US Pharm. 2008;33(6):3.

It is amazing to me how many issues relating to retail pharmacy haven't changed all that much over the past two decades. Aside from the dramatic changes in pharmacy technology, many day-to-day concerns have remained relatively stagnant. While the profession has made some headway in solving some of those problems, I still get plenty of mail from pharmacists complaining about intolerable working conditions, pathetic reimbursements from third-party prescription programs, anemic balance sheets, and a general misunderstanding by consumers as to what pharmacists really do behind the prescription counter.

One of the things I hear repeatedly from our readers is that pharmacists are their own worst enemies and that they brought these issues on themselves. Some will say it is the cutthroat nature of the business side of the profession; others are quick to blame the lack of pharmacist unification, and they point fingers at their respective associations for allowing the profession to be controlled by "outsiders" who only care about their own bottom lines. It would take many hours of debate and far more space than this column allows to develop a clear consensus how or why the profession evolved, or didn't evolve, to where it is I won't even attempt it.

A recent Associated Press story that hinted at the way pharmacy could be practiced in the future in the United States recently caught my attention, especially if universal health care were to become a reality. The story reported on pharmacists in Britain being trained to prescribe drugs and provide "basic care" to patients without the guidance of a physician. According to the article, the impetus for having pharmacists diagnose and prescribe rose out of an effort to cut costs in a "financially overburdened health system." The British Government claims that once trained, pharmacists would be able to treat certain medical conditions, such as colds and minor stomach and skin problems, and perform routine health care screenings as well as administer vaccinations. It claims that pharmacists could save physicians approximately 57 million consultations a year. The article made no mention of pharmacists' remuneration. But I think it is fair to assume that under a universal health care system, pharmacists would get paid for their services.

Could this happen in the U.S.? Absolutely. With the U.S. health care system taking center stage on all the presidential candidates' platforms, I believe it will be sooner than you think. The bigger question is: Will you be ready?

In many areas of this country, pharmacists have already begun to get involved in collaborative practice agreements with physicians in their communities. According to the National Association of Boards of Pharmacy's 2007 Survey of Pharmacy Law, pharmacists in 38 states may, to one degree or another, "initiate, modify, and/or discontinue drug therapy pursuant to a collaborative practice agreement or protocol." I remember how overjoyed I was back in 1986 when I heard that Florida had passed legislation creating a formulary of prescription drugs from which pharmacists were allowed to dispense without a prescription, or permission, from a physician. I immediately flew down to Florida and toured the state, interviewing pharmacists. Expecting to see and hear the beginning of a new era for pharmacy, my enthusiasm quickly waned as I learned there was no widespread acceptance of the new law. In fact, many pharmacists in the Sunshine State wanted no part of it. While some had liability concerns, most just said they felt they weren't equipped to deal with pharmacist prescribing.

A lot has happened in the past 22 years since the passage of that and other prescriptive legislation in the U.S. As a whole, many retail pharmacists have changed their attitudes relative to their job descriptions. And while it may be a bit presumptuous of me, I think today's retail pharmacists are ready to take up the challenge of accepting more responsibility, which would advance our profession to a whole new level.

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