By Sonal Shah, PharmD, senior manager, Deloitte Center for Health Solutions, Deloitte Services, LP
This week’s blog, by Sonal Shah, a senior manager in US Center for Health Solutions appeared first as a Health Forward Blog. It explores how the changing role and scope of pharmacy has been instrumental in the US community response to COVID-19 and will continue to evolve further. While clearly focused on the US market this insightful analysis resonates with the UK’s Royal Pharmaceutical Society’s key principles for transformation seen across the pharmacy workforce following the COVID-19 pandemic. It also builds on the People Plan for the future pharmacy workforce.1 It also reflects some of our findings in the ‘The Future of Public Health’ report series, for a more preventative approach to care. By sharing the blog, we hope that it provides a sense check on the UK’s plan for making more effective use of the extensive skills of our pharmacists.
The pharmacist of the future
A few months ago, I provided the keynote speech at the Industry Pharmacists’ Organization’s (IPhO) annual conference. IPhO is a professional organization dedicated to supporting industry pharmacists, fellows, and students in advancing their career objectives. This type of organization didn't exist when I was a pharmacy student. I wish it had.
All pharmacy students who are graduating today are Doctors of Pharmacy (PharmD), which means they receive as much classroom clinical instruction as medical doctors. Most people think of pharmacists as the people in white lab coats who stand behind a counter at the local pharmacy and fill prescriptions. But that is an exceptionally narrow view the profession. There are essentially three broadly recognized career paths for pharmacy students: community, hospital (which can include managed care), and industry. I pursued the ‘industry’ path and did my post-doctoral fellowship at a large pharmaceutical company. This was a popular choice for pharmacy students, particularly in my home state of New Jersey, which has been referred to as ‘the medicine cabinet of the US’ because it is home to so many pharmaceutical companies. As a student, I was always interested in marrying the science of pharmacotherapy with the business of innovation. Industry was a natural path for me. An organization like IPhO could have provided me with more visibility into a wide range of professional opportunities.
Things have changed a bit since I graduated pharmacy school. Most recently, COVID-19 has provided an opportunity for community pharmacists to step up by helping to diagnose patients and deliver vaccines. This begs the question: What other new opportunities might emerge for today’s pharmacy students? How can health care stakeholders help ensure that pharmacist’s practice at the top of their license? The Deloitte Center for Health Solutions (USA) recently conducted interviews with 36 stakeholders from various parts of the pharmacy landscape (i.e., community pharmacies, health systems, health plans, academia, and trade groups) to help define the pharmacist of the future.
A key theme at the IPhO conference was the growing demand for industry pharmacists. This need is being driven—at least in part—by the number of increasingly complex therapies being developed by biopharmaceutical companies. Deloitte research on measuring the return on pharmaceutical innovation reveals that the top 15 biopharma companies are increasingly focused on oncology, immunology, and rare diseases. This focus has boosted the demand for pharmacists as post-doctoral fellows. According to a recent IPhO study, 83 companies train PharmDs through Post-Doctoral Industry Fellowship Programs. Last year, the number of pharmacists in these roles rose to a new high of 628 fellows.2 The majority of these fellows were staffed in roles supporting complex therapeutic areas such as oncology and immunology.
Emerging opportunities for pharmacists in industry include a range of roles in medical affairs, regulatory affairs, clinical research/development, commercial, and health outcomes. A student who has received pharmacy training would likely be able to come up to speed quickly on novel therapeutics and offer a different perspective to a pharmaceutical company. For example, pharmacists understand the patient journey from both the health care provider’s (HCP) perspective and patient’s perspective. They might be able to offer insights to help optimize clinical-trial design, drug formulation and administration, product positioning, provider and consumer-marketing tactics, and channel strategy. Further, the clinical knowledge and the understanding of pharmacology can create richer peer-to-peer interactions between industry and HCPs throughout the lifecycle of a product.
Students who want to work with physicians in clinical settings typically pursue residencies, just like physicians. Ideally, these students work in a hospital setting where they collaborate with physicians on treatments. According to our research, the practice of medicine and the practice of pharmacy could occupy distinct places along the patient journey in the future. A physician might make the diagnosis, and the pharmacist could take it from there. Knowing the patient’s diagnosis and other clinical circumstances, the pharmacist of the future would have the training needed to recommend optimal therapy and monitoring. Pharmacists are typically well equipped to do this after four years of education dedicated to pharmacotherapy (as opposed to physicians who typically study this for just one or two semesters).
Just like physicians who want to become specialists, pharmacy school graduates who want to specialize can pursue additional training as residents in ICU medicine, oncology, transplant, or infectious diseases, for example. As the technology behind treatments become more complex (and as the use of multiple concurrent therapies becomes the norm) it could become increasingly difficult for physicians to practice without a pharmacist by their side. This complexity could drive even further specialization in clinical pharmacy.
Community pharmacy is more likely to call for generalists, although there are opportunities for specialization here as well, particularly around chronic diseases. As my colleague George Van Antwerp noted in his March 21 blog, the traditional community pharmacy model is ripe for disruption. Our research suggests that community pharmacists of the future will be able to supplement or extend the services of primary care providers in several areas:
- in chronic condition management, pharmacists could focus on conditions that are medication-heavy or involve multiple medications. For instance, in some diabetes-management programs (upon diagnosis and referral from a physician) a pharmacist acts as the main care provider, with full autonomy around diabetes-related prescribing and testing.
- when it comes to prevention and wellness, community pharmacists can conduct annual wellness visits, routine screenings, patient education, and can support medication adherence.
- community pharmacists can diagnose and prescribe treatments for flu, bladder infections, rashes, and other minor acute illnesses.
- pharmacists can work closely with psychiatrists to optimize medication therapy for behavioural health conditions, administer depression screening questionnaires, or manage polypharmacy.
- a pharmacist’s expertise can be valuable to help elderly patients age in place. These patients might be on multiple drugs and their ability to metabolize them changes with age, which can increase the chances of drug-related adverse events.
Based on our research, pharmacists of the future could be in high demand—particularly in the pharmaceutical sector, in clinical settings, and even in digital health and analytics. Ideally, new opportunities could also unfold in the community setting if pharmacists are able to take on more clinical duties. However, the transition for community pharmacists to become patient-focused vs product-focused will likely depend on retailers’ willingness to embrace the full potential of the talent they already have in their stores.
2 Analysis of 2020-2021 PharmD Industry Fellowships, Industry Pharmacists’ Organization