Concerns about the Accelerating Expansion of Pharmacy Education: Time for Reconsideration

Concerns about the Accelerating Expansion of Pharmacy Education: Time for Reconsideration A discussion paper prepared by the American Pharmacists Association and the American Society of Health-System Pharmacists November 23, 2010 1

Abstract In response to a shortage of pharmacists, many educational organizations stepped up to meet the demand. Responses included new schools of pharmacy, additional campuses, and larger class sizes at existing schools. This rapid expansion raises questions about these schools (new and old) ability to recruit and retain sufficiently prepared faculty and staff. The expansion in capacity also places major pressures on schools to maintain high standards while filling classes with top notch students. In short, this paper asks whether the continued expansion of schools and colleges of pharmacy will compromise the quality of pharmacy graduates and impact the workforce needs of the profession. A significant reduction in the quality of graduates potentially could occur because of an insufficient number and/or experience of faculty members and an insufficient number of practitioners and practice sites to mentor students during the introductory and advanced experiential education portion of the curriculum. Finally, although authorities in health care quality advocate that health professionals be educated in an interdisciplinary fashion, schools of pharmacy not associated with schools of other health care disciplines may be challenged to train students in this manner. Most of these issues are not new to pharmacy education, and several groups have been working to address many of them. However, because of the potential serious implications of these issues for the safe and effective use of medications in the United States, the pharmacy practice and educational communities should jointly and systematically assess the near-term and long-term workforce needs of pharmacy practice and plan how to best meet those needs. Introduction Largely in response to a shortage of pharmacists, many institutions of higher education in the United States have embarked upon a significant expansion in pharmacy education, through both the creation of new schools of pharmacy and the expansion of existing schools. This discussion paper is intended to stimulate dialogue among all stakeholders, and especially with the educational and practice communities about the ramifications of this expansion. We note that this paper focuses on the preparation of pharmacists for frontline, general practice. Issues related to postgraduate residency training and specialization are not addressed here. While it was earlier manpower projections that stimulated education institutions to increase production, revised projections have not seemed to abate the continued proliferation. The current situation in which decisions about the quality and quantity of pharmacy graduates are (to varying degrees) divorced from planning for changes in pharmacy practice is not in the public interest. Among the potential risks of this disconnect between education and practice are that (1) new graduates will have an array of knowledge, skills, abilities, and attitudes that are not well aligned with the current and evolving needs in practice, (2) education s expansion plans will significantly exceed the capacity of practitioners to offer high-quality experiential education, (3) a decline (in the 2

aggregate) may occur in the quality of graduates, and (4) there will be substantial imbalance between the supply of and demand for new pharmacy graduates. Wellinformed and well-intentioned leaders in pharmacy education and practice may disagree about the extent and seriousness of these risks; however, they must all concede that there has been no broad-based, systematic exploration of these issues. Joint dialogue on these topics between the educational and practitioner sectors of the profession is needed, and until it occurs, it would be wise to avoid further expansion of pharmacy education. Planning for Change in Pharmacy Practice The best contemporary example of planning for change in pharmacy practice is associated with the efforts of the Joint Commission of Pharmacy Practitioners (JCPP) which, in November 2004, approved its Future Vision of Pharmacy Practice (Appendix). JCPP is currently working on activities that lead to the implementation of its desired picture of the future. This is a significant undertaking because it involves all of the national practitioner organizations, representing all sectors of practice. For the first time, these organizations have developed an explicit consensus about the desired characteristics of future pharmacy practice, focusing on the year 2015. The simple, one-sentence JCPP vision statement is consistent with the thrust of the current standards for pharmacy education: Pharmacists will be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes. The JCPP document goes on to describe (1) the foundations of pharmacy practice, (2) how pharmacists will practice, and (3) how pharmacy practice will benefit society. This manifesto is quite clear in proclaiming that pharmacists will retain their historic responsibility for preparing and distributing medications to patients: As experts regarding medication use, pharmacists will be responsible for design and oversight of safe, accurate, and timely medication distribution systems. The big challenge (and uncertainty) is the rate at which pharmacists will shift their work in medication distribution from doing to oversight. But this is only one of many challenges. Preliminary work by a JCPP vision implementation committee has identified the following areas or domains in which significant change must be achieved in order to fulfill the vision for practice: Member Organizations of the Joint Commission of Pharmacy Practitioners (JCPP): Academy of Managed Care Pharmacy, American College of Apothecaries, American College of Clinical Pharmacy, American Pharmacists Association, American Society of Consultant Pharmacists, American Society of Health-System Pharmacists, National Community Pharmacists Association; Liaison Members: American Association of Colleges of Pharmacy, Accreditation Council for Pharmacy Education, National Association of Boards of Pharmacy, National Council of State Pharmacy Association Executives 3

