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Malcolm E. Brown is a pharmacist and sociologist
from Beccles, Suffolk
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Imagine a game of cricket between pharmacists and pharmacy technicians.
Whose side would you be on? The answer may help to tell us who we are
and whom we may upset. The question is pertinent since it has been suggested
that pharmacy technicians may become the “pharmacists
of the future” (PJ,
23 October, p597) and pharmacists the “new
apothecaries” (PJ,
6 November, pp684–5). Further, from January 2005, pharmacy technicians
will become registered by the Royal Pharmaceutical Society.
This article is not a polemic against pharmacy technicians. On the contrary,
I believe that pharmacy technicians have contributed much and will contribute
more to pharmacy. I also gratefully acknowledge that during accuracy
checks pharmacy technicians have saved my pharmaceutical bacon. This
article is an attempt at one sociological analysis of our present situation.
Metaphorically the water is muddy; I filter it and report on the solids
and filtrate.
A society may be divided into two groups: “us” and “them”.
We feel emotionally attached to “us”. We trust and co-operate.
We feel antipathy, suspicion, fear and pugnacity towards “them”. “Us” is
the in-group and “them” the out-group.1
Large in-groups, such as our Society, require preaching to generate and
maintain identity. Preaching requires enormous effort. For pharmacists
this has spanned several generations and generated fundamental bonds.
They include commitment, dedication and even passion; witness our recent
contortions.
Once registered, will pharmacy technicians be “us” or “them”?
An “us” group has similar socioeconomic class, status and
reference group; a “them” group does not.
First, consider socioeconomic class: how much you earn. Presently, pharmacists
earn significantly more than pharmacy technicians, although overlap in
salaries already occurs and that is probably fair. In future, pharmacists
may have left their pharmacies to undertake more highly paid practice,
leaving pharmacy technicians in those pharmacies. Pharmacy technicians,
to boost their income, may advertise that they are always present in
pharmacies, unlike pharmacists. Perhaps, that should then be a wake-up
call to pharmacists. However, it is arguable that protest would be hypocritical:
years ago, in advertisements, chemists
and druggists once capitalised upon their continuous presence compared
with the apothecaries who then dispensed most
prescriptions.
Second, consider status. Status is symbolic. It occurs, for example,
when income is conspicuously and stylishly spent. So class and status
are intertwined.
Presently pharmacists, compared with pharmacy technicians, possess higher
status. A gap exists between degree level education and NVQ3 qualifications.
However, soon, pharmacy technicians will probably be graduates. That
is the second stage in the 10-stage process to professional independence
that I previously outlined (PJ, 15 March 2003, p364).
Pharmacy technicians may also want to rename themselves. Perhaps pharmacists
should be wary if pharmacy technicians lobby to be renamed pharmacy (pharmaceutical)
technologists. Such a title would be presumptuous at NVQ3 but defendable
at NVQ5 or degree level.
Will technicians claim letters after their names, such as ARPharmS (associate/affiliate)
or even MRPharmS (after all the existing members have awarded themselves
fellowships)? Will pharmacists respond by designating themselves “Dr”;
ratcheting up the normal qualification to PharmD, as in the US, would
be one strategy to justify this. However, the meaning of the title “Dr” varies
between countries; Italians with bachelor degrees are now, legally, bestowed
with the title of “Dr”. Will the public easily confuse pharmacy
technicians’ registration certificates, prominently displayed in
pharmacies, with those of pharmacists, as they did with the imposing
certificates of early pharmaceutical chemists and medical practitioners?
Will pharmacy technicians give orders to, and evaluate the professional
practice of, pharmacists as frequently as the reciprocal? Will pharmacy
technicians be sued for negligence during accuracy checks without a pharmacist
also occupying the dock? Presently “ordinary” pharmacists,
not just the superstars, contribute to numerous committees at many levels.
Will pharmacy technicians replace those pharmacists?
Finally, let us consider the reference group, ie, the group that the
in-group compares itself with and aspires to be like. The group striving
to go up in the world endeavours to emulate the reference group’s
speech, words, dress and decisions upon when to behave boldly, irreverently
or obediently. The group on the make apes the reference group’s
valuations of what is worth paying attention to and what is beneath them.
I suggest that pharmacists’ reference group is presently medical
practitioners and pharmacy technicians’ is pharmacists. Note the
limited aspirations of pharmacists from the educational perspective;
their reference group is not, for example, architects, whose academic
course is significantly longer than that of medical practitioners.
There are two sorts of reference group. One is normative, where the reference
group may reward or punish the “lower” group. The other is
comparative, where, despite the “lower” group’s endeavours
to mirror the reference group’s behaviour, the “lower” group
is ignored. However, it follows that it cannot be rewarded or punished.
I suggest that the reference groups of pharmacists and pharmacy technicians
are both normative.
Some characteristics that differentiate “them” from “us” cannot
be so easily described but remain important. They are the awesome, minute
detail of traits, attributes and behaviours constituting a whole. It
is what ethnographers endeavour to report in a “rich, thick” description
that helps enable you to know, in your bones, whether a group is “us” or “them”.
It is not just, for example, the level of the academic certification
but also the kinds of knowledge that cannot be written down in books
that identify a group as “us” or “them”. Such
categorisation is unobtrusive but formidably firm. An illustration is
that during complex, clinical interactions with a patient, a pharmacist,
compared with a pharmacy technician, may be more likely to possess the
urbanity to know when to speak and when to stay silent. If those tests
cannot distinguish pharmacists and pharmacy technicians, “they” will
have become “us”.
Until then, in- and out-groups need each other to understand what they
are. Registration with our Society must work for both groups. Pharmacy
technicians must feel that they receive value for their fees or they
will not join. Maybe they will contribute the liveliness of a “newer” group.
Maybe pharmacists have become complacent within their comfort zone and
need their tails tweaking. Maybe pharmacy technicians will be enthusiastic
about attending branch meetings. Pharmacy technicians remain interested
in physically handling medicines. Maybe pharmacy technicians, as pharmacists’ allies,
may assist pharmacists to retain most dispensing under their ultimate
control.
The question about whose side you are on may still disturb you. If so,
this answer may assist. I am on the side of neither pharmacists nor pharmacy
technicians; I am on the side of patients.
Reference
1. Bauman Z. Thinking sociologically. Oxford:Basil Blackwell; 1990.
pp32–53. |
The
Pharmaceutical Journal