How To Change The Board Certification Process

Transcription

1 BPS Pharmacy Specialty Structure and Framework Discussion Paper July 2014 PURPOSE The purpose of this paper is to solicit comments from the profession of pharmacy, as well as those outside of pharmacy, on the future structure and framework for recognizing pharmacy specialties. BPS is proactively evaluating and refining the structure and framework of specialty recognition to increase capacity for board certification for pharmacists that will meet the increasing needs of our evolving healthcare system and the patients we serve. This paper is designed as a starting point for gathering feedback and stimulating thoughtful discussion that will ultimately inform any changes to the BPS Specialty Recognition structure. The BPS process for examining the specialty recognition structure and framework includes: Posting this paper for public comment Convening a steering committee of stakeholders Convening a broader stakeholder advisory committee Developing a potentially updated structure and process for recognition of pharmacy specialties and subspecialties (anticipated release for comment early 2015) Obtaining input on any structure and framework changes (early 2015) Finalizing a revised the BPS Specialty structure and framework (mid- 2015) The expected outcome of this process will be to develop a model that will not only meet current needs but will be flexible enough to accommodate changes in the healthcare system and the evolving role of pharmacist specialists. The BPS Board of Directors will consider all input before issuing a final model in This paper discusses and seeks input on the potential to develop subspecialties and their related criteria. It also looks to gather feedback to answer key questions about future specialty areas, such as those areas that may be considered to be non- clinical. This paper does not propose answers to all of the issues or questions within the BPS Specialty Recognition structure and leaves open the possibility to discuss other processes or structures. There is a survey link at the end of this paper to gather feedback and comments from all stakeholders. BPS encourages you to respond to the survey to help inform this decision making process. WHY EVALUATE THE PHARMACY SPECIALTY STRUCTURE? As the importance of board certification grows, it is appropriate for BPS to review the current model and consider changes that will serve the public and the profession into the foreseeable future. The current 07/18/14 1

2 structure has historically served its purpose, but with the significant growth in pharmacist board certification over the past 5 to 10 years, the time has come to proactively undertake this endeavor. It should be noted that when the original structure was developed in 1976, the success of board certification within the profession was not assured. In essence, the growth of pharmacist board certification has paralleled the expanded roles of pharmacists within healthcare delivery systems in the U.S. and globally. The evolution within BPS and the role of the pharmacist is now occurring at a rapid rate and is a testament to the tremendous efforts of many national organizations, schools and colleges of pharmacy, and most importantly, the individual practitioners who have responded to the needs of patients in all practice settings. Further, the BPS Strategic Plan approved in October 2012 states three broad goals: 1 1. Increase the number of Board Certified Pharmacists (includes growing the numbers in each current specialty to meet the needs of the healthcare system and recognizing new specialty areas) 2. Define a pharmacy specialty board certification model that can evolve within a changing healthcare delivery system (goal of this discussion paper and related activities) 3. Maintain an effective governance model that includes volunteer leadership, staff, and resources to support BPS current functions and anticipated growth and evolution (Informed by goals 1 and 2) OVERARCHING CONSIDERATIONS As BPS embarks on this process to review the board certification structure, it is important to consider various points in contemplating potential changes. Those points include the following: Approximately 20,000 pharmacists are BPS Board Certified and could be affected by any changes to the specialty certification and/or recertification framework. The current certification model is generally consistent with other healthcare board certification processes, is well- regarded nationally, and is accredited by the National Commission on Certifying Agencies (NCCA). 2 The NCCA standards require demonstration of a valid and reliable process for development, implementation, maintenance, and governance of certification programs. BPS is committed to growing the number of pharmacy specialties, however, there is a risk that the profession could become overspecialized. If the marketplace does not demand certain specialized skills, then a critical mass of pharmacists in an area is not likely to exist. A critical mass is required to ensure feasibility and sustainability of any new specialty. Subspecialties are only suggested in this paper as a way to create efficiencies in the overall board certification process, especially when smaller numbers may exist. Likewise, the suggestion that the Added 2 07/18/14

