By: Jaclyn Boyle, PharmD, MS, MBA, BCACP, Ryan Sullivan, PharmD candidate 2023, George Fahmy B.S., PharmD candidate 2025, and Dale English II, R.Ph., B.S.Pharm., Pharm.D., FASHP
Why do we need more pharmacists in primary care?
Shortcomings in primary care, particularly in medically underserved areas, presents substantial concerns for patient access. The Association of American Medical Colleges (AAMC) predicts a shortage of 17,800-48,000 primary care physicians by 2034. Primary care serves the purpose of prevention and treatment of chronic illnesses. As community pharmacists are within 5 miles of any person in the United States, our profession can play an integral role in closing this primary care gap. The largest gaps continue to exist in medically underserved areas/healthcare professional shortage areas. Transformational changes in pharmacy within the United States, particularly community pharmacy, through comprehensive medication management, point-of-care testing, collaborative practice agreements, chronic disease state management, limited prescribing rights, and the evolving role of pharmacy technicians have notably expanded the scope of practice of the pharmacist. As pharmacy practice settings change and more patient care services are offered in accessible locations, it is time for our profession to ensure our PharmD graduates are ‘practice ready’ for primary care roles.
Is the entry-level PharmD curriculum in pharmacy education currently preparing/equipping students to provide primary care?
With the impending healthcare professional shortages in primary care looming, current Accreditation Council on Pharmaceutical Education (ACPE) Standard 11 (Interprofessional Education) and Standard 13 (Advanced Pharmacy Practice Experience) ensure that students are prepared to provide entry-level patient-centered care with no less than 36 weeks of experiential learning focused on direct patient care.2 Institutions such as The University of California San Francisco School of Pharmacy provide curricular blueprint examples that focus on transforming their PharmD curriculum to prioritize primary care. They believe less time should be spent in the classroom and more time dedicated to active learning, interprofessional education, and a strong base knowledge of traditional and new domains of science3. The Vice Dean, Dr. Youmans, cited the aforementioned shortage of primary health care providers, expanding practice roles for pharmacists, and recent legislation giving pharmacists the chance to practice to the full extent of their expertise as reasoning for altering the curriculum.3
When comparing the educational competencies of PharmDs to that of other interprofessional associates, such as nurse practitioners (NP) and physician assistants (PA), there are many commonalities. Subtle nuances point to differences in emphasis on therapeutics for pharmacists compared to diagnostic skills for NPs and PAs.4 Pharmacists have been embedded within primary care physicians’ offices within the U.S. as well as internationally. There is a paucity of literature to support the positive impact of pharmacists in these direct patient care roles. However, one could argue that to address primary care gaps across the United States, especially in medically underserved areas, a pharmacist’s knowledge of medication, in collaboration with the diagnostic skills of another mid-level provider, could sufficiently assist in closing this gap.
While the curriculum required to receive a PharmD appears to be comparable to that of mid-level providers, there is not a consensus. The American College of Clinical Pharmacy (ACCP) and American Society of Health-System Pharmacists (ASHP) have position statements and policy positions, respectively, that pharmacy education is not adequate for newly graduated pharmacists to be involved in direct patient care roles. However, there continues to be an inadequate number of residency opportunities available and newly graduated pharmacists would not meet the expectations of the associations’ positions. On the other hand, ACPE accreditation standards for Doctor of Pharmacy programs require graduates to be “Practice Ready”. In order to best support the World Health Organization’s definition of primary care, institutions should focus on sharing best practices in teaching and assessing ACPE Standards 2.3 and 2.4.
So, is healthcare ready for pharmacists to fill in the gaps of primary care??
An ongoing challenge to pharmacists being able to fill the primary care gap exists in the lack of adequate reimbursement for such services. While 37 states legally recognize pharmacists as healthcare providers, the Center for Medicare and Medicaid Services does not currently recognize pharmacists as providers under the Social Security Act, disrupting continuity of care for Medicare beneficiaries.5 Due to a lack of infrastructure to integrate pharmacists into existing reimbursement processes, the profession continues an uphill battle to remove structural barriers in compensation and developing sustainable pharmacy services. Additionally, current ACPE standards do not require colleges and schools explicitly to address reimbursement strategies in their curricula.
How will the Academy approach solutions for closing the primary care gap while ensuring high-level training for pharmacists who can step into this vital role in healthcare?
References
1. Supapaan T, Low BY, Wongpoowarak P, Moolasarn S, Anderson C. A transition from the BPharm to the pharmd degree in five selected countries. Pharmacy Practice. 2019;17(3):1611. doi:10.18549/pharmpract.2019.3.1611
2. Accreditation Council for Pharmacy Education. https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf. Published February 22, 2015. Accessed November 22, 2022.
3. Jacobson, David. PharmD Curriculum Transformation. UCSF School of Pharmacy, The Regents of the University of California, 13 Jan. 2022
4. Manolakis PG, Skelton JB. Pharmacists’ contributions to primary care in the United States collaborating to address unmet patient care needs: The emerging role for pharmacists to address the shortage of primary care providers. American Journal of Pharmaceutical Education. 2010;74(10). doi:10.5688/aj7410s7
5. Weitzman, Debbie. Provider Status for Pharmacists: It’s about Time. Pharmacy Times, Pharmacy Times, October 7, 2020
Author Bio(s):
Jaclyn Boyle, PharmD, MS, MBA, BCACP, is the Assistant Dean of Student Success and an Associate Professor of Pharmacy Practice at the Northeast Ohio Medical University College of Pharmacy. Her educational interests include professional development, well-being and leadership. Jaclyn is very active in professional organizations. In her free time, she enjoys spending time with her family and friends, spinning, and yoga.
Ryan Sullivan, PharmD candidate 2023, is a student at Northeast Ohio Medical University College of Pharmacy. His educational interests include patient care and communication, leadership, and business. In his free time, Ryan enjoys running, working on cars, and spending time with loved ones.
George Fahmy B.S., PharmD candidate 2025, is a student at St. John’s University College of Pharmacy and Health Sciences. His educational interests include primary care, pharmacy education, student development and academia, and clinical pharmacy practice, and especially in ambulatory care setting. In his free time, he enjoys playing basketball, traveling, and watching shark tank.
Dale English II, R.Ph., B.S.Pharm., Pharm.D., FASHP, is the Associate Dean of Student Affairs and Professor of Pharmacy Practice at Sullivan University College of Pharmacy and Health Sciences. His educational interests include leadership, professional development, diversity, equity, and inclusion, and wellbeing initiatives. In his free time, he enjoys spending time with friends and family, the outdoors, and exploring new endeavors.
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