America's population is aging, the number of new medications--and drug prescriptions--is growing rapidly, and the cost of seeing a doctor is increasing, especially for the uninsured. It's no surprise, then, that more and more patients are turning to their local pharmacist for counseling and advice. "For most of the last century, things started shifting to more commercially available products," says Robin Corelli, an associate professor at the School of Pharmacy of the University of California, San Francisco (UCSF). But "today we are moving back toward having more emphasis on the provision of care."

That, says Corelli, is good news for pharmacists because it makes their work more rewarding. "We're back to the roots of community pharmacy, where in the old days we were more the frontline caregivers."

Learning the trade

Although the core goal of a Pharm.D. program is to teach students the pharmacology of the drugs and which drugs are used for what conditions, Pharm.D. programs put a lot of emphasis on teaching undergraduates how to deal with patients, Corelli says. Roughly half of the 4-year Pharm.D. program focuses on the clinical aspects of the job, and communication skills are a major part of that. Students have on average one full year of multiweek internships at local pharmacies, where they apprentice with working pharmacists. It's a chance for them to put into practice what they have learned about how to deal with patients and drugs. "Students learn how to translate very complex medical jargon into what a patient can understand and actually integrate within their lifestyle. Patient counseling is the centerpiece of their education," Corelli says.

The focus on communication--and empathy for patients--starts early in the Pharm.D. curriculum. During the first year of pharmacy school, students start learning how to counsel patients on managing illnesses (i.e., chronic respiratory conditions) and how to use medical devices (such as inhalers). "Students practice on themselves how to use these devices and see what a patient actually has to go through," Corelli explains. "Throughout their studies, they learn how to translate and impart the necessary information so when they are in a working pharmacy situation, they not only know how to fill a prescription but can also counsel the patient on how to properly use medical devices."

Many pharmacists jump straight from Pharm.D. training to a pharmacy job, but when Heather Free finished her degree at The Ohio State University in 2003, she chose to do a 1-year residency. A residency at a University of Maryland-run community-care pharmacy, she says, sharpened her patient-care skills. "My residency has allowed me to know how to multitask, prioritize, and also manage my drug-dispensing component of my job so I can be more of a community [pharmacist] and give those kinds of services to my patients," she says.


Heather Free with a pharmacy patient

Jobs in the community

Today, Free is a pharmacy manager at a Target store pharmacy in Hyattsville, Maryland. Working at a large retail chain does involve counting pills, but she says her main job is dealing with patients. "I put emphasis on a lot of counseling, following through with medications, educating the patient on things like learning how to use a diabetes meter, for instance." Returning customers are good for business, but for her, it's more a question of personal values. "My passion is helping patients, and their care comes first in my job," she says. "For me, it's all about attaining loyalty and trust."

That kind of trust is especially important in dealing with patients suffering from chronic diseases, and a passion for this kind of work draws a few pharmacists out of the pharmacy and into community clinics. Michelle Sherman, an assistant clinical professor of pharmacy at the UCSF School of Pharmacy, runs a consultancy that works with HIV clinics in Laguna Beach, California, training staff how to manage drug therapies and teaching patients how to take the medications appropriately. "Drug management is especially critical with HIV disease. The person walks away with a bag full of drugs that cost thousands of dollars, and the ramifications of not taking the drugs properly are disastrous," says Sherman. "It's like walking away with a loaded gun and figuring out how you put on the safety."

Although it may take a few extra years of focused residencies and on-the-job training to get into a specialty pharmacy niche like this--Sherman has been at it for 20 years--it can be very rewarding. What excites her is the rapid pace of change in her field: "New discoveries are coming out every day, and it's all cutting edge and new."

But her career path isn't common. "In the area where I work, nobody has really done what I've done," Sherman says of her consulting practice. "I have drawn my own map to do it, and now I'm charting my own course to where I'm going."

Charting your own course

In scientific circles, starting a business usually means commercializing some exciting new research idea. But in pharmacy, entrepreneurship often has a very different character.

After Ken Thai graduated from the University of Southern California (USC) in 2003, he did a residency at an in-store pharmacy with the Ralph's grocery chain so that he could sharpen his caregiving skills, learn how to run a pharmacy, and hone his business skills. "It was a really good experience for me in terms of seeing how pharmacy can go beyond just giving out medicine," Thai says.


Ken Thai instructs a patient on the use of a blood pressure monitor.

During his residency, he was able to work with a professor--Michael Rudolph, executive director of community pharmacy practice at the USC School of Pharmacy--who runs a network of eight community pharmacies. To train Pharm.D. students who want to go independent, Rudolph has developed courses that address the business and entrepreneurial aspects of pharmacy practice. Students learn how to read balance sheets, write business plans, and understand cash flow.

Thai's approach to getting out into the community was to emulate his mentor: He now owns his own pharmacy. Rudolph estimates that 30% or more of his students are interested in starting their own businesses--but, he notes, most will join retail chain pharmacies instead "because of the sheer number of jobs available and the supply and demand for pharmacists today."

Despite the increased interest in entrepreneurship, the number of independent pharmacies is declining. About a third of the nation's community pharmacies were independently owned in 2005, compared with about 44% in 1995, according to the National Association of Chain Drug Stores.

"You can have pharmacies that have coffee shops or sell durable medical equipment or just whatever works in your particular area," Rudolph says. "See what the need is and try to become that niche player. A small independent business can still be successful even when there's behemoth big-bucks retail in the same community." But whatever services are added, the key to a successful pharmacy, Rudolph says, is to provide sound patient services. "As the aging population seeking health care grows, so does the need for community pharmacists who can offer counseling and care," says Rudolph. "Pharmacy is definitely becoming a communication profession."

More than a year after opening his own pharmacy, Thai finds that he spends most of his time counseling patients and mentoring students doing internships how to do the same. He has seen his client numbers and his staff size increase steadily, and he credits this success to his desire to interact with people. "Pharmacists are the main people that deal with patients, so it's really difficult to go through all that schooling and acquire all that knowledge and not be able to communicate and share it," Thai says. "I think we've come a long way from the old days when we were just a guy in a lab coat in the back giving out drugs."

Andrew Fazekas is a correspondent at Science Careers and may be reached at afazekas@aaas.org.

Comments, suggestions? Please send your feedback to our editor.

Photos, top to bottom: Rodrigo Senna, courtesy Heather Free, courtesy Ken Thai

DOI: 10.1126/science.caredit.a0700087

Andrew Fazekas is a correspondent at Next Wave and may be reached at afazekas@aaas.org.

 

10.1126/science.caredit.a0700087