What Does it Mean to Be a Pharmacist?

Apothecary. Chemist. Druggist. Pharmacist. These are labels that have defined the role of individuals in the practice of pharmacy for the past century. While varied, the role has always harkened back to our role as the gatekeepers to medications for patient use. 

Nonetheless, times are changing. There is now a push in the profession to achieve provider status in the United States. Some news outlets have highlighted the changing roles of pharmacists (see USA Today), which may be indicative of new roles in healthcare. But you do not have to look further than mainstream news to spot the upcoming battle that lays ahead for the fight by pharmacists for provider status. 

But this is nothing new. Pharmacists have been engaged in some avenues of clinical status for several years now. Several large organizations such as the VA system utilizes pharmacists in their own clinics to evaluate, manage, and prescribe medications for patients for a variety of chronic health conditions. Many states also have set collaborative practice agreements for pharmacists to manage and prescribe as well. Even California has just passed some measures for pharmacists provider status.

But now with a national push, there will be more of upcoming discussion on what pharmacists can and cannot do. A lot of this will take place between currently established medical professions and their organizations. However, I feel, the biggest obstacle that pharmacy will face will not come from the medical establishment, but the patient population itself.

How Does Pharmacy Overcome it's Association with Dispensing Only?

What strikes me as most interesting is that routinely, pharmacists rank high (number 2 behind nurses) as the most trusted professionals available. And I have to ask myself why? Is it due to our heightened availability? There is a pharmacy on almost every street corner. We are a free and usable information source, with high visibility. Perhaps it's also due to our current hands off status, we are the individual that many see after getting out of the hospital or a doctor visit, where they can speak to about last minute questions and thoughts. Whatever the case, our practice has always thus been tied to our dispensing of medications and perhaps that is why we are most trusted, to ensure quality and right drug is given for the patient. But that may in itself be our biggest hurdle to cross.

What is the Public Perception of Pharmacists?

While its true that pharmacists occupy other areas in healthcare and have multiple specialties, overall perception and interaction by the average patient will be in the community setting. For pharmacy to suddenly achieve provider status and start practicing, this could come as a sudden shock. The pharmacist that dispenses medications may suddenly turn into the provider managing their diabetes. This cultural shock may be a huge encumbrance. Many patients will not see this coming, and many may not want it.

If I were not a pharmacist, my understanding of pharmacy would be rather limited. My memory of pharmacists as a child was visiting a local pharmacy where I played with the toys in the corner while my father picked up the medications at the counter and a man in a white coat gave it to them. I never knew what they spoke about, was he educating my father on what amount to give to me or side effects? As a teen and adult, my visits to the pharmacy were always for OTC products or for antibiotics if ill. I suffer from no chronic diseases that require monthly visits, and my interactions were limited. Contrast that with my childhood visit to the doctors office for checkups were I regularly saw nurses and physicians who poke, prodded, and stabbed me with needles, and the difference in experience is a huge. My experience tells me these are the people who will treat, and that the pharmacy is where I get what is prescribed. Not where I go to get help initially.

But outside my personal experience, there is also the overall presentation of pharmacists in media, which may be the only other way for individuals to see pharmacists.

Pharmacists in the Media

I am having a really difficult time with coming up with a positive demonstration of pharmacy in the media within the past few decades. Or, rather any reference to pharmacy overall. In most TV shows, pharmacists are absent or none existent. There are no pharmacists in ER or similar documentary TV shows, despite the fact that they are present at many large institutions now. 

In drama television, such as House or Nurse Jackie, the pharmacist comes across as a bumbling individual or is giving prescription narcotics for sexual favors. Even in the shows Law and Order and Desperate Housewives, pharmacists are portrayed as a villain as they use their knowledge or access to medications to cause harm (e.g. diluting cancer medications).

Comedy television puts pharmacist in a rough spot as well. Family Guy has a pharmacist that at times really comes across as a hypochondriac with terrible social skills (But I guess at least he's not using his own drugs). South Park has a few episodes of pharmacists, but perhaps one that has always stood out to me was the one where the pharmacist was recommending what OTC medication would help the main characters 'Trip Balls' (seen here). But in all honesty, these two shows poke fun at all healthcare professionals.

There have been some iconic roles of pharmacists that put the practice of pharmacy in a good light though. This includes It's a Wonderful Life, In old California, and several older shows. However, most of these are prior to the 1970's. 

One group of pharmacists have even taken to investigating the public portrayal of pharmacists in media I was surprised to find out. Their research (seen here "Lights, Camera, Action: Examining Pharmacists' Portrayal in Film and Television") demonstrates that overall, pharmacists have been demonstrated to be pushovers, drug dealing, big mouth, and psychotic at times. Overall, lately pharmacists have been more of a villain than a hero in media, and that may be very well what could hurt the push for a larger role in healthcare.

I do not think that pharmacy will face the biggest barrier to provider status from other healthcare professionals. I expect resistance. Rather, I think our patients will be the biggest barrier to overcome due to poor portrayal of the profession and overall lack of knowledge of pharmacists skills and capabilities outside of dispensing medications.

So What Does Pharmacy Need to Do?

We need to step up our presence in the community if pharmacy wants to become providers. Patients will need to see what skills pharmacists have, what education they have (many do not know pharmacists have rotations or may explore post-grad training as residents or fellows), and how this can be expanded beyond 'Lick, Stick, and Pour.' 

And I don't mean commercials like Target is putting out showing a pharmacist saying they went to school to understand why Pepto is Pink. It needs to be a demonstration of understanding of disease state and treatment. 

Perhaps pharmacists should push for some presence in media, wouldn't it be nice to have a character even on Scrubs or Grey's Anatomy (wait, maybe not that show, to much drama). Or, we need a nice Youtube channel for students and others to share their experience, maybe make a nice series! Public outreach should be taken up heavily, reaching to parents, children, and other patient groups that pharmacists can play a role and what they can do. Awareness should be a large push for pharmacists lobbying for provider status. If not, other's could equally capitalize on poor perceptions of pharmacists and use it against the profession.

Other Items that Need Addressing on the Road To Provider Status

While pharmacy can push for provider status, I think some thought needs to be taken into consideration. Pharmacists as providers may be a nice way to make up for the lack of primary care physicians and address chronic conditions of a burgeoning aging population, but that does not mean all pharmacists want that role. There needs to be a serious talk about that. I like to joke that "People want to be docs because they want to diagnose, others want to be nurses because they like to directly take care of patients, and people want to be pharmacists because they like drugs." (Thats a hit or miss joke depending on who hears it.) 

Taking that into consideration, if pharmacy achieves some semblance of provider status, what does it mean for those that do not take up the cause or cannot reach it due to training? There are only so many residency positions out there, and pharmacy school if already four years long. Do we change the curriculum? Make a new degree? I equally fear for my profession and am hopeful at the same time for the future. My fear stems from the distancing from our roles with medication dispensing, which could put us at risk for serious ramifications, and from a clash between pharmacists who do and do not want to be providers. My hope comes from expanded roles and increased patient interactions. In the end, I became a pharmacist to help patients in the community. In one fashion or another, pharmacy cannot lose this vision in a grab for more responsibilities.