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Pharmacy Degree Requirements

The primary purpose of this study was to determine the immunization and other health-related policies in place at colleges and schools of pharmacy for pharmacy practice faculty members assigned to off-campus sites. Secondary objectives were to determine other types of employment requirements for pharmacy practice faculty such as degrees, certifications, licenses, and memberships in professional organizations, as well as the breakdown of full-time fully funded, full-time co-funded, part-time, and volunteer faculty. A self-administered questionnaire was mailed to the director of the department/division of pharmacy practice at the 81 accredited colleges and schools of pharmacy; duplicate packets were sent to nonrespondents. Fifty questionnaires were returned for an overall response rate of 62 percent. Only 25 percent of respondents indicated that any physical test and/or immunization is required or recommended by the college/school. The most common items required were a PPD, and measles/mumps/rubella vaccinations or titers. For full-time pharmacy practice faculty, 79 percent practice off-campus with the most common sites being hospitals, outpatient clinics, and community pharmacies. Twenty-seven of 47 respondents indicated that only a PharmD degree is required for employment. Licensure in the state in which the college/school is located and completion of a pharmacy practice residency (or equivalent experience) are the only two qualifications required by at least 70 percent of respondents. For institutions offering tenure, a smaller percentage of pharmacy practice faculty (55 percent) were on the tenure track compared with all faculty members (74 percent). Colleges and schools do not have programs in place to ensure that off-campus faculty members meet CDC requirements for health care workers. Colleges and schools should encourage residency training, board certification, and membership in professional associations.

INTRODUCTION

Recommendations for the immunization of health care workers are issued by the Centers for Disease Control and Prevention (CDC)(1). The CDC does not specifically identify pharmacists, but the assumption can be made that since the recommendations include all persons employed in health care institutions, pharmacists and pharmacy students are included. The recommendations include immunizations against hepatitis B, influenza, measles, mumps, rubella, and varicella. In addition, the CDC recommends all unvaccinated adults receive tetanus-- diphtheria toxoid (DPT or Td) followed by a Td booster every 10 years. Vaccination of health care workers against hepatitis A, tuberculosis, pneumococcal disease, pertussis, typhoid fever, and vaccinia (smallpox) are recommended only in specific situations. In addition, the CDC recommends that strategies be in place for the prevention and control of tuberculosis. This is generally interpreted as meaning that health care workers should undergo periodic PPD (purified protein derivative of tuberculosis) screening.

Today's pharmaceutical education requires that students participate in introductory as well as advanced practice experiences (i.e., clerkships)(2). These off-campus experiences take place in a variety of environments including hospitals, emergency medicine departments, community pharmacies, ambulatory clinics, home health care, managed care organizations, drug information centers, physician offices, and long-term care facilities. Commonly, colleges and schools of pharmacy utilize full-time (i.e., fully funded by the college/school or co-funded by the practice site) faculty members to precept students. Depending on their practice area, these faculty members may interact with patients who have a variety of contagious illnesses. Alternatively, the faculty might have contagious diseases, such as tuberculosis or varicella, and could infect patients. As a result, faculty members practicing in these environments should fall under the CDC guidelines for health care workers even though they may be classified as college or school of pharmacy employees.

A previous study conducted by the investigators examined the immunization and other health requirements for pharmacy students prior to and during their introductory and advanced practice experiences(3). The study revealed that the majority of colleges and schools of pharmacy had specific health requirements for students, but these requirements were not in compliance with CDC recommendations. Specifically, greater than 90 percent of colleges and schools of pharmacy require entry-level PharmD students to obtain a PPD and possess proof of immunity to or be vaccinated against measles, mumps, and rubella; 85 percent of colleges and schools require hepatitis B vaccination or proof of immunity. Fewer institutions require entry-level students to obtain other vaccinations such as varicella (58 percent) and Td (53 percent), a physical examination (40 percent), or relatively routine blood or urine tests (3 to 17 percent, depending upon the test). Compared with requirements for nontraditional PharmD students, significantly more colleges and schools require entry-level students to have an SMA 12, undergo a PPD, and provide proof of vaccination against measles, mumps, rubella, and hepatitis B; other requirements do not differ significantly by degree program(3).

