I recently returned from the American Society of Health-System Pharmacists (ASHP) Pharmacy Residency Capacity Stakeholders Conference, having represented ACCP together with John Murphy, Stuart Haines, Curtis Haas, and Michael Maddux. The context underlying this conference was the growing gap between the number of available residency positions and the number of residency applicants. Data presented by Peter Vlasses, Executive Director of the Accreditation Council for Pharmacy Education, indicated that in 2013, more than 13,000 new pharmacy graduates will be exiting U.S. pharmacy schools. Currently, there are 1262 accredited residency positions available to the 25% to 30% of graduates who will seek residencies this year. The gap is obvious. And compounding this gap is the growth in demand for residency training among new graduates. Janet Teeters, Director of ASHP’s Accreditation Services Division, presented data from the Residency Matching Service showing that, whereas demand for residency training is currently growing at a rate of about 14%, the number of positions has only grown by 7%. So we not only have a gap, we also have a gap that is getting bigger over time.

You might ask why this is of importance to ACCP. Isn’t residency training the primary concern of ASHP? Regarding accreditation, administration, and program director development, this is certainly true. But many of the initiatives outlined in ACCP’s strategic plan are predicated on the continued growth of a clinical workforce that has completed postgraduate training and board certification. ACCP has gone on record to suggest that all pharmacists who provide direct patient care and manage complex medication regimens in the future (i.e., by 2020) will have completed residency training.¹ ASHP has included a similar view in its vision statement for the future of pharmacy practice.² Our two organizations currently stand alone on this position among national professional pharmacy associations. Although postgraduate training makes sense when considering the roles we believe clinical pharmacists will play in the evolving health care system, only time will tell if we are right. But one thing is certain: we’ll never be able to realize this vision if we don’t start doing something about “the gap.”

Before I talk about the recommendations that emerged from this conference, I’d like to speak to an issue that seems to emerge during most discussions about requiring postgraduate training and board certification for direct patient care practice. These topics make many people uneasy because, to this point, there has been no standard approach to credentialing pharmacists to practice in most settings other than licensure and, in some cases, residency training. Many of us have taken different paths to get to the places we are today, and these paths may not have included formal residency training or board certification. We have established our bona fides in different ways. So it is important to realize that when ACCP and ASHP articulate a position that says residency will be required in the future, they aren’t necessarily addressing today’s practitioners. Rather, this vision focuses on the most efficient and meaningful way to approach the training and credentialing of the clinical pharmacists of tomorrow.

Many excellent recommendations were developed during this stakeholders’ conference, and a complete summary will be made available soon by ASHP. But here are three take-home messages I’m thinking about right now.

• Funding for residencies must be addressed. Depending on government funding through CMS, as we often do today, will probably not be adequate for the future. This leads me to what I saw as one of the most important recommendations. We need innovators to develop new ways to finance residency training.
• We need to reconsider our current residency training models and embrace new models that view the resident as an independent practitioner-learner. In this model, residents interact with “attending pharmacists” who are responsible for mentoring several residents at the same time. This is not to say that experienced practitioners cede all of their patient care responsibilities to trainees. However, increasingly autonomous residents should be able to expand clinical pharmacy services while seasoned clinicians remain primarily responsible for overseeing and teaching the residents. Obviously, this concept emulates the current training models that have been used successfully in medicine.
• We need to consider models that will allow the centralized administration of a residency program that involves many institutions so that small to medium hospitals—several of which seem to have the capacity to add new residency positions—can have increased involvement in residency training. This is currently an untapped resource. However, these institutions will need assistance to administer the programs and manage many of the processes needed to ensure accreditation.

What can ACCP do to help increase residency capacity? We have had and continue to have committees and task forces working on issues related to residency training. I’d like to suggest two concrete things we can do right now.

1. ACCP can foster growth in residency capacity by providing its members with the tools it takes to justify and develop new positions. ACCP member Heath Jennings, from the University of Chicago, became something of a star at the conference after his presentation showing how his institution rapidly expanded its residency programs based on a new service model and budgetary justification. I’m suggesting that our membership has expertise in this area, and we need to tap into it so that others can have the tools they need to create new positions. I would like to see educational programming developed in this area.
2. Other ACCP members (including Curt Haas) are developing new residency models that look like the “practitioner-learner” model recommended at the conference. We need to make sure that the experiences of these programs are presented at ACCP meetings so we can all learn from them. I’m suggesting that ACCP have a forum for this topic at a future meeting.

Many additional recommendations from the conference will be discussed by the profession in the near future. All the stakeholders will have roles to play. I’ll be sharing my perspectives with the Board of Regents at our upcoming spring and summer board meetings. ACCP is an important player in this process, and we’ll need member involvement to drive meaningful increases in residency capacity during the next few years. I’m looking forward to working with you on this important issue, and I welcome any suggestions you might have.

References

1. Murphy J, Nappi J, Bosso J, et al. American College of Clinical Pharmacy’s vision for the future: residency training as a prerequisite to direct patient care practice. Pharmacotherapy 2006;26:722–33.
2. American Society of Health-System Pharmacists. ASHP long-range vision for the pharmacy work force in hospitals and health systems. Am J Health Syst Pharm 2007;64:1320–30.