Several recent positive developments related to Board of Pharmacy Specialties (BPS)-recognized board certification hold significant promise. But before getting into the details, it is important to provide some historical context....

ACCP has long been an advocate, sponsor, and staunch supporter of specialty board certification of clinical pharmacists and has acknowledged and maintained that BPS is and should be the profession’s designated body overseeing the recognition of pharmacy specialists.^1-5 ACCP has also invested considerable resources to develop and provide high-quality certification and recertification materials and programs across several BPS-recognized specialties. In fact, the first strategic direction of the ACCP strategic plan states: “Increase practitioner access to specialist certification, recertification, and other means of ensuring maintenance of competence.” The objectives within this strategic direction pertain to an expanded recognition of specialties, with the intent of best meeting the certification needs of clinical pharmacists who provide direct patient care in multiple practice environments and specialties.⁶

ACCP has backed up this commitment with action. The College has been a co-petitioner or co-requestor on each recently considered new specialty, including ambulatory care, pediatrics, critical care, cardiology, and infectious diseases. We have also submitted preliminary requests for additional specialties in collaboration with partner organizations.

Certainly, ACCP is “all in” on the importance and relevance of board certification. The organization has published position statements, commentaries, and white papers expressing its belief that clinical pharmacists who provide direct patient care should be board certified in their specialty or board-eligible if specialty recognition is not yet available in their particular practice focus.^1-5 This was most recently reiterated and clarified by the ACCP Board of Regents commentary published this spring (please see my March 2013 column for more details).⁵

Although we celebrate the continued growth in the number of specialties recognized, it is important to remember that ACCP has expressed significant concerns about the current specialty framework for pharmacy that was first developed almost 40 years ago. Some of these concerns include the lack of alignment with contemporary specialty training (PGY2) and the practice of clinical pharmacy; inefficient and cost-ineffective processes for developing new specialties; and, until now, an overall lack of strategic thinking and professional dialogue about how the framework should be modified to best meet the needs of patients, professional colleagues, and clinical pharmacists.² For the past decade, ACCP has expressed its concerns to BPS regarding the specialty framework and has been joined in this discussion by other organizations. In 2009, ACCP published a white paper proposing a revision of the specialty framework that would employ a broad-based core or primary certification, followed by subspecialty certification in several relevant clinical pharmacy subspecialties.² The recommendations included in this white paper had previously been shared with BPS and other stakeholders, as early as 2007. Although BPS did commission an external study of the specialty framework during this time, BPS affirmed its intent not to revise this framework in 2010. This prompted an open letter from then-ACCP President James Tisdale, who expressed frustration with the lack of progress toward establishing a coherent, contemporary specialty framework, openly challenging BPS to reconsider its decision about revision. Tisdale’s letter called for BPS to conduct a meaningful discussion with stakeholders about this issue.⁷

Why did ACCP continue to actively co-petition BPS for the recognition of new specialties when we were in disagreement with the current framework? Many of our members asked the same question on several occasions. There are several valid answers. (1) Despite a lack of agreement on the framework, the continued growth of specialty recognition was in the best interest of clinical pharmacists who were avidly seeking new certification options. (2) ACCP needed to remain engaged in the process to ensure that the petitions and specialty recognition standards would continue to meet the rigor and quality that ACCP members, other health professionals, and the public should expect. (3) The continued growth of recognized specialties (with relatively few board-eligible candidates) would further highlight and emphasize the need to rethink the overall structure of specialty recognition. Staying involved in the process and continuing to work with our colleagues at BPS would be much more productive and likely to address our concerns in the long run than would disengaging and pursuing specialty recognition outside BPS.

Fast-forward to two important announcements recently released by BPS. First, in January 2013, the BPS Board of Directors published a white paper that articulated its 5-year strategic plan. In this document, BPS discusses the plan “to create a scalable foundation on which to build future board certification activities for pharmacists.” The vision expressed in the plan contains four points:

• The number of Board Certified Pharmacists will significantly increase to facilitate progress towards a future model where board certification will be the expectation for pharmacists engaged in direct patient care.
• BPS will recognize new pharmacy specialties and/or subspecialties in areas that are consistent with, but not limited to, the growth of accredited postgraduate year 2 (PGY2) residency programs. In addition, BPS will evaluate the current specialty recognition structure and process and consider potential modifications.
• BPS will routinely gather and publish statistics on the number of Board Certified Pharmacists and will facilitate research related to the value of BPS board certification. Board Certified Pharmacists will be recognized, valued and compensated within healthcare delivery systems worldwide for their contributions to direct patient care.
• BPS will continually assess its model for recertification based on the principles of continuing professional development that ensure current knowledge consistent with the scope of the specialty.⁸

