There’s been a lot of discussion lately relating to pharmacy credentialing, and I thought as an “old-timer” I should finally weigh in. My guess is that most of you that read this column have yet to go out onto the ASHP Connect Platform to sign up and weigh in on discussions there. Many of you are probably signed up with LinkedIn but probably haven’t signed on the ASHP discussion page there either. Both of these sites have been actively discussing credentialing or something that could relate for some time now.
Even though I have self-identified as an “old-timer” (I can’t believe I’m actually admitting it, but most ICHP members have now been in practice for less time than me!), I am signed on to both of these aforementioned sites plus Twitter (don’t use it much at all) and Facebook (I use it to mostly keep up with family and friends). I’ve seen discussions on Connect and LinkedIn especially regarding credentialing from two perspectives recently.
The first discussion revolves around credentials required to enter into a collaborative agreement with a physician and more importantly for provider status for pharmacists. Some proponents believe that if the physician and pharmacist or groups of one or both can agree that that the pharmacists are qualified to manage a collaborative agreement, that should be sufficient credentials to provide the services. Another camp believes that some additional credential (BPS Certification, residency or other national certification) should be required before the agreement and/or provider status are granted.
The other discussion is in regard to ASHP Policy Position 0701 Requirement for Residency that reads: “To support the position that by the year 2020, the completion of an ASHP-accredited postgraduate-year-one residency should be a requirement for all new college of pharmacy graduates who will be providing direct patient care.” The discussions have been predominated by individual pharmacists that believe this is not an appropriate goal and creates unfair barriers for those pharmacists who have been out in practice for some time. Now it has been said that one-year of residency training is equivalent to three years of pharmacy practice experience, and I think that is probably a fair analogy. However, complaints have been raised that residency trained pharmacists without experience are receiving preferential selection over other pharmacists with strong work experience and skills. On the other hand, pharmacy students complain (and rightly so) that there are not enough residency programs to meet the current needs, let alone achieve the 2020 mandate anytime soon. The sad thing about this discussion is that this policy position was approved by the ASHP House of Delegates more than 5 years ago, and now the debate is beginning to heat up!
One recent responder to the discussion on residency requirement made an excellent point that having not completed a residency even though he had obtained a two-year add-on PharmD long before the PharmD was required was a handicap to his future career options. But rather than give up and settle for the few “staff” positions that are left these days, he recently took the BCPS exam and passed it handily. This BCPS credential should prove to be the great equalizer. Because he finished his formal pharmacy education long before residencies were widespread and sought after, he can now provide proof that he has the “knowledge” and the “experience” to qualify for many clinical positions.
There are other Board of Pharmacy Specialties certifications in Nutritional Support, Psychiatry, Oncology, Ambulatory Care, and Nuclear Pharmacy with additional specialty certifications coming for Pediatrics and Critical Care very soon. I believe that these credentials in addition to the Certified Diabetic Educator (CDE) credential available from the National Certification Board for Diabetes Educators and the Certified Geriatric Pharmacist (CGP) credential provided by the American Society of Consultant Pharmacists will provide that needed credential or equalizer that solves both discussions.
Pharmacists who have graduated more than 10 years ago and feel they should be able to provide patient care services that are reimbursed separate from providing the medication should seek Board certification that is most appropriate for their type of practice. Their years of experience make up for much of the residency training they may have missed. Certainly there could be gaps, but my experience, long ago as it was, something tells me that the missing training is there when you’re working if you pay attention and want to learn.
In addition, pharmacists seeking new positions who have obtained the appropriate Board certification should be considered equally and fairly when compared to new pharmacists who have completed their PGY1 and even PGY2 residencies in some cases. Experience is a great equalizer and Board certification indicates a dedication to a higher standard than is now required in many places. Yes, Board certification is required already in some institutions to be considered for any position, but most hospitals, while beginning to embrace residency training (and hopefully providing it, too) have yet to make that important Board granted credential an absolute requirement.
It seems to me that if experienced pharmacists who may not have had chances at residencies want to provide cognitive services for a fee, enter into a collaborative practice arrangement with a physician or physician group, or even seek another position that will advance their career, in all cases, they ought to be willing and able to prove their knowledge with some sort of Board certification.
Because the nature of the certification process in general is based on legal principles of fairness, because the individuals seeking certification jobs depend on it being fair and unbiased, it seems to me that this is the only fair route to take. We can continue to build more and more layers to enter the profession, but we must provide an avenue for those already in it to achieve equal status. Board certification does that and does not discriminate. It is the equalizer.