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APhA Task Force on Specialties in Pharmacy
FINAL REPORT
APhA Task Force on Specialties in Pharmacy The APhA Task Force on Specialties in Pharmacy was created by the APhA Board of Trustees in January 1973 to consider the issue of specialization in pharmacy practice and to recommend a mechanism for recognition of specialties and the certification of specialist. The preliminary report of the Task Force appeared in the February 1974 issue of JAPhA and the membership was requested to submit comments.
I
n 1971 the House of Delegates of the American Pharmaceutical Association adopted a policy statement which contained in part the following provision-"that an organizational mechanism be established within the structure of the Association for the recognition of specialties and certification of specialists." Following adoption of this statement and following further deliberations and discussions, the Board of Trustees of APhA created a Task Force on Specialties in Pharmacy in the spring of 1973 and directed it with the following chargeTo identify existing or potential areas of specialization in pharmacy practice or, alternatively, to determine that currently there are no specialties and/or that the practice of pharmacy does not lend itself to such specialization.
In addition, during the 1974 APhA Annual Meeting, an open hearing was held to receive comments relatlve to the final report of the Task Force. The following report has been submitted to the APhA Board of Trustees with recommendations for its implementation.
On the basis of these conclusions, the Task Force on Specialties in Pharmacy has developed (1) a statement of criteria which it recommends be employed as the basis for official recognition of an area of specialization in pharmacy, (2) an outline of the structure and responsibilities for the proposed Board of Pharmaceutical Specialties, and (3) a list of general qualifications for certification of individual pharmacy specialists. The Task Force has refrained from identifying any existing areas of specialization in pharmacy on the basis that such decision should more properly be made by the proposed Board of Pharmaceutical Specialties. However, the Task Force has concluded that there are potential areas of plmrmacy practice that may in time be recognized as specialties.
2. To propose the means by which such specialties should be
identified if specialties do exist or if it can be concluded that there will be one or more field s of specialization. 3. To develop the means by which individuals should be identified
as having met the predetermined criteria for such specialties, including recommendations for continuing education or recertification. 4. To consider other matters of immediate concern as identified
by the Task Force. In pursuing its assignment, the Task Force sought comments and suggestions from members of the profession of pharmacy. It consulted with and obtained statements from representatives of a number of other pharmaceutical organizations. It studied other professions with respect to their policies and practices of specialization and certification. With the assistance of a consultant, the members of the Task Force considered all this information, related it to potential developments in the education for and the delivery of health care, and then deliberated in meetings of the Task Force and in meetings of the subcommittees. The Task Force on Specialties in Pharmacy has concluded thatWhether or not at this time there are areas of practice that could be identified as specialties in pharmacy, one or more areas of practice may qualify as an approved specialty in pharmacy in the near future. Therefore, an official board with independent decision making authority should now be established and charged with the responsibility of formally recognizing specialties in pharmacy once they are judged to have met approved criteria. Furthermore, such board should be empowered with the final responsibility of granting certification to individuals who have met the qualifications for certification as specialists in an officially recognized field of specialty. 618
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
Criteria for Recognition of Specialties in Pharmacy Certification has been defined as the process by which a non-governmental agency or association grants recognition to an individual who has met certain predetermined qualifications specified by that agency or association. In the past half century, the process has been increasingly employed in the health fields to identify individuals who are considered to be qualified in a specialized area of professional practice or who have attained superior competence in the broad areas of responsibility of a particular profession. The growth of certification has been encouraged by scientific and technological developments, by increasing numbers of persons seeking health care, by changes in the management and delivery of health care, by growing recognition of the need to protect the public from unqualified personnel, and by the desires of members of the health professions for recognition of special professional competence, as well as for economic and social recognition. All of these factors have been exerting influences on all of the professions, including pharmacy. To insure that specialty certification, as it may relate to the identification of qualified persons in an identifiable specialized area of pharmacy, is conducted not merely for the benefit of pharmacy but more especially for the benefit of society, the Task Force on Specialties in Pharmacy recommends that the following criteria be met by any group of pharmacists in the United States who wish to have their practice recognized as a specialty in pharmacy. For purposes of this report, the Task Force is relying on the definition of pharmacy, as currently defined by the American Pharmaceutical Association, which states that "pharmacy is defined as that personal health service that assures safety and efficacy in the procuring, storing, prescribing, compounding, dispensing
delivering, administering, and use of drugs and related articles. " Criterion I- The area of specialization in the practice of pharmacy rests on a specialized knowledge of pharmaceutical sciences, which have their basis in the biological, physical, and behavioral sciences, and not on the basis of managerial, procedural, or technical services, nor on the basis of the environment in which pharmacy is practiced. Criterion 2- The area of specialization shall be one for which specially trained practitioners are needed to fulfill the responsibilities of the profession of pharmacy in improving the health and welfare of the public, which responsibilities may not otherwise be effectively fulfilled. Criterion 3- The area of specialization shall represent an identifiable and distinct field of practice that calls for special knowledge and skills acquired by education and training and/or experience beyond the basic pharmaceutical education and training. Criterion 4- The area of specialization shall be one in which schools of pharmacy and/or other organizations offer recognized education and training programs to those seeking adval1ced knowledge and skills in the area of specialty practice so that they may perform more competently. Criterion 5-The area of specialization shall be one in which there is an adequate educational and scientific base to warrant transmission of knowledge through teaching clinics and scientific and technical publications immediately related to the specialty. Criterion 6-The area of specialization shall be one in which there exists a significant and clear health care demand to provide the necessary public reason for certification. Criterion 7- The area of specialization shall be comprised of a reasonable number of individuals who devote most of the time of their practice to the specialty area. Board of Pharmaceutical Specialties Responsibilities