1. Practice Model 2. Payment Policy 3. Professionalism 4. Regulatory Policy 5. Education 6. Communications 7. Leadership 8. Workforce Planning 9. Research The vision for practice will be achieved over a number of years. There is no way to know with certainty how long this will take. During the implementation of the vision, the work of pharmacists nationwide will be in transition between traditional functions and direct patient care activities. New pharmacy graduates will need to perform both the traditional work of the profession and the work that is linked to the future. Unless pharmacy graduates have been inculcated with this mindset during their education, they may be reluctant to perform tasks such as order review, product preparation, and distribution, which (in the absence of a well-defined category of auxiliary pharmacy workers) could seriously compromise the quality of pharmacy services and lead to an erosion of public confidence in the profession. Pharmacy education must prepare graduates who are equipped intellectually, emotionally, and professionally to contribute to the transformation of practice and to cope with the transition process. The number of pharmacists needed in the future depends on (1) the pace of transition from pharmacist doing to oversight in medication distribution and (2) the pace of developing and implementing a new practice model that encompasses patient care services and compensation for those services. A conference convened by the Pharmacy Manpower Project, Inc., estimated that it would be feasible to reduce, between the years 2001 and 2020, the number of pharmacists engaged in order fulfillment by 27% through the development of automated systems and use of supportive personnel. 1 Pharmacists no longer needed in the order fulfillment process would be available to provide patient care services, assuming that compensation is available for those services. There are, of course, many uncertainties associated with projections of this nature, which again speaks to the need for robust dialogue between education and practice. Quantifying the Expansion of Pharmacy Schools Before 1987, the number of pharmacy schools (72) in the United States had remained relatively constant for many years. Since then, there has been a rapid growth of new pharmacy schools and expansion programs (satellite pharmacy programs offered at other campuses of a university, and expanding class sizes). As of July 2010, there are 115 U.S. based colleges and schools of pharmacy with accredited (full or candidate status) professional degree programs and five schools with pre-candidate status 2 As of December 2009, students are enrolled at 120 U.S. colleges and schools of pharmacy. An 4

additional 20 schools have been identified where feasibility and exploration of new programs is underway. While the expansion of pharmacy schools has in part been fueled by the pharmacist shortage, it is important to understand that many new schools have been created in private institutions and in some cases at for-profit institutions. There have been relatively few new programs established in public institutions, and the establishment of pharmacy programs represents a significant source of new revenues for many private institutions, including both not-for-profit and for-profit programs. In many cases a clear need for new programs has not been documented. While some programs have been established that serve unique needs in previously unserved large geographic regions, some new programs have been established in states with multiple existing programs and in fact even within the same cities. The expansion of new schools and colleges has also greatly increased demand for faculty nationwide. Since new programs require the recruitment of a full complement of faculty these programs generate disproportionately greater demand for new faculty. However, the development of these new programs only partly explains the expansion of pharmacy education. Existing programs have also expanded their enrollments, added branch campuses, or both. This expansion of existing programs has had greater impact on the expansion of student enrollment. According to the Accreditation Council for Pharmacy Education (ACPE), from 2005-08 a 36.5% increase in student enrollment was expected. Expansion at existing schools accounted for 84% of this enrollment growth. 3 The rapid, unexpected growth of pharmacy educational programs has many potential implications for pharmacy practice, which practitioner organizations and educational institutions have an obligation to assess. Among the issues raised by pharmacy education s expansion are (1) the actual effect on ameliorating the shortage of pharmacists, (2) exacerbation of the already-serious faculty shortage, (3) inability of practice sites to accommodate increased demands for experiential education (both introductory and advanced), and (4) the potential for a negative effect on the quality of education and, ultimately, on the quality of new graduates practicing pharmacy. Impact of the Expansion of Pharmacy Education on the Supply of Pharmacists The history of the pharmacy profession has shown periods of both a shortage and a surplus of practitioners. During the last decade the profession experienced a pharmacist shortage. The current pharmacist shortage began around 1998 and was quickly characterized as potentially more drastic than those of the past because of the population s growing need for medications. Other reasons that have been mentioned for the shortage include new pharmacist patient-care roles; new pharmacist roles in areas such as information technology and managed care; more public and health-professional awareness of (and demand for) the expertise of pharmacists; and the business expansion of the chain drugstore industry. However, as the decade draws to a close, evidence demonstrates that the shortage is rapidly abating and in fact the profession is likely entering a period of surplus. 5

