An investigation into the factors leading to role conflicts and perceptions experienced by the beginning pharmacist

Inconsistent Socialization in Pharmacy-A Pattern in Need of Change

Of all the health professions, pharmacy has probably received the least attention from social and behavioral scientists who are interested in . professionals and professionalism as a subject matter in its own right. 1 There is a clear void in terms of sociological or psychological data about pharmacists .

tempts to describe the inconsistent socialization process as an entity in its own right (as defined above), but also would instigate some thoughts from interested researchers on components of the model which are in need of research. The four major components of inconsistent socialization for pharmacy are1. Career choice processes and influences 2. Forces of socialization 3. Clashing of socialization forces 4. Results of socialization clashes Figure 1 (page 617) illustrates these major components and their attributes. While this figure is a structured representation of the inconsistency model proposed, it does not necessarily include every component of inconsistent socialization. The inconsistent socialization process begins at the career choice stage. It continues and becomes more apparent at the stage of entry into the formal educational period in a college of pharmacy and in the practice setting in which practical experience (often referred to as externship or internship) is gained. At the point of entrance into the last phases of schooling or into the occupation itself, the inconsistencies of the socialization process become apparent, resulting in previously unconsidered alternatives to professional practice. This article will examine each of these components in light of its own distinct character, as major influences in the socialization of the pharmacist; and how each of these factors is associated with the primary actors in the socialization schemethe aspiring pharmacist, the regulatory agencies, the educational system and its institutions, and the members of the profession themselves (the strength and relevance of these actors obviously varies at different stages).

Smith has advocated that social models of pharmacy be developed. 2 The development of alternative analytic and descriptive models and the fitting of data to them would permit the pharmacy profession to understand itself better and also to contribute to knowledge in the social and behavioral sciences . In addition, it is important that this data be subsequently used to enable the profession to appropriately plan change. In this article we attempt to develop and apply the model of " inconsistent socialization" to pharmacy . Although this is only one of several approaches which could be taken, we believe this particular model is extremely relevant for pharmacy . We define inconsistent socialization asthe process by which the individual develops or acquires incompatible or conflicting behaviors, beliefs and values from formal or informal sources due to the absence of uniformity or agreement within the idealized group model into which he is being socialized . Obviously, total consistency is absent within any profession, so that inconsistent socialization becomes a matter of degree. We believe that such inconsistency is extensive within the pharmacy profession. With this definition the following concepts are stressed1. Socialization is in itself a process by which an individual acquires the behaviors, beliefs and values of the group with which he comes or aspires to be identified, 2. That formal and informal agents or sources facilitate the process itself, 3. That nonuniformity or lack of agreement about an idealized model of a given social group is in itself a cause for inconsistent socialization patterns and 4 . That these differing socialization patterns arise from differing ideological bases found within the formal and informal sources of socialization. The major issues in this article are thrust within the framework of socialization occurring during the student years. Although socialization occurs throughout the life cycle, it is beyond the scope of this article to cover the entire socialization process. 3 We propose a model which not only at-

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Career Choice Processes and Influences The career choice concept contains two basic alternative positions-( 1) the choice for an occupation is planned, rational, deliberate and purposive and (2) the choice is spontaneous, nonrational and accidental. That both types of career choices exist is evident from studies by Sherlock and Cohen,4 and Katz and Martin.s Sherlock and Cohen, in a study of career choice among dentistry students, found the two major factors influencing choice were desired rewards and realities of access. Both factors were strongly influenced by the occupational history of the individual's family . Of particular importance was the emphasis placed upon occupa-

tional status, achievement and sources of income within the extended family. In contrast with the study of dental students, Katz and Martin relate that student nurses ' career choices do not involve subjective career-oriented decisions. Rather, the nurses seemed to make their choice based upon "situationally delimited" actions-such as wanting to be close to eligible young physicians or to remain with a close friend of the same sex who had chosen to be a nurse. Occupational choice for pharmacy students has not been studied to the extent that definitive choice patterns can be outlined. However, based upor, subjective analysis from experiences with students in several colleges of pharmacy, we lean toward the assumption that career choices in pharmacy consist for the most part of a blend of the purposive and the spontaneous . Some support for this assumption is found in the studies by Schwirian and McCormack. 6 . 7 Even though there is a 14year difference between the Schwirian and McCormack findings some important points can be noted from their conclusions. Schwirian found that when pharmacy students were asked to indicate an alternative career, there was a high factor loading on the choice to be a physician if pharmacy was not selected. This can be interpreted in the context of a desired career choice which could not be attained and subsequent spontaneous choice for pharmacy was made. McCormack found that her respondents in a college of pharmacy came from small, upwardly mobile urban families , and that pharmacy was particularly open to lower-income groups and unappealing to those in high-income groups. In terms of mobility, McCormack stated that 85 percent of the respondents expected to have a greater income than their fathers. In light of McCormack's data, the career choice in pharmacy has a distinct purposeful nature-that of increasing social status through occupational status for those from lower socioeconomic status situations. There are several areas which should be examined to understand the extent to which patterns of career choice influence the student to choose pharmacy. The extent and the direction (positive or negative) of the following career influences may be examined1. The effect of parents, extended family members or close friends who have pharmacy as their occupation, 2. The effect of having had work experience in a community or hospital pharmacy. This experience may haw" been

