Pharmacists are health professionals who practice the art and science of pharmacy. In their traditional role, pharmacists typically take a request for medicines from a prescribing health care provider in the form of a medical prescription and dispense the medication to the patient and counsel them on the proper use and adverse effects of that medication. In this role, pharmacists ensure the safe and effective use of medications. Pharmacists also participate in disease state management, where they optimise and monitor drug therapy – often in collaboration with physicians and/or other health professionals. Pharmacists have many areas of expertise and are a critical source of medical knowledge in clinics, hospitals, and community pharmacies throughout the world.
Pharmacists are sometimes small-business owners, owning the pharmacy in which they practice. They are also very skilled and specialized individuals with specific knowledge that makes them a vital part of any healthcare team. They act as a learned intermediary between patients and other healthcare providers to ensure that proper medical therapy is chosen and implemented in the best way possible.
Pharmacists are sometimes referred to as chemists (or dispensing chemists), which sometimes causes confusion with scientists in the field of chemistry. This term is a historical one, since pharmacists originally were required to complete an undergraduate degree in Pharmaceutical Chemistry (PhC) and were known as "Pharmaceutical Chemists".
Skills and roles
Pharmacists are exceptionally trained in medicine-related fields including pharmacology, chemistry, pharmaceutical chemistry, pharmacy practice (including drug interactions, medicine monitoring, medication management), pharmaceutics, pharmacy law, physiology, anatomy, biochemistry, kinetics, nephrology, hepatology, and compounding medications. Additional curriculum covers basic diagnosis with emphasis on disease state management, therapeutics and prescribing (selecting the most appropriate medication for a given patient).
Pharmacists are often the first point-of-contact for patients with health inquiries. This means that pharmacists have large roles in the primary care of patients. These roles may include, but are not limited to:
- clinical medication management
- the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing
- Specialized monitoring of simple and complex disease states
- reviewing medication regimens
- monitoring of treatment regimens
- general health monitoring
- Compounding medicines
- general health advice
- providing specific education to patients about disease states and medications
- oversight of dispensing medicines on prescription
- provision of non-prescription medicines
- counseling and advice on optimal use of medicines
- advice and treatment of common ailments
- referral to other health professionals if necessary
- dosing drugs in renal and hepatic failure
- pharmacokinetic evaluation
- education of physicians and other healthcare providers on medications and their proper use
- prescribing medications in collaboration with other healthcare professionals
- Providing pharmaceutical information
- promoting public health by administering immunization
Qualifications and registration
The basic requirement for pharmacists to be considered for registration is an undergraduate or postgraduate Pharmacy degree from a recognized university. In most countries this involves a four-year course to attain a Bachelor of Pharmacy (BPharm) degree. However, in the United States, to become a registered pharmacist, students graduating after Jan 1, 2003, must complete a Doctor of Pharmacy degree, which requires completion of four years at an accredited college of pharmacy (most students applying for admission into a college of pharmacy already have an undergraduate degree, however, many schools admit students after completion of 2 years of undergraduate pharmacy prerequisites or directly from highschool into a six-year accelerated program). In the United States, a Bachelor of Science (BPharm) degree in Pharmacy will not be sufficient to become a licensed or registered pharmacist in any state. Any college graduate who has graduated on or prior to Jan 1, 2003, is grandfathered and can register; however, new students after Jan 1, 2003, must complete the Doctor of Pharmacy program or PharmD. Typically it takes 183 credits to graduate in the United States as a Doctor of Pharmacy in most accredited colleges of pharmacy.
To practice as a pharmacist, the person must be registered with the relevant statutory body, which governs the registration and practice of pharmacy within the territory of its jurisdiction. There is often a requirement for the pharmacy graduate to have completed a certain number of hours of experience in a pharmacy, under the supervision of a registered pharmacist. The statutory body will usually administer a written and oral examination to the prospective pharmacist prior to registration.
