provide. I’d personally never, as a pharmacist, provide oncology medications or services because I know full well that I’m incompetent in oncology—this should be left to pharmacists who are specially trained and board certified.
We’ve unintentionally said to the world that we don’t trust ourselves to self-regulate. As a pharmacist, I find it insulting—and in my discussions with pharmacists across the country, I’m not alone in this feeling.
State boards of pharmacy and state pharmacy associations: it’s time to unwind the mess that has been created over 30 years and start treating pharmacists as true professionals. Let’s stop placing extra educational requirements on pharmacists going forward. If a pharmacist engages in a practice that is outside of his or her knowledge, leading to harm of a patient, then the pharmacist should be accountable for that irresponsible action. And if they want to provide a service for which they feel they need more training, a plethora of options exist in the marketplace to avail themselves of that training. That’s how it works in medicine, nursing, dentistry, and all other professions. And that’s how it should work in pharmacy, too.
For every pharmacist. For all of pharmacy. ■