Dr. Kral was kind enough to post a quest blog regarding the credentialing process for “pain and palliative care pharmacists”; her insight of which I hope will summon opinions from our medical, nursing, and perhaps other provider partners. This is particularly relevant today since our pharmacy and medical colleagues could perhaps benefit from a refresher on the importance of an interdisciplinary team approach to medicine and essential collaboration for better patient outcomes. Consider a recent public statement by Dr. Sterling to pharmacists, “Don’t Call Us We’ll Call you”. Really? We should be calling each other about all sorts of therapeutic dilemmas for the greater good, although I do believe that in this case the AMA has some valid points. But, I don’t think that Dr. Sterling would be distraught if a pharmacist contacted him about the risk of widened QTc interval and possible resultant Torsades de pointes followed by sudden death, if a new RX was presented for methadone in a patient on amiodarone or azithromycin. We all need to recognize that well trained MD’s clearly are experts in diagnostics, but well trained pharmacists are clearly experts in therapeutics. Hence, Dr. Kral’s quest for your input follows. Dr. J. Fudin
Dr. Lee Kral is an adjunct assistant professor at The University of Iowa College of Medicine. She is a Board Certified Pharmacotherapy Specialist (BCPS) and a Certified Pain Educator (CPE). A comprehensive biosketch appears beneath this blog post.
Dr. Kral writes…
Dear pain and palliative care colleagues,
Our group of pain and palliative care pharmacists has been discussing a credentialing dilemma. We would appreciate feedback on this so we aren’t working in isolation (or an alternate universe). Let me explain.
All pharmacists must take a basic national licensure exam (called NABPLEX) in addition to state licensure exams to obtain a license upon graduation from an accredited college of pharmacy. Many graduates with entry level degrees (previously BS Pharm, now Pharm D) go on to practice in the community/retail setting or general hospital practice. This would be similar to a General Practitioner in medicine. Much like the medical field, those who wish to have a clinical practice go on to complete a residency. Our general practice residencies are similar to a medical internship year with a broad scope of clinical experiences. If a pharmacist completes a general practice residency (PGY1) he/she can then go on to a specialized residency such as pain and palliative care (PGY-2). This would be similar to a fellowship in medicine.
The Board of Pharmaceutical Specialties (BPS) is our post-graduate credentialing body. They administer the board certification exams that are the mirror of general board examinations in medicine (internal medicine, anesthesia, physical med/rehab). There are a number of principle areas for examination in pharmacy (including general pharmacotherapy, ambulatory care, pediatrics, nuclear medicine, etc.) The BPS boards are optional in pharmacy, and are pursued by those who wish to pursue academia and/or high level clinical practice. However, we currently do not have a defined system in place for board certification in pain and/or palliative care congruent with that of the medical profession.
When I speak to multidisciplinary pain groups around the country, I get questions from physicians like “We would like to hire a pharmacist for our group. How do I know who to hire and what credentials should I look for?” At this point I can suggest considering someone that has completed a specialized Pain and Palliative Care (P&PC) residency, earned general board certification, and/or earned a certified pain educator (CPE). Would it mean anything to our readers if we could offer a board certification in P&PC?
We don’t really want to explore something completely new that nobody recognizes. Nursing has their own systems and paths for various certification exams and various credentials, which can get confusing. Several of our staff nurses have an ASPMN pain certification, but I don’t know what that means.
So the questions are these:
Would it make sense to emulate the medical model of subspecialty exams?
It would seem that we have fallen into a similar model historically (see above).
Is Pain and Palliative Care an important enough practice area to be considered one of the core board exams for a pharmacist (like pediatrics)? Or should it be considered a subspecialty, as it is in medicine because it crosses all practice areas?
Are 10 or 20 years of pain management/palliative care experience adequate?
If you were hiring a pharmacist to work in your pain center, what would you consider benchmarks for a candidate?
If some type of board certification exam is developed for pain/palliative care, what does it mean in today’s healthcare system? As with any credible professional board exam, there is significant time and financial commitment involved in developing the exam (and studying for it).
Does a subspecialty certification mean anything to those who would hire us (healthcare systems, hospices, private practice pain clinics)? Or will any warm body do?
Are we wasting our time and money or is it money well spent?
Dr. Kral received her BS and Pharm.D. degrees from the University of Iowa College of Pharmacy and completed a pharmacy practice residency at the University of Iowa Hospitals and Clinics (UIHC). She is a board certified pharmacotherapy specialist (BCPS) and a Certified Pain Educator (CPE). She is on the faculty at the University of Iowa Center for Pain Medicine and holds adjunct professor status at the University of Iowa Carver College of Medicine. She serves as a preceptor for pharmacy residents, anesthesia residents and pain fellows. She provides clinical pharmacy expertise for the acute pain service, runs a pharmacist-based pain medication management service, leads house-wide pain education and serves on the hospital Pain Management Task Force.