Meeting the PharmD Challenge: Back to School? Michael J. Major

The reason for your relegation to backseat status? The arrival of the "all-PharmD curriculum"-the upshot of the American Council on Pharmaceutical Education's 1989 mandate that all accredited pharmacy schools phase out the BS and move to the PharmD as the sole entry-level pharmacy degree no later than the year 2000. Beginning this year, all new pharmacy school enrollees will be required to complete six years of coursework leading to a doctorate of pharmacy. By 2005, the five-year BS in pharmacy will be a thing of the past. The impact of this shift is already being felt. According to the American Association of Colleges of Pharmacy, 64% of the graduating class of 2000 will have a PharmD, up sharply from 25% in 1997.

If you're one of the tens of thousands of pharmacists who hold only a BS, the degree you were once so proud of is quickly becoming passé. You're told that you won't be able to compete in the marketplace; you won't even be able to compete with young graduates fresh out of pharmacy school. Just to run in place, you'll have to spend as much as $30,000 to go back to school for three years, or spend almost as much to attend even-ing or weekend classes in one of the nation's roughly 40 non-traditional PharmD programs-just when you had started dreaming of retirement.

Faced with the unsettling prospect of being buried in a deepening PharmD blizzard, what do you do? Put your practice on hold and go back to school full-time? Enroll for part-time study in a non-traditional program? Or simply stand pat with your BS, grit your teeth, and stick it out?

Do You Need a PharmD?

In the view of Armon B. Neel, Jr., FASCP, president of Institutional Pharmacy Consultants in Griffin, Georgia, "It will be necessary for all pharmacists to have a PharmD, for they will be helpless in the marketplace without it. . . . And I think there should be one universal doctoral degree that all pharmacists launch from." But Neel believes that compelling practicing pharmacists with a BS degree to go back to school is neither fair nor necessary.

"I've looked into a number of traditional and non-traditional PharmD programs and have found they're too academically oriented," Neel says. "There's a lot of preliminary-even remedial-work in the courses, and the schools themselves are now 20 years behind in responding to the modernization of the clinical aspects of how the profession is actually being practiced." In a broad sense, he says, "Educators really need to go back and rethink their agenda so that students are taught more to be clinicians and facilitators of care and less to be simply order-takers and retailers."

Neel says the key distinguishing characteristic of the PharmD curriculum-an extra year of study in a clinical rotation to hone patient-care skills-is an excellent idea, but hardly necessary for someone who's already practiced several years in the field. A more equitable solution, he believes, would be development of a standardized method to assess practicing pharmacists' skills and knowledge base, then requiring individual pharmacists to acquire only the additional education they need to meet objective standards of skills and knowledge. For some, that might mean three years of additional training; for others, it might mean three months. For those who meet those standards, Neel believes, the doctorate should be "grandfathered" in, as was the case some years ago with the doctorate of jurisprudence for lawyers.

'Did You Earn It?'

However, Marasco believes, a PharmD credential acquired through grandfathering, testing, or even a non-traditional pharmacy school curriculum may be devalued-and called into question. "The first question some people will ask is: Were you able to complete [a non-traditional PharmD program] in a shorter time frame than that involved in completing a traditional academic program? The next question will be: Did you earn your degree or was it simply given to you because you were grandfathered in or took a test?" For those reasons, he says, "I went back to school to get a master's degree in pharmacy administration so that I would have something solid to differentiate myself if and when I receive the PharmD designation somewhere down the road. So when I'm asked, 'Were you given your PharmD or did you earn it?' I can reply, 'Well, I may have been given my PharmD, but I earned my masters."

Marasco, one of the first recipients of the "Certified Geriatric Pharmacist" (CGP) designation conferred by the Commission for Certification in Geriatric Pharmacy, believes credentialing programs and specialty traineeships, such as those offered through ASCP, are an excellent way to acquire the clinical skills and professional differentiation pharmacists want. "The intense, specialized training I received as a participant in the ASCP Research and Education Foundation's Parkinson's Disease Pharmacotherapy and Wound Care Traineeships was some of the most rewarding of my career," he says. "The clinical abilities of the facilitators and the other attendees greatly motivated me to be better at everything I do professionally. The end result is that I gained additional knowledge many other pharmacists may not have"-knowledge he feels will be invaluable in setting himself apart from the pack and gaining an edge on the competition.

In Marasco's view, the most important issue is not whether a pharmacist holds a PharmD degree or designation, but their level of competence. When Marasco interviews prospective pharmacist employees, he looks primarily for clinical, computer, and communication skills, giving the nod to a PharmD graduate only if that candidate is clearly superior to one with a BS or if the two are equivalent in every other way. It's widely accepted that up to half of the knowledge acquired in pharmacy school is obsolete within two years of practice, he notes. "If you are not continually increasing your knowledge after graduation, within a couple of years you may not be able to practice effectively in a clinical setting." He says he religiously reads about 12 journals a month, as do his closest professional colleagues, "as a matter of pride," so they can stay at the highest level of their profession.

Marasco agrees with Neel that pharmacy schools, like medical and nursing schools, are somewhat behind the curve in training students in the latest clinical practices, as well as recognizing that many practicing pharmacists do not keep their knowledge current after graduation. Regardless of the degree they hold, Marasco says, it's incumbent upon pharmacists to embark on a process of continuous skills enhancement and lifelong learning.

