In penning last month’s open letter to ACCP members (ACCP’s Board Certification Quandary), President Jim Tisdale didn’t know what to expect in member response. “I received many thoughtful and thought-provoking e-mails. This is clearly an issue of importance to ACCP members.” Among the messages Dr. Tisdale received were several from current and past leaders in clinical pharmacy.

Robert M. Elenbaas, Pharm.D., FCCP, ACCP Executive Director Emeritus, provided additional historical perspective to supplement the open letter:

Consideration of a new framework for pharmacy specialties is long past due. The College should be encouraged to keep this important issue among its highest priorities. In the early 1980s, I was honored to serve as co-chair of the Committee on Clinical Pharmacy as a Specialty. Our original charge was to seek recognition of Clinical Pharmacy as a specialty by the Board of Pharmaceutical Specialties (BPS). Although supported by many at the time, the concept of Clinical Pharmacy as a specialty also encountered resistance. In part, this resistance arose because people had difficulty envisioning how a Clinical Pharmacy specialty would relate to other potential clinically-based specialties in the future. Even then, in the early days of the BPS, the framework that had been conceived for pharmacy specialties was being stressed. To make a long story short, what eventually resulted was the recognition of Pharmacotherapy as a specialty. Although this relieved some of the concerns regarding “Clinical Pharmacy,” it only delayed the need to consider our specialty framework.

The first Pharmacotherapy certification exam was given in 1991. It did not take long before the concept of subspecialties began to emerge. The Society of Infectious Diseases Pharmacists requested that BPS establish infectious diseases as a formal subspecialty of Pharmacotherapy. About this same time, ACCP encouraged BPS to create a new structure characterized by a core pharmacotherapy exam that would test knowledge and skills common to all clinical practitioners, supplemented by a more focused “subspecialty” exam in areas like cardiology, infectious diseases, and the like. The College advocated such a structure because it was viewed as the most efficient and cost-effective way to certify the largest number of qualified clinicians. In 1993, BPS opted not to go down this path, but eventually (in 1997) created the “Added Qualifications” process. Once again, this only delayed the need to consider our specialty framework.

We now have nearly 20 years worth of experience since the advent of Pharmacotherapy, Nutrition Support, Oncology, and Psychiatry as formal pharmacy specialties. If pharmacy is indeed well down its transformational path to a patient-centric health profession, then we must assure that our credentialing processes of the future will meet not only our needs but the needs of patients, other health professionals, and the entire healthcare system. We cannot delay any longer in considering the optimal framework for pharmacy specialization, and in moving with all due speed to put that framework in place.

Stuart Haines, Pharm.D., FCCP, BCPS, a former Past President of ACCP, also commented on the issues addressed in Dr. Tisdale’s letter:

Board Certification is an important quality assurance process intended to provide payers, employers, and patients a validated mechanism to identify qualified individuals who are prepared to engage in specific areas of practice. From the practitioner perspective, board certification validates that he or she possesses the requisite knowledge (and to lesser degree, skill) gained through training and experience. Unfortunately the current system of board certification in pharmacy fails to recognize important, well-established areas of practice and for which specialized training is available. For example, pharmacists working in the critical care setting clearly require specialized knowledge and skills—but there is no mechanism for payers, employers, patients, or accreditation bodies to determine whether the pharmacist working in the intensive care unit is qualified to do so. Moreover, there is no mechanism to determine if a “graduate” from a critical care pharmacy residency possess the knowledge and skills needed to practice independently. Our board certification framework should match our residency training framework. At the moment, there is a significant disconnect.

Jill Burkiewicz, Pharm.D., BCPS, who served as ACCP Secretary from 2006 until 2009, wrote:

I am pleased that ACCP continues to actively advocate for a new specialist certification framework. As our profession continues to grow and diversify, a new model that allows for the recognition of the array of specialists and subspecialists is needed to not only meet our needs as a profession but more importantly the patients we serve.

Jerry Bauman, Pharm.D., FCCP, BCPS, Dean of the University of Illinois at Chicago College of Pharmacy and 1997–1998 ACCP President, pointed to the need to address the specialist certification conundrum:

Unfortunately, and in direct contrast to the profession of medicine, for pharmacy there is a disconnect between board certification and post-Pharm.D. residency and fellowship training. It seems clear, in order for the profession to continue to move forward, this vexing problem must be solved. ACCP and President Tisdale should be applauded for recognizing this and taking a shot across the bow toward a solution.

Although most responses received by Dr. Tisdale supported the perspectives articulated in his letter, several important points related to specialist certification were raised. “In view of the number of members interested in this subject, and their varied understanding of specialist certification,” in Dr. Tisdale’s words, “I think it’s important to make certain that both the procedures involved in specialist certification and the College’s viewpoints on this process are clearly understood. I plan to devote my July President’s Column to discussion of the key arguments raised in member responses to the letter.” In addition to Dr. Tisdale’s column, the July issue of the ACCP Report will feature more comments from members who replied to the open letter.