Pharm.D plan pits UM vs. drugstores

FIGHT OVER PHARMACY'S FUTURE

October 28, 1992|By Michael Dresser | Michael Dresser,Staff Writer

It's a civil war in which the front-line soldiers wear white lab coats.

Pharmacy, a quiet profession that faces a turbulent future, is in the midst of a national struggle that has divided its practitioners and pitted many of the nation's pharmacy schools against the chain drugstores that employ many of their graduates.

For several years, retail executives and educators have clashed at university after university over the question of how to train the pharmacists of the 21st century, who will face a world in which thousands of new drugs will be created by high-technology processes.

Now the battleground is the University of Maryland, where the fight is expected to come to a head Friday.

That's when a divided Board of Regents will meet to decide whether the university's School of Pharmacy, part of the University ofMaryland at Baltimore, will become the 15th school in the nation to replace its five-year bachelor of science program with one that awards a doctor of pharmacy degree (Pharm.D.) and requires at least six years of study.

The transition is one that the administration and faculty of the School of Pharmacy have been planning for three years and talking about for almost a decade. Confident that the program will go through, the university has already printed brochures describing the program.

If the drugstore chains have their way, those brochures won't be worth the paper they're printed on.

Concerned that the proposal would mean fewer pharmacists and skyrocketing salaries, the Maryland Association of Chain Drug Stores -- whose members include Giant Food, Safeway Stores, Revco and Rite Aid -- is waging a vigorous campaign to scuttle the plan and keep the option of earning a bachelor's degree. Leading their charge is one of Maryland's most effective lobbyists, Baltimore lawyer Franklin Goldstein.

How the issue is decided at Maryland could have ripplesthrough the entire pharmacy profession. "Maryland's the biggest battleground I'm aware of," said Richard A. Hutchinson, head of the Department of Pharmacy Practice at the University of Illinois campus in Chicago.

The confrontation between the chains and pharmacy school is being watched.

The Pharm.D. fight has gone beyond a simple policy dispute. It has become a political struggle over who should control state-sponsored professional education -- academics with a vision of improved public health or employers with an eye on marketplace realities.

The drugstore chains say that community pharmacies employ 60 percent to 70 percent of the graduates of the nation's pharmacy schools. They say that entitles them to a strong voice in major academic decisions that affect them.

Pharmacy educators bristle at that argument. "Our customers are first the students and second the patients," said David A. Knapp, dean of the School of Pharmacy. "The employer is a stakeholder, but the employer is not a customer of the School of Pharmacy."

Proponents of the all-doctorate program aren't saying that 30 years' worth of University of Maryland School of Pharmacy graduates have been poorly educated. They aren't arguing that every pharmacist who now holds a B.S. needs to get a Pharm.D. Nobody is talking about yanking a pharmacist's license if he doesn't go back to school.

But Pharm.D. advocates contend that though five years' training may be adequate for today's retail-store pharmacists, it will not be enough for the future. Universities, they say, must give their students a foundation for practicing pharmacy 30 or 40 years from now, when the baby boom generation is in its heavily medicated old age.

In part, these advocates are motivated by a vision of a profession far different from today's. They say biotechnology will bring thousands of sophisticated new drugs to the market -- each with the potential of interreacting with thousands of others. In many cases, they say, medications will be tailored very narrowly to meet the needs of small groups or even individuals.

These drug therapies will require careful monitoring after the prescription is put in the patient's hands, advocates of the six-year program say. No longer will the pharmacist be able to stay behind the counter, they contend.

"A pharmacist has got to be more than a purveyor of drug products, but someone who will take an active and assertive role in assuring quality drug therapy for the patient," Dr. Knapp said.

The chains and many small proprietors fear that the switch to an all-Pharm.D. program would aggravate what they say is a serious shortage of pharmacists. That shortage, they say, is driving wages up at a time when insurance carriers are cutting back sharply on reimbursements for prescription medicines. The employers would rather see the universities produce more pharmacists.

"Five-year programs give the pharmacists all the tools they need to practice pharmacy in today's setting," said Russ Fair, Giant's director of pharmacy services, adding that any future needs can be met through continuing education programs.

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