LETTERS
sion to contribute to the triple aim of improved population health, better care, and lower costs. Disclosure: I am a federal government employee but completed this letter on my own time. This letter constitutes my personal perspective and not the views of the U.S. government. George A. Neyarapally, PharmD, MPH JD candidate University of Maryland School of Law Baltimore [email protected] doi: 10.1331/JAPhA.2014.14028
References 1. Strand MA, Miller DR. Pharmacy and public health: a pathway forward. J Am Pharm Assoc. 2014;54(2):193-197. 2. Traynor K. Congressional fellows help set health care policy. Am J Health Syst Pharm. 2013;70(22):1960-1964.
Pharmacist demand and the need for expanded postgraduate training I would like to thank Taylor et al.1 for their thought-provoking analysis of pharmacist demand. This issue is important to experienced and new pharmacists alike; I found the most striking finding to be that the demand for pharmacists in 84% of states is lower than predicted. A recent article by Brown2 in the American Journal of Pharmaceutical Education discussed the prospects of the pharmacy profession. He highlights the growth in pharmacist education—from 7,000 graduates in 2001 to more than 11,000 graduates in 2011—noting that 62% of the growth came from expansion of existing programs. Taking into account the appearance of new programs and the expansion of current programs, he states that there are 15,000 projected graduates in the year 2018. He continues that even with 12,000 pharmacy positions opening each year, there will be a 20% unemployment rate among pharmacists. Of these new pharmacists, many finish their education with an average of $123,000 of debt. These predictions of unemploy-
ment are worrisome and important to discuss. There is great promise for the pharmacy profession in expanding responsibilities and roles; we already see pharmacists leading antibiotic stewardship programs, performing home visits in patientcentered medical homes, and engaging in medication therapy management (MTM) for complex patients in the community. The profession is constantly evolving, and pharmacists are evolving along with it. However, while the number of graduates seems to be reaching demand, the number of postgraduate training positions may not be. Though the number of postgraduate year 1 residency positions has increased more than 40% since 2009,3,4 many pharmacists seeking positions fail to match with a program. According to residency match statistics for 2013, the American Society of Health-System Pharmacists this past year had 1,438 applicants (36.6%) who did not match for a PGY1 position.5 It may be time to turn our focus onto expanding postgraduate training, so pharmacists are adequately trained to continue to take on new roles and responsibilities. As we push for provider status, we should continue developing postgraduate training opportunities to ensure that our profession stays current with the changing health care environment. Nadia Kudla, PharmD Postgraduate Year 1 Pharmacy Practice Resident University of Pittsburgh Medical Center St. Margaret Pittsburgh, PA [email protected] doi: 10.1331/JAPhA.2014.13207
References 1. Taylor TN, Knapp KK, Barnett MJ, et al. Factors affecting the unmet demand for pharmacists: state-level analysis. J Am Pharm Assoc. 2013;53(4):373–381. 2. Brown DL. A looming joblessness crisis for new pharmacy graduates and the implications it holds for the academy. Am J Pharm Educ. 2013;77(5):90.
Journal of the American Pharmacists Association
j apha.org
Downloaded From: http://japha.org/ by a North Dakota State University User on 06/03/2014
3. American Society of Health-System Pharmacists. Summary results of the match for positions beginning in 2009: residencies and programs. https://natmatch.com/ashprmp/stats/2009progstats.html. Accessed November 2, 2013. 4. American Society of Health-System Pharmacists. Summary results of the match for positions beginning in 2013: residencies and programs. Accessed November 2, 2013. https://natmatch.com/ashprmp/ stats/2013progstats.html 5. American Society of Health-System Pharmacists. Summary results of the match for positions beginning in 2013: applicants. https://natmatch.com/ashprmp/ stats/2013applstats.html. Accessed November 2, 2013.
Provider status and the need for additional qualified residency opportunities—Response to Kudla The authors are in agreement with Dr. Kudla’s recommendation for increased efforts at expanding residency opportunities for pharmacists. Recently passed legislation in California recognizes completion of a residency as one of three criteria, any two of which qualify a pharmacist for Advanced Practice Pharmacist (APP) status.1 These three criteria are earning certification in a specialized area of practice (e.g., ambulatory care or oncology); completing a postgraduate residency program; or experience in providing clinical services to patients for 1 year under a collaborative practice agreement with a physician, health system, or APP pharmacist. New graduates without the prerequisite residency training may find their future scope of practice limited (or more difficult to satisfy) as a result of not fulfilling this requirement. As Dr. Kudla notes, there is already more demand for residencies than there are positions; the new law will likely further increase residency demand. APP status allows an expanded scope of practice for pharmacists, including the ordering and interpretation of clinical laboratory tests and furnishing a set of defined prescripMAY/JU N 2014 | 54:3 |
JAPhA 215
tion medications such as hormonal contraception and travel medications. In addition, pharmacists with APP status will be authorized to initiate, adjust, and discontinue drug therapy for patients in accordance with established clinical protocols. While many pharmacists will want to achieve APP status, limitations in available postgraduate year 1 positions may hinder their professional aspirations. The APP “story” is just one example of how the current shortage of residencies can affect pharmacists’ careers and the pharmacy profession.
Katherine K. Knapp, PhD, FAPhA Professor and Dean [email protected] Bijal Shah, BSPharm, PhD Associate Professor, Social, Behavioral and Administrative Sciences Mitchell J. Barnett, PharmD, MS Associate Professor, Pharmacy Practice College of Pharmacy Touro University, California Vallejo, CA Thomas N. Taylor, PhD Associate Professor College of Pharmacy & Health Sciences Wayne State University Detroit, MI
Laura Miller, PhD Senior Economist National Association of Chain Drug Stores Foundation Alexandria, VA doi: 10.1331/JAPhA.2014.13230
Reference 1. California Legislative Information. SB493. http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB493. Accessed November 11, 2013.
DRY MOUTH The #1 Cause1,2
The Leader in Dry Mouth Symptom Management
Be part of the solution. Start the conversation today. Many patients on medications silently cope with Dry Mouth symptoms, not knowing the potential consequences.2 Early identification is important.
Recommend Biotène. The Silent Coping2
A full range of products to help meet your patients’ individual needs.
The Potential Impact *1-4 • Daily discomfort • Bad breath • Mouth infections† • Up to 3X higher cavity risk
Moisturizing Relief
Everyday Protection
If Dry Mouth is unmanaged † Biotène is not indicated for the treatment of mouth infections. 1) Porter SR. et al. Oral Medicine: An update of the etiology and management of Xerostomia. Oral Surg Oral Med Oral Pathol Jan2004;97(1):2846. 2) Dry Mouth The Malevolent Symptom: A Clinical Guide. Ed. By Sreebny LM, Vissink A, Blackwell Publishing 2010. 3) Papas AS, et al. Caries prevalence in xerostomic individuals. J Can Dent Assoc. Feb. 1993;59(2):1719. 4) Guggenheimer J, Moore PA. Etiology, recognition and treatment. JADA.2003;134:61-69.
Saliva Stimulation
*
© 2014 GlaxoSmithKline Consumer Healthcare
GSK4-005 Biotene Half Page_PharmacyToday.indd 2
216 JAPhA | 5 4 :3 | M AY /JUN 2014
ja p h a .org
#1 DENTIST & PHARMACIST RECOMMENDED BRAND FOR DRY MOUTH SYMPTOMS
14-03-19 2:27 PM
Journal of the American Pharmacists Association
Downloaded From: http://japha.org/ by a North Dakota State University User on 06/03/2014
sion to contribute to the triple aim of improved population health, better care, and lower costs. Disclosure: I am a federal government employee but completed this letter on my own time. This letter constitutes my personal perspective and not the views of the U.S. government. George A. Neyarapally, PharmD, MPH JD candidate University of Maryland School of Law Baltimore [email protected] doi: 10.1331/JAPhA.2014.14028
References 1. Strand MA, Miller DR. Pharmacy and public health: a pathway forward. J Am Pharm Assoc. 2014;54(2):193-197. 2. Traynor K. Congressional fellows help set health care policy. Am J Health Syst Pharm. 2013;70(22):1960-1964.
Pharmacist demand and the need for expanded postgraduate training I would like to thank Taylor et al.1 for their thought-provoking analysis of pharmacist demand. This issue is important to experienced and new pharmacists alike; I found the most striking finding to be that the demand for pharmacists in 84% of states is lower than predicted. A recent article by Brown2 in the American Journal of Pharmaceutical Education discussed the prospects of the pharmacy profession. He highlights the growth in pharmacist education—from 7,000 graduates in 2001 to more than 11,000 graduates in 2011—noting that 62% of the growth came from expansion of existing programs. Taking into account the appearance of new programs and the expansion of current programs, he states that there are 15,000 projected graduates in the year 2018. He continues that even with 12,000 pharmacy positions opening each year, there will be a 20% unemployment rate among pharmacists. Of these new pharmacists, many finish their education with an average of $123,000 of debt. These predictions of unemploy-
ment are worrisome and important to discuss. There is great promise for the pharmacy profession in expanding responsibilities and roles; we already see pharmacists leading antibiotic stewardship programs, performing home visits in patientcentered medical homes, and engaging in medication therapy management (MTM) for complex patients in the community. The profession is constantly evolving, and pharmacists are evolving along with it. However, while the number of graduates seems to be reaching demand, the number of postgraduate training positions may not be. Though the number of postgraduate year 1 residency positions has increased more than 40% since 2009,3,4 many pharmacists seeking positions fail to match with a program. According to residency match statistics for 2013, the American Society of Health-System Pharmacists this past year had 1,438 applicants (36.6%) who did not match for a PGY1 position.5 It may be time to turn our focus onto expanding postgraduate training, so pharmacists are adequately trained to continue to take on new roles and responsibilities. As we push for provider status, we should continue developing postgraduate training opportunities to ensure that our profession stays current with the changing health care environment. Nadia Kudla, PharmD Postgraduate Year 1 Pharmacy Practice Resident University of Pittsburgh Medical Center St. Margaret Pittsburgh, PA [email protected] doi: 10.1331/JAPhA.2014.13207
References 1. Taylor TN, Knapp KK, Barnett MJ, et al. Factors affecting the unmet demand for pharmacists: state-level analysis. J Am Pharm Assoc. 2013;53(4):373–381. 2. Brown DL. A looming joblessness crisis for new pharmacy graduates and the implications it holds for the academy. Am J Pharm Educ. 2013;77(5):90.
