| How Should the Scope of Pharmacy Practice Be Decided? |
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How Should the Scope of Pharmacy Practice Be Decided? Overall, scope of practice must be guided—not by emotion or protectionism—but by true action in the public interest. Is there a hotter term in the pharmacy sphere now than the phrase “scope of practice?” It seems that everyone has an opinion, some expressed ardently, yet there remains a lot of confusion about the way in which the term is understood and applied. Moreover, there is reasonable conjecture about who exactly may lay claim to authority in relation to this matter. Beyond any doubt, it has been established that pharmacists do have a critical role in various aspects of health care. These roles range across acute care in hospitals, long-term care, consulting practices in various settings, and in traditional community pharmacy. Of course, scope of practice was previously not a big thing to consider—pharmacists were largely entrusted with the tasks of dispensing prescriptions and distributing medicines—essentially fulfilling to the letter the instructions of physicians, and this would sometimes involve compounding products that could not be procured from commercial sources. These were roles contemporary to the times where pharmacists operated in a specific niche, but of course times change. Pharmacists now have training and expertise that justifiably positions them as the foremost authorities in promoting safe and effective medication use, a rubric of skills that extends well beyond those inherent to the original roles of the work. There is no reason to think that once the pharmacy profession had transitioned beyond original, traditional roles, scope should effectively be frozen at that point, with no opportunity to adapt or further develop. The education of pharmacists has become considerably more sophisticated, and it includes experiential learning delivered in multidisciplinary settings. This curriculum is in common with other professionals in health care: Advances in pharmacy training and practice should progress in a fashion analogous to that of other disciplines such as nursing, psychology, dentistry, or indeed medicine itself. What is in question, therefore, is the scope of practice, bound inextricably to the evolving duties, activities, and responsibilities that attach to qualified personnel, circumscribed by relevant legislative frameworks, and implied authorizations in specific law. Sometimes regarded as the boundaries of practice, scope is contingent upon regulations, local institutional policies, and professional guidelines. FMuch anguish has arisen, at times quite vitriolic in nature, about what the scope of practice for pharmacists ought to be. Some stakeholders, often those with a profound conflict of interest, make public declarations and representations to legislators, seeking to influence the parameters of scope of practice for pharmacists. Consider, for example, a letter sent from the American Medical Association to various US Congressional leaders, ostensibly seeking to “protect the health and safety” of patients by opposing legislation allowing pharmacists to test and treat patients for certain illnesses.1 Although it is not difficult to understand the possible motivations involved—both honorable and possibly much more base in nature, the tone of the correspondence is unmistakable. The letter, dated July 23, 2024, includes phrases such as “this bill would inappropriately allow pharmacists to perform services that would otherwise be covered if they had been furnished by a physician” and “while pharmacists are well-trained as medication experts within an interprofessional team, their training in patient care is limited” and “neither the didactic nor practice experience component of a pharmacist’s education prepares them to clinically assess patients.” All of this stated like undifferentiated, indisputable facts, dogma coming from a group of influential medical organizations and directed at some of the most powerful stewards of political process that exist in the nation. Here is a group of people who presume to speak authoritatively about another profession of whom they, at best, have limited insight into the real nature of the training, experience, or skillset of that profession. Imagine if the converse were to be true: Would a coalition of pharmacy-related groups write to Congress to assert that because physicians lack the explicit and sophisticated training in medication relevant sciences that the right to prescribe medications should be rescinded from the ambit of medical practice, and instead left to rest with pharmacists alone? Consider the affront, the outrage, the acerbic response that would arise. Yet, there is a cogent argument that can be made to say that physicians should be left to diagnose and order tests (as they are extensively trained to do); after which, the task of selecting and prescribing drugs, with due deference to the myriad of relevant considerations (that are often obscure to physicians) should be restricted to the health professionals who receive the right training to do so. After all, with a packed training agenda, it seems apparent that physicians receive a dangerous dearth of information and training in medication-related sciences. This alternative scenario will never come to pass, of course. To be honest, nor should it. The question is, why would one professional group presume to dictate and delineate the scope of practice for another? Overall, scope of practice must be guided—not by emotion or protectionism—but by true action in the public interest. Factors like improving patient safety and overall standards of care, optimal access to timely health care, cost-effectiveness of care models, reducing inappropriate load on hospitals and primary care clinics (particularly in times of health crisis) need to be considered alongside the training and availability of professionals engaging in the provision of health care. Balanced against this, sensible legislation and systems design are needed to guard against scope confusion, outlining who can or who should be delivering care, and who can be recognized with properly remunerated provider status. Liability issues must be considered, appropriate legislation designed and implemented without fear or favor, and a workforce capable of delivering the necessary care must be trained or recruited and retained. If the COVID-19 pandemic has taught us anything, it is that demands upon the health systems of the world can be very dynamic. Failure to adapt and respond can prove to be misguided. The previous trenchant resistance to increased involvement of pharmacists in vaccination efforts has largely been forgotten now, but if it had succeeded in locking pharmacists out of this part of the scope of their practice, the cost in terms of human misery and financial implications would have been enormous. As it happens, pharmacists played a vital role in the pandemic response, actually bravely stepping up to address an urgent need in a time of crisis. Chris Alderman BPharm,
© 2024 American Society of Consultant Pharmacists, Inc.
1. Henry TA. Physicians to Congress: Don’t Expand Pharmacists’ Scope of Practice. AMA News Wire. American Medical Association. Published Aug 9, 2024. Accessed September 20, 2024. https://www.ama-assn.org/practice-management/scope-practice/physicians-congress-don-t-expand-pharmacists-scope-practice |
10/23/2025 » 10/26/2025
2025 ASCP Annual Meeting & Exhibition