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understand or do not care about pharmacy practice, so that "overproving" their concerns may be necessary. PharmD Degree
By David R. Work
O
ne can, of course, examine a document such as the "Final Report of the Task Force on Pharmacy Education" and find many worthwhile comments-some positive, some negative, and a few lateral in nature. Among the positive notes is the impressive 25-page section on references and bibliography, which is evidence of the vast array of sources examined and used as underpinning for the document. Other generally positive statements found are the recommendations that the curriculum should be reviewed and that curricular experimentation, innovation, and flexibility be allowed. ' Some items, however, evoke controversy and have begun to be the focus of discussion. For example, one recommendation is that "curriculum should contain an externship and a clerkship of such quality and quantity to serve in lieu of the internship requirements." While some Boards of Pharmacy have effectively abandoned the internship requirement, or let it go to the colleges and universities by default, it is my
observation that the overwhelming majority of Boards are unwilling to release their rights and responsibilities in this area without demonstrated interest in the everyday practice of pharmacy on the part of the large majority of faculty. There is a saying among politicians that perception is reality. For example, it is common to hear that Republicans are against Social Security and for big business, while Democrats are charged with being soft on communism and big spenders. While these charges may not be true, they are used in political encounters, and if the public perceives these charges to be accurate they believe them regardless of whether any individual candidates might deserve the label. In order to shed these labels as commonly perceived by the public, it is often necessary for candidates to "overprove" their concerns in these areas. The same might be said of pharmacy faculty when it comes to the everyday practice of our profession. For many years, the perception has been that the everyday practitioner believes that college faculty either do not
American Pharmacy Vol. NS26, No.2, February 1986/103
Perhaps the most commonly discussed recommendation is the evolution of the six-year PharrnD as the sole entry-level degree for the practice of pharmacy. Most of the attention given to this concept up to this point surrounds the additional educational component necessary, the different academic designation, and the perceived threat of this development to pharmacists who hold only a bachelor's degree. Anyone who has attended an NABP meeting in the last three years recognizes the exceptional amount of heat and smoke-with very little lightgenerated by this topic. Other comments within the report on the professional practice degree that are curious are the two references to the BS degree. In one case, the authors concede that students should have the option of acquiring a BS in pharmacy science or pharmacy technology on the way to completion of the PharmD degree. In another paragraph it is stated that the BS entry level should not be abandoned until and iffuture developments so warrant. These phrases produce, almost by reflex, the question, "What good would a BS in pharmacy science or pharmacy technology be if the PharmD is the sole entry level?" A more intriguing question also arises when one queries, "What developments warrant abandonment of the BS degree?" Curious logic also occurs later in the section on the professional practice degree (note the order of the occurrence here). The report says if the decision is made to move to the sixyear PharmD degree, then a study should be made to establish the superiority of the six-year degree. What we see here is an unabashed declaration of first making a decision' and then looking for the evidence to support that decision. It is all too easy to forget that Boards of Pharmacy exist to protect the public health, safety, and wel-
31
fare. Boards function in this respect by determining candidate competency through the NABPLEX examination and other exams. In order to justify promotion or even acceptance of the PharmD by Boards in lieu of the BS degree, there must be an assessment of performance by holders ofPharmD and BS degrees. One method of comparing graduates of BS vs. PharmD programs has been suggested by the N ABP Committee on Education, which would involve comparing NABPLEX scores for BS and PharmD candidates. It is my understanding that NABP staff is now investigating the possibility of obtaining this information, and the results should be interesting. As a person trained in law, I have learned that when experienced people write for a publication they are usually quite careful and ordinarily mean precisely what they say. Under these circumstances, I am more than concerned about the phraseology in the recommendation regarding the professional practical degree. In the execu ti ve summary the phraseology is:''The Task Force recommends that the six-year PharmD evolve as the desired goal with the intent that it become the sole entry level for the practice of pharmacy." In the section of the report captioned ''The Professional Degree" there are somewhat more words: "The TaskForce recommends that a six-year professional degree with an enhanced professional competency evolve as the desired goal with the intent that it become the sole entry level for the practice of pharmacy." At the present time, the academic degree serves as the major criterion for entry into the licensure exam, but it is the Boards of Pharmacy that determine competency and determine when a person enters practice and is a pharmacist. If one goes back and re-reads each phrase, it becomes clear that the Task Force did not intend the PharmD degree to be the sole degree, but it is intended that the degree, in and of itself, is sufficient for practicing pharmacy, and licensure by the Boards would be surplusage. This conclusion is further supported by the additional reference in the body of the report to "enhance
32
"P
harmacists want peace in their profession, and they shall have it."