Journal of the American Pharmaceutical Association

By Henri R. Manasse Jr., Jesse E. Stewart and Richard H. Hall

gained during high school, beginning college days or during " stints" in the Armed Forces , 3. The effect of career inventories such as the Strong Vocational Interest Blank (SVIB) on young persons. The SVIB , in regard to pharmacy, is based upon interests of male pharmacists practicing in 1947 in New York. A scale for women pharmacists is not available 8 4. The effect of current societal interests in drugs and their use. Other factors needing consideration are the effects of social/ethnic origins, selective recruitment and female occupational choices. In terms of inconsistent socialization , the occupational career choice in pharmacy becomes important when one considers why pharmacy was chosen. Polarized ideological differences regarding the perceived role of the pharmacist held by the person making the choice produce a wide base from which socialization has or must take place. In some cases, at the time of entrance into the profession the perceived role may be quite dissimilar from the practitioner 's actual role . It is here where the inconsistencies begin. These inconsistencies are beyond the control of the individual or the profession . Forces of Socialization In the socialization of the aspiring pharmacist several major forces or agents are identified. In this article we are intentionally ignoring the role of the student as an acting participant in the socialization process, other than in terms of his or her value system. Olesen and Whittaker have vividly described the " studentmanship " involved in professional socialization .9 These forces are most likely to be highly integrated, but, at the same time , may also be unique and distinct. The student subjected to these forces is required to do so in view of the professional " steps " which must be taken in order to attain the status of professional registered pharmaCist. The forces are1. Personal value system of the student 2. Changes in societal imperatives 3. Peer effects 4. Ideology of the college of pharmacy (and of its staff) which the student is attending 5. Location of the college of pharmacy (parochial or cosmopolitan environment) 6. Practice setting(s) in which the student completes his practical experience Pavalko describes the broad role of so-

Vol. NS 15, No. 11 , November 1975

Figure 1-A Modeling of the Components of Inconsistent Socialization in Pharmacy I. Career Choice processes and influ ences

,,

Spontaneous cho ice Pur posiye cho ice Exte nded or nu clea r ,fam il y Ear ly w'ork experiences ,

---- -----

, T ype of schoo l and locat ion I

Id eo logy ot' t he edu cationa l inst itu tio , n

, Pract ic,e sett ing ,

Career i'nve , ntories

Changes in societal im pera,tives

Curre nt' societal interests

Peer effects ,

III. Clashing of sociaIiza tion forces I

Co ll ege , goals

New edu cat io nal al tern a tives

,

Di ssa ti sfactio n in practi , ce

Pract itio ner goa ls , Regula tive age ncy, goals

Stu d e~t expec,t at io ns Co nsl/m er expecta , tio ns

I

Pat ien't expectat ions

cialization as that of an agent for learning a social role. 1o Inherent in such a process is learning not only specific skills and knowledge on a strictly cognitive level , but also acquiring the norms, values, orientations and self-conceptions associated with the profession in which the socialization takes place . The six factors listed above influence the content of the socialization process and the extent of influence on the individual. Konopka states that value formation within the individual is a developing phenomenon which reaches its peak at adolescence. 11 However, there is constant reevaluation of those values , particularly if the surrounding system allows choices . The heterogeneity of the practitioner pharmacist, the environments in which pharmacy is practiced, the professional staffs in the colleges and the general structure of the colleges of pharmacy allow for a great degree of dissimilarity of value-systems within the student population . These heterogeneous systems affect a student's total attitude structure (knowledge and affect) regarding the profession in which he is about to become socialized . In a study by Robert Buerki, differing value systems within one college of pharmacy's student population were vividly demonstrated. 12 Students were given descriptions of two pharmacists-Pharmacist Smyth, devoted to the professional model, and Druggist Smith, with marginal commitments to professionalism . When asked if the description of Smyth was representative of the typical community pharmaCist, 100 percent of the control group (students in a social psychology class) responded affirmatively while students in pharmacy ranged from 91 .3 percent (first-year students) to 64.7 percent (fifth-year students) in affirmative responses . The differing