3 Qualifications program remain in some capacity is also intended as a way to recognize practitioners in smaller or emerging specialty areas. Potential changes to the current board certification framework should not utilize grandfathering, as this is generally not acceptable to meet accreditation standards for certifying agencies and may not assure that patients experience the highest quality of care. BPS completed a stakeholder survey and review process in 2013 that reaffirmed the seven criteria that must be addressed for a proposed area of pharmacy practice to be recognized as a specialty. 3 Therefore, the criteria for recognized specialties have been re- affirmed by the profession, and any criteria to recognize subspecialties should be based upon those re- affirmed criteria. BPS is open to discussing other models beyond the one suggested in this paper. To stimulate consideration of this topic, an overview of the certification framework utilized by physicians, nurses and physician assistants is provided. BPS BACKGROUND AND CURRENT MODEL Early in its history, the leaders of BPS recognized that some differentiation within large, broad specialties might be important. Richard Penna, in his 1974 editorial titled, Specialties in Pharmacy, published in response to the release of the original APhA Taskforce on Specialties in Pharmacy, references the possibility of the profession developing subspecialties. 4 In the late 1990s, BPS discussions around this issue led to the creation of a small number of areas of Added Qualifications (Cardiology and Infectious Diseases) within the broad specialty of Pharmacotherapy. As the number of pharmacists achieving BPS specialty certification has increased significantly over the past decade and with specialty certification becoming more widely recognized and appreciated within pharmacy and other health professions, the topic of subspecialties has attracted more attention. As of July 2014, nearly 20,000 pharmacists hold BPS specialty certification, and the demand for advanced level credentials by pharmacists, as well as many employers, is growing at a significant rate. 5 The Mission of the Board of Pharmacy Specialties (BPS) is to improve patient care by promoting the recognition and value of specialized training, knowledge, and skills in pharmacy and specialty board certification of pharmacists. In this context, the topic of the BPS specialty structure and framework and subspecialty certification has emerged as one of increased discussion and potential major significance. This paper examines several issues related to the concept of subspecialty certification and the general framework for specialization in order to promote further exploration and discussion within the pharmacy profession and its stakeholders. The BPS Strategic Planning White Paper, published in January 2013, makes the following statement regarding the 2017 BPS vision as it relates to subspecialty recognition: 1 07/18/14 3

4 BPS will recognize new pharmacy specialties and/or subspecialties in areas that are consistent with, but not limited to, the growth of accredited postgraduate year 2 (PGY2) residency programs. In addition, BPS will evaluate the current specialty recognition structure and process and consider potential modifications. The White Paper goes on to state that achieving the 2017 vision must occur in a way that accommodates and encourages the evolutionary growth of pharmacist board certification through increasing flexibility and efficiency for all stakeholders. However, remaining steadfast to the rigor and quality of the BPS process and the accreditation standards established by the National Commission for Certifying Agencies and other oversight groups will be essential. 6 BPS recognizes pharmacy specialties based upon the criteria outlined in this paper, and each specialty is independent of any other BPS recognized specialty. BPS currently recognizes eight specialties: Ambulatory Care Pharmacy Critical Care Pharmacy Nuclear Pharmacy Nutrition Support Pharmacy Oncology Pharmacy Pediatric Pharmacy Pharmacotherapy Psychiatric Pharmacy Each specialty has its own eligibility and recertification criteria. BPS does not currently recognize subspecialties but has established an Added Qualifications program that is used to recognize an enhanced level of training and experience within one segment of a BPS- recognized specialty that targets specific diseases or patient populations. Added qualifications are awarded to those individuals who are BPS board certified in an existing specialty upon review of a professional portfolio that demonstrates their experience. Currently, Cardiology and Infectious Diseases are areas of added qualifications under the Pharmacotherapy specialty. As this paper discusses potential revisions to the current BPS certification framework, which could result in recognizing subspecialties and re- examining the current Added Qualifications program, BPS believes that the future growth of pharmacist board certification should progress in a manner consistent with the Council on Credentialing in Pharmacy s Framework for Credentialing in Pharmacy Practice, 7 which illustrates the continuum of a pharmacist s career from professional education to board certification. BPS supports this framework as particularly valuable because the role of the pharmacist is continuing to evolve, and this model accommodates that evolution. 4 07/18/14