This white paper from the BPS Board is important for many reasons. First, it recognizes the importance of aligning the board certification of specialists with formal specialty training (PGY2). Second, it uses the terms specialty and subspecialty when referring to the specialty recognition process, consistent with the two-tiered framework proposed in the 2009 ACCP white paper. Finally, it acknowledges the need to evaluate the current specialty recognition structure and consider modifications. In the text of the document, BPS discusses the need for a streamlined specialty review process and consideration of the need to evolve to a process that includes a series of broad-based “primary certifications,” with the development of pharmacy subspecialties within these primary areas. The paper discusses parallels with the American Board of Medical Specialties’ structure to create efficiencies for smaller but important areas of practice. This strategic plan is well aligned with ACCP’s viewpoint and is very encouraging to anyone seeking a more coherent, efficient, and well-aligned specialty recognition framework for pharmacy.

The second important BPS announcement was made in an April 24, 2013, memo from BPS Board Chair and Executive Director William Ellis to the chief staff officers of several stakeholder organizations. The memo detailed BPS’s intent to embark on a 12-month process of evaluation to develop a scalable foundational model for the future specialty certification of pharmacists. The two stated goals of this evaluation are to (1) consider revisions in the overall petition submission process and (2) explore a potential subspecialty recognition model. BPS has expressed its commitment to maintaining the high standards of rigor and quality that characterize the current board certification process while considering ways to accommodate and encourage the growth of pharmacy specialty recognition.⁹ Unfortunately, this announcement also means a delay in the analysis of recently conducted role delineation studies addressing potential new specialties in cardiology and infectious diseases. Therefore, any decision relative to a call for petitions must await completion of this broader evaluation. Although unfortunate for clinical pharmacists who practice in these specialty areas, this is understandably a necessary decision, given the impact of the outcome of this evaluation on the consideration of additional new specialties and subspecialties in the future.

I applaud these recent steps by the current BPS leadership. In fact, many important decisions and analyses will arise regarding the specialty framework, the fate of currently recognized specialties and board-certified pharmacists, and the sustainability of any new model that is proposed. However, I believe these are clear indicators that BPS is moving in a positive direction to increase the relevance and professional alignment of specialty recognition. It will also be important that all stakeholders have input into this process and an opportunity to comment on and respond to whatever proposals come forth. It will not be easy to restructure the specialty recognition process—but truly worthwhile endeavors are rarely easy!

1. Saseen JJ, Grady SE, Hansen LB, et al. Future clinical pharmacy practitioners should be board-certified specialists. Pharmacotherapy 2006;26:1816-25. Available at http://www.accp.com/docs/positions/whitePapers/wp_phco200612.pdf. Accessed May 13, 2010.
2. Blair MM, Freitag RT, Keller DL, et al. Proposed revision to the existing specialty and specialist certification framework for pharmacy practitioners. Pharmacotherapy 2009;29:3e-13e. Available at http://www.accp.com/docs/positions/whitePapers/Pharm2902_ACCP-Blair-Specialists.pdf. Accessed May 10, 2013.
3. American College of Clinical Pharmacy. Board certification of pharmacist specialists. Pharmacotherapy 2011;31:1146-9. Available at http://www.accp.com/docs/positions/positionStatements/BoardCertiPosStatmnt.pdf. Accessed May 10, 2013.
4. Shord SS, Schwinghammer TL, Badowski M, et al. Desired professional development pathways for clinical pharmacists. Pharmacotherapy 2013;33:e34-e42. Available at http://www.accp.com/docs/positions/guidelines/phar1251.pdf. Accessed May 10, 2013.
5. American College of Clinical Pharmacy. Board of Regents commentary. Qualifications of pharmacists who provide direct patient care: perspectives on the need for residency training and board certification. Pharmacotherapy 2013. In press. Available at http://www.accp.com/docs/positions/commentaries/ACCP_Brd_Commntry_Qualifications.pdf. Accessed May 10, 2013.
6. The Strategic Plan of the American College of Clinical Pharmacy. November 12, 2010. Available at http://www.accp.com/docs/about/ACCP_Strategic_Plan.pdf. Accessed May 10, 2013.
7. Tisdale JE. An Open Letter to ACCP Members: ACCP’s Board Certification Quandary. May 24, 2010. Available at http://www.accp.com/docs/misc/BoardCertificationQuandary.pdf. Accessed May 10, 2013.
8. Board of Pharmacy Specialties Board of Directors. Five‐Year Vision for Pharmacy Specialties. January 12, 2013. Available at http://www.bpsweb.org/pdfs/BPS_Whitepaper_Jan2013.pdf. Accessed May 10, 2013.
9. Saseen J, Ellis W. Memorandum to ACCP, ASHP, APhA, ASPEN, CPNP, HOPA, PPAG dated April 24, 2013. Available at http://www.accp.com/docs/careers/BPS_Strategic_Planning_Memo.pdf. Accessed May 13, 2013.