Community Pharmacy and Consultant Pharmacists
Nearly everyone is familiar with community pharmacists and the pharmacy in which they practice. Six out of every ten pharmacists provide care to patients in a community setting. You probably visit the community pharmacist more often than you do any other member of the health team. Pharmacists talk to people when they are healthy and when they are sick; when they are "just browsing" or when they are concerned with an emergency; when they have specific needs as well as when they are seeking advice or information. Pharmacists are playing an increasing role in the "wellness" movement, especially through counseling about preventive medicine. According to one estimate, pharmacists receive more than two billion inquiries a year from their patrons.
Pharmacists serve patients and the community by providing information and advice on health, providing medications and associated services, and by referring patients to other sources of help and care, such as physicians, when necessary. Likewise, advances in the use of computers in pharmacy practice now allow pharmacists to spend more time educating patients and maintaining and monitoring patient records. As a result, patients have come to depend on the pharmacist as a health care and information resource of the highest caliber. Pharmacists, in and out of the community pharmacy, are specialists in the science and clinical use of medications. They must be knowledgeable about the composition of drugs, their chemical and physical properties, and their manufacture and uses, as well as how products are tested for purity and strength. Additionally, a pharmacist needs to understand the activity of a drug and how it will work within the body. More and more prescribers rely on pharmacists for information about various drugs, their availability, and their activity, just as patrons do when they ask about nonprescription medications.
If pharmacists develop a desire to combine their professional talents with the challenge of the fast-moving community pharmacy practice, they will often consider a management position within a chain pharmacy practice or ownership of their own pharmacy. In chain practice, career paths usually begin at the store level with possible subsequent advancement to a position at the district, regional, or corporate level. Many chain companies have management development programs in marketing operations, legal affairs, third party programs, computerization, and pharmacy affairs. The spirit of entrepreneurship and motivation has enabled many pharmacists to successfully own their own pharmacies or, through establishing consultation services, own their own pharmacy practices.
Hospitals and Other Institutional Settings
As society's health care needs have changed and expanded, there has been an increased emphasis on provision of care through organized health care settings. As a result, an increased number of pharmacists now practice in hospitals, nursing homes, extended care facilities, neighborhood health centers, and health maintenance organizations. As members of the health care team composed of physicians and nurses, among others, institutional pharmacists have an opportunity for direct involvement with patient care. The knowledge and clinical skills that the contemporary pharmacist possesses make this individual an authoritative source of drug information for physicians, nurses, and patients. In addition to direct patient care involvement, pharmacists in hospitals are responsible for systems which control drug distribution and are designed to assure that each patient receives the appropriate medication, in the correct form and dosage, at the correct time. Hospital pharmacists maintain records on each patient, using them not only to fill medication orders but also to screen for drug allergies and adverse drug effects.
Contemporary hospital pharmacy practice is composed of a number of highly specialized areas, including nuclear pharmacy, drug and poison information, and intravenous therapy. In addition, pharmacists provide clinical services in adult medicine, pediatrics, oncology, ambulatory care, and psychiatry. The nature and size of the hospital helps to determine the extent to which these specific services are needed. Because of the diversity of activities involved in pharmacy departments, there is also demand for management expertise, including finance and budgeting, personnel administration, systems development, and planning. Approximately 38,000 licensed pharmacists work on a full- or part-time basis in hospitals or nursing homes. As hospital pharmacists continue to become more involved in providing patient-oriented services, the demand for practitioners in this area of pharmacy continues to grow.
Managed Care Pharmacy
Increasingly, pharmacists are employed in various capacities within managed care organizations (MCOs). Managed care is a system designed to optimize patient care and outcomes and foster quality through greater coordination of medical services. MCOs incorporate pharmaceutical care which strives to improve access to primary and preventive care, and ensure the most appropriate and effective use of medical services in the most cost-effective manner. The number of individuals enrolled in managed care programs has risen dramatically in recent years. At the end of 1995, it was estimated that more than 130 million individuals in the U.S. received health care services through some form of managed care. As managed care continues to assume a larger role in our health care system, opportunities for pharmacists practicing in these types of settings are expected to grow. Areas in which managed care pharmacists can play a role include:
Practice Guidelines and Protocol Development
Managed care pharmacists often work directly with physicians and other care givers to determine which medical treatments, including which drug therapies, are most effective in enhancing patient outcomes. That can involve regularly reviewing medical literature to determine which medications are the safest and most effective for treating certain diseases, gathering data from the plan's patient population, and performing analyses based on that research.