As previously indicated, the Task Force on Specialties in Pharmacy recommends the creation of a Board of Pharmaceutical Specialties, and also recommends that this Board be authorizeda. to recognize specialties in pharmacy, if and when such specialties meet the criteria for recognition; b. to approve the qualifications for certification in each recognized field of specialization ; c. to grant final approval for the certification and re-certification of individuals who have met the qualifications for certification as specialists in an officially recognized field of specialization ; d. to issue certificates to certified specialists; and e. to serve as the coordinating agency and clearing house for information among the organizations and groups representing the various recognized fields of specialization. It is- proposed that this Board of Pharmaceutical Specialties be created, as hereinafter recommended, and that the Board function even though there may be no recognized specialties in pharmacy in the immediate future. Structure
In developing the subsequent recommendations relating to the structure and operations of the proposed Board of Pharmaceutical Specialties, the Task Force adopted certain guiding principles. Principle I-Although the Board of Pharmaceutical Specialties must be empowered with independent authority to carry out the responsibilities stated above, it should be provided administrative services and be supported, at least initially, by the American Pharmaceutical Association-the
national association that most broadly represents ·the profession of pharmacy. By such an arrangement, services could be provided without the necessity of adding to the already large number of organizations related to pharmacy. Principle 2-The Board of Pharmaceutical Specialties should be broadly composed since specialization in pharmacy would have an influence on the education of pharmacists and the practice of pharmacy, as well as on the delivery of health care in which other professions, the government, and the general public have a direct interest, including a major financial interest. Principle 3-Financing for the Board of Pharmaceutical Specialties should be provided from several sources: the American Pharmaceutical Association, which is expected, at least initially, to provide administrative support; other pharmaceutical associations; each pharmaceqtical specialty organization, group, or society when the field of specialization is officially recognized; grants from governmeht agencies and independent foundations; and fees from candidates seeking certification or re-certification. Using these principles as a guide, the Task Force on Specialties in Pharmacy presents the following specific recommendations as to the structure of the ·Board of Pharmaceutical Specialties. Composition of the Board
Members of the Board of Pharmaceutical Specialties should be appointed for staggered three-year terms with tpe privilege of serving no more than two terms in sqccession. The Board should comprise fifteen (15) members to be appointed in the following mannerNine (9), broadly representative of the profession of pharmacy, including individuals engaged in practice, education, and licensure, to be appointed by the American Pharmaceutical Association after solicitation of suggested nominees from national organizations representing these groups. Six (6) to be appointed by the Board itself after solicitation of suggested nominees from appropriate organizations so that of the six, two would be from the general public, one from the federal government, and on a rotating basis, three from related health professions. In deciding on the appointment of individuals from related health professions, the Board of Pharmaceutical Specialties should seek suggestions from such organizations as the American Dental Association, American Hospital Association, American .Medical Association, American Nurses' As~ociation, American Osteopathic Association, and National Medical Association. The ~hairman of each specialty council (described later in this report), once a pharmaceutical specialty has been recognized and a specialty council for that field of specialty has been created, should serve without vote as an ex-officio member of the Board. Officers of the Board
The officers of the Board should comprise a Chairman, Vice Chairman, and Secretary, each elected on an annual basis by the Board. Each officer should be eligible for election to a maximum of three successive one-year terms. Committees of the Board
The Board should operate through committees which should include an Executive Committee, a Review Committee for initial consideration of requests from pharmaceutical groups seeking recognition for specialty status, and Appeals Committee for the hearing of appeals from groups unsuccessful in seeking recognition for specialty status and of appeals from individuals who may not have been granted certification in a recognized pharmaceutical specialty, and Vol. NS14, No. 11, November 1974
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such other committees as from time to time the Board may deem to be appropriate and necessary. With the exception of the Appeals Committee, all committees may be comprised of both Board members and nonBoard members, each to be nominated by the Chairman and approved by the Board . The Appeals Committee should compri se three members, the chairman of which should be appointed by the Board but none should be a member of the Board. The Appeals Committee should be empowered either to uphold the original decision or remand to the Board or the appropriate specialty council for further review. M eetings of the Board The Board should be expected to meet at least once each year and at such other times as either it or the Chairman considers advisable. Approcal o/Specialties R ecognition of a specialty should require a two-thirds vote of the Board. Administrative Services/or the Board The American Pharmaceutical Association should provide, at least initially, the administrative support services for the independent Board of Pharmaceutical Specialties. For further assistance, the Board should be empowered to employ consultant services as it deems appropriate and necessary. Financing o/the Board Financing for the Board of Pharmaceutical Specialties should be approved initially by the American Pharmaceutical Association, by other pharmaceutical organizations, and by grants from various sources, including both government and independent foundations. If and when fields of pharmaceutical specialties are recognized and individuals are certified as specialists, the fees collected from certified individuals will be an increasing source of income. The establishment of the amount of individual fees for initial certification and of annual fees for recertification shoul d be a responsibility of the Board. Such fees should be modest and yet sufficient to assist adequately in financing the f unctions of certification of specialists. Reports of the Board The Board of Pharmaceutical Specialties should be expected , on an annual basis, to make reports of its activities to the American Pharmaceutical Association, to other national pharmaceutical organizations, and to each organization group, or society representing a recognized field of pharma~ ceutical specialty. Specialty Councils of the Board of Pharmaceutical Specialties For .each pharmaceutical specialty that has been officially recogmzed, the Board of Pharmaceutical Specialties should create a specialty council responsible to the Board and charged to perform certain functions. Functions of the Specialty Councils- In conformity with policies established by the Board of Pharmaceutical Specialties and s~bject to final approval by the Board, each Specialty CounCIl should be expected to fulfill the following functions1.
dev~lop ~nd codify requirements for individual specialty and certificatIOn and re-certification, which proposed requirements s~ould . be publicly available for adequate wide-spread conSIderatIOn before presentation to the Board for adoption;
2. develop a~d administer examinations, at least once each year, to determme the competency of candidates for certification and re-certification; 620
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
3. evaluate the qualifications of individuals seeking certification or re-certification, and submit to the Board the names of candidates, recommended for certification or re-certification· and ' 4. recommend policies with respect to such matters as length of time of continued certification before qualifications for recertification must be met, time interval permitted between the filing of an application for certification and successful completion by the candidates of all requirements, and the number of attempts permitted a candidate for the passing of an examination or meeting of other requirements.