Australia
In Australia a pharmacist must complete an undergraduate four-year Bachelor of Pharmacy course followed by an internship and independent examinations set by resepective state registration boards. In addition, graduates are required to complete an approved graduate training course for that state, for example the Pharmacist Graduate Training Course (PGTC) offered by the Pharmaceutical Society of Australia . There is the option of a postgraduate two-year Master of Pharmacy (MPharm) course for those with undergraduate science degree background.
Pharmacists are registered by Pharmacy Boards in individual states such as the Pharmacy Board of Victoria. In Western Australia, pharmacists are registered by the Pharmaceutical Council of Western Australia. Individual states have differing requirements for pharmacy graduates for registration, but generally graduates are required to complete approximately one year of practice under the supervision of a registered pharmacist. In addition, graduates are required to complete an approved graduate training course for that state, for example the Pharmacist Graduate Training Course (PGTC) offered by the Pharmaceutical Society of Australia NSW Branch is required in New South Wales. On meeting these requirements, graduates are eligible to sit the registration examination which may involve both written and oral components.
Chile
In Chile, students must study six years to become pharmacists. The best school of pharmacy is at Universidad de Chile, in Santiago de Chile. Chilean pharmacist are very high skilled professionals, prepared not only to dispense and be able to work at clinical and communitary pharmacy, but in Pharmaceutical, Food and Cosmetic industry too at every level, including drug development (a Degree is needed here), manufacturing, management, marketing, etc., due to the very strong scientific preparation they receive, including engineering and pharmaceutical technology topics. The official title for pharmacists in Chile is Químico Farmacéutico (Chemist and Pharmacist), and their degree is Licenciado en Ciencias Químicas y farmacéuticas (Bachelor in Chemical and Pharmaceutical Sciences).
Denmark
The pharmacist (Danish: farmaceut) education in Denmark takes place at the Faculty of Pharmaceutical Sciences at the University of Copenhagen.
The Bachelor of Pharmacy (BPharm) degree (Danish: bachelor i farmaci) takes 3 years. The Master of Pharmacy (MPharm) degree (Danish: cand.pharm.) takes 2 more years — a total of 5 years. To work as a pharmacist in a Danish pharmacy a MPharm degree is requested.
After graduation as a pharmacist (MPharm), you can begin the 3 year Doctor of Pharmacy (DPharm) education programme (Danish: dr.pharm.).
Beside the pharmacists, in Denmark there's another professional group with a pharmaceutical tertiary higher education — i.e. the pharmaconomists (experts in pharmaceuticals) whose education takes place at The Danish College of Pharmacy Practice.
France
In France, a six-year PharmD (called "Diplôme d'Etat de Docteur en Pharmacie") must be completed. At the end of these 6 years, young pharmacists can choose to pass a competitive examination: If they succeed, the few students chosen can then follow a four-year post-graduate specialty (like Physician). It is a pharmaceutical residency called "Internat en Pharmacie". During this residency, pharmacists specialized in Laboratory Medicine called "Biologie médicale" or in Hospital Pharmacy.
Greece
In Greece, a five-year University course must be completed. This course is offered by the University of Athens, the University of Thessaloniki and the University of Patras. The course comprises 4 years of theory and laboratory practice and a 5th year of compulsory, full-time in-service training in a community pharmacy and the pharmaceutical department of a hospital. An additional trimester placement in a pharmaceutical industry is also an option, however it does not count towards the acquisition of the license to practice. Upon successful completion of the course, a Degree in Pharmacy is awarded.
The pharmacy graduate may pursue a career in the industry after graduation. A career in this field does not require a license to practice pharmacy. However, pharmacists wishing to open a pharmacy, work in hospitals or in the National Organization of Medicines must first successfully participate in board examinations organized by the Greek Ministry of Health, in order to obtain a License to Practice Pharmacy.
New Zealand
In New Zealand, as with other western nations, a four year BPharm must be completed, followed by an internship at a pharmacy (Community, Hospital, Industry &/or University). Pharmacists are registered with the Pharmacy Council and must meet competence standards as set by the Pharmaceutical Society Of New Zealand. The degree can be taken at University Of Otago in Dunedin and University Of Auckland in Auckland. The School of Pharmacy is divided into three main sections of research focus. These are:
Division of Pharmacy Practice: Focussed on the inter-relationship between pharmacists and the communities they serve. Division of Phamaceutical Sciences: Focussed on the molecular mechanism and biological basis of drug development. Division of Pharmacotherapy: Focussed on the application and effects of pharmaceuticals in clinical settings.
