Pharmacists find changed profession [St. Louis Post-Dispatch]

May 14--ST. LOUIS -- Nearly 180 young men and women graduate Saturday from St. Louis College of Pharmacy, facing changes in their profession few could have envisioned when they began their studies six years ago.

Not only is the job market wobbly, but the skill-set required to be a pharmacist has shifted.

Pharmacists today need to be equipped to work in different environments, from retail chains and mail-order businesses to hospitals and nursing homes. They need to know how to dispense drugs but also be comfortable with technology's increasing role in drug therapy; handle business matters from running a pharmacy to knowing the ins and outs of Medicare; and navigate the politics of health care reform.

"It's a frightening time for pharmacists because the ones who are attempting to sustain themselves in the old way, focusing on distribution, are finding it tough to survive," said Wendy Duncan, the college's dean and vice president of academic affairs. "And the people who are trying to work in new ways in the clinical setting are having difficulty making a living."

Founded in 1864, St. Louis College of Pharmacy is the oldest college of pharmacy west of the Mississippi River. And like other schools of pharmacy, its mission is to prepare its students for these new uncertainties.

Many of this year's 178 graduates have already secured jobs with six-figure salaries that will enable them to live in style and begin paying off their student loans. But the demand for newly trained pharmacists has cooled in the past year, leaving about 10 percent of graduates still scrambling for work.

Duncan said the college was revamping its curriculum to emphasize business skills and how pharmacists can make money as the health care industry changes. She plans to reduce the number of traditional lecture classes, focusing instead on individual studies as well as workshops and public service projects that emphasize teamwork, problem-solving and communications skills.

For more than a decade, pharmacists were in high demand, recruited with signing bonuses of up to $10,000 and even leased BMWs for graduates with a Doctor of Pharmacy degree. Meanwhile, the number of new schools of pharmacy nationwide proliferated.

But with the recession, some retail chains have closed their 24-hour pharmacies, hired fewer pharmacists and used lower-cost technicians to fill the gaps.

Big retail chains with enormous drug-buying power, such as Walgreens, have driven many independent, family-owned community pharmacies out of business. Pharmacy benefits managers such as Express Scripts Inc. are competing directly against retail chains, offering direct mail deliveries of prescription medicines to consumers.

Still, new opportunities for pharmacists are emerging. Clinical pharmacists are becoming more accepted as key members of a patient's health care team, as experts in drug therapy who can help manage a patient's long-term care.

"Students need to know how pharmacy fits into the rest of the health care system -- the social, economic and political aspects of health care," said Ken Schafermeyer, a professor at the college who specializes in health economics.

St. Louis College of Pharmacy is one of the nation's largest independent colleges of pharmacy. Its campus, which includes a high-rise residence hall, a library stocked with medical journals, and laboratories equipped with laptop computers, is tucked into a 6-acre site next to the Barnes-Jewish Hospital complex.

Sixty percent of its graduates plan to work for retail pharmacies. Others have been hired by hospitals, long-term care including nursing homes, the military, the pharmaceutical industry and managed care organizations. Fifteen percent -- a higher number than in previous years -- will begin two-year clinical residency programs at hospitals and other health care facilities.

"The pharmacist has to be a continuing, self-educated professional," said Terry Seaton, a professor of pharmacy practice. "We graduate generalists. We introduce them to multiple settings and high levels of technology."

Today, computers are used to not only help make better prescribing decisions, but also to administer some medicines. For example, computerized "smart pumps" infuse dosages of drugs for chemotherapy. Computers also track how well patients are responding to medicines and whether they are sticking to their drug therapy schedules. Robots help fill mass prescriptions at distribution plants and direct-mail facilities.

"Medication safety is a very high priority for this college," Seaton said. "We are preparing our students to select drugs in a particular situation, to modify them as necessary, and to monitor them for both efficacy and for safety."

Ron Fitzwater, chief executive of the Missouri Pharmacy Association, said the college was "on the forefront" in its clinical programs and for preparing students "to play a greater role in health care -- in not only helping patients understand their medications, but also working collaboratively with physicians and other health care providers to manage their drug therapies."

Enrollment has held steady in recent years. Admissions requirements include high grade-point averages, letters of recommendation and strong test scores. Freshman tuition runs $20,600, plus room and board. Ninety-nine percent of students receive financial aid.

Most of the college's 1,250 students are from the St. Louis metropolitan area or Southern Illinois, but others hail from 25 other states, and its graduates are working nationwide and overseas. One of its graduates, Samih Darwazah, is the founder and chairman of London-based Hikma Pharmaceuticals.

Students say the program, which consists of academic work as well as clinical rotations at hospitals, retail pharmacies and nursing homes, is rigorous.

"Second or third year, you could have a quiz or exam three out of five days of the week," said Sarah Smith, a third-year student.

Some students said parts of the college's curriculum needed updating, noting required courses that date to a century ago when pharmacists made medicines and specialized in drug properties, compounds and extractions.

Duncan said the college's new focus would help position pharmacy graduates to assume a highly valued, "hub" role in health care reform.

"There's an opportunity to do things that have never been done before, and that can be beneficial for the patient."

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