A Strong Motivating Factor

Instead, Kazarian decided to return to school to study psychology, "purely for recreation and enjoyment," and he has found the experience has had significant spin-off benefits from both a personal and business standpoint. "My wife saw me enjoying the school experience-not just the studying, though that was certainly part of it, but also just being back in school. So she enrolled in the PharmD program at the University of Florida. Halfway into her first year, as I saw the neat stuff she was doing, I got a bit envious," he admits.

Now Kazarian is resolved to follow his wife's lead. "I'll go on the record: As soon as I finish up my courses for a degree in psychology, I'm enrolling in a PharmD program," he says, adding, "I think pharmacists who don't do it will be shortchanging themselves. I graduated from pharmacy school in 1964, but so much has changed since then. The problem is that it's easy to take a narrow focus and get a very myopic view of the profession. Going back to school gives you the broad overview. For me, I think it's going to be a breath of fresh air," he says. "I used to think of myself as a pretty good pharmacist, and I still do, but I find myself picking up the phone and discussing cases with Nancy all the time. The rate of development of new knowledge is phenomenal. These days, even if you study only one system of the body, you really can't understand everything. There are so many new discoveries, you simply can't keep up with it all."

What about the expense of going back to school? It's substantial, Kazarian acknowledges, but he believes pharmacists make enough money to afford it, and the cost is far easier to bear if spread over the years. Based on his wife's experience, does he think pursuing a PharmD degree is too time-consuming? "Well, it did take away from our quality TV time," he quips, adding, "We should all be keeping up with reading journals and studying anyway. School just provides a little more structure."

Kazarian believes pharmacists who decide, as he did, to return to school may find it's a more enjoyable, meaningful experience than it was the first time around. "Then, it was more of an ordeal, with lots of things you had to grind through that you often couldn't see the purpose of. But now it's so much more exciting and fun, because you immediately see the significance of what you learn in your everyday work life."

Asked how he might feel about receiving a PharmD degree through grandfathering or some sort of examination, Kazarian is unequivocal: "I think it would be shameful to claim a degree I didn't earn. I'm a registered pharmacist and damn proud of it. I'm proud that my wife has earned a PharmD, but I don't want to claim a PharmD for myself until I earn it."

Kazarian does not share the opinion that pharmacy schools are behind the times. "My exposure is limited to the PharmD program at the University of Florida," he says, "but given the high quality of education there, I would have to assume that other schools' programs are comparable."

The Nontraditional Path

Feldman, who serves on the faculty at Northeastern as a clinical assistant professor, is taking graduate courses in the PharmD curriculum. His many years' of clinical practice will fulfill some of the clinical rotation requirements. "I've been a practicing pharmacist for 26 years and worked 15 years in a psychiatric hospital, so for me to be forced to complete all the rotation requirements would be a joke." Similarly, he says, it would be a joke for someone who has just earned a PharmD degree to assume their skills and knowledge base are equivalent to those of someone who's been in the trenches a number of years.

Northeastern is now moving to establish a full-fledged nontraditional PharmD program. Once that program is up and running, Feldman plans to be one of the first enrollees; the PharmD credits he's already earned will give him a head start.

The program under development at Northeastern, like the nontraditional PharmD programs already established at other pharmacy schools, are specifically geared to the needs of full-time practicing pharmacists. One such program is offered by the Massachusetts College of Pharmacy and Allied Health Sciences (MCPAHS). "A colleague of mine is enrolled in that program, and her experience has also been very positive," Feldman says.

After looking into the MCPAHS curriculum and several other PharmD programs, both traditional and nontraditional, Feldman feels there's "a huge difference" in the quality of the programs offered by different schools. He agrees with Neel and Marasco that some are woefully out of date. "In today's environment, a working consultant pharmacist needs to wear multiple hats. He has to be a good clinician and a good businessperson who understands finance and health administration, as well as having knowledge of how things work in the real world. There is a big gap between the academic and the clinician in the trenches, and the gap is getting wider all the time. You don't really learn anything until you're with a patient-until you actually see a patient in respiratory distress, until you know what a particular type of wound smells like."

Despite the shortcomings of some PharmD programs, Feldman says the best programs have much to offer, particularly with regard to teaching the latest principles of health care administration and, even more important, pharmacoeconomics. "One of the more critical tasks for us today is helping nursing homes and other health care facilities save money by offering comparable but lower-cost drugs. The economics of pharmacy is a big area that needs to be mastered." Another important area is analysis and proper interpretation of scientific studies. "Most published papers have an abstract, a synopsis, and a conclusion. Many pharmacists read those and assume they understand scientific fact. But if you read the full study and talk about the design of the study, many pharmacists go blank in the face. They don't really understand the methodology of the research, whether it's valid or not-for instance, the difference between a p value of 80% and one of 90%, which makes a big difference." A good grounding in modern pharmacoeconomic principles is crucial, he feels, to being able to translate research findings into better patient care practices and improved outcomes.

Feldman feels a high-calibre nontraditional PharmD may be the best way for many veteran pharmacists to meet the PharmD challenge without an undue sacrifice in time or money. "You fully earn your PharmD degree, in a reasonable amount of time, while still maintaining your full-time job." Best of all, he says, "You can still have a life."