Composition 0/ the Specialty Councils-the majority of the members of each Specialty Council, whose size should be established by the Board, should be appointed or elected by the appropriate national pharmaceutical specialty organization, or group, whose membership would be comprised primarily of individuals who are specialists in that field of pharmaceutical specialty. * Other members of the Specialty Council should include individuals engaged in related practice of pharmacy and be appointed by the Board of Pharmaceutical Specialties after consultation with appropriate representatives of these other areas of practice. The Board should have the power to decide on the numbers to be appointed to each Specialty Council, and the numbers may vary among fields of specialty. All members of Specialty Councils should be appointed or elected for staggered three-year terms subject to serving no more than two successive terms. The chairman and other officers should be elected annually by the section and be eligible for election to a maximum of three successive oneyear terms. Qualifications for Certification of Individual Specialists The qualifications for certification of individuals as specialists should be developed initially by each appropriate Specialty Council, subject to final approval by the Board of Pharmaceutical Specialties. These qualifications or requirements should include such factors as ethical and moral standing, level of education, extent of training, practical experience, successful passing of an oral and/or written examination, license to practice, and payment of fees. Citizenship and membership in professional organizations or societies should not be qualifications for certification. Approval of By-Laws The adoption of by-laws for the Board of Pharmaceutical Specialties, or any revisions in them, should be subject to the approval of the Board of Trustees of the American Pharmaceutical Association. Creation of Board of Pharmaceutical Specialties It is recommended that, concurrent with the acceptance and approval of this report by the Board of Trustees of the American Pharmaceutical Association, the Board also appoint a committee to draft the by-laws and establish the detailed plans for the creation, by July 1, 1975, of the Board of Pharmaceutical Specialties and for the implementation of the recommendations of this report. Following its organization and the election of officers of the
* Th e members of
the T ask F orce h ave assum ed that i n additi on to the responsibility oj appointing
0:elect zng ?{fici als to serve on a Specialty C ouncii , each such p harm aceuticai sp eci alty organiza·
tzon, or g roup , wo uld perform other acti 'jities , such as encourage the study, elevate the standa rd.. , promote lInd improve the prar.tice of the pha rmaceutical sp ecialty w ith w hich it is dir ectly conce rned, and s timula! e the developm ent of adequate training standards f or the specialty .
Board of Pharmaceutical Specialties, one of its first orders of business would be the development and adoption of procedures by which pharmaceutical groups seeking specialty status might be considered for official recognition. Review of the Board ofPharmaceutical Specialties It is further recommended that no later than five years from the date of creation of the Board of Pharmaceutical Specialties, a review should be undertaken of the Board's structure, operations, and financing, with special attention given to the composition of the Board. The review should be undertaken by a special committee created for this purpose and comprised of five (5) individuals: one (1) appointed by the American Pharmaceutical Association, one (1) appointed by the American Association of Colleges of Pharmacy, one (1) appointed by the National Association of Boards of Pharmacy, and two (2) nonpharmacists, one of whom shall be chairman, appointed jointly by the three above-named organizations. Similar reviews should subsequently be conducted at periodic intervals. In such reviews, provisions should be made to retain a' proportion of nonpharmacists on the Board at least no less than that provided initially.
Other Matters The fourth charge to the Task Force on Specialties in Pharmacy stated that it should "consider other matters of immediate concern as identified by the Task Force." In pursuance of this assignment, the Task Force has identified two matters that it wishes to call to the attention of the Board of Trustees of the American Pharmaceutical Association, namely, a definition for pharmacy and the recognition through means other than 'certification in a specialty.
The Task Force on Specialties in Pharmacy recommends(1) that a new definition of pharmacy be developed, (2) that
the Board of Trustees of the American Pharmaceutical Association assume the initiative in seeing that such a definition is produced, and (3) that an interdIsciplinary group, including members of closely related professions and of the general public, be included in the drafting body. Recognition Through Means Other Than Certification in a Specialty
As stated earlier in this report, certification ·is employed both to identify individuals who are qualified in a specialized area of professional practice, as well as individuals who have attained superior competence in the broad areas of responsibility of a particular profession. This Task Force was specifically charged to consider certification as it relates to specialization of practice. However, the members of the Task Force believe that consideration should be given to the issue of recognition of exceptional competence or accomplishment through means other than certification in a specialty. The AACPjAPhA Task Force on Continuing Competence in Pharmacy is functioning concurrent with the Task Force on Specialties in Pharmacy. In view of the factthat the conclusions and recommendations of each, especially with regard to this matter, may have a bearing on the conclusions of the other, and in view of the fact that each Task Force is expected to complete its final report within a few months of each other, it is recommerided that the Board of Trustees give consideration in whatever manner it considers most appropriate to the question of recognition of exceptional accomplishment or accomplishment through means other than certification in a specialty. Respectfully Submitted, Jeffrey Cohelan William J. Edwards Leonard D. Fenninger John A. Gans Paul G. Grussing Robert G. Leonard Robert L. Ravin William K. Selden Ouida C. Upchurch Warren E. Weaver Lloyd M. Parks, Chairman
Definition ofPharmacy
To identify specialties in pharmacy, it is necessary that there be a definition of pharmacy. The Task Force has relied on the definition adopted by the American Pharmaceutical Association, as quoted in an earlier section of this report. In so doing, the Task Force realizes that the definition is not adequate for the issues that will face pharmacy in the future. Therefore, the officially adopted definition appears under present modes of practice to be too ambiguous.