professional competency," which is now adjudicated by the licensing boards. If this is indeed the message contained within this report, then we had all best take notice. In an unrestrained burst of common sense, the Task Force also states that the external PharmD degree issue cries out for resolution. Certainly more than one school, college, or university can develop a program and make it available to hospital and community pharmacists in a time and manner amenable to completion. The additional knowledge and skills cannot be so abstruse that they can only be conveyed to those who have forsaken job, home, and perhaps family for life in a teaching medical center. Over and over again, studies have shown that one of the primary problems faced by the pharmacy profession is finding an available avenue for upward mobility. Indeed, in some institutions or perhaps corporations the possession of an advanced degree is the sine qua non for promotion. Witho\lt the reasonable availability of a PharmD degree, holders of BS degrees will be relegated to second-class status through no fault of their own. Learning from Lawyers The only viable alternative I can see for resolving this situation is to learn from the lawyers, and do as the law schools did in the 1960s when Bachelor of Law degrees (LLBs) were deemed equivalent to JD degrees. A virtually identical procedure could occur in pharmacy, with the Bachelor of Science degree deemed equivalent to the PharmD degree, with the exchange of one for
the other. Statistics developed in the performance study ofBS vs. PhannD candidates on the NABPLEX exam might be significant in this respect. Ai?, to the length of time, whether it be five years or six years, or more, I believe it is the most appropriate course of action to allow free-market forces to work and thereby obtain strength through diversity. In that way, the most efficient system would be available through competition, while numerous choices for potential students would be provided. In searching the literature pertaining to the switch from the LLB to the JD degree there are numerous quotations that could be just as easily attributed to the BS vs. PharmD discussion. Phrases occur such as "first professional degree," and there are discussions about confusing first professional degrees with advanced degrees (JD vs. JSD; PharmD vs. PhD) and about whether the LLB is a graduate or undergraduate degree. APhA President John F. Schlegel was right, in my opinion, when shortly after taking office· he said that pharmacists want peace in their profession, and they shall have it. In this case I see nothing wrong with the movement to a PharmD degree, but if the educators cannot find a way to make an external degree reasonable and attainable for practicing pharmacists, then, in order to keep peace in this profession, I believe it will be necessary to provide PharmD degrees for holder of BS certificates. While this may be an unpleasant quid pro quo for many educators, it is at this point where they can make a moral judgment to see if, considering the entire situation, the ends justify the means. We need to resolve this issue soon and move on to other matters-such as promoting more effective teaching, ensuring rewards for research in colleges, and ensuring better public protection by the Boards. ®
David R. Work, JD, is executive director, North Carolina Board of Pharmacy, P.O. Box H., Carrboro, NC 27510. This paper was presented at the NABP-AACP District III meeting, August 11-13,1985, Howey-in-tMHills,FL.
American Pharmacy Vol. NS26, No.2, February 1986/104
By David R. Work
O
ne can, of course, examine a document such as the "Final Report of the Task Force on Pharmacy Education" and find many worthwhile comments-some positive, some negative, and a few lateral in nature. Among the positive notes is the impressive 25-page section on references and bibliography, which is evidence of the vast array of sources examined and used as underpinning for the document. Other generally positive statements found are the recommendations that the curriculum should be reviewed and that curricular experimentation, innovation, and flexibility be allowed. ' Some items, however, evoke controversy and have begun to be the focus of discussion. For example, one recommendation is that "curriculum should contain an externship and a clerkship of such quality and quantity to serve in lieu of the internship requirements." While some Boards of Pharmacy have effectively abandoned the internship requirement, or let it go to the colleges and universities by default, it is my
observation that the overwhelming majority of Boards are unwilling to release their rights and responsibilities in this area without demonstrated interest in the everyday practice of pharmacy on the part of the large majority of faculty. There is a saying among politicians that perception is reality. For example, it is common to hear that Republicans are against Social Security and for big business, while Democrats are charged with being soft on communism and big spenders. While these charges may not be true, they are used in political encounters, and if the public perceives these charges to be accurate they believe them regardless of whether any individual candidates might deserve the label. In order to shed these labels as commonly perceived by the public, it is often necessary for candidates to "overprove" their concerns in these areas. The same might be said of pharmacy faculty when it comes to the everyday practice of our profession. For many years, the perception has been that the everyday practitioner believes that college faculty either do not
American Pharmacy Vol. NS26, No.2, February 1986/103
Perhaps the most commonly discussed recommendation is the evolution of the six-year PharrnD as the sole entry-level degree for the practice of pharmacy. Most of the attention given to this concept up to this point surrounds the additional educational component necessary, the different academic designation, and the perceived threat of this development to pharmacists who hold only a bachelor's degree. Anyone who has attended an NABP meeting in the last three years recognizes the exceptional amount of heat and smoke-with very little lightgenerated by this topic. Other comments within the report on the professional practice degree that are curious are the two references to the BS degree. In one case, the authors concede that students should have the option of acquiring a BS in pharmacy science or pharmacy technology on the way to completion of the PharmD degree. In another paragraph it is stated that the BS entry level should not be abandoned until and iffuture developments so warrant. These phrases produce, almost by reflex, the question, "What good would a BS in pharmacy science or pharmacy technology be if the PharmD is the sole entry level?" A more intriguing question also arises when one queries, "What developments warrant abandonment of the BS degree?" Curious logic also occurs later in the section on the professional practice degree (note the order of the occurrence here). The report says if the decision is made to move to the sixyear PharmD degree, then a study should be made to establish the superiority of the six-year degree. What we see here is an unabashed declaration of first making a decision' and then looking for the evidence to support that decision. It is all too easy to forget that Boards of Pharmacy exist to protect the public health, safety, and wel-
