Apothecary, Chemist, Druggist, Pharmacist, What's Next?
I call myself the Digital Apothecary, as a jest to the traditional sense of my profession mixed with my love of all technological things. However, it must be said, that the profession I lead and teach has been called many things in the past. In past centuries, we were known as apothecaries. That can be seen in William Shakespeare works, and even in J.K. Rowling's Harry Potter series. These individuals that were responsible for materia medica eventually graduated to the terms of chemist, druggist and pharmacist this past century.
(For a good look at the history of pharmacy and key individuals, I would invite you to look at this presentation from the Washington State University School of Pharmacy, and at this website dedicated towards historical endeavors of past pharmacists.)
The names change, but overall, the roles do not. Or do they?
Pharmacists, like their forbears, have been tied to the procurement and dispensing of medications. Some traditional pharmacy practices have steadily decreased, to be marginalized by a small subset of pharmacists, such as compounding of medications. We simply do not make everything anymore, and probably for the best. Rather, the pharmaceutical industry has given us a source of prepared bottled medications to dispense to the public.
Originally, it was thought, that this advent would help pharmacists be more engaged with the community. We could step out from behind the counter, and work with patients. However, the steady increase of drugs available, the sheer deluge of medications prescribed, has relegated the majority of pharmacists still to still stand behind the counter. We may not be 'Count, Pour, Lick & Stick' like we use to be, but now we "Call, Confirm, Type, Print, & Verify" like never before. It's amazing, it's not necessarily the drugs that are the problem anymore, we have moved beyond that. It's the infrastructure of current pharmacy practice. We are trying to embracing other aspects, such as increased patient counseling and medication therapy management (MTM) and vaccinations. But nonetheless, the workflow and time to do these activities is of concern.
On the other hand, there is now a substantial number (thought still minority of the profession) of pharmacists engaged in clinical roles. Mostly confined to hospitals and outpatient realms, the push for pharmacists providing clinical services is immense. These pharmacists provide clinical services such as ambulatory clinic services, disease management, antibiotic stewardship, and more.
To embrace this Pharmacy schools have moved to provide further clinical knowledge in students. Towards the last century, we moved away from a BS to a PharmD, integrating clinical courses and rotations into the curriculum. In essence, we have created pharmacists inclined to clinical services, that will for the most part, be responsible for the old practice of medication dispensing, with a few trying to break out and being clinicians.
Pharmacists vs. Pharmacists?
My greatest conundrum, or Zen Koan, is "What is a pharmacist without drugs?" The big push for clinical roles and responsibilities, the legislation proposals for provider status, makes me pause and question is pharmacy moving in a significant direction of practice for all, or will there be a potential schism amongst current pharmacists?
There will need to be a great change in the practice of pharmacy, education, and infrastructure for all pharmacists to be providers or engage in clinical duties. What do we do with pharmacists that do not hold the PharmD, and only hold an RPh? What do we do with the majority of pharmacists that did not do residency? I would hate to see that only pharmacists who gain further training after gaining their PharmD are the only ones eligible for clinical duties. There simply is not enough residencies to go around.
In addition, what about our traditional roles? I love technology, and there are great advances that could soon either help the practice of pharmacy, or remove the human element. If pharmacists are not dispensing, what are they going to do? I think that is the biggest question, how do we make such a transition to other activities, and make them financially viable? We cannot simply flip a switch.
Looking to the Future
My large concern is the public perception of pharmacy. I stand by the fact we have a poor outlook in the grand scheme of things. We are not represented well in the media, as I mentioned before. When was the last time you saw a good portrayal of pharmacists in recent media? For that reason, to expand, will we need to adopt a new name to build a new persona?
Calling oneself a 'Pharmacist' may not be enough soon. It is hard, even to throw in the term 'Clinical Pharmacist' (shouldn't all pharmacists be clinical?) to separate the multiple duties the practice of pharmacy now holds. How can a patient reconcile a pharmacist that prescribes them medicine with the pharmacist they will the go and their medications from? How can two individuals with the same title, perform two so very different duties. If we pursue these great changes for the practice of pharmacy, how do we space ourselves from traditional or left behind roles?
For that reason, I wonder what the name of pharmacists will be in the future. Pharmacy Practitioner? Advanced Pharmacist? Another term? I do not know. But what I do hope is that whatever changes in the future with the profession comes, we as current pharmacists do it together and not separately.