The paradox of pharmacy: A profession's house divided

To describe the paradox in pharmacy between the vision of patient care and the reality of community pharmacy practice and to explore how integrated reimbursement for the retail prescription and linking cognitive patient care services directly to prescription processing could benefit the profession.

A dichotomy exists between what many pharmacists do and what they've been trained to do. Pharmacy leaders have formulated a vision for pharmacists to become more involved in direct patient care. All graduates now receive PharmD-level training, and some leaders call for requirements of postgraduate residency training and board certification for pharmacists who provide patient care. How such requirements would relate to community pharmacy practice is unclear. The retail prescription remains the primary link between the pharmacist and the health care consumer. Cognitive services, such as medication therapy management (MTM), need to be integrated into the standard workflow of community pharmacies so as to become a natural extension of the professional services rendered in the process of filling a prescription. Current prescription fees are not sufficient to support legitimate professional services. A proposed integrated pricing system for retail prescriptions includes a $15 professional fee that is scaled upward for value-added services, such as MTM.

Pharmacy includes a diversity of practice that has historically been a source of division. For pharmacists to reach their potential as patient care providers, the various factions within the profession must forge a unified vision of the future that addresses all realms of practice.