5 Figure 1: Practitioners in Direct Patient Care Source: Council on Credentialing in Pharmacy Figure 2: Post- licensure certification relative to pharmacy practice focus Source: Adapted from Council on Credentialing in Pharmacy LEGEND: BCADM = Board Certified Advanced Diabetes Management, BCNP = Board Certified Nuclear Pharmacist, BCNSP = Board Certified Nutrition Support Pharmacist, BCOP = Board Certified Oncology Pharmacist, BCPP = Board Certified Psychiatric Pharmacist, BCPS = Board Certified Pharmacotherapy Specialist, CDE = Certified Diabetes Educator, CDM = Certified Disease Manager, CGP = Certified Geriatric Pharmacist It is important to note that the term subspecialty is used primarily in this paper to describe specific practices contained within a larger specialty. The terms subspecialty and added qualifications have been used historically in other professions (notably medicine). Other terms may also be considered. 07/18/14 5

6 Another important assumption is that this paper, for practical purposes, considers existing BPS specialties as primary specialties and does not attempt to re- classify existing specialties as subspecialties. Models of Specialty Recognition in Other Health Professions As BPS considers evolving the structure and framework for specialty recognition of pharmacists, the varied models for specialization utilized within other health professions provide examples for evaluation and potential adaptation. Among health professions, the structure and framework for specialization varies widely from certificates of added qualifications to initial credentialing and licensing to complex structures with layers of specialties, subspecialties, and other credentials. The influence of market forces, such as links between reimbursement and board certification, varies and directly influences the demand for specialty credentials and the numbers of specialties and certified individuals within some health professions. These and other drivers also are important factors in pharmacy s consideration of alternative structures. Within medicine, specialties and subspecialties are utilized, with varying elements of added qualifications. Differences in alignment and recertification exist between traditional medicine and osteopathic medicine. Nursing employs a model comprised of an array of individual specialty certifications, without subspecialties. For physician assistants, specialty recognition is relatively new, implemented within this decade, and their model builds upon certification of physician assistants through certificates of added qualifications in seven therapeutic areas. Summaries of these models and the certifying organizations are outlined below. The Medical Model American Board of Medical Specialties (ABMS) For well over 100 years, the medical profession has recognized specialty and subspecialty practices in multiple areas. In many respects, the medical model has set the tone for credential development in a number of professions including pharmacy. It is worth considering the medical model in this discussion, although there are important differences that must be kept in mind. For physicians, board certification is essentially a requirement for practice because it is tied to many forms of reimbursement. Sheer numbers of practitioners and their rate of seeking post- licensure credentials is one great difference. Of the approximately 850,000 practicing physicians in the U.S. today, it can be estimated that upwards of 90% hold specialty and/or subspecialty credentials. 8 Of the approximately 287,000 actively practicing pharmacists, only about 8% hold BPS certification, and far fewer hold certifications from other organizations. 9 BPS believes that one practical difference between the roles of physician specialists and pharmacist specialists is the broad- based expertise of pharmacists in evaluating and managing a wide range of complex medication- related issues that span a number of patient- specific conditions. BPS further believes that the unique value of Board Certified Pharmacists is their in- depth understanding of all 6 07/18/14

