What’s the first word you think of when you think of PRNs? I think of the word “specialty.” That’s because more than half of the 24 ACCP PRNs can be mapped to medical specialties or subspecialties. During my year as ACCP president, I have learned about specialization in pharmacy and the importance of credentialing and board certification. I have participated in several meetings of the Council on Credentialing in Pharmacy (CCP), a coalition of national pharmacy organizations formed in 1999 to provide leadership, guidance, public information, and coordination for the profession of pharmacy’s credentialing programs.

The medical specialty board movement started almost 100 years ago to establish qualifications for specialists. At the time, each physician determined whether he or she was qualified to practice a given specialty. The first specialty board, established in 1917, was the American Board of Ophthalmology. Today, the approved Boards of the American Board of Medical Specialties (ABMS) certify specialists in more than 145 specialties and subspecialties. In the United States, about 80%–85% of licensed physicians are board certified. Board certification ensures patients, hospitals, and payers that these physicians have the necessary education, knowledge, experience, and skills to provide high-quality care in a specific medical specialty.

Specialization in pharmacy started with discussions in the 1970s, eventually resulting in the establishment of the Board of Pharmaceutical Specialties (now named the Board of Pharmacy Specialties [BPS]) in 1976. The first pharmacy specialty approved by BPS was nuclear pharmacy in 1978. Ten years later, pharmacotherapy and nutrition support were approved by BPS. Today, BPS recognizes eight pharmacy specialties and two “Added Qualifications” categories (cardiology and infectious diseases) within the pharmacotherapy specialty. In addition, several more specialties are being considered. The two newest specialties, critical care and pediatrics, were approved in 2013. As of July 2014, there were almost 20,000 board-certified pharmacists.

Many ACCP members may not realize the long history of ACCP involvement in support of pharmacy specialties. In 1980, only 1 year after ACCP was formed, ACCP formed a task force to explore the possibility of submitting a BPS petition to recognize clinical pharmacy as a specialty. Following the recommendation of that task force, a committee was formed in 1981 to start the work of developing a BPS petition. Under the leadership of the late Dr. John Rodman, the committee met for the first time in November 1981. After almost 5 years, the petition was submitted to BPS. In July 1987, ACCP was informed that BPS had denied recognition of clinical pharmacy as a specialty because it was “too broad and too general.” However, BPS noted that “an area of practice referred to as clinical pharmacotherapy may be such a specialized area of pharmacy practice as to justify consideration of it for specialty recognition.” The petition was modified to recognize pharmacotherapy as a specialty and was submitted in January 1988. Despite opposition from the American Pharmaceutical Association and the American Society of Hospital Pharmacists, BPS approved the ACCP petition to recognize pharmacotherapy as a specialty in October 1988. It is therefore not surprising that ACCP supports specialization in pharmacy and board certification.^1,2 Furthermore, ACCP believes that clinical pharmacists who provide direct patient care should be board certified.³

As specialization in pharmacy continues, the pharmacy profession continues to discuss and debate the role of board certification in the credentialing and privileging of pharmacists. I agree with ACCP’s position—that board certification contributes to improved patient care; is a valid assessment of a pharmacist’s level of specialized knowledge in a designated area of practice; and is an essential element of clinical privileging.² However, some disagree with ACCP’s position and believe that all licensed pharmacists are qualified to provide direct patient care. Others believe that structured postgraduate education programs (e.g., certificate programs) or experiences (e.g., traineeships) are equivalent to board certification.

Clinical pharmacists are well positioned to assume an expanded role in a reformed health care delivery system. Discussion and debate among those in the profession about specialization and credentialing in pharmacy are necessary and even healthy. But we must not forget to consider the perspective of other stakeholders—patients; physicians, nurses, and other health care team members, hospitals, and payers.

References

1. Saseen JJ, Grady SE, Hansen LB, et al. Future clinical pharmacy practitioners should be board-certified specialists. Pharmacotherapy 2006;26:1816-25.
2. American College of Clinical Pharmacy. Board certification of pharmacist specialists. Pharmacotherapy 2011;31:1146-9.
3. American College of Clinical Pharmacy. Qualifications of pharmacists who provide direct patient care: perspectives on the need for residency training and board certification. Pharmacotherapy 2013;33:888-91.