31
fare. Boards function in this respect by determining candidate competency through the NABPLEX examination and other exams. In order to justify promotion or even acceptance of the PharmD by Boards in lieu of the BS degree, there must be an assessment of performance by holders ofPharmD and BS degrees. One method of comparing graduates of BS vs. PharmD programs has been suggested by the N ABP Committee on Education, which would involve comparing NABPLEX scores for BS and PharmD candidates. It is my understanding that NABP staff is now investigating the possibility of obtaining this information, and the results should be interesting. As a person trained in law, I have learned that when experienced people write for a publication they are usually quite careful and ordinarily mean precisely what they say. Under these circumstances, I am more than concerned about the phraseology in the recommendation regarding the professional practical degree. In the execu ti ve summary the phraseology is:''The Task Force recommends that the six-year PharmD evolve as the desired goal with the intent that it become the sole entry level for the practice of pharmacy." In the section of the report captioned ''The Professional Degree" there are somewhat more words: "The TaskForce recommends that a six-year professional degree with an enhanced professional competency evolve as the desired goal with the intent that it become the sole entry level for the practice of pharmacy." At the present time, the academic degree serves as the major criterion for entry into the licensure exam, but it is the Boards of Pharmacy that determine competency and determine when a person enters practice and is a pharmacist. If one goes back and re-reads each phrase, it becomes clear that the Task Force did not intend the PharmD degree to be the sole degree, but it is intended that the degree, in and of itself, is sufficient for practicing pharmacy, and licensure by the Boards would be surplusage. This conclusion is further supported by the additional reference in the body of the report to "enhance
32
"P
harmacists want peace in their profession, and they shall have it."
professional competency," which is now adjudicated by the licensing boards. If this is indeed the message contained within this report, then we had all best take notice. In an unrestrained burst of common sense, the Task Force also states that the external PharmD degree issue cries out for resolution. Certainly more than one school, college, or university can develop a program and make it available to hospital and community pharmacists in a time and manner amenable to completion. The additional knowledge and skills cannot be so abstruse that they can only be conveyed to those who have forsaken job, home, and perhaps family for life in a teaching medical center. Over and over again, studies have shown that one of the primary problems faced by the pharmacy profession is finding an available avenue for upward mobility. Indeed, in some institutions or perhaps corporations the possession of an advanced degree is the sine qua non for promotion. Witho\lt the reasonable availability of a PharmD degree, holders of BS degrees will be relegated to second-class status through no fault of their own. Learning from Lawyers The only viable alternative I can see for resolving this situation is to learn from the lawyers, and do as the law schools did in the 1960s when Bachelor of Law degrees (LLBs) were deemed equivalent to JD degrees. A virtually identical procedure could occur in pharmacy, with the Bachelor of Science degree deemed equivalent to the PharmD degree, with the exchange of one for
the other. Statistics developed in the performance study ofBS vs. PhannD candidates on the NABPLEX exam might be significant in this respect. Ai?, to the length of time, whether it be five years or six years, or more, I believe it is the most appropriate course of action to allow free-market forces to work and thereby obtain strength through diversity. In that way, the most efficient system would be available through competition, while numerous choices for potential students would be provided. In searching the literature pertaining to the switch from the LLB to the JD degree there are numerous quotations that could be just as easily attributed to the BS vs. PharmD discussion. Phrases occur such as "first professional degree," and there are discussions about confusing first professional degrees with advanced degrees (JD vs. JSD; PharmD vs. PhD) and about whether the LLB is a graduate or undergraduate degree. APhA President John F. Schlegel was right, in my opinion, when shortly after taking office· he said that pharmacists want peace in their profession, and they shall have it. In this case I see nothing wrong with the movement to a PharmD degree, but if the educators cannot find a way to make an external degree reasonable and attainable for practicing pharmacists, then, in order to keep peace in this profession, I believe it will be necessary to provide PharmD degrees for holder of BS certificates. While this may be an unpleasant quid pro quo for many educators, it is at this point where they can make a moral judgment to see if, considering the entire situation, the ends justify the means. We need to resolve this issue soon and move on to other matters-such as promoting more effective teaching, ensuring rewards for research in colleges, and ensuring better public protection by the Boards. ®
David R. Work, JD, is executive director, North Carolina Board of Pharmacy, P.O. Box H., Carrboro, NC 27510. This paper was presented at the NABP-AACP District III meeting, August 11-13,1985, Howey-in-tMHills,FL.
American Pharmacy Vol. NS26, No.2, February 1986/104