Pharmacists are allied health professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use. The role of the pharmacist has shifted from the classical "lick, stick, and pour" dispensary role (that is, "lick & stick the labels, count & pour the pills"), to being an integrated member of the health care team directly involved in patient care. Pharmacists undergo university-level education to understand biochemical mechanisms of action of drugs, drug uses and therapeutic roles, side effects, potential interactions, and monitoring parameters. This is mated to education in anatomy, physiology, and pathophysiology. Professional interpretation and communication of this specialized knowledge to patients, physicians, and other health care providers are functions which pharmacists provide, and are central to the provision of safe and effective drug therapy.
In many countries, pharmacists must hold the title of Doctor of Pharmacy in order to exercise their profession.
The most common pharmacist positions are that of a community pharmacist (also referred to as "retail pharmacist" or "dispensing chemist"), or a hospital pharmacist, where they instruct and counsel on the proper use and adverse effects of medically prescribed drugs and medicines. In most countries, the profession is subject to professional regulation. Depending on the legal scope of practice, pharmacists may contribute to prescribing (also referred to as "pharmacist prescriber") and administering certain medications (e.g. immunizations in some jurisdictions). Pharmacists may also practice in a variety of other settings, including industry, research, academia, military, and government.
- 1 Nature of the work
- 2 Training and practice by country
- 3 Noted people who were pharmacists
- 4 See also
- 5 References
- 6 Further reading
- 7 External links
Nature of the work
Historically, the fundamental role of pharmacists as a healthcare practitioner was to distribute drugs that had been prescribed to patients. In more modern times, pharmacists advise patients and health care providers on the selection, dosages, interactions, and side effects of medications, and act as a learned intermediary between a prescriber and a patient. Pharmacists monitor the health and progress of patients to ensure the safe and effective use of medication. Pharmacists may practice compounding; however, many medicines are now produced by pharmaceutical companies in a standard dosage and drug delivery form. In some jurisdictions, pharmacists have prescriptive authority to either independently prescribe under their own authority or in collaboration with a primary care physician through an agreed upon protocol.
Increased numbers of drug therapies, ageing but more knowledgeable and demanding populations, and deficiencies in other areas of the health care system seem to be driving increased demand for the clinical counselling skills of the pharmacist. One of the most important roles that pharmacists are currently taking on is one of pharmaceutical care. Pharmaceutical care involves taking direct responsibility for patients and their disease states, medications, and the management of each in order to improve the outcome for each individual patient. Pharmaceutical care has many benefits that may include but are not limited to: decreased medication errors; increased patient compliance in medication regimen; better chronic disease state management; strong pharmacist-patient relationship; and decreased long-term costs of medical care.
Pharmacists are often the first point-of-contact for patients with health inquiries. This means that pharmacists have large roles in the assessing medication management in patients, and in referring patients to physicians. These roles may include, but are not limited to:
- clinical medication management, including reviewing and monitoring of medication regimens
- assessment of patients with undiagnosed or diagnosed conditions, and ascertaining clinical medication management needs
- specialized monitoring of disease states, such as dosing drugs in renal and hepatic failure
- compounding medicines
- providing pharmaceutical information
- providing patients with health monitoring and advice, including advice and treatment of common ailments and disease states
- supervising pharmacy technicians and other staff
- oversight of dispensing medicines on prescription
- provision of non-prescription or over-the-counter drugs
- education and counseling for patients and other health care providers on optimal use of medicines (e.g. proper use, avoidance of overmedication)
- referrals to other health professionals if necessary
- pharmacokinetic evaluation
- promoting public health by administering immunizations
Education and credentialing
The role of pharmacy education, pharmacist licensing, and graduate continuing education vary from country to country and between regions/localities within countries. In most countries, pharmacists must obtain a university degree at a pharmacy school or related institution, and/or satisfy other national/local credentialing requirements. In many contexts, students are required to first complete pre-professional (undergraduate) coursework followed by about four years of professional academic studies in order to obtain a degree in pharmacy (e.g. Bachelor of Pharmacy or PharmD). Pharmacists are educated in pharmacology, pharmacognosy, chemistry, organic chemistry, biochemistry, pharmaceutical chemistry, microbiology, pharmacy practice (including drug interactions, medicine monitoring, medication management), pharmaceutics, pharmacy law, physiology, anatomy, pharmacokinetics, pharmacodynamics, drug delivery, pharmaceutical care, nephrology, hepatology, and compounding of medications. Additional curriculum may cover diagnosis with emphasis on laboratory tests, disease state management, therapeutics and prescribing (selecting the most appropriate medication for a given patient).