Reactions to Comments Submitted to the Task Force on Its Preliminary Report
The APhA Task Force on Specialties in Pharmacy published a Preliminary Report in the February 1974 issue of the Journal -of the American Pharmaceutical Association, asking for comments and opinions on the material contained within the Report. In addition, the Task Force sent copies of its Preliminary Report to a number of national pharmaceutical associations, seeking comments and reactions of these groups. The Task Force received numerous replies to its requests which were considered in detail, during its April 18, 1974 meeting. Many of the replies were helpful in assisting the Task Force in preparing its Final Report for the Board of Trustees. The Task Force fett that a number of comments submitted deserve a response so that the intention of the Task Force
contained in its Final Report is understood clearly by all. The Task Force's reaction to a number of comments which were received follows: 1. Fulfillment of its Charge:
Several individuals observed that the Task Force had not fulfilled its first charge which was to identify areas of specialization. The Task Force thoroughly considered its option to investigate pharmacy practice and determine areas of specialization. However, the Task Force decided that if it was to recommend a structure by which specialties would be identified and specialists certified, it would be counterproductive to Vol. NS14, No. 11, November 1974
621
recognize areas of specialization concurrently. The Task Force, therefore, concluded that it should refrain from identifyin g any existing areas of specialization in pharmacy on the basis that such a decision should more properly be made by the proposed Board of Pharmaceutical Specialties. However, th e Task Force concluded th at there are potential areas of pharmacy practice that may in time be recognized as specialties. 2. Criterion One:
A number of respond ents interpreted Criterion One as excluding, outri ght , certain areas of pharmacy practice as areas of specialization. They interpreted the statement, "and not on manageria l, procedura l, or technical services, nor on the environment in which pharmacy has practiced," to infer that the Task Force was stating that management or. institutional pharmacy is not an area of specia lization. The Task Force wishes to emphasize that Criterion One establishes the basis on which specia lties shall be chosen. In so doing, the Task Force recommends that the basis be in the biological , physical, and behaviora l sciences. Indeed, the Task Force feels that any potential specialty, including hospital pharmacy, should be considered, if it can be demonstrated that the area of specialization rests on the basis just mentioned. The Task Force is most emphatic, however, that recognition shall not be on the sole basis of managerial , procedural, or technical services, nor on the basis of the environment in which pharmacy is practiced. The Task Force has reworded its Criteria in its Final Report to clarify its meaning. 3. Responsibilities of the Board of Pharmaceutical Specialties:
Severa l respondents felt that the Board of Pharmaceutical Specia \ties is given too much unilateral authority in the recognition of specialties and the certification of specialists. As mentioned above, the Task Force believes strongly that the process of specialization in pharmacy- as well as other hea lth professions- should be controlled by the profession, but with representation and input from other health professions and the public. The Board of Pharmaceutical Specialties is structured to accomplish this purpose. The Task Force fee ls it would be counter-productive to diffuse this responsibility among organizations representing officially recognized specialties. The Task F orce considers it vital for the future of the profession that the Board of Pharmaceutical Specialties be recognized throughout the entire profession as the one body with the authority to recognize specialties and certify specialists. The Task F orce, likewise, feels that it is necessary to structure the Board of Pharmaceutical Specialties so that it is responsive and responsible to the profession. The Task Force believes that its recommended structure will accomplish these goals. 4. Composition of the Board:
A number of comments were directed toward recommending representatives from specific areas of pharmacy practice on the Board of Pharmaceutical Specialties. Other comments were directed at the representation, specifically, from the American Association of Colleges of Pharmacy and the National Association of Boards of Pharmacy on the Board of Pharmaceutical Specialties. Other respondents pointed out that the Board should be composed of an odd number of members to avoid tie votes. The Task Force has recognized the inconsistency in its recommendations concerning the composition of the Board of Pharmaceutical Specialties. It believes that the Board should be broadly representative of the pharmacy profession with no specific group represented on 622
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
the Board. Therefore, the Task Force has revised its recommendation in this regard to provide that the Board of Pharmaceutical Specialties be comprised of fifteen members, with nine broadly representative of the profession, including individuals involved in practice, education, and licensure, to be appointed by the American Pharmaceutical Association, after solicitation of suggested nominees from a national organizasion representing these groups. Six Board members are to be nonpharmacists, appointed by the Board itself, after solicitation of suggested nominees from appropriate organizations. Of the six, two would be from the general public, one from the federal government and three from related health professions . 5. Nonpharmacists on Board of Pharmaceutical Specialties:
Comments were also submitted questioning the inclusion of nonpharmacists on the Board of Pharmaceutical Specialties. Some listed medicine as an example, pointing out that nonphysicians are not involved in the specialization process of the medical profession. The Task Force is fully aware of the pro.; cedures used by medicine in recognizing specialties in certifying specialists. However, the Task Force realizes that in pioneering the specialty area, medicine has made mistakes from which we should all learn. The Task Force believes strongly that the process of specialization impacts not only on the profession itself, but on associated health professions and most certainly on the public. Thus, these areas should be represented on the Board. The Task Force feels that the pharmacy profession has a rare opportunity to create a specialty system which would best serve the profession, its sister professions, and the public, by involving nonpharmacist health practitioners, as well as the public. Such a system could well serve as the model on which future specialty recognition systems in other professions are based. 6. Task Force to Report to APhA Board of Trustees or House of Delegates?
Several comments were directed toward the matter of whether the Report of the Task Force should be approved by the APhA House of Delegates or the APhA Board of Trustees. The Task Force points out that it was created by the APhA Board of Trustees, pursuant to a policy adopted by the APhA House of Delegates . Since it was created by the Board, the Task Force must report back to the Board . The Task Force believes, however, that the Board of Trustees would be receptive to any suggestions regarding the Board's implementation of the Report. The Task Force also wishes to point out that APhA has several programs which function with independent decision-making authority within the structure of the Association. The National Formulary and the APhA Judicial Board each possesses its own procedures and is independent in its designated areas of interest. Neither the APhA Board of Trustees nor the House of Delegates can interpose itself in the activities of these two groups when these activities are consistent with previously established protocols and/or by-laws. The Task Force sees no difference between these two Association activities and the proposed Board of Pharmaceutical Specialties. . While there were other comments submitted in response to the Task Force's Preliminary Report, the above are representative of the comments submitted. The Task Force appreciates the time and effort spent by individuals in responding to the Preliminary Report. The comments were most helpful in assisting the Task Force in completing its work. The Task Force believes that its Final Report represents a workable process for the recognition of specialties and the certification of specialists. The Task Force also feels that the process will be fair to all pharmacists, and especially fair to related professions and the public . •
APhA Task Force on Specialties in Pharmacy The APhA Task Force on Specialties in Pharmacy was created by the APhA Board of Trustees in January 1973 to consider the issue of specialization in pharmacy practice and to recommend a mechanism for recognition of specialties and the certification of specialist. The preliminary report of the Task Force appeared in the February 1974 issue of JAPhA and the membership was requested to submit comments.