A primary justification used to justify the expansion of pharmacy education is to address the pharmacist shortage. So far, what impact has there been? In the year 2008-2009, 10,998 students were awarded first professional degrees in pharmacy. 2 Professional student pharmacist enrollments have continued to rise for nine consecutive years. Annual increases were 4.1 percent in fall 2001, 8.4 percent in fall 2002, 10.7 percent in fall 2003, 5.1 percent in fall 2004, 6.0 percent in fall 2005, 4.4 percent in fall 2006, 4.3 percent in fall 2007, 3.9 percent in fall 2008 and 3.8 percent in fall 2009. Attrition estimates (tracking enrollees through to graduation) over the past five years have averaged 8.2 percent per class. Total first professional degree enrollment was 54,710 in fall 2009. The gender shift in pharmacy is likely to reduce some of the gains made by graduating more pharmacists. Studies have shown that a female pharmacist contributes 0.9 FTE to the workforce as compared to 1.1 FTE for a male pharmacist, mainly due to differences in life-long work patterns between men and women. 4 When assessing the adequacy of the projected numbers of pharmacists for the future, it is vital to consider what roles they will be playing in health care. It is likely that fewer pharmacists will be needed for traditional dispensing and drug product distribution activities because of automation, standardization of dispensing and distribution processes, and expanded use of auxiliary workers. While there is immense need for pharmacists to engage in medication therapy management and other clinical activities, current reimbursement systems are stifling the growth of the number of practitioners in these areas. It is uncertain how quickly the financial basis for pharmacy practice will change. The pharmacy profession has not undertaken a rigorous capacity analysis to assess how many pharmacists will be needed in the future. Unfortunately, pharmacy has not received sustained attention by federal health care workforce planners. The profession should pursue research to better understand how the interplay of multiple factors (e.g., plans for expanded education, faculty shortages, capacity of practice sites to handle experiential education, gender shift in the profession, changes in population demographics, new coverage of medications for Medicare beneficiaries, changes in other health professions, changes in pharmacist retirement patterns, the impact of healthcare reform) will affect the future balance between the supply of and demand for pharmacists. In 2008, the Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions (HRSA) issued a report entitled: The Adequacy of Pharmacist Supply: 2004 to 2030. 5 This report indicated that in 2004 the supply of pharmacists was growing significantly faster than previously projected. The HRSA report projected growth of 79,000 new pharmacists from 2004 to 2020 (226,000 to 305,000) and a growth of 68,800 full-time-equivalent (FTE) pharmacists (191,200 to 260,000). The HRSA report also projects that population growth and rising per capita consumption of pharmaceuticals will continue to increase the demand for pharmacists and projects a demand for 256,000 pharmacists in 2020. The report concluded that there was a moderate shortfall of pharmacists in 2004 and that the future supply was likely to grow at a rate similar to the growth in demand. 6