7 medications. So, it may follow that pharmacy will never see the need, demand, or even desirability for the high level of specialization that characterizes the medical profession today. For more than 75 years, the American Board of Medical Specialties (ABMS) has been the medical organization overseeing physician certification in the United States. It assists its 24 member boards in their efforts to develop and implement educational and professional standards for the evaluation and certification of physician specialists. There are currently a total of 160 specialty and subspecialty certifications offered through the 24 ABMS Member Boards. Nearly 800,000 physicians are Board Certified by an ABMS Member Board(s). To become certified in a particular subspecialty, a physician must be board certified by one of the 24 ABMS member boards. 10 One example is pediatrics. To become certified in a particular subspecialty, a physician must first be board certified by the American Board of Pediatrics (ABP) and complete additional training as specified by ABP. After primary board certification is granted by ABP, pediatricians can earn subspecialty recognition in areas such as neurodevelopmental disabilities, pediatric cardiology, and pediatric critical care medicine. 11 ABMS Member Boards may issue, alone or in conjunction with another Member Board, certificates to designate qualifications in one or more subspecialty areas. Currently, ten subspecialty certificates are issued by multiple boards, including one that is co- sponsored by ten ABMS Member Boards. It should be noted that in 1985, the ABMS Committee on Certification, Subcertification and Recertification (COCERT) included the terms Added Qualifications and Special Qualifications that were meant to recognize the practitioner s identification within the primary discipline from which he or she holds a certification, as well as the added preparation. Over time, these terms were deemed to be confusing, and in 1995, the use of these terms to describe subspecialty certificates issued by ABMS Member Boards was discontinued. However, ABMS Member Boards, at their option, may continue to designate existing subspecialty certificates as Added Qualifications and Special Qualifications and use the terms freely for internal purposes. 12 Bureau of Osteopathic Specialists (BOS) The Bureau of Osteopathic Specialists (BOS) was organized in 1939 as the Advisory Board for Osteopathic Specialists to meet the needs resulting from the growth of specialization in the osteopathic profession. It was thought at that time that there should be standardization of postdoctoral education and regulations for certification in the various specialties or fields of practice. Therefore, the Board of Trustees of the American Osteopathic Association (AOA), through its agency, the Advisory Board for Osteopathic Specialists, became the certifying body. The body's name was changed from the Advisory Board to the Bureau in Osteopathic Medicine has an organizational structure very similar to that of BPS. The various osteopathic specialties operate under the umbrella of the BOS, and the BOS is a division of the AOA. Currently, there are 18 certifying Boards offering 39 Primary Certifications. Within those basic specialties, there are a total of 28 Special Qualifications and 63 Added Qualifications credentials available. The AOA is considering a policy change to rename Special Qualifications as Subspecialties. 07/18/14 7

8 Within the BOS structure, physicians do not have to maintain their primary specialty once they have earned Special Qualifications. However, those that earn Added Qualifications need to maintain the primary certification or Special Qualifications that the Added Qualifications credential is linked to. 13 Nursing The American Nurses Credentialing Center (ANCC) is a subsidiary of the American Nurses Association (ANA). ANCC's internationally recognized credentialing programs certify and recognize individual nurses in specialty practice areas. ANCC also recognizes healthcare organizations that promote nursing excellence and quality patient outcomes. In addition, ANCC accredits healthcare organizations that provide and approve continuing nursing education. 14 ANCC's Certification Program enables nurses to demonstrate their specialty expertise and validate their knowledge through targeted exams that incorporate the latest nursing- practice standards. ANCC offers three broad classes of certifications: Nurse Practitioner Certification with 12 specific certifications (97,993 hold certification) Clinical Nurse Specialty Certifications with 10 specific certifications (11,923 hold certification and 3,220 hold other advanced level certifications) Specialty Certifications with 27 certifications (62,818 hold certification) As of 2013, a total of 175,954 nurses hold certifications through ANCC. 15 The work of the ANCC is broad and includes certification, accreditation and education. Only certification is within the scope of BPS, while the accreditation and education activities are carried out by other organizations within pharmacy, differing from the nursing model. However, in the area of certification, it should be noted that ANCC does not offer a fully developed subspecialty program. There is one subspecialty credential under Nurse Practitioner Certification to recognize Emergency Nurse Practitioners. This credential is awarded by holding a primary Nurse Practitioner certification followed by a portfolio review, which is similar to the current BPS Added Qualifications program. 16 Physician Assistants In 1972, the National Board of Medical Examiners (NBME) and the American Medical Association convened representatives from fourteen organizations, including the American Academy of Physician Assistants, to discuss the need for establishing an independent certifying authority for the physician assistant profession. Three years later, the National Commission on Certification of Physician Assistants (NCCPA) was formed to fulfill that role. NCCPA is the only nationally recognized certifying body for physician assistants (PAs) in the United States. Established as a not- for- profit organization in 1975, NCCPA is dedicated to assuring the public that certified physician assistants meet professional standards of knowledge and clinical skills. All U.S. states, the District of Columbia and the U.S. territories rely on NCCPA certification criteria for initial 8 07/18/14