Upon graduation, pharmacists are licensed either nationally or by region to dispense medication of various types in the settings for which they have been trained. Some may undergo further specialized training, such as in cardiology or oncology.
Training and practice by country
The Australian Pharmacy Council is the independent accreditation agency for Australian pharmacists. It conducts examinations on behalf of the Pharmacy Board of Australia towards eligibility for registration. The Australian College of Pharmacy provides continuing education programs for pharmacists.
Wages for pharmacists in Australia appear to have stagnated. The award wages for a pharmacist is $812 a week. Pharmacist graduates are the lowest paid university graduates most years. Most pharmacists do earn above the award wage; the average male pharmacist earns $65,000, a female pharmacist averages $56,500. Over recent years, wages have stagnated, and even gone backwards. There are more graduates expected in the next few years making it even harder to get a job. Job security and increase in wages with regards to CPI could be unlikely.  This is due to the large numbers of pharmacy graduates in recent years, and government desire to lower PBS costs. Contract and casual work is becoming more common. A contract pharmacist is self-employed and often called a locum; these pharmacists may be hired for one shift or for a longer period of time. There are accounts of underemployment and unemployment emerging recently.
The Canadian Pharmacists Association (CPhA) is the national professional organization for pharmacists in Canada. Specific requirements for practice vary across provinces, but generally include a Bachelor's Degree in Pharmacy from a recognized university, successful completion of a national board examination through the Pharmacy Examining Board of Canada, and practical experience through an apprenticeship/internship program.
The vast majority (80%) of Canada’s licensed pharmacists work in community pharmacies, another 15 percent in hospital or institutional pharmacies, and the remainder work in situations that may not legally require licensed pharmacists such as associations, pharmaceutical companies, and consulting firms. The wages for pharmacists, at about CAD $95,000, are slightly better than Australia but not as good as in the US. Wages being significantly higher in Canada than the prospect for most developing countries, recruitment of pharmacists from South Africa and other countries with acute health workforce shortages to work in private franchise chains is subject to controversy.
In ancient Japan, the men who fulfilled roles similar to pharmacists were respected. The place of pharmacists in society was settled in the Taihō Code (701) and re-stated in the Yōrō Code (718). Ranked positions in the pre-Heian Imperial court were established; and this organizational structure remained largely intact until the Meiji Restoration (1868). In this highly stable hierarchy, the pharmacists — and even pharmacist assistants — were assigned status superior to all others in health-related fields such as physicians and acupuncturists. In the Imperial household, the pharmacist was even ranked above the two personal physicians of the Emperor.
As of 1997, there were 46 universities of pharmacy in Japan, which graduated about 8000 students annually. Contemporary practice of clinical pharmacists in Japan (as evaluated in September 2000) focuses on dispensing of drugs, consultation with patients, supplying drug information, advising on prescription changes and amending prescriptions. These practices have been linked to decreases in the average number of drugs in prescriptions, drug costs and incidence of adverse drug events.
In Tanzania, the practice of pharmacy is regulated by the national Pharmacy Board, which is also responsible for registration of pharmacists in the country. By international standards, the density of pharmacists is very low, with a mean of 0.18 per 10,000 population. The majority of pharmacists are found in urban areas, with some underserved regions having only 2 pharmacists per region. According to 2007-2009 data, the largest group of pharmacists was employed in the public sector (44%). Those working in private retail pharmacies were 23%, and the rest were mostly working for private wholesalers, pharmaceutical manufacturers, in academia/teaching, or with faith-based or non-governmental facilities. The salaries of pharmacists varied significantly depending on the place of work. Those who worked in the academia were the highest paid followed by those who worked in the multilateral non-governmental organizations. The public sector including public retail pharmacies as well as faith based organizations paid much less. The Ministry of Health salary scale for medical doctors was considerably higher than that of pharmacists despite having a difference of only one year of training.