, ,

,

,

Personal value system

IV. Results of socializa lion clashes

,

,

Ro le stra in Lack bf ego au to nomy

value-orientations are closely attached to differing value-expectations and states of idealization. But, as Harvey suggests, pharmacy does not have a dominant value orientation and thus recruits persons from divergent value orientations. 13 Harvey feels that as long as the differential value orientations are maintained, there will be conflict in reaching unity on a professional ideology in pharmacy. Thus, differing ideas are brought to the field by the students and these are in turn reinforced by the socialization process. The degree to which socialization within a ideological framework takes place would certainly be a function of the values brought by the students themselves. Changes in societal imperatives and the effect of peers are also important forces of socialization . Although these forces may be closely tied to value systems and structures, we should consider the impacts of social change to be determinants of norms, orientations and self-conceptions. As an example , several aspects of social change which have altered professional socialization in pharmacy to some extent are1. The faddishness of drug use in our society has resulted in a myriad of opinions among practitioners, pharmacy educators, and students. Pharmacy students for the most part have antagonistic feelings toward the abuse of drugs, pharmacy practitioners detest " dope fiends, " and pharmacy educators strongly project their negative attitudes toward nonclinically indicated use of drugs. 2. Legislative impacts on the practice of pharmacy have been numerous . The advent of restrictive pharmacy practice acts, partial socialized medical programs, and stringent laws concerning narcotic and dangerous drugs all have aided in the cre-

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Inconsistent Socialization in Pharmacy- A Pattern in Need of Change

ation of specialized socialization patternsstudents may "learn " to "hate " the legislators, the patients on " relief " seeking prescription medications, and the consumer in general since it is he or she who originates the legislation . The legislation imposed upon practice is interpreted and seen , in effect, as treading upon the " territorial imperatives" which the profession is trying so hard to stake out for its own . 3. The attitudes and expectations of the public have changed somewhat leading to conflicting ideas about pharmacy . As many authors relate, pharmacy tends to be viewed as both a science and a commercial venture. 14 - 16 These views are somewhat nebulous and dependent upon the present " news " situation. Braucher and Evanson relate the unpopularity of pharmacy during the Kefauver Committee investigations of the drug industry.17 Similar fluctuations in attitudes toward the social image of pharmacy are currently being manifested during legislative hearings on other pharmacy related issues. In these instances the student learns to become defensive and tends to gravitate toward an ideological frame of reference supportive of his own convictions . 4 . The highly publicized information and knowledge explosion has also had a profound effect on socialization within the profession. This concept is founded on the fact that knowledge has become extremely specialized and clustered around certain types of experts . In pharmacy's case, the student is strongly advised that he is the expert in drugs and drug therapy and that he should assume the role of drug expert (in contrast to the patient's view which sees the physician in the drug expert role) . Peer influence can be seen when students begin to socialize with others of differing backgrounds . Each student brings his own experiences and attitudes which he shares with others, i.e., students oriented towards hospital pharmacy practice because of hospital pharmacy experience and/or towards community practice because a pharmacy is owned by family or close friends . The ideology of a college of pharmacy, in general, and its staff, in particular, is a crucial variable in the socialization process. Schwirian found that students at the Universities of Wyoming, Maryland and Southern California are most likely to view pharmacy as a science, while those at the Universities of Puerto Rico and Arkansas, and South Dakota State University are most likely to view pharmacy as a service rather than a science . 18 Although there

618

may be some question as to whether science and service are separable in pharmacy without good definition of each term, in the case of pharmacy practice the Schwirian data do show differential attitude development on the part of different universities. It is highly probable that colleges of pharmacy administered by conservative deans and highly physical science-oriented staffs have a different definition of professional imperatives for pharmacists than their liberal counterparts in colleges characterized as avant garde. This type of differential socialization based upon school-type is evident in the profession of nursing . 19 Although Alluto and coworkers did not find differences in professional commitment, they did find marked differences in student personality characteristics and expectations concerning professional role conflicts in different types of schools . This could be the case in pharmacy although there is no evidence to support this fact among different colleges of pharmacy. However, colleges of pharmacy located within large state universities have quite different orientations towarQ professional practice than those which are private and self-supporting . The mission of the latter is closely tied to the need for survival, having to maintain " popular" attitudes in order to keep attracting new students. Other factors to be considered include the percentage of pharmacists and active practitioners on the faculty, faculty members ' individual outlooks toward pharmacy practice , the school's activities in general professional affairs and the degree of personal affinity of faculty members toward students . Closely related to the ideology of the college of pharmacy is its location in terms of urban environment or regional environment (as defined by Schwirian) .2o It can be speculated that those colleges of pharmacy located within urban areas tend to have a more cosmopolitan orientation and cosmopolitan conception of pharmacy practice . In contrast, those colleges of pharmacy situated in non-urban areas (primarily colleges which attract students from a wide region), can be expected to reflect a parochial view toward practice . Both the cosmopolitan and parochial views would necessitate a differential process of socialization. Indeed, Schwirian found that students from smaller hometowns have a stronger image of pharmacy as a health profession than those students who come from larger cities.21 She states that " students at regional schools attribute significantly higher prestige to the pharmacy pro-