9 licensure or regulation of physician assistants. More than 100,000 physician assistants have been certified by NCCPA. To attain certification, PAs must graduate from an accredited PA program and pass the Physician Assistant National Certifying Exam (PANCE). PANCE is a multiple- choice test that comprises 300 questions that assess broad medical and surgical knowledge. After passing PANCE, PAs become NCCPA- certified, which entitles them to use the Physician Assistant- Certified (PA- C ) designation until the expiration of their first cycle (approximately two years). To maintain NCCPA certification and retain the right to use the PA- C designation, they must fulfill continuing medical education (CME) requirements every two years and pass a recertification exam every six to ten years. In 2009, the NCCPA Board of Directors provided the final approval for NCCPA to launch a Certificate of Added Qualifications (CAQ) program to recognize the PAs experience and knowledge in certain specialty areas. Today, CAQs are offered in cardiovascular/thoracic surgery, emergency medicine, hospital medicine, nephrology, orthopaedic surgery, pediatrics and psychiatry. To earn a CAQ, PAs must be NCCPA certified and have a valid state license (or comparable authorization to practice); meet specialty specific requirements related to CME, experience, and procedures and patient- case management; and pass a specialty exam. The first specialty CAQ exams were administered in September Current BPS Model In 2014, BPS is the predominant provider of specialty or advanced practice (beyond licensure) credentials in the profession. The following numbers are active certificants in currently recognized BPS specialties: BPS Specialty Pharmacotherapy Cardiology Added Qualifications Infectious Diseases Added Qualifications Ambulatory Care Pharmacy Oncology Pharmacy Psychiatric Pharmacy Nutrition Support Pharmacy Nuclear Pharmacy Active certificants as of June , ,659 1, New specialties have been approved in Pediatric Pharmacy and Critical Care Pharmacy, and several others have been suggested. In this expanding environment, it is critical to outline how specialty practices are currently identified. BPS completed a stakeholder survey and review process in 2013 that reaffirmed the seven criteria that must be addressed for a proposed area of pharmacy practice to be recognized as a specialty. 3 The criteria are as follows: 07/18/14 9

10 NEED - Specialization should address public health and/or patient care needs which are not being supplied currently and that pharmacists in the proposed specialty could meet. DEMAND - BPS describes demand as a willingness and ability of stakeholders and other entities to pay for the services of a Board Certified Pharmacist in the proposed specialty. NUMBER and TIME - A reasonable number of practitioners should be devoting most of the time in the practice of the specialty area to make the certification process economically justifiable for the public and the profession. SPECIALIZED KNOWLEDGE - This criterion calls for specialized knowledge, beyond the knowledge base of the doctor of pharmacy degree, of one or more of the pharmaceutical sciences and the biological, physical, behavioral, and administrative sciences which underlie them. SPECIALIZED FUNCTIONS - Specialization refers to an identifiable field of pharmacy practice that requires specialized functioning and is distinct from other BPS- recognized pharmacy specialties. EDUCATION and/or TRAINING - Schools and colleges of pharmacy and/or other organizations must offer recognized education and training programs to those seeking advanced knowledge and skills in the area of specialty practice. TRANSMISSION OF KNOWLEDGE - There must be an adequate transmission of specialized knowledge through professional, scientific, and technical literature directly related to the specialty area. The re- affirmation of these criteria sets the stage for a discussion regarding subspecialties. CONSIDERING A BPS FRAMEWORK REVISION BPS proposes that the profession should consider evolving the board certification process to include a series of primary pharmacy specialty certifications in multiple areas with subspecialties. BPS specialties are currently viewed as relatively broad in scope. The recognition of primary board certifications based on the criteria listed above would facilitate the development of pharmacy subspecialties in the future as need and demand arise. Primary certifications would accomplish two important goals: Ensure that core competencies needed by the Board Certified Pharmacist are evaluated Demonstrate a broad range of knowledge and experience Almost 75 percent of board certified pharmacists responding to a survey question, as part of the BPS strategic planning process, supported the implementation of an examination requirement for the current Added Qualifications program, which would make that program very similar to subspecialty recognition. Therefore, a model to draw upon for a type of subspecialty recognition already exists within BPS through the Added Qualifications program. However, it is envisioned that a subspecialty recognition process would be different from the current BPS Added Qualifications program. In addition to required subspecialty practice experience, the candidate would also have to demonstrate knowledge through an 10 07/18/14