This report also projects that there will be 110 schools in operation in the fall of 2010. As noted earlier, as of July 2010 there are 115 U.S. based colleges and schools of pharmacy with accredited (full or candidate status) professional degree programs and five schools with pre-candidate status. An additional 20 schools have been identified where feasibility and exploration of new programs are currently underway. The HRSA report also projected 10,000 graduates in the year 2008 increasing to 12,000 by 2030. In 2008-2009 nearly 11,000 graduates entered the workforce and enrollment increased by another 3.8% in 2009. Therefore the profession is growing new schools and producing graduates at a rate that is currently significantly outpacing HRSA assumptions and it is logical to conclude that should this trend continue it will create a supply that outpaces demand. As of May 2010, the Aggregate Demand Index (ADI) published by the Pharmacy Manpower Project (PMP) was 3.28, down 0.09 from the previous month and 0.45 from the same month the previous year. 6 The ADI scale is 1-5 with 1 reflecting a high surplus and 5 a high demand. The ADI for community pharmacy has fallen to 2.85 demonstrating that a surplus currently exists in the community practice setting. The ADI for institutional pharmacy is 3.80 indicating that a modest shortage still exists in institutional practice. While there has been some fluctuation over time in the ADI, the trend line of the ADI has been declining for the last decade (figure 1). Aggregate Demand Index for Pharmacists 1999-2010 5.00 4.80 4.60 Key: 5=high demand (severe shortage) 3= balanced supply and demand 1= high supply (surplus) 4.40 ADI Value 4.20 4.00 3.80 3.60 3.40 3.20 3.00 Jan-00 Jan-01 Jan-02 Jan-03 Jan-04 Jan-05 Jan-06 Jan-07 Jan-08 Jan-09 Jan-10 National ADI Figure 1 In contrast to pharmacy s experience, the American Association of Medical Colleges (AAMC) recently issued a statement on the pending shortage of physicians as a reason to increase medical school enrollments by 15% and also to increase medical residencies. 7 This report recommends that the expansion should draw medical students from rural, 7

disadvantaged, or underserved populations, and that expansion should occur in a controlled context of quality that is judged by an accreditation body and the availability of adequate financial and clinical resources. Medicine has used the reasoning of the need for increasing practitioners in rural, disadvantaged or underserved areas to support expansion of its programs. Early expansion of pharmacy s programs utilized some of this same reasoning, but the profession could benefit from medicine s comprehensive systematic examination of the issues related to expansion. Shortage of Pharmacy Faculty Exacerbated by Expansion Faculty recruitment and retention has been identified as one of the top issues and challenges of colleges and schools of pharmacy. Nationally, there is a severe shortage of faculty in colleges of pharmacy. 8 In the 2008-2009 academic year, there were 396 total vacant/lost faculty positions (based on survey responses from 101 schools), down from 425 for the 2007-2008 academic year. In 2008-2009, most of the vacant/lost positions were in the clinical science/pharmacy practice area (53.5%), followed by pharmaceutical sciences (31.3%), social and administrative science (8.1%), administrative positions (4.88%), and research/non-instructional (2.3%). In the 2008-2009 academic year, the top three reasons for all vacancies were: moved to a faculty position at another school of pharmacy (20.1%), moved to a practice position in the health care private sector (15.4%), or retired (12.6%). These data were essentially the same as in the 2002-2003 report. 9 In 2008-09, nearly half of the positions (48.1 %) remained vacant because there were not enough qualified candidates, a slight increase from 2007-08 (47.4%). Faculty members moving to another school of pharmacy is one of the top factors in vacancies. It is likely that some faculty members are taking opportunities at the newer schools for higher paying positions and opportunities to build new programs. Because the pool of candidates is not sufficient to address the current faculty shortage, it is difficult to understand how more schools are going to find qualified faculty without enticing faculty members from established schools. With more schools on the horizon and absent an influx of net new faculty, it is likely that further dilution of the current faculty pool will continue, impacting the overall ability of the schools and colleges to meet the educational needs of student pharmacists. To address the faculty shortage, schools of pharmacy and professional organizations are working to increase the visibility of careers in academia. These efforts include (1) adding teaching opportunities within residency and fellowship programs and (2) creating educational programs, targeted to student pharmacists and new practitioners, on how to develop a career as a faculty member. The American Association of Colleges of Pharmacy (AACP) has developed strategies for (1) promoting academic careers to young professionals in the clinical and pharmaceutical sciences and (2) enhancing faculty development. AACP also created the Academic Leadership Fellows program to develop faculty members and administrators. AACP, APhA, ASHP, and other pharmacy organizations efforts have included educational and exhibit programs at professional 8

