The Pharmaceutical Journal Vol 266 No 7151 p783
June 9, 2001

Comment

“They sold me a dream of pharmacy — now I want my money back!”

By Kevin Taylor and Geoffrey Harding

Consumer culture has infiltrated the university system: education and training are now treated like commodities — with courses offered and delivered for consumption by the universities’ “customers”. For instance, the performance of universities in both teaching and research is now published in league tables in order for students, when choosing courses, to make informed choices. Consumer choice then, is at the heart of University Plc, not least because, with the introduction of tuition fees and student loans, students are paying for a service. As consumers, they are empowered to demand that service is of an appropriate quality, and openly to criticise courses and lecturers when either fall short of their expectations, even occasionally pursuing their “rights” through litigation.

Set against these developments we were struck by the poignancy of Ian Wood’s recent letter to this journal.¹ In particular, he articulately expressed his disappointment that having recently graduated he had been “looking forward to an exciting and interesting career. However, this was not the case.” This is not simply the naivety of inexperience meeting the reality of workaday life, but instead is the testament of a “consumer” who feels he has been “sold” something that has not measured up to expectations.

We found the letter at one and the same time both depressing and refreshing: depressing because it articulates what for many is a reality — contemporary practice falls short of expectations in many ways; refreshing in that as a “consumer” the correspondent is prepared to say what others in the past have dared not utter — “They sold me a dream of pharmacy bearing little resemblance to reality.”

Pharmacy graduates have always been highly trained, having extensive intellectual, scientific and clinical knowledge and a wide range of practical and social skills. If, as is frequently claimed, pharmacists’ skills and knowledge are underused in practice, recent developments to expand pharmacy education will have far-reaching ramifications, not least for employers of pharmacy graduates. Schools of pharmacy have introduced the extended MPharm degree, from which the first graduates will emerge later this year. Simplistically, it could be argued that graduates will have 33 per cent more knowledge than was previously the case. However, schools of pharmacy have seized the opportunities offered by the MPharm’s introduction to review wholesale the content and style of teaching of their degree programmes. Contemporary teaching methods have been introduced, students have increased exposure to practice during their courses (usually with “enlightened” employers) and course content has been overhauled in order to educate, train and prepare prospective pharmacists for an idealised model of modern pharmaceutical service delivery. Students are presented with a vision of what pharmacy is, can be and should be, and are equipped with the full gamut of skills necessary for current and future practice.

In the past five years or so, pharmacy undergraduate training has been radically overhauled and it is timely to question whether the practice, particularly of community pharmacy, has changed over the same period, so as to enable the new graduates’ skills to be fully used. Despite much rhetoric about “new” roles and activities, the fundamentals of daily practice remain, for the majority of pharmacists, largely unchanged. It is becoming increasingly apparent that sustainable change of the culture and practice within pharmacy is difficult to instigate, being constrained by the remuneration system, the domination of pharmacy by the multiples, pharmacists’ long working hours, and the fact that pharmacy remains politically neutered. Although individual pharmacists may engage with local initiatives, the “New Pharmacy” with its new professional roles is nebulous and ill-defined, and its delivery is beyond the controlling influence of pharmacists’ professional and representative bodies. Instead, pharmacy remains as ever largely defined and controlled by the expediencies of government and corporate business. The danger is that the mismatch between the expectations and the reality of pharmacy for the new graduates is compounded, storing up problems for the future.

Mr Wood’s dissatisfaction with the experience of working in pharmacy is not unique. We noted that in a recent survey of hospital pharmacists, job satisfaction was lowest for those in junior grades² and similar sentiments are frequently expressed to pharmacy lecturers by former students. Further, pharmacy students who undertake vacational employment in busy pharmacies, where pharmacists’ activities comprise almost exclusively those associated with the technical aspects of dispensing, often become highly cynical on returning to university when teaching staff discuss and advocate the wide range of activities pharmacists are able to undertake.

Given the disappointment, dissatisfaction and disillusionment with pharmacy evident in Mr Wood’s letter, we are pleased it has generated a debate in The Journal. When the experience of pharmacy for one recent graduate is common to many, there is some serious soul searching to be done, not just by individuals, but also by pharmacy academics, pharmacy’s regulatory body and employers about their collective responsibilities to the future workforce. Graduates embarking on a career in pharmacy this summer will be the first to have passed through the new extended degree programme. We should not be surprised if some of these students enter pharmacy harbouring a latent resentment at the loss of a year’s income resulting from their additional year of study. They leave university with high expectation and debt which may find expression in a heightened desire to capitalise on their new and expensively acquired skills. These graduates have trained in an environment where they are increasingly seen, and see themselves, as consumers with associated legitimate rights. Just as these students will undoubtedly need to adapt to meet the challenges of pharmacy “in the real world”, so too the profession, employers and their pharmacist colleagues will be expected to meet their aspirations both as professionals and consumers who have “bought” into pharmacy.

References

1. Wood DN. The profession: Practice is neither interesting not exciting [letter]. Pharm J 2001;266:654.
2. Rajah T, Bates I, Davies JG, Webb GD, Fleming G. An occupational survey of hospital pharmacists in the south of England. Pharm J 2001; 266:723–6.