American College of Clinical Pharmacy
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ACCP Report - January 2009

President’s Column

Ambulatory Care as a Specialty

Written by John E. Murphy, Pharm.D., FCCP


John E. Murphy, Pharm.D., FCCP

Together with the American Society of Health-System Pharmacists (ASHP) and the American Pharmacists Association (APhA), ACCP jointly sponsored and participated in developing a petition to the Board of Pharmaceutical Specialties (BPS) to recognize Ambulatory Care as a specialty. ACCP also participated in the initial evaluation of the potential for specialty status by providing names of ambulatory care members to BPS when it conducted its role delineation. The documentation for the petition was submitted in November. At least three open hearings will be held in which individuals and groups will have an opportunity to provide comments. In addition, any individual or group may provide written comments to BPS (visit http://www.accp.com/govt/positionPapers.aspx#Petitions_title to view the petition or its executive summary). The first open hearing was held in December at the ASHP Midyear Clinical Meeting in Orlando; two more are scheduled in April at the upcoming APhA meeting in San Antonio and ACCP’s International Congress in Orlando. BPS will then study the petition and the comments received as the determination is made whether to recognize ambulatory care as a specialty.

I had the opportunity to attend the first open hearing at ASHP as the BPS liaison to ACCP. This was my last official BPS duty, as my term on that board ended in 2008. I would characterize much of the hearing’s commentary as positive, together with some requests for additional information about the specialty petitioning process. The Society for Infectious Disease Pharmacists (SIDP) and ACCP’s Infectious Diseases PRN did go on record at the meeting as opposing the recognition of Ambulatory Care as a specialty, although it appeared to be largely based on their interests in having BPS restructure its recognition processes to allow smaller groups of pharmacists practicing in specialty areas to have access to a certification examination. Currently, infectious diseases, like cardiology, is an “Added Qualification” within the Pharmacotherapy specialty.

ACCP has urged BPS to evaluate needed changes in the current processes for developing specialties, and the 2008 Certification Affairs Committee recently completed an ACCP White Paper that proposes potential options for revision of the existing specialty certification framework (visit http://www.accp.com/docs/positions/whitePapers/CertifAffrsWPFinal11-08.pdf to review this paper). We continue to believe that the BPS model developed many years ago, although useful until now, has not necessarily fostered the growth and diversification of specialties. Furthermore, we believe that the specialty recognition process should be more coherently aligned with the profession’s PGY2 residency specialties.

ACCP is committed to the continued expansion of specialty recognition and believes in the importance of supporting the pursuit of Ambulatory Care as a specialty. Thus, the Board of Regents decided that the College should serve as a co-petitioner for this new specialty together with ASHP and APhA. ACCP has stated that “future clinical pharmacy practitioners should be board-certified specialists” (see http://www.accp.com/docs/positions/whitePapers/wp_phco200612.pdf); however, this vision cannot be realized until specialty certification is made available to pharmacists engaged in specialty or subspecialty practices that extend beyond the current five BPS specialties: Nuclear Pharmacy (est. 1978), Nutrition Support Pharmacy (est. 1988), Pharmacotherapy (est. 1988), Psychiatric Pharmacy (est. 1992), and Oncology Pharmacy (est. 1996).

Will Ambulatory Care be recognized as a specialty? If so, what implications will that have for the future? Pharmacotherapy is by far the largest specialty within our profession. The continued annual increases in registrants for the Pharmacotherapy certification examination suggest that this growth will continue. Many ACCP members call this specialty their own. The other BPS specialties have increased in size more gradually but are sustained by both ACCP members and nonmembers who continue to demonstrate their knowledge through the certification and recertification process. If the Ambulatory Care specialty is recognized by BPS, it could create considerable opportunity for clinical pharmacists providing direct patient care in community pharmacies, clinics, and other ambulatory care settings to demonstrate their competence in this specialty. Perhaps this, in turn, will help in our continuing battle for expanded recognition of clinical pharmacists’ direct patient care services by patients, other health care professionals, and payers. Because most pharmacists practice in community pharmacy settings, the availability of this specialty might motivate more pharmacists to develop direct patient care services in these settings and to demonstrate their competence through certification. Ultimately, it is about helping our patients realize better outcomes from their medication therapy. And remember that expanding specialist certification also has the potential to increase recognition of the value of pharmacists and the care they provide to patients. I enthusiastically support initiatives that can achieve these goals!