One of the recommendations from the study of student health requirements(3) was to examine the health and immunization requirements for pharmacy practice faculty members at colleges and schools of pharmacy. Interestingly, although the American Council on Pharmaceutical Education (ACPE) guidelines(2) indicate that colleges and schools need to ensure that pharmacy students meet specific health requirements, including immunizations against certain communicable diseases, there is no such requirement for faculty members. A review of the literature did not uncover any published report that addressed these topics.

The primary objective of the present study was to determine the immunization and other health related policies in place at colleges and schools of pharmacy for pharmacy practice faculty members assigned to off-campus sites (e.g., hospitals, clinics, and community pharmacies). In addition, the study was designed to determine other types of requirements for pharmacy practice faculty such as degrees, certifications, licenses, and memberships in professional organizations, and the breakdown of full-time fully funded, full-time co-funded, part-time, and volunteer faculty.

METHODOLOGY

A self-administered survey instrument was developed and reviewed for completeness, case of completion, and overall suitability by persons with expertise in survey design and/or familiarity with the subject matter at four colleges and schools of pharmacy. Following revision, the questionnaire was submitted to and approved by Long Island University's institutional review board. The questionnaire solicited general information on the number of pharmacy practice faculty, their employment status (i.e., full-time, part-time, volunteer, fully funded, or co-funded), their practice sites, and various hiring requirements (e.g., degrees, certifications, licenses, and professional memberships). The survey specifically requested information regarding faculty teaching pharmacotherapeutic or clerkship courses and not faculty members from other disciplines that may be in the same department/division. In addition, the survey requested information on whether various immunizations and/or tests (e.g., complete blood count and SMA 6/7) were required or recommended by the college/school of pharmacy prior to a pharmacy practice faculty member beginning employment. The survey requested that respondents provide information on college or school requirements and not those requirements that may be imposed by individual practice sites. Respondents were permitted to write-in responses specific to their institution not covered in the survey1.

The questionnaire was mailed in March 2001 to the chair of the department or division of pharmacy practice at the 81 colleges and schools of pharmacy in the United States and Puerto Rico that were listed as accredited by ACPE. In addition to the survey, the packet included a postage-paid return envelope and a cover letter indicating that the results from individual respondents would not be shared with others and only aggregate data would be presented or published. Duplicate packets were mailed to non-respondents approximately six weeks later (May 2001); telephone calls and/or e-mail messages were sent approximately six weeks later (July 2001) to the remaining nonrespondents. Data analysis was descriptive and is presented as either numbers of respondents or converted to percentages based upon the total number of respondents to an individual survey item.

RESULTS

A total of 50 questionnaires were returned for an overall response rate of 62 percent. Respondents reported an average of 22 (range 5 to 95) full-time pharmacy practice or clinical pharmacy faculty members. For the full-time pharmacy practice faculty members 79 percent have off-campus practice sites and the remaining 21 percent are campus-based. For the full-- time faculty 78 percent are fully funded by the college/school and the remaining 22 percent are co-funded with other institutions. For colleges/schools reporting employment of part-time pharmacy practice faculty members, the average number was six (range 1 to 30).

Table I depicts the percentage of full- and part-time faculty in various practice settings. Independent of full- or part-time status the most common practice sites were hospitals, outpatient clinics, and community (chain or independent) pharmacies. A greater percentage (67 vs. 43 and 37 percent) of cofunded faculty members practice in hospitals as compared with fully funded and part-time faculty members, respectively. Respondents rarely reported having pharmacy practice faculty members practicing at community health centers, home health care companies, or pharmacy benefit managers. In addition to the practice sites detailed in Table I, respondents indicated that faculty members practice in "other" locations such as drug information centers (most frequently cited), academic administration, physicians' offices, departments of mental health, poison control centers, prisons, alternative medicine practices, and in research environments. Volunteer faculty (data not shown) were reported to practice primarily in hospitals and community pharmacies. The numbers of volunteer faculty were difficult to assess as some respondents reported ranges or percentages, while others stated that the number varies each semester/year.

Health-Related Requirements

Very few institutions reported that physical examinations, immunizations,. and/or other tests were pre-employment requirements (see Table II). In fact only 10 of the 50 respondents indicated that any of the physical tests and/or immunizations were required or recommended by the institution. Although several respondents did note that the faculty did adhere to site-specific requirements, this information was not specifically requested in the survey. Of the institutions indicating some tests were required the most common were PPD and measles, mumps, rubella vaccines or titers. Even fewer respondents indicated any immunizations or physical tests were required on an annual basis. Only a PPD was either required or recommended on an annual basis by more than one (four) college or school of pharmacy.