In the United Kingdom, most pharmacists working in the National Health Service practice in hospital pharmacy, community pharmacy or in primary care trusts. Pharmacists are able to undertake additional training in order to allow them to prescribe medicines for specific conditions.
In British English (and to some extent Australian English), the professional title known as “pharmacist” is also known as “dispensing chemist”. A dispensing chemist usually operates from a pharmacy or chemist's shop (also called “drug store” elsewhere), and is allowed to fulfil medical prescriptions as well as dispense over-the-counter drugs and other health related goods.
The new professional role for pharmacists as prescriber has been recognized in the UK since May 2006, called the “Pharmacist Independent Prescriber”. Once qualified, a pharmacist independent prescriber is able to prescribe any licensed medicine for any medical condition within their competence, with the exception of controlled drugs.
In the United States, the majority (65%) of pharmacists work in retail settings, mostly as salaried employees but some as self-employed owners. About 22% work in hospitals, and the rest mainly in mail-order or Internet pharmacies, pharmaceutical wholesalers, offices of physicians, and the Federal Government.
All graduating pharmacists must now obtain the Doctor of Pharmacy (Pharm.D.) degree before they are eligible to sit for the North American Pharmacist Licensure Examination (NAPLEX) to enter into pharmacy practice.
Students must complete 4 years of graduate level training at a pharmacy school, often after receiving a bachelors degree. A bachelors degree is not required as most pharmacy schools only require two years of undergraduate education and the completion of a list of prerequisites. Competition to obtain entry into pharmacy school, however, limits the number of students admitted without a bachelors degree. There are currently 116 accredited pharmacy schools in the United States (late 2009), and 6 of these schools offer "accelerated" 3 year PharmD programs by attending school almost year round - with fewer breaks for summer and holidays. There also is one fully accredited "distance/online" 4 year PharmD program offered by Creighton University. Pharmacists receive a PharmD (Doctor of Pharmacy) upon graduation, and licensure after passing the NAPLEX and MPJE.
Mandatory courses may include:
Besides taking classes, additional requirements before graduating may include, for instance, a certain amount of hours for community service, e.g. working in hospitals, clinics, and retail.
Specialization and credentialing
American pharmacists can become certified in recognized specialty practice areas by passing an examination administered by one of several credentialing boards.
- The Board of Pharmaceutical Specialties certifies pharmacists in six specialties:
- The Commission for Certification in Geriatric Pharmacy certifies pharmacists in geriatrics specialty practice.
- The American Board of Applied Toxicology certifies pharmacists and other medical professionals in applied toxicology.
Earnings and wages
According to the 2010 "Pharmacy Compensation Survey":
- Directors of Pharmacy $125,200
- Retail Staff Pharmacists $113,600
- Hospital Staff Pharmacists $111,700
- Mail Order Staff Pharmacists $109,300
- Clinical Pharmacists $113,400
According to the US Bureau of Labor Statistics - Occupational Outlook Handbook, 2010-11 Edition:
- Median annual wages of wage and salary pharmacists in May 2008 were $106,410. The middle 50 percent earned between $92,670 and $121,310 a year. The lowest 10 percent earned less than $77,390, and the highest 10 percent earned more than $131,440 a year.
Noted people who were pharmacists
- Hubert Humphrey, US Vice-President 1965-69
- Jim Wilson (Los Angeles), city council member
- Classification of Pharmaco-Therapeutic Referrals
- Dispensing chemist
- History of pharmacy
- List of pharmacists
- List of pharmacy associations
- List of pharmacy schools
- Pharmacy Automation - The Tablet Counter
- Pharmacy technician
- Pharmacy residency
- ^ a b c A Situational Analysis of Human Resource Issues in the Pharmacy Profession in Canada. Human Resources Development Canada, 2001. Accessed 15 July 2011.
- ^ MedScape News, Preceptors' Perspectives on Benefits of Precepting Student Pharmacists, accessed 15 July 2011.