I
n 1971 the House of Delegates of the American Pharmaceutical Association adopted a policy statement which contained in part the following provision-"that an organizational mechanism be established within the structure of the Association for the recognition of specialties and certification of specialists." Following adoption of this statement and following further deliberations and discussions, the Board of Trustees of APhA created a Task Force on Specialties in Pharmacy in the spring of 1973 and directed it with the following chargeTo identify existing or potential areas of specialization in pharmacy practice or, alternatively, to determine that currently there are no specialties and/or that the practice of pharmacy does not lend itself to such specialization.
In addition, during the 1974 APhA Annual Meeting, an open hearing was held to receive comments relatlve to the final report of the Task Force. The following report has been submitted to the APhA Board of Trustees with recommendations for its implementation.
On the basis of these conclusions, the Task Force on Specialties in Pharmacy has developed (1) a statement of criteria which it recommends be employed as the basis for official recognition of an area of specialization in pharmacy, (2) an outline of the structure and responsibilities for the proposed Board of Pharmaceutical Specialties, and (3) a list of general qualifications for certification of individual pharmacy specialists. The Task Force has refrained from identifying any existing areas of specialization in pharmacy on the basis that such decision should more properly be made by the proposed Board of Pharmaceutical Specialties. However, the Task Force has concluded that there are potential areas of plmrmacy practice that may in time be recognized as specialties.
2. To propose the means by which such specialties should be
identified if specialties do exist or if it can be concluded that there will be one or more field s of specialization. 3. To develop the means by which individuals should be identified
as having met the predetermined criteria for such specialties, including recommendations for continuing education or recertification. 4. To consider other matters of immediate concern as identified
by the Task Force. In pursuing its assignment, the Task Force sought comments and suggestions from members of the profession of pharmacy. It consulted with and obtained statements from representatives of a number of other pharmaceutical organizations. It studied other professions with respect to their policies and practices of specialization and certification. With the assistance of a consultant, the members of the Task Force considered all this information, related it to potential developments in the education for and the delivery of health care, and then deliberated in meetings of the Task Force and in meetings of the subcommittees. The Task Force on Specialties in Pharmacy has concluded thatWhether or not at this time there are areas of practice that could be identified as specialties in pharmacy, one or more areas of practice may qualify as an approved specialty in pharmacy in the near future. Therefore, an official board with independent decision making authority should now be established and charged with the responsibility of formally recognizing specialties in pharmacy once they are judged to have met approved criteria. Furthermore, such board should be empowered with the final responsibility of granting certification to individuals who have met the qualifications for certification as specialists in an officially recognized field of specialty. 618
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
Criteria for Recognition of Specialties in Pharmacy Certification has been defined as the process by which a non-governmental agency or association grants recognition to an individual who has met certain predetermined qualifications specified by that agency or association. In the past half century, the process has been increasingly employed in the health fields to identify individuals who are considered to be qualified in a specialized area of professional practice or who have attained superior competence in the broad areas of responsibility of a particular profession. The growth of certification has been encouraged by scientific and technological developments, by increasing numbers of persons seeking health care, by changes in the management and delivery of health care, by growing recognition of the need to protect the public from unqualified personnel, and by the desires of members of the health professions for recognition of special professional competence, as well as for economic and social recognition. All of these factors have been exerting influences on all of the professions, including pharmacy. To insure that specialty certification, as it may relate to the identification of qualified persons in an identifiable specialized area of pharmacy, is conducted not merely for the benefit of pharmacy but more especially for the benefit of society, the Task Force on Specialties in Pharmacy recommends that the following criteria be met by any group of pharmacists in the United States who wish to have their practice recognized as a specialty in pharmacy. For purposes of this report, the Task Force is relying on the definition of pharmacy, as currently defined by the American Pharmaceutical Association, which states that "pharmacy is defined as that personal health service that assures safety and efficacy in the procuring, storing, prescribing, compounding, dispensing
delivering, administering, and use of drugs and related articles. " Criterion I- The area of specialization in the practice of pharmacy rests on a specialized knowledge of pharmaceutical sciences, which have their basis in the biological, physical, and behavioral sciences, and not on the basis of managerial, procedural, or technical services, nor on the basis of the environment in which pharmacy is practiced. Criterion 2- The area of specialization shall be one for which specially trained practitioners are needed to fulfill the responsibilities of the profession of pharmacy in improving the health and welfare of the public, which responsibilities may not otherwise be effectively fulfilled. Criterion 3- The area of specialization shall represent an identifiable and distinct field of practice that calls for special knowledge and skills acquired by education and training and/or experience beyond the basic pharmaceutical education and training. Criterion 4- The area of specialization shall be one in which schools of pharmacy and/or other organizations offer recognized education and training programs to those seeking adval1ced knowledge and skills in the area of specialty practice so that they may perform more competently. Criterion 5-The area of specialization shall be one in which there is an adequate educational and scientific base to warrant transmission of knowledge through teaching clinics and scientific and technical publications immediately related to the specialty. Criterion 6-The area of specialization shall be one in which there exists a significant and clear health care demand to provide the necessary public reason for certification. Criterion 7- The area of specialization shall be comprised of a reasonable number of individuals who devote most of the time of their practice to the specialty area. Board of Pharmaceutical Specialties Responsibilities
As previously indicated, the Task Force on Specialties in Pharmacy recommends the creation of a Board of Pharmaceutical Specialties, and also recommends that this Board be authorizeda. to recognize specialties in pharmacy, if and when such specialties meet the criteria for recognition; b. to approve the qualifications for certification in each recognized field of specialization ; c. to grant final approval for the certification and re-certification of individuals who have met the qualifications for certification as specialists in an officially recognized field of specialization ; d. to issue certificates to certified specialists; and e. to serve as the coordinating agency and clearing house for information among the organizations and groups representing the various recognized fields of specialization. It is- proposed that this Board of Pharmaceutical Specialties be created, as hereinafter recommended, and that the Board function even though there may be no recognized specialties in pharmacy in the immediate future. Structure