fession ... regional school students have significantly less of a business orientation than their urban school counterparts ." 22 One of the major forces in the socialization process of the pharmacy student is the type of pharmacy in which the student completes his practice experience . In this experience the student gains definitiveness in his status, strengthens his professional attitudes, begins to establish his reference groups and commits himself to an ideology .23 In the work setting several important factors are contingent upon the direction of the socialization forces. These include the general philosophies and attitudes of the preceptors (pharmacist supervisors) toward the social objective of pharmacy practice, their system and structure of values, goals for their own careers, the type and location of the pharmacy in which the experience is gained , the involvement of the pharmacy 's professional staff in organizational affairs and continuing education, and the relationship that the pharmacy fosters on an inter- and intra professional basis . Many pharmacy students accumulate a significant portion of their required internship hours while enrolled in school, so the student must deal with the theory versus practice reality conflict relatively early. It is in this complex maze that the student begins to actually play the role for which he is being trained. In the pharmacy, the student is shaped by both practitioners and patients alike into a set of behaviors composing the social role of the pharmacist. Not only is the pharmacy the "real world " for the student, but it also becomes the primary focus for incompatibility of prior socialization goals and the locus of inconsistencies with which the student will soon be confronted . At the present time it is impossible to determine the relative weights to be assigned to these agents or forces of socialization . Certainly all are important. Research is needed to determine their relative importance at the different career stages. Clashing of Socialization Forces Some behavioral scientists have too simplistically explained social behavior as a function of the roles a person occupies . Yet, a more concise definition of social behavior indicates that it remains a function of one 's own expectations of the role he occupies, the expectations that others hold of him and the expectations of the employing organization. Thus , the expectations of a role represent the sum of several inputs, and, in turn , each of these inputs provides

Journal of the American Pharmaceutical Association

Manasse, Stewart, and Hall

an influence on the final product-the behavior of the individual. 24 The major issue concerning pharmacy practice today is whether the practice of pharmacy is in fact a profession. Certain authors have termed the pharmacist a " marginal professional" while others have used the term of " quasi-professionaL" 25 Undoubtedly much of this disparity is due, at least in part, to the fact that the pharmacist attempts to fill a professional role while he actually practices in a business environment. Furthermore, the argument that the pharmacist is dealing with a physical commodity-the drug-and not simply a service, reinforces those who prefer the term " quasi " or " marginal " professional. In a recent article, Denzin and Mettlin have attempted to describe and explain this issue, and the inherent inconsistencies, by coining the term " incomplete professionalization " to describe the practice of pharmacy.26 According to these authors, pharmacy has indeed taken on some of the characteristics of a profession, but it has failed to disassociate itself from some of the so-called marginality factors which inhibit complete professionalization for an occupation . Meanwhile, they also assume that certain dominant practice patterns enable some segments of the profession , such as hospital pharmacy, to remain more professional than other segments , such as those practitioners located in a community setting. For years, the practice of pharmacy, as represented by boards of pharmacy which control the profession 's licensure standards and law enforcement, has had a conflicting opinion with those who participate in the educational training of the student in the formal setting . Board members have traditionally criticized the colleges for producing an educational product that is imperfect and without the competencies needed to translate academic knowledge into practice . Conversely, colleges of pharmacy have traditionally defended their product and criticized the seemingly unstructured, but required, internship program which they claim causes the student to abandon, or at least modify, many of the principles acquired during the student's formal academic training . The role conflict felt by the individual pharmacist when he first begins to practice can thus be expected, and even predicted. The college of pharmacy has spent from five to six years to produce an individual practitioner who can function in a variety of practice settings, and who, as claimed by many, is the most over-educated and