- ^ World Health Organization. Classifying health workers. Geneva, 2010.
- ^ a b c US Bureau of Labor Statistics. Occupational Outlook Handbook, 2010-11 Edition - "Pharmacists". Accessed 14 July 2011.
- ^ a b Canadian Pharmacists Association What do Pharmacists do? Accessed 14 July 2011.
- ^ Royal Pharmaceutical Society of Great Britain. Pharmacist prescribing.
- ^ Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice. 2nd ed. Toronto: McGraw-Hill; 2004.
- ^ Australian Pharmacy Council. Accessed 14 July 2011.
- ^ http://www.pharmacynews.com.au/article/pressure-on-pharmacists-wages-a-global-trend/503997.aspx Pressure on pharmacists wages
- ^ http://beta.guild.org.au/uploadedfiles/wa_branch/services_to_members/pharmacists%20wage%20rates%2021.07.05.pdf Pharmacist Wage Rates
- ^ http://www.psa.org.au/site.php?id=121 PSA article
- ^ http://www.pharmacynews.com.au/article/pressure-on-pharmacists-wages-a-global-trend/503997.aspx Pressure on Pharmacists wages a global trend
- ^ a b http://www.pharmacynews.com.au/article/Slow-start-to-pay-race/520873.aspx Slow start to pay race
- ^ http://www.pharmacynews.com.au/article/Hospital-pharmacy-jobs-under-threat/524670.aspx Hospital pharmacy jobs under threat
- ^ Attaran A, Walker RB. "Shoppers Drug Mart or Poachers Drug Mart?" CMAJ 2008; 178(3) doi: 10.1503/cmaj.071733
- ^ Titsingh, Isaac. (1834) Annales des empereurs du japon, p. 434.
- ^ Kawahara A. The Role of the Pharmacist in the Health-Care System - Preparing the Future Pharmacist: Curricular Development. Report of a Third WHO Consultative Group on the Role of the Pharmacist, Vancouver, Canada, 27-29 August 1997. Accessed 18 July 2011.
- ^ Yuki I et al. Role of the Clinical Pharmacist in Pharmaceutical Care. Japanese Journal of Pharmaceutical Health Care and Sciences (2005) 31(2): 113-120.
- ^ Tanzania Ministry of Health and Social Welfare. Assessment of the Pharmaceutical Human Resources in Tanzania and Strategic Framework, Dar es Salaam, 2010.
- ^ National Health Service. NHS Careers in Detail: Pharmacist. Accessed 14 July 2011.
- ^ Department of Health. Pharmacist independent prescribing FAQ. Accesed 14 July 2011.
- ^ Accreditation Council for Pharmacy Education. Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Available at: http://www.acpe-accredit.org/pdf/S2007Guidelines2.0_ChangesIdentifiedInRed.pdf. Accessed on February 15, 2011.
- ^ Board of Pharmaceutical Specialties
- ^ ABAT Certification Examination Credentialing Information
- ^ 2010 Pharmacy Compensation Survey - Spring Edition PharmacyOneSource.com
- (Japanese) Asai,T. (1985). Nyokan Tūkai. Tokyo: Kōdan-Sha.
- (French) Titsingh, Isaac, ed. (1834). [Siyun-sai Rin-siyo/Hayashi Gahō, 1652], Nipon o daï itsi ran; ou, Annales des empereurs du Japon. Paris: Oriental Translation Fund of Great Britain and Ireland....Click link for digitized, full-text copy of this book (in French)
- Association of Community Pharmacists of India (ACPI)
- Pharmacy Council of India (PCI)
- Pharmacy at the Open Directory Project
- Nepal Pharmacy council (NPC)
- International Pharmaceutical Federation (FIP)
- RPSGB Veterinary Pharmacist Education Programme (VPEP)
- International Pharmaceutical Students Federation (IPSF)
- Royal Pharmaceutical Society of Great Britain
- Canadian pharmacy technicians (rxpt.ca)
- Pakistan Pharmacists Society (PPS)
- Canadian Pharmacist Journal
- United Kingdom Clinical Pharmacy Association (UKCPA)
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