11 examination component. A decision will need to be made as to whether the BPS Added Qualifications program would continue to meet a need for the profession and the public. The current Added Qualifications program could be useful as a credential that is a precursor to subspecialty recognition. Board Certified pharmacists in one specific primary specialty, who have an emerging specialized practice, could petition BPS to recognize an area as one of Added Qualifications according to the criteria already established by BPS. Figure 3. Proposed Basic Structure for BPS Credentials BPS Primary Specialty BPS Subspecialty awarded by meeting eligibility criteria and passing a subspecialty examination BPS Added Qualifications awarded by meeting eligibility criteria and portfolio review Board Certification in a primary specialty would likely be required to be eligible for subspecialty recognition or Added Qualifications. Eligibility, examination and recertification criteria for a subspecialty area would be generally consistent with the requirements already in place for the primary board certification. However, BPS must ensure there is a clear distinction between specialties, subspecialties and Added Qualifications. It is important that BPS clearly and effectively communicates the qualifications represented by each credential to the public and other healthcare stakeholders. It is envisioned that individuals who currently hold the BPS Added Qualifications designation in Cardiology and/or Infectious Diseases will have a period of time to meet any requirement for a new BPS credential in those areas. One of the principal BPS criteria for recognizing a specialty involves formal education and training in the specialized practice area. A growing driver for the development of additional specialty and/or subspecialty credentials within the pharmacy profession is the major growth of accredited residency training programs beyond the initial PharmD degree and licensure. The American Society of Health- System Pharmacists (ASHP) accredits PGY- 1 and PGY- 2 residencies, and the number of accredited programs and residents has also experienced significant growth over the past decade. The following table includes the practice areas with significant numbers of residency programs and residents. Given that such training is likely one of the greatest incentives for the development of specialty or subspecialty certifications, these data are of immense importance to the current discussion. 07/18/14 11

12 Figure 4. Accredited Residency Information (Source: ASHP - July 1, 2014) Only practices with 10 or more accredited residencies as of 2014 are shown. Pharmacy practice area PGY2 or Number of accredited programs Number of residents since 2007* comb PGY1/PGY2 Critical Care Ambulatory Care Oncology Admin Health System (PGY2 with or without MS, 12 month or 24 month programs all included) Infectious Diseases Psychiatry Pediatrics Internal Medicine Solid Organ Transplant Cardiology Emergency Medicine Pharmacy Informatics Geriatric Pharmacy Drug Information Pharmacotherapy 24 month Pain Management/Palliative Care Pharmacy practice area PGY1 Number of accredited programs Number of residents since 2007* Health System ,319 Community Managed Care * These numbers are approximate only. Resident numbers are based on positions filled at the time of the match. It does not include post match placements, or residents that do not complete programs. Program numbers are based on actual programs in the ASHP accreditation process as of 7/1/14, which should correspond to when these residents began their residency from the 2014 match. To begin this dialogue, BPS proposes a model where certification in a primary specialty is conferred to those pharmacists who meet the requirements in a specified field of pharmacy practice under the jurisdiction of the appropriate BPS Specialty Council. Primary certification represents a distinct and well- defined field of pharmacy practice. As stated earlier, for practical purposes, BPS considers existing specialties as primary specialties and does not attempt to re- classify existing specialties as subspecialties. From the primary board certifications, BPS proposes to recognize subspecialties within the primary pharmacy specialty. The development of a subspecialty recognition process would create efficiencies for 12 07/18/14