Drug utilization review/drug use evaluation
Managed care pharmacists review drug utilization to determine which patients and prescribers are using particular medications. This allows the pharmacist to determine whether some drugs are inappropriately prescribed or used. With this knowledge in hand, the pharmacist and other care providers can then actively intervene in the patient's care process to assure better outcomes.
Care management programs
Often called "disease management programs," these programs involve having pharmacists, physicians, case managers and other care givers work together to effectively manage and coordinate the overall care of patients who are at high risk of serious complications because of certain disease states. For example, a care management program might identify all diabetic patients within a certain plan population, and then place special emphasis on making sure those patients receive regular education and counseling about their disease, including how and when to take their medications. Pharmacists might then interact with the patient and the patient's physicians on a regular basis to try to keep the patient as healthy as possible.
Other responsibilities in the managed care environment can include:
- contracting with local pharmacies (to develop networks to serve plan members);
- contracting with pharmaceutical manufacturers (to receive rebates on prescription drug products and other value-added services);
- claims processing (so patient-prescriber data can be transmitted electronically to assure accurate claims payment and provide information to assist with clinical functions such as drug utilization review); and
- developing and managing the plan's approved drug therapy options.
The Pharmaceutical Industry
Another career option in pharmacy is represented by the pharmaceutical industry which produces chemicals, prescription and on prescription drugs, and other health products. Pharmacists do such things as marketing, research and product development, quality control, sales, and administration. Many pharmacists go on to obtain postgraduate degrees in order to meet the technical demands and scientific duties required in pharmaceutical manufacturing. Pharmacists with an interest in sales and administration can combine this with their technical background in pharmacy by serving as medical service representatives. These representatives call on a variety of health care professionals to explain the uses and merits of the products their firms produce. Experienced and successful medical service representatives with administrative abilities often rise to supervisory or executive posts in the pharmaceutical industry. Pharmacists are also employed as sales representatives, supervisors, and administrators in wholesale drug firms.
Academic Pharmacy
They are involved with teaching, research, public service, and patient care. Others serve as consultants for local, state, national, and international organizations. Becoming a member of the faculty at a college of pharmacy usually requires a postgraduate degree and/or training (e.g., Ph.D. degree or residency or fellowship training following the professional degree program). While some pharmacists who complete graduate school exercise the option to teach, there currently exists a shortage of faculty, creating an array of excellent professional opportunities.
Pharmacy practice faculty have significant responsibility for patient care, in addition to their work in teaching and research. These academicians often are called educator/ practitioners, and they serve as role models for pharmacy students and residents in many education/practice settings. Faculty in disciplines other than pharmacy practice usually are involved in pharmaceutical sciences research. The pharmaceutical scientists are mainly concerned with research that includes sophisticated instrumentation, analytical methods, and animal models that study all aspects of drugs and drug products. Moreover, social, economic, and behavioral science research often uses survey methods and statistical analyses to solve complex problems of drug utilization management, health care delivery, marketing, management, and other practice issues. To paraphrase one current pharmacy faculty member, "Perhaps no other job in pharmacy has such far-reaching effects on the profession as that of an educator. It is in academia that one can excite individuals about pharmacy and lay the groundwork for continuing advances in the field."
Other Fields in Pharmacy
At the state level there are agencies charged with regulating the practice of pharmacy to preserve and protect the public health. These legal boards governing pharmacy practice usually have pharmacists employed as full-time executive officers and inspectors. As more state health agencies consolidate their purchases, a pharmacist is often engaged as a purchaser of medical and pharmaceutical supplies for the entire state. Nearly every state has an active pharmaceutical association which employs a full-time executive officer, usually a graduate of a college of pharmacy.
Several national professional associations are also guided by pharmacists with interest and special talents in organizational work. You may know other pharmacists who are engaged in highly specialized tasks. There are pharmacists in advertising, packaging, technical writing, magazine editing, and science reporting. There are pharmacists with legal training serving as patent lawyers or as experts in pharmaceutical law. There are pharmacists in America's space laboratories and aboard ships such as the S.S. Hope; others direct large manufacturing firms or specialize in medicinal plant cultivation.
By now, it should be clear to you that the diversity of pharmacy is one of its chief strengths. And, in diversity lies your opportunity. In the United States, the vast majority of pharmacists practice in community or hospital pharmacies, or long-term and ambulatory care facilities. The remainder follow one or another of the special fields you have just reviewed. The opportunity for success in any of these fields is wide open for men and women with ability, education, and imagination.