Postgraduate studies include diplomas, Masters, PhD and DPharm. which may be clinical, practice or pharmaceutical specialties.
Republic of Ireland
In the Republic of Ireland, a 4-year BPharm/BSc Pharm degree must be completed followed by one year of post-registration training. The one year of post registration training must be undertaken in a pharmacy approved by the Pharmaceutical Society of Ireland and under the supervision of a Tutor Pharmacist who has received further training for this role. Trinity College, Dublin was the only university offering the BPharm course in the Irish Republic until recently. In 2003 two new Schools of Pharmacy were opened. A Pharmacy department was created at University College, Cork on the southern coast of Ireland as well as another Pharmacy school in the Irish capital, Dublin. (Royal College of Surgeons in Ireland)
Spain
In Spain, the Degree in Pharmacy (called licenciatura en farmacia) is consisting of 5 years. Last one is divided into two semesters, first one is similar as previous years (theory and laboratory practice) but second one is a full-time in-service training in a community pharmacy or at the pharmaceutical department of a hospital. This estructure is changing by another according to European Higher Education Area's System.
After obtaining degree certificate, there is the chance of opening a pharmacy sitting an examination in order to achieve a license. There is also the chance of postgraduate programs as Masters (Industry, Consultant pharmacist, phytotherapy, etc.) and Doctorates and of carrying hospital specialty programs out (FIR or farmacéutico interno-residente, pharmacist intern-resident) by means of an examination like medical specialties (MIR). These specialties are: "Hospital pharmacist", "Clinical microbiology and parasitology", "Clinical biochemistry", "Clinical immunology", "Clinical analysis", "Radiopharmacy" and "Drug and medicines' control and analysis".
There are 15 universities with licenciatura in Pharmacy in Spain, three of them are private universities.
Thailand
In Thailand, there are currently two kinds of programs for Pharmacy studies.1) a regular 5 years program - Bachelor of Pharmacy2) a 6 years program - Pharm D.
The universities in Thailand still base their teachings on the regular 5 years program while preparing itself to be ready for the 6 years Pharm D. program. Anyone graduating with B. Pharm can take extra 2 years course to complete Pharm. D.
United Kingdom
In the United Kingdom, integration with the European Union has resulted in the BPharm and BSc courses being superseded by a four-year course for the qualification Master of Pharmacy (MPharm). In Great Britain the Royal Pharmaceutical Society of Great Britain is responsible for regulation of pharmacy affairs and in Northern Ireland it is the Pharmaceutical Society of Northern Ireland. Graduates must complete one year of practical training and pass a registration examination before they can be entered on the register of pharmacists, known as the register of pharmaceutical chemists.
Please see the List of schools of pharmacy in the United Kingdom which offer the MPharm course.
Pharmacists registered in other countries can also register in the UK. Overseas pharmacists are required to undertake the Overseas Pharmacists Assessment Programme (OSPAP), a one year intensive course focused on pharmacy practice in Great Britain. OSPAP authorisation can be given by the Royal Pharmaceutical Society of Great Britain and the course is undertaken either the University of Sunderland, Aston University or the University of Brighton. However, pharmacists that have obtained their qualifications and are registered in other countries of the European Economic Area can register with the Royal Pharmaceutical Society of Great Britain without undergoing additional or pre-registration training.
Pharmacists in the UK can now be accredited to perform a number of enhanced services. These include but are not limited to Medicine Use Reviews (MUR's) and Patient Group Directives (where certain prescription only medicines can be sold by the pharmacist for indications of hair retention, weight loss and erectile dysfunction).
The titles Pharmacist, Pharmaceutical Chemist and Pharmaceutist are legally protected in the United Kingdom[8]. They can only be used by individuals that are registered with the Royal Pharmaceutical Society of Great Britain ; any other users are guilty of a criminal offence.
