JULY ,Edition # 29, 2001

"A Doctor's Dilemma", a movie of some thirty to forty years ago, came to mind recently when I was talking to my son, a fourth year pharmacy student, about his plans for the future.
In Western Australia the fourth year of the course consists of three thirteen weeks rotations in community, hospital or other pharmacy areas and Andrew (my son) had recently finished his hospital rotation.
Up until this time he had never shown any interest in hospital pharmacy but surprised me by saying that, if he won Lotto (ie could afford it), he would not be a community pharmacist but would prefer to work in a hospital!
The Dilemma is, of course, whether to seek professional fulfilment or monetary reward. Jon Aldous, in Edition #28, wrote about this but my conversation with my son brought home to me just how much of a problem this is going to become for future pharmacy graduates.
On reflection I asked myself "Why has pharmacy allowed this situation to develop?"
In many of the other professions high achieving graduates are snapped up by top firms, who make use of their skills, and reward them commensurately. Pharmacy, on the other hand, has no such reward system associated with clinical excellence - you make your money from commercial enterprise.
Medical specialists and top lawyerS demand, and receive, payment at very high rates for their services, but highly qualified consultant pharmacists are unlikely to grow rich applying their skills.
Thus the dilemma for a young pharmacy student, become a rich entrepreneur, buying and selling businesses, or a "poor" (relatively speaking) pharmacist applying the clinical knowledge and skills garnered through years of study and hard work.
Two weeks ago I attended a workshop for DVA pharmacists concentrating on Medication Management and Consultant Pharmacy. As part of the workshop we heard from two guest speakers, the Victorian State Coroner and Registrar of the Pharmacy Board of Victoria, who spoke on medication errors and the importance of pharmacist input into quality use of medicines.
There was general agreement that pharmacists comprise the group most qualified and skilled to manage medications most effectively but the means of remunerating this role escapes all.
This does not have to be so, there must be some way of encouraging the best of our children to move the profession forward without penalising them financially.
Possibly Neil Johnston's column in Edition #28 questioning the restrictions placed on pharmacy ownership may open a solution to the dilemma.
Legal firms grow large and can offer partnerships based on ability to attract clients. Thus they can seek out and employ top graduates, at appropriate salaries, to continue the practice of law.
(Lawyers may be the source of many jokes, but a large proportion of them can laugh all the way to the bank-can you say that about pharmacists?)
Top medical students are encouraged to specialise and make a very "comfortable" living from their profession, not so pharmacy graduates who needs become "glorified shopkeepers" to earn the same sort of income.
Could not large pharmacy conglomerates offer the same avenues to a clinical consultancy career, as do legal firms to their graduate associates, or do I dream?
An English friend of mine received a scholarship from the Boots Company to study pharmacy and was encouraged to apply his skills after graduating, how about Sigma, Fauldings or other large pharmaceutical companies doing the same here in Australia.
Let us create a new clinical pharmacy career path for Australian pharmacy graduates.
In passing, it is interesting to note that, in WA, the prizes in second and third years for clinical pharmacy are offered by the Society of Hospital Pharmacists. Does this say something to you budding clinicians?
Through the DVA Workshop and AACP I have recently received information regarding DMMR which is a start to recognition of our professions' expertise but the old problem still remains. The medical practitioner is still the gate keeper and therein lies the block to medication reviews, doctors are loathe to refer patients to consultant pharmacists.
The new framework makes provision for all members of the health care team to identify patients likely to benefit from the service but the review can proceed only if the doctor will refer to the pharmacist.
Our experience in DVA, where domiciliary medication reviews have been a fact of life for time, is that these referrals are few and far between due, in part, to inter-professional distrust.
It is pleasing to see that at least two Divisions of General Practice, here in Perth, have accepted that there is a major stumbling block. Osborne and Fremantle are working to develop more collaborative approaches, one through informal breakfast meetings to discuss the issue, the other by use of a more formal process in nursing homes.
Until this wall of resistance is broken down it will be increasingly difficult for pharmacy graduates to escape the commercial realities of community pharmacy. Hospital pharmacy offers a professionally rewarding career but hospitals find it impossible to match salaries offered in the community and so attract staff.
Last year, in WA alone, numerous clinical pharmacist positions in the state hospital system remained unfilled.
As an old (in more ways than one) hospital pharmacist this distresses me, as I developed most of my clinical skills working as a member of the health care team in the wards.
This raises the question, "If doctors and pharmacists can work together professionally in the hospital setting why is there so much angst in the community?"
I will attempt to expand on this in future offerings.
Note that the views expressed in this column are my own and may not reflect those of the Department.
Ends
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