Vol. NS 15, No. 11, November 1975

under-utilized of any health professional. The role expectations of this student, who has an extensive background in organic and physical chemistry, pharmacology and prescription compounding, are obviously strained when the reality of community pharmacy practice is finally acknowledged. As soon as the pharmacist becomes registered his function is hampered and he finds the use of his intensive training retarded .27 The pharmacist can spend considerable time explaining the difference between two or more products to a patient, and his ability to do this is obviously dependent upon his extensive educational training. Yet, the fact that he cannot charge for such advice may encourage the pharmacist to emphasize the product which will yield the most profit. As seen by the younger pharmacist, this is certainly not professional conduct; yet the realities of this kind of business tend to force this kind of behavior . Numerous other examples could be cited, but they all reflect upon the belief that professionalism must be earned by the individuals seeking it and must be recognized by the society giving it.

Inconsistent socialization is thus a product of conflicts which arise within the individual and/or within the profession or occupation. The person entering the socialization process brings with him certain values, norms and expectations which he has gained from previous experience and education. The pharmacy student has had the college of pharmacy, represented by its faculty members, as a dominant influencer in the formation of his values and norms. Those practicing pharmacy, whether it be in a community, a hospital or another type of pharmacy setting, likewise have dominant influencers which are obviously not the same. A number of different groups and organizations, such as the state board of pharmacy, the state and national pharmaceutical associations, local associations, and certainly peer association, along with an unmeasured influence coming directly from the consumer tend to produce different expectations and to require adaptation by the practicing pharmacist. This so-called adaptive process has been investigated, but certainly not in a direct manner.

Henri R. Manasse Jr.

Henri R. Manasse Jr., PhD, is assistant professor of pharmacy practice and director, Investigational Program for Self-Directed Study at the University of illinois college of pharmacy, where he received his BS. Manasse earned an MA in educational psychology at Loyola University of Chicago and a PhD in pharmacy administration at University of Minnesota. His current research interests are in professional socialization in pharmacy with major interests in personality and value correlates to academic experience . Manasse is a member of APhA , AACP, AAAS , National Council on Measurement in Education , American Sociological Association , Rho Chi and Phi Kappa Phi.

Jesse E. Stewart

Jesse E. Stewart, PhD, is assistant professor of pharmacy practice at the University of Illinois college of pharmacy. He received his BS from Oregon State University, and his MS and PhD in hospital pharmacy and pharmacy administration , respectively, from the University of Minnesota college of pharmacy . While doing graduate work, he was a research assistant for the Minnesota State Board of Pharmacy, for which he helped design a comprehensive examination for an evaluation of the internship experience in the state. Stewart is a member of APhA, ASHP, AACP, American Public Health Association, Rho Chi and Kappa Psi.

Richard H. Hall

Richard H. Hall, PhD, is professor of sociology and industrial relations at the University of Minnesota. Hall received his undergraduate education at Denison University, and his MA and PhD from the Ohio State University. He is a noted authority on occupational sociology and has authored three textbooks as well as numerous other publications . Hall is an associate editor for Administrative Science Quarterly and The Sociological Quarterly and is presently completing an investigation titled " The Effectiveness of Social Regulatory Systems for Problem Youth ." He is currently on sabbaticalleave at the University of Vermont where he is investigating organizational sociology .

619

Inconsistent Socialization in Pharmacy-A Pattern in Need of Change

A study by Linn and Davis attempted to identify those activities which occupy most of the pharmacist's time, as well as those activities which he prefers to spend his time doing. 28 It is not surprising that dispensing prescription orders and rendering advice to patrons about health problems consumed the largest portion of the pharmacist's time and were identified by the pharmacist as being the most preferred activities. The fact that the same activities which were related to what pharmacists are presently doing are also related to what they prefer to do could be identified as simple adaptation by the pharmacist. However, a number of other functions which could be identified as "professional" functions were not preferred by the pharmacists surveyed in the Linn and Davis study. If, in fact , these findings can be interpreted as being at least generally representative of the practice of pharmacy, then it is not surprising that role conflict is often experienced by the pharmacy student when he enters practice. Linn and Davis also concluded that pharmacists who were younger, at their job a shorter period of time or had recently taken some postgraduate study in pharmacy were more likely to have both interest and involvement in professional on-the-job activities, as defined in the study, than were their counterparts .29 Although this study did not attempt to define pharmacy as either a profession or a "marginal" profession, it showed that those pharmacists who had recently participated in some form of postgraduate ed·ucation tended to express more professional interests and involvement than those who had not. Also, it can be stated that "socialization into the profession seems to indicate that strong professional interests and involvements are most likely among pharmacists just entering the profession and increasingly less likely among older professionals." 30 Again, the term inconsistent socialization can be used to describe this socialization process which repeatedly seems to dichotomize the younger and the older pharmacists in practice . An unknown factor here is the extent to which schools of pharmacy themselves may have changed over the years, thus contributing to the differences noted between the young and the old . The socialization which occurs after formal education explains most of these differences, however. Another important aspect which affects this socialization process is how the com-