United States
Traditionally in the United States, the Bachelor of Pharmacy was the first-professional degree for pharmacy practice. However, in 1990, the American Association of Colleges of Pharmacy (AACP) mandated that a Doctor of Pharmacy would be the new first-professional degree beginning with the class of 2006.
Admissions
Today, individuals seeking to become pharmacists must first complete a pre-pharmacy undergraduate program. This program consists of a minimum of 60-70 semester credit hours (90-100 quarter credit hours) of undergraduate coursework in basic and advanced sciences; however, many students find completion of a four year program (between 120-130 semester credit hours) leading to a Bachelor of Science degree in biology, chemistry, or a similar field enhances their chances of admission. In addition, a PCAT (Pharmacy College Admission Test) score is required at most colleges and schools of pharmacy. Additional requirements for entry may include essays, references, an interview or participation in other on-campus activities.
Professional Coursework
After admission, a student will typically complete a four year pharmacy program, although some schools offer accelerated three year programs. The curriculum typically begins with courses in physiology and pathophysiology, medicinal chemistry, pharmacognosy, pharmacology and toxicology. Once a student is proficient in these core pharmaceutical sciences, instruction in evidence based therapeutic application of pharmacologic agents begins. Aside from usage of agents, students are taught to recognize and assess risk factors for disease, interpret clinical data and recognize interactions of drugs and disease states.
While most schools teach the core science courses separately, some schools take a systems-based approach, teaching all of the material from physiology to therapeutics for a particular body system before moving on to another. Augmenting the pharmaceutical sciences, courses in ethics, management, pharmacy law, communications, public health and advocacy are taught throughout the professional program.
In addition to didactic work, students of pharmacy are required to have practice experience. These experiences are generally directed by the school, conducted under the supervision of a preceptor and are intended to complement work done in the classroom. The final year of most programs consists entirely of practice experience. Successful completion of the practice experience objectives may yield academic credit and satisfy state pharmacy board requirements for internship.
Upon completion of all professional curriculum and practice experiences, the student will graduate and be awarded the Doctor of Pharmacy (PharmD) degree and typically seek licensure by examination.
Licensure
Pharmacists must be licensed by the state pharmacy board of the state in which they wish to practice, with one exception: A pharmacist with an active license may practice in a federal facility regardless of the state which issued the license.
In order to obtain an initial license, or license by examination, a candidate must have graduated from an AACP accredited school or college of pharmacy, satisfy requirements for internship, write and pass the North American Pharmacist Licensure Examination (NAPLEX), in some states write and pass the Multi-state Pharmacy Jurisprudence Exam (MPJE) and sometimes an additional state exam. Upon licensure, one may then be designated "Pharmacist" or "Registered Pharmacist" ("R.Ph."), as usage of these titles are generally regulated by state governments
A pharmacist in good standing may reciprocate an active licensure by examination to another state. Typically the requirements for licensure by reciprocity are less intensive and may require as little as passing an additional law exam.
After obtaining a license, it must be periodically renewed by completing continuing education and other requirements as prescribed by the state of licensure.
Post-Graduate Work
A new pharmacy graduate may choose to complete an optional post-graduate residency (one to three years) rather than entering directly into pharmacy practice. A pharmacy residency consists of one to two years of general residency and one to two years of specialized residency. Residencies allow a graduate to further hone their clinical skills in a structured environment.
Specialities
Practice specialisation
Specialties exist within the pharmacy profession, with the place of occupation being the major differentiator. Specialities include:
- Academic pharmacist
- Clinical pharmacist (consisting of many subspecialities such as Pediatrics, Geriatrics, etc.)