13 important, smaller areas of practice, as well as create flexibility for pharmacists to earn and maintain a credential that is more focused on their daily practice (i.e., the Board Certified Oncology Pharmacist could earn subspecialty recognition in the area of bone marrow transplantation). If fully developed, a pharmacy board certification subspecialty framework would likely require a primary board certification and then application to the subspecialty area that would have its own unique eligibility requirements, examination, and recertification criteria. It is the belief of BPS that if a pharmacist attains subspecialty certification within a particular primary specialty, after holding that primary credential, (s)he must also maintain the primary certification, even if his/her practice is principally in the subspecialty area. While medical specialties differ on this requirement, the evolution of the profession of pharmacy in clinical roles still finds that employers and healthcare colleagues value the broad knowledge base that a pharmacist possesses, which is validated by an initial BPS primary specialty area. SUMMARY COMMENTS AND NEXT STEPS This paper provides historical information about BPS processes and background regarding specialty recognition models in other health professions as a basis for outlining a proposed model for examining the BPS specialty structure and framework. The existing BPS specialty framework is valid, reliable, and rigorous. Process revisions will focus on increasing flexibility and expanding capacity for board certification of pharmacists. The key question is whether BPS will develop a subspecialty model drawing on elements utilized in medicine; develop a model where there are a number of stand- alone specialties and no subspecialties, similar to nursing; or develop a completely different model that would be credible to all stakeholders and developed in consideration of realities within the existing BPS specialty framework. Once this foundational question is answered, with profession- wide input and consensus, the details of implementing the structure and framework can be discussed. Finally, it is critical that any changes to the specialty framework be sustainable and, most importantly, support the BPS mission to improve patient care by promoting the recognition and value of specialized training, knowledge and skills in pharmacy and the specialty board certification of pharmacists. BPS is proactively engaging all stakeholders in a defined process to evolve the pharmacy specialty structure and framework. The next steps in this process are as follows: Distribute the draft discussion paper for public comments (July - September 2014) Establish a Specialty Framework Steering Committee to guide the overall process of gathering input (July 2014) Establish a Specialty Framework Advisory Committee of approximately 25 stakeholders to review and comment on the input received during the public comment period (August 2014) Convene a meeting of the Specialty Framework Steering and Advisory Committees to openly discuss and recommend changes (if appropriate) to the BPS Specialty Recognition Process (November 2014) 07/18/14 13

14 PROVIDING FEEDBACK Feedback from all BPS stakeholders is necessary to effectively evolve a specialty framework reflective of the certification needs within the profession of pharmacy and the healthcare system. Comments on the BPS Specialty Structure and Framework, as outlined in this paper, can be provided in the following ways: Online at is recommended By e- mail to bpsframework@aphanet.org By mail to BPS, 2215 Constitution Ave., NW, Washington, DC REFERENCES 1 Board of Pharmacy Specialties. BPS Strategic Plan. Accessed at on July 15, Institute for Credentialing Excellence. National Commission for Certifying Agencies (NCAA) Accreditation. Accessed at on July 15, Board of Pharmacy Specialties. Petitioner s Guide for Recognition of Pharmacy Practice Specialty. Accessed at on July 15, Penna RP. Specialties in Pharmacy. J Am Pharm Assoc. 1974;14(11): Board of Pharmacy Specialties. Board of Pharmacy Specialties Announces Results of the Spring 2014 Certification and Recertification Exams. Accessed at on July 15, Board of Pharmacy Specialties. White Paper: Five- Year Vision for Pharmacy Specialties. January 12, Accessed at on July 15, Council on Credentialing in Pharmacy. Scope of contemporary pharmacy practice roles, responsibilities, and functions of pharmacists and pharmacy technicians. J Am Pharm Assoc. 2010;50e Boukus E, Cassill A, and O'Malley AS. A Snapshot of U.S. Physicians: Key findings from the 2008 health tracking physician survey. Washington, DC: Center for Studying Health Change (HSC); Accessed at on July 15, United States Department of Labor, Bureau of Labor Statistics. Occupational employment and wages, May Accessed at on July 15, American Board of Medical Specialties. About ABMS: Who we are and what we do. Accessed at on July 15, American Board of Pediatrics. Subspecialty Certification. Accessed at on July 15, American Board of Medical Specialties. Expansion of Specialties and Growth of Subspecialties. Accessed at on July 15, American Osteopathic Association. Bureau of Osteopathic Specialists: History and Structure. Accessed at aoa/development/aoa- board- certification/pages/bos- history.aspx on July 15, American Nurses Credentialing Center. Homepage. Accessed at on July 15, American Nurses Credentialing Center ANCC Certification Data. Accessed at ANCC- Certification- Statistics- pdf.pdf on July 15, American Nurses Credentialing Center. ANCC Certification Center. Accessed at on July 15, National Commission on Certification of Physician Assistants. About Us: Purpose and Mission. Available at on July 15, /18/14