620

munity pharmacist views himself. An individual's role perceptions are a function of three principle elements- 31 1. His personal predisposition 2. The expection of others whom he perceives as significant to his specific role 3. The situational setting of the role The conclusions drawn by Belasco and Arbeit from the questionnaire sent to practicing community pharmacists indicate the importance of role perceptions. These authors concluded, "The elements which serve to distinguish the way pharmacists view their professional roles are factors which relate to their place in the organizational structure of the pharmacy." 32 The perceptions the pharmacist has of his role are dependent upon the position he holds in the organizational hierarchy (Le ., whether he is an owner or an employee). Whether this reflects Corwin's statement that "the career is a process of transformation in status" cannot be determined from the data presented. 33 It may be that the pharmacy owner feels more responsibility to the patient than does the employee pharmacist and places his overall status slightly higher than his employee's. Likewise, as the owner-pharmacist moves into an administrative role, which often happens, he may feel a need to compensate for his decreased expertise in the practical sense, and thus feels that his new role is more important to the overall care of the patient (practice of pharmacy). This might be an explanation, in some instances, for the perceived discrepancy in status. The inconsistencies that impede the socialization process in pharmacy have been examined from the recent graduate's point of view. We have discussed briefly the practicing pharmacist, the board of pharmacy and the college of pharmacy and why conflicts among and between these groups help to perpetuate the inconsistent socialization process in pharmacy. Other groups, such as consumers and fellow health professionals, act as "significant others" in the socialization, as well as the professionalization process of the pharmacist. The pharmacist's perceptions as expressed by these two groups, have had significant impact upon the role conflict suffered by pharmacy in recent years, and this has led , in part, to the inconsistent socialization process. The opinion offered by many physicians and members of the general public concerning the pharmacist's present vocation implies that he is merely a specialized retailer dealing in a restricted commodity, prescription drugs. Modifications of existing

role expectations will be necessary if pharmacy is to perpetuate its desired new role(s) as expressed by a patient-oriented attitude, and an active interest in healthcare delivery. That the public (including physicians) has an effect upon the inconsistencies in pharmacy practice was demonstrated by Knapp , Knapp and Edwards in a recent study.34 Their results, using a 19-statement scale and a semantic differential scale, indicated that the pharmacist was seen as not doing anything considered objectionable, but, on the other hand, he was seen as not doing those activities considered most acceptable in an ideal pharmacist. Thus, the argument that the pharmacist is not performing many of the functions desired of him by the public is SUbstantiated. Their findings also suggest that pharmacists themselves have a tendency to underestimate the ideal pharmacist as perceived by the public. These results suggest that the pharmacist is identified by the public as an incomplete professional (Le ., not living up to his potential), and that the pharmacists included in the survey generally agreed with this assumption and thus felt role discrepancy. If the public is defined as a "significant other" or reference group for pharmacists, it is not surprising that its ambivalent feelings and perceptions about pharmacy practice be reflected and acknowledged by the pharmacist. The inconsistent socialization process experienced by the pharmacist is indeed influenced, and even perpetuated, by the general public. Belasco and Arbeit state that the socializing experiences of the schools of pharmacy, the profession itself, the internship programs and the professional associations generate an occupational image which provides cohesiveness for the profession. 35 It is difficult to agree with such a statement given the results of their own study and others cited in this article. A consistent and congruous socialization process simply does not exist in the practice of pharmacy for a multitude of reasons. Different norms and value systems are imparted to the pharmacist from the time he enters college until he retires from practice. These different influential groups, and their effect upon the socialization process have been examined, and it seems clear that only through a unified effort by all those involved can this situation be altered, if such a change is thought to be desirable. Results of Socialization Clashes There is a turnover of students in any college or school in a university. Numerous

Journal of the American Pharmaceutical Association

Manasse, Stewart, and Hall

reasons are given for this turnover, but, in general, investigators ignore the underlying reasons and simply accept the occurrence . Little, if any, research has been conducted in the pharmacy profession to identify and delineate specific reasons why colleges of pharmacy experience a dropout rate which seems exceptionally high. We can argue that the curriculum requirements are more difficult than for many other colleges, and pharmacy is often ranked with medicine, dentistry and engineering by other campus members as being "tough ." Certain pharmacy school courses are "weeding out" courses; most professional schools can easily identify them. For some, these particular courses serve as an excuse to leave the college of pharmacy, but for others they serve as a disappointment and personal defeat. Moreover, the afflicted student may associate both the college and the practice of pharmacy with certain arduous course requirements, and his perception of the practice of pharmacy is undoubtedly altered . Another problem facing pharmacy educators involves the student who decides that pharmacy is not for him and transfers . Some might argue that it is better to rid the profession of the unsure before it is too late in order to provide facilities for those students who truly want to practice pharmacy . Others would argue, however, that it is primarily the lack of proper socialization in the student setting. This socialization process might be a formal and an informal introduction into pharmacy practice , including professional attitudes and beliefs . In recent years , there has been a major

effort among younger faculty members to introduce the student to the practice setting in the first year of the professional curriculum, reaffirming a previous conviction for those who decide that pharmacy is still desirable to them . It also provides an opportunity for the unsure individual to assess the practice and decide on a course of action earlier in his academic career. The disgruntled student can decide to pursue a career in research or he could simply transfer out of the college of pharmacy. A phenomenon probably not unique to pharmacy is that of individuals who decide not to practice pharmacy but to enter graduate school instead. Many of these students had planned a research career in pharmacy early in their professional education. Yet, what about those students who enter graduate school in an area of pharmacy simply because they do not want to practice pharmacy as it is known today? How will the attitudes of this latter group affect the individuals that the graduate student might contact through a later teaching career? One may wonder how many colleges ever contemplate the fact that their faculty often represents this individual who was too disenchanted with his chosen field to practice it, and chose a teaching-research field instead. The effect of this person on the student is difficult to measure, but at least minimally, the values and norms of this faculty member might be imparted to the students . We can only speculate on the impact of this sort of individual upon the profession . As the student continues through pharma-

cy school, his attitudes and perceptions about the practice are formulated by an informal socialization process. The inconsistency of this process and its resulting ramifications have been examined, but the effect of his inconsistency upon the career process of the pharmacist has never truly been measured. It may be that discord within the profession and within particular faculty members causes the student to transfer or decide to enter graduate school, thus avoiding a confrontation of value systems . A final area worth examining deals with attitudes and perceptions and their effect on the practitioner in a pharmacy setting. Shaw uses the term " ego-straining " to explain the pharmacist's problem when he is looked upon as an entrepreneur as well as a professional. 36 While the professional is supposed to be "governed" by norms of service, the pharmacist finds himself tightly bound by both state and federal laws because he deals with commodities as well as service. These restrictions on his practice blunt the pharmacist's autonomy and produce a certain amount of alienation. Some practitioners do not mind the restrictions because they lessen their autonomous professional responsibility toward the patient, but many others resent the intrusion into professional practice. Shaw has also stated that the amount of alienation experienced by the pharmacist depends upon the lack of ego-autonomy available over his practice .3 7 It is not surprising that young pharmacists enter pharmacy practice and undergo role strain , powerless(Continued on page 658)

the American Assoc iation o f Colleges o f Pharmac y, Las Vegas. Nev. (April 8. 1967) 13. Harvey, E., " Some Implications of Va lue Differentiation in Pharmacy '" Can. Rev. Soc. and A nthrop., 3, 23- 37

26. Denzin, N .K ., and Mettlin , C.J. , " Incomplete Professionalization: The Case of Pharmacy, " Soc. Forc., 46, 375 (March 1968) 27 . Shaw, C. T., " Professionalism- A Sociological Evaluation o f Commerc ialism and Inc on sistenc ies in Pharma cy ," JAPhA , NS11, 5 39 (Oct. 197 1) 28. Linn. L. S., and Davis . M .S .• " Factors Associated With Act ual and Pre ferred Activities of Pharmacists, " JAPhA , NS11, 5 45 (Oc t. 1971 ) 29 . Ibid. p. 54 7 30 . Ibid. p. 548 3 1. Belasco and Arbeit, loc. c it. 32. Ibid. p. 508 33. Cor win. R. G .• " The Professional Employee: A Study of Co nflict in Nursing Roles," in Ronald M. Pavalko, Sociological Perspectives On Occupa tions, F.F. Peacock Publishers. Inc .• Itasca. III .• 26 1- 275 (1972) 3 4. Knapp. D .E.. Knapp. D .A .. and Edwards. J.D .• " The Pharmacist as Perc eived by Ph ysicia ns, Pa trons and Other Pharmacists'" JAPhA. NS9 , 80 (Feb. 19 6 9) 35. Belasco a nd Arbeit. op. cit.• p. 509 36 . Shaw , C.T., "Societal Sanctioning- The Pharmacist' s Tarnished Image'" Soc . Sci. Med .• 6, 109 (Feb . 19 7 2) 37 . Ibid. p. 11 0 38 . Blauner, R., Aliena tion and Freedom , University of Chicago Press . Chicago . III. . 16- 3 1 (1964) 39. Quinney , E.R. , " Adjustment to Occ upa tional Role Strain: The Case o f Re tail Pharmacy,,' Southwest. Soc. Sc i. 0 .. 44,367 (March 19 64 ) 40 . Ibid. p. 369