Degree, Training, Certification, and Membership Requirements

Of the 47 respondents answering questions regarding requirements for hiring pharmacy practice faculty members, 27 indicated a PharmD degree as the only degree requirement. Four respondents indicated a BS in Pharmacy was required, but a PharmD was preferred by all of these institutions. Seven respondents indicated a PharmD or a BS in Pharmacy was required for employment as a pharmacy practice faculty member. Five respondents indicated a PharmD or a PhD and two respondents indicated a PharmD or BS in Pharmacy and an MS degree were required for employment as pharmacy practice faculty members. Two respondents indicated that there were no requirements; one indicated that a PharmD or BS in Pharmacy or PhD was preferred while the other included a MBA or MPH.

Table III details the certification, licensure, and professional membership requirements of pharmacy practice faculty. Licensure in the state where the college/school is located and completion of a pharmacy practice residency (or equivalent experience) were the only two qualifications required by at least 70 percent of the responding institutions. With regards to licensure, several respondents noted that campus-based faculty were not required to be licensed. One respondent indicated that faculty members practicing at a Veteran's Administration (VA) facility did not need to be licensed in the state where the college/school was located; similarly several respondents indiGated that licensure in the state in which a faculty member practiced was sufficient regardless of whether the college/school was located in that state. One respondent who indicated that licensure was recommended but not required, noted that licensure was required for co-funded faculty members. Very few institutions require cardiopulmonary resuscitation (CPR), advanced cardiac life support (ACLS), or board certifications or membership in professional pharmacy organizations, although many of these certifications and/or memberships were preferred/recommended (see Table III). For example, 64 percent of respondents (32 institutions) indicated that their institutions preferred that pharmacy practice faculty members be board certified as compared with only two percent (one institution) that required board certification.

When queried about pharmacy practice faculty members practicing in a specialty area, a greater number of respondents reported that their institution required completion of a specialty residency (16 institutions, 32 percent) as compared to a fellowship (two institutions, four percent). However the percentages that preferred completion of a specialty residency or fellowship were similar, 66 (33 institutions) and 68 (34 institutions) percent respectively (Table Ill).

Tenure Track Opportunities

Thirty percent (15 out of 50) of respondents indicated that their institutions offer tenure to all faculty members, 64 percent (32 out of 50 respondents) offer tenure to select faculty members, and six percent (3 out of 50 respondents) do not offer tenure. Twenty-two percent of respondents indicated that pharmacy practice faculty members must be on the tenure track, 52 percent allow faculty members to opt for the tenure track, 10 percent do not consider pharmacy practice faculty for tenure track, and the track is dependent upon the specific position for the remaining 16 percent. For institutions offering tenure, a smaller percentage of pharmacy practice faculty members (55 percent) were on the tenure track as compared with all college/school faculty members (74 percent).

DISCUSSION

Although somewhat arguable, we believe that pharmacy practice faculty based at off-campus sites who have direct contact with patients should adhere to the CDC recommendations for health care workers. As a result, they should undergo physical examinations, be tested for immunity against various communicable diseases such as measles, mumps, and rubella, and should be screened for tuberculosis. In a recent article by Shepherd and Grabenstein (a physician and vaccinologist, respectively)(4), the authors include "pharmacy personnel" in a population with occupational risk of exposure to vaccine-preventable diseases and should, therefore, follow CDC guidelines.

In the present study, only 10 of the respondents indicated that any of the tests or immunizations were required or even recommended for pharmacy practice faculty members by the college or school. Reasons for these low figures are unclear, but it may be that colleges/schools assume that the off-campus sites are ensuring compliance with CDC recommendations. There are no data available to support or refute this assumption.

In a previous study, greater than 85 percent of colleges and schools of pharmacy indicated that they require entry-level PharmD students to obtain a PPD and possess proof of immunity to or be vaccinated against measles, mumps, rubella, and hepatitis B(3). It would seem logical that pharmacy practice faculty members should be held to the same standards that are required of pharmacy students.

Approximately 80 percent of the pharmacy practice faculty members have off-campus practice sites, which appears to support the premise that faculty are precepting students enrolled in introductory and advanced practice experiences. The vast majority of the off-campus full-time and co-funded faculty practice in hospitals, while the second largest group practice in outpatient clinics. Recognizing that the ACPE accreditation standards(2) emphasize the need for students to train in community pharmacies it is likely that within a few years a greater percentage of faculty members will practice in this arena. In addition, it is noteworthy that almost one quarter of pharmacy practice faculty positions are co-funded with other institutions. This might mean that since the faculty member is an employee of the practice site he/she is required to abide by that institution's immunization and other health requirements, thus meeting CDC guidelines. On the other hand although the large number of co-funded positions is understandable, it may place additional burdens on the faculty as they may have dual reporting responsibilities.

An ACPE guideline indicates that preceptors should meet licensing requirements of the facility in which they practice(2). Seventy-six percent of the respondents indicate that licensure in the state that the college/school is located is required and an additional 20 percent indicate that licensure is recommended/preferred. Therefore, it appears that many colleges/schools are in compliance with this guideline. Reasons for deviations from the licensure requirement provided by respondents included faculty practicing in VA hospitals or neighboring states or campus-based faculty not maintaining a practice.

It is also somewhat surprising that few institutions require or recommend/prefer that pharmacy practice faculty complete a specialty residency or fellowship, and only two percent of respondents require faculty to be board certified. In a 1997 report of the Task Force Concerning Board Certification Requirements for Pharmacy Practice Faculty, 466 of 3,577 (13 percent) of pharmacy practice faculty were certified in a pharmacy practice specialty area(5). Further, no college or school of pharmacy required board certification prior to employment. The Task Force encouraged pharmacy practice faculty members to become board certified in a specialty area. The present study only requested data on requirements prior to employment. It is encouraging that in the present study, 64 percent of colleges/schools prefer/recommend board certification.

Finally, it appears that compared with nonpharmacy practice faculty, a somewhat higher percentage of pharmacy practice faculty members may opt for a tenure track or a non-tenure track position, or are not eligible for tenure. Although this may be a means to "protect" service-intensive faculty from the typical research-intensive requirements for tenure, we do not believe this implies that pharmacy practice faculty are any less capable of attaining tenure.

CONCLUSIONS

The results of this study show that colleges and schools of pharmacy do not have programs in place to ensure that offcampus faculty members meet specific requirements for health care workers as outlined by the CDC(l). Given the health risks associated with the provision of pharmaceutical care, colleges and schools should consider implementing a program to ensure that the minimum requirements are met. In addition given the litigious nature of society, assuming that hospitals and other practice sites are ensuring that the guidelines are being met, may be a mistake. It does not appear to be appropriate for colleges and schools to hold pharmacy students to a higher standard of health care than the faculty.

Colleges and schools should strive to ensure that all pharmacy preceptors are licensed. Institutions should consider raising the standards for new faculty by encouraging (if not requiring) specialty residency training prior to beginning employment and board certification within five years of initial appointment. Colleges and schools also should encourage the faculty to join professional societies, which, in turn, may increase the ability of the associations to execute change and will provide a role model for students to join the associations as well. To accomplish this, colleges and schools may wish to pay the membership fee for the faculty to join an association. Finally, colleges and schools of pharmacy and individual pharmacists should petition the CDC to include all pharmacists (including pharmacy faculty) and pharmacy students in their list of health care workers requiring specific immunizations.

1 A copy of the survey document can be obtained by contacting the authors.

References

(1) Immunization of Health-Care Workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC), MMWR Morbidity Mortal Weekly Rep., 46(RR- 18), 1-44(1997).

(2) Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree, American Council on Pharmaceutical Education, Inc, Chicago IL (June 14, 1997).

(3) Kirschenbaum, H.L. and Kalis, M.M., "Immunization and other health requirements for students at colleges and schools of pharmacy in the United States and Puerto Rico," Am. J Pharm. Educ., 65, 35-40(2001).

(4) Shepherd, J.E. and Grabenstein, J.D., "Immunizations for high risk populations," J. Am. Pharm. Assoc., 41(6), 839-849(2001).

(5) Report of the Task Force Concerning Board Certification Requirements for Pharmacy Practice Faculty," Am. J. Pharm. Educ., 61, 213-- 216(1997).

Michelle M. Kalis

Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Avenue, Boston MA 02115-5896

Harold L. Kirschenbaum

Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, 75 Dekalb Avenue, Brooklyn NY 11201

Copyright American Association of Colleges of Pharmacy Summer 2002
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