Journal of the American Pharmacists Association
j apha.org
Downloaded From: http://japha.org/ by a North Dakota State University User on 06/03/2014
3. American Society of Health-System Pharmacists. Summary results of the match for positions beginning in 2009: residencies and programs. https://natmatch.com/ashprmp/stats/2009progstats.html. Accessed November 2, 2013. 4. American Society of Health-System Pharmacists. Summary results of the match for positions beginning in 2013: residencies and programs. Accessed November 2, 2013. https://natmatch.com/ashprmp/ stats/2013progstats.html 5. American Society of Health-System Pharmacists. Summary results of the match for positions beginning in 2013: applicants. https://natmatch.com/ashprmp/ stats/2013applstats.html. Accessed November 2, 2013.
Provider status and the need for additional qualified residency opportunities—Response to Kudla The authors are in agreement with Dr. Kudla’s recommendation for increased efforts at expanding residency opportunities for pharmacists. Recently passed legislation in California recognizes completion of a residency as one of three criteria, any two of which qualify a pharmacist for Advanced Practice Pharmacist (APP) status.1 These three criteria are earning certification in a specialized area of practice (e.g., ambulatory care or oncology); completing a postgraduate residency program; or experience in providing clinical services to patients for 1 year under a collaborative practice agreement with a physician, health system, or APP pharmacist. New graduates without the prerequisite residency training may find their future scope of practice limited (or more difficult to satisfy) as a result of not fulfilling this requirement. As Dr. Kudla notes, there is already more demand for residencies than there are positions; the new law will likely further increase residency demand. APP status allows an expanded scope of practice for pharmacists, including the ordering and interpretation of clinical laboratory tests and furnishing a set of defined prescripMAY/JU N 2014 | 54:3 |
JAPhA 215
tion medications such as hormonal contraception and travel medications. In addition, pharmacists with APP status will be authorized to initiate, adjust, and discontinue drug therapy for patients in accordance with established clinical protocols. While many pharmacists will want to achieve APP status, limitations in available postgraduate year 1 positions may hinder their professional aspirations. The APP “story” is just one example of how the current shortage of residencies can affect pharmacists’ careers and the pharmacy profession.
Katherine K. Knapp, PhD, FAPhA Professor and Dean [email protected] Bijal Shah, BSPharm, PhD Associate Professor, Social, Behavioral and Administrative Sciences Mitchell J. Barnett, PharmD, MS Associate Professor, Pharmacy Practice College of Pharmacy Touro University, California Vallejo, CA Thomas N. Taylor, PhD Associate Professor College of Pharmacy & Health Sciences Wayne State University Detroit, MI
Laura Miller, PhD Senior Economist National Association of Chain Drug Stores Foundation Alexandria, VA doi: 10.1331/JAPhA.2014.13230
Reference 1. California Legislative Information. SB493. http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB493. Accessed November 11, 2013.
DRY MOUTH The #1 Cause1,2
The Leader in Dry Mouth Symptom Management
Be part of the solution. Start the conversation today. Many patients on medications silently cope with Dry Mouth symptoms, not knowing the potential consequences.2 Early identification is important.
Recommend Biotène. The Silent Coping2
A full range of products to help meet your patients’ individual needs.
The Potential Impact *1-4 • Daily discomfort • Bad breath • Mouth infections† • Up to 3X higher cavity risk
Moisturizing Relief
Everyday Protection
If Dry Mouth is unmanaged † Biotène is not indicated for the treatment of mouth infections. 1) Porter SR. et al. Oral Medicine: An update of the etiology and management of Xerostomia. Oral Surg Oral Med Oral Pathol Jan2004;97(1):2846. 2) Dry Mouth The Malevolent Symptom: A Clinical Guide. Ed. By Sreebny LM, Vissink A, Blackwell Publishing 2010. 3) Papas AS, et al. Caries prevalence in xerostomic individuals. J Can Dent Assoc. Feb. 1993;59(2):1719. 4) Guggenheimer J, Moore PA. Etiology, recognition and treatment. JADA.2003;134:61-69.
Saliva Stimulation
*
© 2014 GlaxoSmithKline Consumer Healthcare
GSK4-005 Biotene Half Page_PharmacyToday.indd 2
216 JAPhA | 5 4 :3 | M AY /JUN 2014
ja p h a .org
#1 DENTIST & PHARMACIST RECOMMENDED BRAND FOR DRY MOUTH SYMPTOMS
14-03-19 2:27 PM
Journal of the American Pharmacists Association
Downloaded From: http://japha.org/ by a North Dakota State University User on 06/03/2014