pharmacy and scientific meetings. APhA recently published a book entitled Getting Started as a Pharmacy Faculty Member by David P. Zgarrick. This reference informs readers about the types of academic positions available, how colleges and universities operate, how to go about obtaining a position, and how to succeed in academia. In sum, there is a serious shortage of qualified, experienced faculty at schools of pharmacy nationwide, and this may well compromise the quality of education for student pharmacists. The shortage of qualified, experienced faculty may also reduce the leadership and professional mentorship of student pharmacists. These problems have been recognized in academia and are being addressed; the practice and educational communities should jointly assess how to build on these efforts. Immense Challenges Related to Experiential Education Rotation Sites One of the most significant concerns about expanded pharmacy education is the availability of quality experiential rotation sites. Many experiential education coordinators at schools of pharmacy have been finding it increasingly difficult to place students at sites. Many practitioners are finding it difficult to comply with the requests from schools of pharmacy to handle student rotations and offer quality experiences for students. The American Pharmacists Association (APhA) and the American Society of Health- System Pharmacists (ASHP) conducted a joint survey of experiential education directors nationwide (September 2005) to assess the scope of this issue. An email survey was sent to experiential directors asking them about the degree of difficulty in placing students in a hospital or health-system setting, community pharmacy setting, managed care setting, and long-term-care setting. Of the 86 individuals queried, 43 (50%) participated in the survey (Tables 1 and 2). Respondents reported that placing students in a quality hospital or health-system pharmacy setting is by far the most difficult. For this sector of practice, 81% of respondents said it is extremely difficult or somewhat difficult to find student rotations. In the comments provided by survey participants, experiential coordinators reported that this is due to staffing cuts within hospitals and health systems, competition with other schools, and managers not perceiving benefits in providing training for students. The degree of difficulty of placing students in quality community sites was somewhat easier, with the overall response of 51% extremely difficult or somewhat difficult. Most experiential coordinators felt that community sites were more plentiful and, therefore, it is easier to place students in these sites. Because managed care and long-term care sites were reported to be elective rotations, results were largely dependent on location, student interest in participating in this type of rotation, and site interest in taking students. A few experiential coordinators volunteered that they expect to have more difficulty in placing students in quality rotations as class sizes increase and new schools open. 9

Hiring managers in pharmacy practice were surveyed separately on their facility s capacity to accommodate the number of requests they receive for advanced student rotations during the last year of the curriculum. About 46% of hospital and health-system respondents indicated that the requests somewhat exceeded or far exceeded their capacity. In community pharmacy, almost 18% of hiring managers responded that requests somewhat or far exceeded their capacity; managed care pharmacy, 25%; longterm-care pharmacy, 53%. These data corroborate the findings from the survey of experiential education directors, especially in hospital and health-system settings and long-term-care settings. Hiring managers in community pharmacies did not perceive that their capacity was as low as experiential directors indicated. Based on the data and comments provided by experiential coordinators, it is clear that the expansion of pharmacy education will outpace the availability of quality experiential rotation sites. The results clearly show challenges in finding rotation sites today; future expansion of education (including the implementation of IPPEs) will make this problem more severe, especially in states that already have multiple schools of pharmacy. This factor is likely to have a detrimental effect on the preparedness for practice of future graduates. More recently, an online survey of ASHP members identified as U.S. pharmacy directors was conducted by ASHP and AACP in 2007 to assess capacity to meet the experiential education requirements for doctor of pharmacy students. 10,11 This survey projected that there may be adequate capacity in hospitals to accommodate advanced experiences at least through 2012. However, meeting capacity would require an 81% increase from 2007 levels with most growth occurring in hospitals that already participate. The results of this survey also demonstrated that there may be capacity for introductory experiences, but it is important to note that the requirements for these were not fully evolved at the time of the survey. The implementation of requirements for Introductory Pharmacy Practice Experiences (IPPEs) adds to these existing challenges. Increasing demand for training sites to accommodate the expansion of residents can only add to the challenge. At the same time that colleges are seeking to expand the number of students in both introductory and advanced experiences at practice sites, several pharmacy organizations are advocating that all new graduates should complete a residency (at least in some practice environments). Although the number of residencies and residency positions continues to grow, the number of graduates seeking a residency position is greatly outpacing the growth of residency positions. In 2010, the number of unmatched residents exceeded 1,000. This further exacerbates the challenges in accommodating students in experiential rotations as there is a limited pool of preceptors available to accommodate rapidly increasing numbers of IPPE, APPE, and resident experiences. There is a need to examine the profession s models for precepting trainees and explore the role of residents in precepting students during IPPE or APPE experiences using a team model akin to experiential models used in medicine. 12 Further, the continuing growth of pharmacy school graduates also further exacerbates the need to develop new residency positions to accommodate these graduates. 10

Concerns about the quality and quantity of experiential rotation sites are not new issues that can be attributed only to the expansion of pharmacy schools. These issues were discussed when schools of pharmacy began moving from dual entry-level degrees to the all-pharm.d. degree. This transition required far more rotation sites for longer periods of time to accommodate the requirements of the Doctor of Pharmacy curriculum. AACP has taken this issue very seriously. In June 2005, the Association held a summit to provide strategies to both the practice and educational communities to improve capacity and quality in experiential education. Recommendations in the final report on the summit deal with preceptor recruitment and training, standardization of the administrative aspects of experiential education, development of tools to better prepare student pharmacists for experiential rotations, improving the quality of rotation sites, and lengthening the rotation period and thereby decreasing the number of rotations required. AACP has a section on its Web site, the Academic-Practice Partnership Initiative, containing resources designed to help improve experiential education. This section features a profile system for identifying exemplary pharmacy practice experiential sites, a professional experience program library of resources, and information on the Summit to Advance Experiential Education in Pharmacy. ASHP and APhA have also compiled web-based resources to support preceptor development. Another recent resource is ASHP s Preceptor s Handbook for Pharmacists by Cuellar and Ginsburg, that provides preceptors with methods to be an effective educator of student pharmacists. APhA has offered educational program tracks focused on preceptor development at its Annual Meetings, as well as other resources for preceptors. In spite of these efforts, there remains a significant need to develop well experienced preceptors. The pharmacy profession should continue to identify and examine the full scope of issues surrounding experiential education, including its effectiveness in preparing pharmacists for current and future practice. The profession needs to build on the resources available and find ways to continue to further improve experiential education. Learning Team-Based Patient Care As pharmacists evolve toward becoming direct patient care providers, more emphasis should be placed on the team-based approach to patient care. This involves pharmacists communicating and collaborating with other health care providers, such as physicians, nurses, and dieticians about a patient s care and taking a team approach to optimizing the overall outcomes of treatment. Student pharmacists should be introduced to team-based patient care throughout their education to foster the development of these skills. Indeed, the Institute of Medicine 13 and The Joint Commission have concluded that the quality problems in health care delivery stem, in large measure, from ineffective interdisciplinary education in the health professions. The team-based approach to care is a central tenet of the recently passed health care reform bill and will likely be a central focus in the 11