References 1. Smith , M.C., " Toward A Sociology o f Pharmacy, " Am. J. Hasp . Pharm.. 25, 42 (Ja n. 1968) 2. Smith. M.C .. ·· Social Models for Pharmacy St udents '" Am . J. Pharm. Educ .. 37, 28- 38 (Feb. 1973) 3 . Brim , e .G., Jr., and Wheeler, S., Socialization after Childhood: Two Essays, John Wiley and Sons. Inc .. New York

(1966) 4. Sherlock . B. and Cohen. A .. " The Strategy of Occupa tio na l Choice: Recru itment to Dentistry, " Soc. Fore ., 44 , 303- 3 13 (March 1966) 5. Katz, F.E. and Martin , H.W ., "Career Choice Processes, " Soc. Forc .• 41 , 149- 154 (Dec . 1962) 6. Schw irian, P.M., " Images o f the Profession Among Beginning Pharmacy Students: Individual and Context ual Correlates. " mimeo report 7. McCormack , T.H., " Th e Druggist' s Dilemma: Problems of a Marginal Occupation,,' Am. J. Social .• 61 , 308- 3 15 (Ja n. 1956) 8 . Kirk , K .W . et al., " Vocational Interests o f Pharmacy Students '" Am . J. Pharm . Educ., 35, 564- 570 (Nov. 197 1) 9. Olesen. V.L.. and Whittaker. EW .. The Silent Dialogue: A Study in the Social Psychology o f Professional Socializa tion. Josse y-Bass . San Francisco . Ca lif. (1968) 10. Pavalko , R.M., ed., Sociological Perspectives on Occupa tions. F.E. Peacock Publisher s. Inc .• Itasca. III. : 150

(1972) 11 . Konopk a , G., " Formation of Va lues In the Developing Person'" Am . J. Orthopsychiatry. 43, 86-96 (Jan . 1973) 12. Buer ki. R.A .. " Pharmacist Smyth and Druggist Smith- A Study o f Pro fessional Aspirations," paper presented to

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(1966) 14 . Thorner, I, " Pharmacy: The Func tional Significa nce of an Institutional Pattern .. ' Soc . Forc .. 20, 32 1 (Marc h 1941 ) 15. Mc Cormack. T.H .. lac. c it. p. 308 16. Wertheimer, A .I. , " Pharmaceutical Services- Some Necessary Distinctions'" JAPhA. NS13 , 260 (May 1973) 17. Braucher, C.l. , and Evanson, R.E ., " The Social Image o f Pharmacy,,' JAPhA, NS2, 99- 10 4 (Feb. 1962) 18 . Schwirian. P.M .. " Toward An Empirica l Typology of Pharmacy Students Based on Student Characteristics ," Am . J. Pharm. Educ .• 36, 1- 15 (Feb . 197 2) 19 . Alluto . J.A .• " A Study Of Differential Socializa tion for Members o f One Pro fessional Occupation, " J . Heahh Soc. Beha v.. 12, 140- 147 (J une 197 1) 20 . Schwirian, P.M., loc . cit. 21 . Schwirian, P.M. , " Images o f the Pro fession Among Beginning Pharmacy Students," mimeo report 22 . Ibid. 23 . Seeman. M .• and Evans. J. W .•.. Ap pre nticeship and Attitude Change'" Am. J. Social.. 67, 3 65- 378 (Jan. 1962) 2 4. Belasco. J.A .. and Arbe it. S .• " The Community Pharma cist Views Himself .. ' JAPhA . NS9, 506 (Oct. 1969) 25 . Wardwell , W .I. , " U mited, Marginal and Quasi-Practitioners," in Howard E. Freeman, Sol Levin , and Leo G. Reeder. Handbook of Medical Sociology, Prentice-Hall. Englewood Cliffs. N.J .• 2 13- 240 (19 63)

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