- Community pharmacist
- Compounding pharmacist
- Consultant pharmacist
- Drug information pharmacist
- Home Health pharmacist
- Hospital pharmacist
- Industrial pharmacist
- Nuclear Pharmacist
- Regulatory-affairs pharmacist
- Veterinary pharmacist
Specialty practice accreditation
United States
In the United States, a pharmacist 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 five specialties:-
- Nuclear pharmacy
- Nutrition support pharmacy
- Oncology pharmacy
- Pharmacotherapy, which has two subspecialties:
(i) Cardiology
(ii) Infectious disease
- Psychiatric pharmacy
- The Commission for Certification in Geriatric Pharmacy certifies pharmacists in geriatrics specialty practice.
- The American Board of Applied Toxicology [10] certifies pharmacists and other medical professionals in applied toxicology.
Australia
In Australia, accreditation exists only for certain specialties and is provided by professional bodies for the following:
- Consultant Pharmacist (AACPA), by the Australian Association of Consultant Pharmacy (AACP)
- Certified Geriatric Pharmacist (CGP), by the Commission for Certification in Geriatric Pharmacy in conjunction with the Society of Hospital Pharmacists of Australia
France
- Biological pharmacist
- Clinical pharmacist
Consultant pharmacist
A
consultant pharmacist is a specialized pharmacist who focuses on reviewing and managing the medication regimens of patients, particularly those in institutional settings such as nursing homes.
Consultant pharmacists are medication therapy experts who take responsibility for their patients’ medication-related needs; ensure that their patients’ medications are the most appropriate, the most effective, the safest possible, and are used correctly; and identify, resolve, and prevent medication-related problems that may interfere with the goals of therapy. Consultant pharmacists manage and improve drug therapy and improve the quality of life of the senior population and other individuals residing in a variety of environments, including hospitals, nursing facilities, subacute care and assisted living facilities, psychiatric hospitals, hospice care, and home- and community-based care.
The primary association representing consultant pharmacists in the United States is the American Society of Consultant Pharmacists, though several other pharmacy associations also represent consultant pharmacists in various respects. The Australian Association of Consultant Pharmacy is the body in Australia which accredits pharmacists. This allows the pharmacist to be remunerated by the Australian government for conducting medication reviews for residents of aged care facilities and people in their homes.
Unlike retail pharmacists and hospital pharmacists, most consultant pharmacists generally own their own practice or work for one of a handful of specialized pharmacy companies, the largest of which is Omnicare. Many consultant pharmacists do not even dispense drugs, and in many ways they resemble physicians more than the traditional concept of a retail pharmacist.
Veterinary Pharmacist
Pharmacists who have a love for animals may want to consider working as a veterinary pharmacist. The Society of Veterinary Hospital Pharmacists (SVHP)[2] and the American College of Veterinary Pharmacists (ACVP)[3] provide information on special training and certification.
ACVP was established to support the efforts of independent pharmacists in developing and strengthening the services they provide for veterinarians. The group provides educational materials and programs, serves as an information resource, and provides networking opportunities for members. Veterinary pharmacists need specialized training in veterinary pharmacology and therapeutics, and they must have continuing education credits in veterinary disease states. In addition to general educational programs, ACVP offers specialty veterinary compounding courses and programs in advanced canine and feline therapeutics. Veterinary pharmacists must be proficient at compounding, which is a key service for animal patients.
In fact, many medications made for humans must be adapted for use in animals, said Kathleen M. Taylor, RPh, FACVP, a veterinary pharmacist at Animal Pharm, Scituate, Massachusetts. She once got a call from a Boston museum about a tamarin monkey who had a bad infection. The monkey was refusing to take its antibiotic, until Taylor produced a marshmallow flavored version.
Dosing for small or very large animals can also be complex, Taylor said. Another common modification involves changing a drug from an oral to a transdermal form.
"Veterinarians rely heavily on my drug knowledge and on my keeping abreast of current treatments of choice for animals," Taylor said. "Most veterinarians have had only one course in pharmacology, and they need our help and ask for it frequently."
Veterinary pharmacists especially enjoy the ability to interact with customers and their pets.
"Nothing makes me happier than when customers come in skeptical about their dog or cat taking a medicated treat, only to have them call the next day telling me how easy it is to medicate their pets!" Taylor said. "It's a very rewarding pharmacy career."
The field of Pharmacy can generally be divided into three primary disciplines:
