The future of pharmacy
Pulse editor
Sunday, January 18, 2009
Historically, pharmacists have been among the most accessible health care providers. While you had to make an appointment to see a doctor or go to a hospital or health clinic to find a nurse, you could always walk into a corner drugstore and find a pharmacist behind the counter. The guy in the white coat would listen to your symptoms, compound a salve for your rash or mix a formula to sooth a colicky baby.
But with the complexity of health care today, the roles of pharmacists are growing.
Photos by BARRY WILLIAMS / AJC Special
Bradley G. Phillips is a professor and the head of the department of clinical and administrative pharmacy at the University of Georgia’s College of Pharmacy.
First-year pharmacy student Kremena Dimitrova calibrates a dropper in a lab at the University of Georgia College of Pharmacy.
First-year pharmacy students Matthew Mack (left) and Yen Nguyen practice using a torsion balance in a lab at the University of Georgia.
“People think that pharmacists just count pills and dispense medication, but that’s just scratching the surface of what we do. I’m sold on pharmacy, because there are so many opportunities in this field,” said James W. Fetterman Jr., Pharm.D., associate professor and experiential coordinator for South University School of Pharmacy in Savannah.
In 30 years in the profession, Fetterman has worked in drugstores, as a clinical pharmacist in hospitals and has been a pharmacy educator. He also started one of the first home infusion companies in South Georgia.
Pharmacists also work as researchers or as inspectors for pharmaceutical companies, the Food and Drug Administration or the Centers for Disease Control and Prevention.
“In a way, pharmacy is coming full circle, and we’re seeing it lean more toward direct patient care,” Fetterman said. “As the population grows and ages, people are taking more prescriptions, and there is more demand for pharmacists to have hands-on time with patients.
“More advanced-practice pharmacists are specializing and rounding with physicians and other health care providers in hospitals as part of a health care team. That’s a win for patients.”
He’s also sees more retail pharmacists involved in medical therapy management, expanding their services to help patients monitor medications and manage chronic diseases.
“We will probably see more of a shift in the utilization of pharmacists in pharmacies — from a product focus to a patient focus,” said H.W. “Ted” Matthews, Ph.D., R.Ph., dean of the College of Pharmacy and Health Sciences at Mercer University in Atlanta.
Pharmacists will still check prescriptions and talk to patients about drugs and their side-effects, but the actual filling may be done by a pharmacy technicians or through automation.
Making a difference
“The Asheville Project showed that pharmacists could make a real difference in helping with disease management and insurance costs,” Matthews said.
Begun in 1996, the Asheville Project was an effort by the city of Asheville, N.C., to provide education and counseling for employees with chronic conditions such as diabetes, asthma, hypertension and high cholesterol. After diagnosis and treatment, employees with these conditions were teamed with community pharmacists to help manage their diseases. That relationship led to better medication compliance, fewer sick days, lower total health costs and increased patient satisfaction with their pharmacists.
The American Pharmacists Association Foundation has promoted this model nationwide as a way to reduce health risks and lower health care costs, and more employers are adopting it. As a result, more pharmacists are becoming certified diabetes educators, monitoring blood pressures, administering immunizations and providing patient seminars.
“The pharmacist is the drug expert, but drugs have become much more complex, and now there’s more chemotherapy drugs and the whole new arena of over-the-counter herbal medications that can cause drug interactions,” Matthews said. “Pharmacists today have to know more about disease states, anatomy, medicine and have more experience with patients, which is why pharmacy schools have moved to doctoral programs in pharmacy.”
Educating pharmacists
All three of Georgia’s pharmacy colleges — at the University of Georgia, Mercer University and South University — graduate students with a doctorate in pharmacy. South University is one of six accelerated (three-year) programs in the country. All three are seeking to add more students as they struggle to keep up with the state’s demand for pharmacists.
The Philadelphia College of Osteopathic Medicine plans to open a new pharmacy school in Suwanee and will accept students in 2010. Presbyterian College is also starting a new pharmacy school in Clinton, S.C.
Nationwide, the number of pharmacy schools has increased to 106 (up from 81 in 2000) to meet national shortages, said Bradley G. Phillips, Pharm.D., BCPS, FCCP, professor and head of the department of clinical and administrative pharmacy at the University of Georgia’s College of Pharmacy.
According to the final report (June 2006) from the Board of Regents of the University System of Georgia’s Task Force on Health Professions Education, Georgia will need 2,110 new pharmacists and 1,790 new pharmacy technicians to meet demand by 2012. The state’s projection for pharmacy school students is about 470 in 2010 — about 30 percent higher than current student admission levels, Phillips said.
The University of Georgia has a new pharmacy building under constuction that will allow the school to increase enrollment from 127 to 200.
Georgia’s shortfall is considered moderate and has recently declined, according to the Pharmacy Manpower Project, which tracks pharmacy shortages, but all projections point to increased demand for services. There are more unfilled jobs in the southern and western portions of the state than in metro Atlanta or North Georgia. Rural areas often don’t have a high enough concentration of patients needed to support the $90,000 to $100,000 average salaries of pharmacists.
“With the state prescription volume expected to be over 10 billion by 2010 — as compared to under 4 billion in 2002 — and with Medicare Part D leading to increased demand for pharmacy services, all Georgia schools have been seeking ways to increase enrollment capacity,” Phillips said.
Several factors add to the challenge, including a shortage of qualified faculty as more professors retire; a lack of adequate classroom and laboratory facilities; a growing percentage of female students who don’t always work full time after graduation; and competition for experiential sites (nursing homes, pharmacies, drugstores) where students can gain the practical training they need.
Since research has shown that about 60 percent of pharmacists stay in the area of their last year of training, the University of Georgia is addressing the state’s regional shortages by sending more students to its campuses in Augusta and Albany. The school also has put faculty in Savannah and wants to increase its statewide footprint with other campuses.
UGA is also developing more postgraduate residency training experiences in areas that need pharmacists. The university offers one-year residencies in community practice and pharmacy practice and two-year programs in pediatrics and ambulatory care.
“About 25 [percent] to 30 percent of our students are pursuing residency programs now. There’s been a national push to see that pharmacists involved in direct patient care get more training,” Phillips said.
Phillips thinks it’s an exciting time for pharmacists.
“The profession is changing and the opportunities are growing,” he said. “There’s more depth and breadth to what pharmacists are expected and asked to do. Patients are demanding more information, and our students want to have more involvement in providing community health care.”