In developing the subsequent recommendations relating to the structure and operations of the proposed Board of Pharmaceutical Specialties, the Task Force adopted certain guiding principles. Principle I-Although the Board of Pharmaceutical Specialties must be empowered with independent authority to carry out the responsibilities stated above, it should be provided administrative services and be supported, at least initially, by the American Pharmaceutical Association-the
national association that most broadly represents ·the profession of pharmacy. By such an arrangement, services could be provided without the necessity of adding to the already large number of organizations related to pharmacy. Principle 2-The Board of Pharmaceutical Specialties should be broadly composed since specialization in pharmacy would have an influence on the education of pharmacists and the practice of pharmacy, as well as on the delivery of health care in which other professions, the government, and the general public have a direct interest, including a major financial interest. Principle 3-Financing for the Board of Pharmaceutical Specialties should be provided from several sources: the American Pharmaceutical Association, which is expected, at least initially, to provide administrative support; other pharmaceutical associations; each pharmaceqtical specialty organization, group, or society when the field of specialization is officially recognized; grants from governmeht agencies and independent foundations; and fees from candidates seeking certification or re-certification. Using these principles as a guide, the Task Force on Specialties in Pharmacy presents the following specific recommendations as to the structure of the ·Board of Pharmaceutical Specialties. Composition of the Board
Members of the Board of Pharmaceutical Specialties should be appointed for staggered three-year terms with tpe privilege of serving no more than two terms in sqccession. The Board should comprise fifteen (15) members to be appointed in the following mannerNine (9), broadly representative of the profession of pharmacy, including individuals engaged in practice, education, and licensure, to be appointed by the American Pharmaceutical Association after solicitation of suggested nominees from national organizations representing these groups. Six (6) to be appointed by the Board itself after solicitation of suggested nominees from appropriate organizations so that of the six, two would be from the general public, one from the federal government, and on a rotating basis, three from related health professions. In deciding on the appointment of individuals from related health professions, the Board of Pharmaceutical Specialties should seek suggestions from such organizations as the American Dental Association, American Hospital Association, American .Medical Association, American Nurses' As~ociation, American Osteopathic Association, and National Medical Association. The ~hairman of each specialty council (described later in this report), once a pharmaceutical specialty has been recognized and a specialty council for that field of specialty has been created, should serve without vote as an ex-officio member of the Board. Officers of the Board
The officers of the Board should comprise a Chairman, Vice Chairman, and Secretary, each elected on an annual basis by the Board. Each officer should be eligible for election to a maximum of three successive one-year terms. Committees of the Board
The Board should operate through committees which should include an Executive Committee, a Review Committee for initial consideration of requests from pharmaceutical groups seeking recognition for specialty status, and Appeals Committee for the hearing of appeals from groups unsuccessful in seeking recognition for specialty status and of appeals from individuals who may not have been granted certification in a recognized pharmaceutical specialty, and Vol. NS14, No. 11, November 1974
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such other committees as from time to time the Board may deem to be appropriate and necessary. With the exception of the Appeals Committee, all committees may be comprised of both Board members and nonBoard members, each to be nominated by the Chairman and approved by the Board . The Appeals Committee should compri se three members, the chairman of which should be appointed by the Board but none should be a member of the Board. The Appeals Committee should be empowered either to uphold the original decision or remand to the Board or the appropriate specialty council for further review. M eetings of the Board The Board should be expected to meet at least once each year and at such other times as either it or the Chairman considers advisable. Approcal o/Specialties R ecognition of a specialty should require a two-thirds vote of the Board. Administrative Services/or the Board The American Pharmaceutical Association should provide, at least initially, the administrative support services for the independent Board of Pharmaceutical Specialties. For further assistance, the Board should be empowered to employ consultant services as it deems appropriate and necessary. Financing o/the Board Financing for the Board of Pharmaceutical Specialties should be approved initially by the American Pharmaceutical Association, by other pharmaceutical organizations, and by grants from various sources, including both government and independent foundations. If and when fields of pharmaceutical specialties are recognized and individuals are certified as specialists, the fees collected from certified individuals will be an increasing source of income. The establishment of the amount of individual fees for initial certification and of annual fees for recertification shoul d be a responsibility of the Board. Such fees should be modest and yet sufficient to assist adequately in financing the f unctions of certification of specialists. Reports of the Board The Board of Pharmaceutical Specialties should be expected , on an annual basis, to make reports of its activities to the American Pharmaceutical Association, to other national pharmaceutical organizations, and to each organization group, or society representing a recognized field of pharma~ ceutical specialty. Specialty Councils of the Board of Pharmaceutical Specialties For .each pharmaceutical specialty that has been officially recogmzed, the Board of Pharmaceutical Specialties should create a specialty council responsible to the Board and charged to perform certain functions. Functions of the Specialty Councils- In conformity with policies established by the Board of Pharmaceutical Specialties and s~bject to final approval by the Board, each Specialty CounCIl should be expected to fulfill the following functions1.
dev~lop ~nd codify requirements for individual specialty and certificatIOn and re-certification, which proposed requirements s~ould . be publicly available for adequate wide-spread conSIderatIOn before presentation to the Board for adoption;
2. develop a~d administer examinations, at least once each year, to determme the competency of candidates for certification and re-certification; 620
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
3. evaluate the qualifications of individuals seeking certification or re-certification, and submit to the Board the names of candidates, recommended for certification or re-certification· and ' 4. recommend policies with respect to such matters as length of time of continued certification before qualifications for recertification must be met, time interval permitted between the filing of an application for certification and successful completion by the candidates of all requirements, and the number of attempts permitted a candidate for the passing of an examination or meeting of other requirements.