implementation phase. The pharmacy profession should examine how interdisciplinary team practice is being taught by schools of pharmacy. Many of the new schools of pharmacy are not located on campuses with an academic health science center. In some cases, the pharmacy school is the only health professional school in the university. Although this situation was commonplace in a former era when pharmacy education was more aligned with chemistry than with health, it is not in line with current guidelines. How will such schools of pharmacy effectively ensure professional interaction with students in other health disciplines and expose student pharmacists to the skills needed for a team-based approach to care? Conversely, many academic health science centers do not have a school of pharmacy. If there is a need to expand pharmacy education, should the profession target these academic health science campuses for the creation of new schools of pharmacy? It would seem that the opportunities on these campuses for interdisciplinary practice and research would attract faculty in the clinical and pharmaceutical sciences as well as provide a rich training environment for students. Conclusions and Recommendations The profession of pharmacy as embodied in its practitioner and educational organizations is expected by the public to make wise workforce planning decisions. Consistent with that expectation are (1) a reasonable balance (currently and in the future) between the demand for and supply of practitioners, (2) reasonable synchronization between planning for practice and planning for education, and (3) preparation of quality practitioners who have the necessary knowledge, skills, abilities, and attitudes to serve the public well. As discussed in this paper, there are reasons to believe that pharmacy has significant opportunities to improve the extent to which it meets these public expectations. As these opportunities are explored, care must be taken to preserve the patient-oriented focus of pharmacy education, which is a significant strength of the profession. Preliminary examination of these issues has led to the following recommendations: 1. Pharmacy practitioner and educational organizations should jointly convene a stakeholders conference on workforce planning to analyze the full range of issues related to the preparation of pharmacists for contemporary and future practice. 2. Informed by the findings of such a conference, pharmacy educational and practitioner organizations should establish an ongoing process for jointly assessing the near-term and long-term workforce needs in pharmacy practice and how to best meet those needs. 12

Appendix Future Vision of Pharmacy Practice Joint Commission of Pharmacy Practitioners* November 10, 2004 Vision Statement Pharmacists will be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes. Pharmacy Practice in 2015 The Foundations of Pharmacy Practice. Pharmacy education will prepare pharmacists to provide patient-centered and population-based care that optimizes medication therapy; to manage health care system resources to improve therapeutic outcomes; and to promote health improvement, wellness, and disease prevention. Pharmacists will develop and maintain: a commitment to care for, and care about, patients an in-depth knowledge of medications, and the biomedical, sociobehavioral, and clinical sciences the ability to apply evidence-based therapeutic principles and guidelines, evolving sciences and emerging technologies, and relevant legal, ethical, social, cultural, economic, and professional issues to contemporary pharmacy practice. How Pharmacists Will Practice. Pharmacists will have the authority and autonomy to manage medication therapy and will be accountable for patients therapeutic outcomes. In doing so, they will communicate and collaborate with patients, care givers, health care professionals, and qualified support personnel. As experts regarding medication use, pharmacists will be responsible for: rational use of medications, including the measurement and assurance of medication therapy outcomes promotion of wellness, health improvement, and disease prevention design and oversight of safe, accurate, and timely medication distribution systems. Working cooperatively with practitioners of other disciplines to care for patients, pharmacists will be: the most trusted and accessible source of medications, and related devices and supplies the primary resource for unbiased information and advice regarding the safe, appropriate, and cost-effective use of medications valued patient care providers whom health care systems and payers recognize as having responsibility for assuring the desired outcomes of medication use. How Pharmacy Practice Will Benefit Society. Pharmacists will achieve public recognition that they are essential to the provision of effective health care by ensuring that: medication therapy management is readily available to all patients desired patient outcomes are more frequently achieved overuse, underuse and misuse of medications are minimized medication-related public health goals are more effectively achieved cost-effectiveness of medication therapy is optimized. * Member Organizations of the Joint Commission of Pharmacy Practitioners (JCPP): Academy of Managed Care Pharmacy, American College of Apothecaries, American College of Clinical Pharmacy, American Pharmacists Association, American Society of Consultant Pharmacists, American Society of Health-System Pharmacists, National Community Pharmacists Association; Liaison Members: American Association of Colleges of Pharmacy, Accreditation Council for Pharmacy Education, National Association of Boards of Pharmacy, National Council of State Pharmacy Association Executives 13

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