Composition 0/ the Specialty Councils-the majority of the members of each Specialty Council, whose size should be established by the Board, should be appointed or elected by the appropriate national pharmaceutical specialty organization, or group, whose membership would be comprised primarily of individuals who are specialists in that field of pharmaceutical specialty. * Other members of the Specialty Council should include individuals engaged in related practice of pharmacy and be appointed by the Board of Pharmaceutical Specialties after consultation with appropriate representatives of these other areas of practice. The Board should have the power to decide on the numbers to be appointed to each Specialty Council, and the numbers may vary among fields of specialty. All members of Specialty Councils should be appointed or elected for staggered three-year terms subject to serving no more than two successive terms. The chairman and other officers should be elected annually by the section and be eligible for election to a maximum of three successive oneyear terms. Qualifications for Certification of Individual Specialists The qualifications for certification of individuals as specialists should be developed initially by each appropriate Specialty Council, subject to final approval by the Board of Pharmaceutical Specialties. These qualifications or requirements should include such factors as ethical and moral standing, level of education, extent of training, practical experience, successful passing of an oral and/or written examination, license to practice, and payment of fees. Citizenship and membership in professional organizations or societies should not be qualifications for certification. Approval of By-Laws The adoption of by-laws for the Board of Pharmaceutical Specialties, or any revisions in them, should be subject to the approval of the Board of Trustees of the American Pharmaceutical Association. Creation of Board of Pharmaceutical Specialties It is recommended that, concurrent with the acceptance and approval of this report by the Board of Trustees of the American Pharmaceutical Association, the Board also appoint a committee to draft the by-laws and establish the detailed plans for the creation, by July 1, 1975, of the Board of Pharmaceutical Specialties and for the implementation of the recommendations of this report. Following its organization and the election of officers of the
* Th e members of
the T ask F orce h ave assum ed that i n additi on to the responsibility oj appointing
0:elect zng ?{fici als to serve on a Specialty C ouncii , each such p harm aceuticai sp eci alty organiza·
tzon, or g roup , wo uld perform other acti 'jities , such as encourage the study, elevate the standa rd.. , promote lInd improve the prar.tice of the pha rmaceutical sp ecialty w ith w hich it is dir ectly conce rned, and s timula! e the developm ent of adequate training standards f or the specialty .
Board of Pharmaceutical Specialties, one of its first orders of business would be the development and adoption of procedures by which pharmaceutical groups seeking specialty status might be considered for official recognition. Review of the Board ofPharmaceutical Specialties It is further recommended that no later than five years from the date of creation of the Board of Pharmaceutical Specialties, a review should be undertaken of the Board's structure, operations, and financing, with special attention given to the composition of the Board. The review should be undertaken by a special committee created for this purpose and comprised of five (5) individuals: one (1) appointed by the American Pharmaceutical Association, one (1) appointed by the American Association of Colleges of Pharmacy, one (1) appointed by the National Association of Boards of Pharmacy, and two (2) nonpharmacists, one of whom shall be chairman, appointed jointly by the three above-named organizations. Similar reviews should subsequently be conducted at periodic intervals. In such reviews, provisions should be made to retain a' proportion of nonpharmacists on the Board at least no less than that provided initially.
Other Matters The fourth charge to the Task Force on Specialties in Pharmacy stated that it should "consider other matters of immediate concern as identified by the Task Force." In pursuance of this assignment, the Task Force has identified two matters that it wishes to call to the attention of the Board of Trustees of the American Pharmaceutical Association, namely, a definition for pharmacy and the recognition through means other than 'certification in a specialty.
The Task Force on Specialties in Pharmacy recommends(1) that a new definition of pharmacy be developed, (2) that
the Board of Trustees of the American Pharmaceutical Association assume the initiative in seeing that such a definition is produced, and (3) that an interdIsciplinary group, including members of closely related professions and of the general public, be included in the drafting body. Recognition Through Means Other Than Certification in a Specialty
As stated earlier in this report, certification ·is employed both to identify individuals who are qualified in a specialized area of professional practice, as well as individuals who have attained superior competence in the broad areas of responsibility of a particular profession. This Task Force was specifically charged to consider certification as it relates to specialization of practice. However, the members of the Task Force believe that consideration should be given to the issue of recognition of exceptional competence or accomplishment through means other than certification in a specialty. The AACPjAPhA Task Force on Continuing Competence in Pharmacy is functioning concurrent with the Task Force on Specialties in Pharmacy. In view of the factthat the conclusions and recommendations of each, especially with regard to this matter, may have a bearing on the conclusions of the other, and in view of the fact that each Task Force is expected to complete its final report within a few months of each other, it is recommerided that the Board of Trustees give consideration in whatever manner it considers most appropriate to the question of recognition of exceptional accomplishment or accomplishment through means other than certification in a specialty. Respectfully Submitted, Jeffrey Cohelan William J. Edwards Leonard D. Fenninger John A. Gans Paul G. Grussing Robert G. Leonard Robert L. Ravin William K. Selden Ouida C. Upchurch Warren E. Weaver Lloyd M. Parks, Chairman
Definition ofPharmacy
To identify specialties in pharmacy, it is necessary that there be a definition of pharmacy. The Task Force has relied on the definition adopted by the American Pharmaceutical Association, as quoted in an earlier section of this report. In so doing, the Task Force realizes that the definition is not adequate for the issues that will face pharmacy in the future. Therefore, the officially adopted definition appears under present modes of practice to be too ambiguous.
Reactions to Comments Submitted to the Task Force on Its Preliminary Report
The APhA Task Force on Specialties in Pharmacy published a Preliminary Report in the February 1974 issue of the Journal -of the American Pharmaceutical Association, asking for comments and opinions on the material contained within the Report. In addition, the Task Force sent copies of its Preliminary Report to a number of national pharmaceutical associations, seeking comments and reactions of these groups. The Task Force received numerous replies to its requests which were considered in detail, during its April 18, 1974 meeting. Many of the replies were helpful in assisting the Task Force in preparing its Final Report for the Board of Trustees. The Task Force fett that a number of comments submitted deserve a response so that the intention of the Task Force
contained in its Final Report is understood clearly by all. The Task Force's reaction to a number of comments which were received follows: 1. Fulfillment of its Charge:
Several individuals observed that the Task Force had not fulfilled its first charge which was to identify areas of specialization. The Task Force thoroughly considered its option to investigate pharmacy practice and determine areas of specialization. However, the Task Force decided that if it was to recommend a structure by which specialties would be identified and specialists certified, it would be counterproductive to Vol. NS14, No. 11, November 1974
621
recognize areas of specialization concurrently. The Task Force, therefore, concluded that it should refrain from identifyin g any existing areas of specialization in pharmacy on the basis that such a decision should more properly be made by the proposed Board of Pharmaceutical Specialties. However, th e Task Force concluded th at there are potential areas of pharmacy practice that may in time be recognized as specialties. 2. Criterion One:
A number of respond ents interpreted Criterion One as excluding, outri ght , certain areas of pharmacy practice as areas of specialization. They interpreted the statement, "and not on manageria l, procedura l, or technical services, nor on the environment in which pharmacy has practiced," to infer that the Task Force was stating that management or. institutional pharmacy is not an area of specia lization. The Task Force wishes to emphasize that Criterion One establishes the basis on which specia lties shall be chosen. In so doing, the Task Force recommends that the basis be in the biological , physical, and behaviora l sciences. Indeed, the Task Force feels that any potential specialty, including hospital pharmacy, should be considered, if it can be demonstrated that the area of specialization rests on the basis just mentioned. The Task Force is most emphatic, however, that recognition shall not be on the sole basis of managerial , procedural, or technical services, nor on the basis of the environment in which pharmacy is practiced. The Task Force has reworded its Criteria in its Final Report to clarify its meaning. 3. Responsibilities of the Board of Pharmaceutical Specialties:
Severa l respondents felt that the Board of Pharmaceutical Specia \ties is given too much unilateral authority in the recognition of specialties and the certification of specialists. As mentioned above, the Task Force believes strongly that the process of specialization in pharmacy- as well as other hea lth professions- should be controlled by the profession, but with representation and input from other health professions and the public. The Board of Pharmaceutical Specialties is structured to accomplish this purpose. The Task Force fee ls it would be counter-productive to diffuse this responsibility among organizations representing officially recognized specialties. The Task F orce considers it vital for the future of the profession that the Board of Pharmaceutical Specialties be recognized throughout the entire profession as the one body with the authority to recognize specialties and certify specialists. The Task F orce, likewise, feels that it is necessary to structure the Board of Pharmaceutical Specialties so that it is responsive and responsible to the profession. The Task Force believes that its recommended structure will accomplish these goals. 4. Composition of the Board:
A number of comments were directed toward recommending representatives from specific areas of pharmacy practice on the Board of Pharmaceutical Specialties. Other comments were directed at the representation, specifically, from the American Association of Colleges of Pharmacy and the National Association of Boards of Pharmacy on the Board of Pharmaceutical Specialties. Other respondents pointed out that the Board should be composed of an odd number of members to avoid tie votes. The Task Force has recognized the inconsistency in its recommendations concerning the composition of the Board of Pharmaceutical Specialties. It believes that the Board should be broadly representative of the pharmacy profession with no specific group represented on 622
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
the Board. Therefore, the Task Force has revised its recommendation in this regard to provide that the Board of Pharmaceutical Specialties be comprised of fifteen members, with nine broadly representative of the profession, including individuals involved in practice, education, and licensure, to be appointed by the American Pharmaceutical Association, after solicitation of suggested nominees from a national organizasion representing these groups. Six Board members are to be nonpharmacists, appointed by the Board itself, after solicitation of suggested nominees from appropriate organizations. Of the six, two would be from the general public, one from the federal government and three from related health professions . 5. Nonpharmacists on Board of Pharmaceutical Specialties:
Comments were also submitted questioning the inclusion of nonpharmacists on the Board of Pharmaceutical Specialties. Some listed medicine as an example, pointing out that nonphysicians are not involved in the specialization process of the medical profession. The Task Force is fully aware of the pro.; cedures used by medicine in recognizing specialties in certifying specialists. However, the Task Force realizes that in pioneering the specialty area, medicine has made mistakes from which we should all learn. The Task Force believes strongly that the process of specialization impacts not only on the profession itself, but on associated health professions and most certainly on the public. Thus, these areas should be represented on the Board. The Task Force feels that the pharmacy profession has a rare opportunity to create a specialty system which would best serve the profession, its sister professions, and the public, by involving nonpharmacist health practitioners, as well as the public. Such a system could well serve as the model on which future specialty recognition systems in other professions are based. 6. Task Force to Report to APhA Board of Trustees or House of Delegates?
Several comments were directed toward the matter of whether the Report of the Task Force should be approved by the APhA House of Delegates or the APhA Board of Trustees. The Task Force points out that it was created by the APhA Board of Trustees, pursuant to a policy adopted by the APhA House of Delegates . Since it was created by the Board, the Task Force must report back to the Board . The Task Force believes, however, that the Board of Trustees would be receptive to any suggestions regarding the Board's implementation of the Report. The Task Force also wishes to point out that APhA has several programs which function with independent decision-making authority within the structure of the Association. The National Formulary and the APhA Judicial Board each possesses its own procedures and is independent in its designated areas of interest. Neither the APhA Board of Trustees nor the House of Delegates can interpose itself in the activities of these two groups when these activities are consistent with previously established protocols and/or by-laws. The Task Force sees no difference between these two Association activities and the proposed Board of Pharmaceutical Specialties. . While there were other comments submitted in response to the Task Force's Preliminary Report, the above are representative of the comments submitted. The Task Force appreciates the time and effort spent by individuals in responding to the Preliminary Report. The comments were most helpful in assisting the Task Force in completing its work. The Task Force believes that its Final Report represents a workable process for the recognition of specialties and the certification of specialists. The Task Force also feels that the process will be fair to all pharmacists, and especially fair to related professions and the public . •