During her nearly three decades holding senior leadership roles for professional associations in the pharmacy discipline, Dr. Lucinda Maine has both witnessed and helped drive the sweeping transformation of the field as a whole, and more specifically, its educational model. Since Dr. Maine began her current role as executive vice president and CEO of the American Association of Colleges of Pharmacy (AACP) in 2002, the number of pharmacy schools in America has grown from 84 to 144 — creating a need to fill a greater number of seats in those programs and ultimately, serving a population of patients who Dr. Maine believes will benefit from increasingly viewing pharmacists as providers of direct health care rather than exclusively as dispensers of prescription drugs. Prior to her position with AACP, Dr. Maine served as senior vice president for Policy, Planning and Communications with the American Pharmacists Association (APhA). She served on the faculty at the University of Minnesota, where she practiced in the field of geriatrics and was an associate professor and associate dean at the Samford University School of Pharmacy. Her research includes projects on aging, pharmacy manpower and pharmacy-based immunizations. In the following interview with Dr. Maine, Liaison dives deeper into her multifaceted perspective on the shifting landscape of pharmacy education and practice, as well as on AACP’s contributions to that ongoing transformation.
Liaison: AACP’s vision is that “academic pharmacy will work to transform the future of health care to create a world of healthy people.” Can you share more about how the Association is working to realize this vision?
Dr. Lucinda Maine, AACP (LM): In pharmacy, we tend to have a bias that medication use is central to quality patient outcomes, but we also know that pharmacists have not yet had as much of an opportunity to exercise their knowledge and skills as would be ideal. The profession has really recognized this and has grappled with it, and it propels us to change our educational model continuously.
Medication use is more important today than it’s ever been. There’s a lot of attention to how expensive it is. But actually, the most expensive medicines may actually be the ones you’re not taking or not taking correctly. If pharmacist education and accessibility were optimized, then we have good evidence that overall health care costs would be easier to control and that patient outcomes would be better. The way we operate in that place is to continuously keep the framework of curricular competencies up to date and synced with where the accreditation process is pointing.
But in 2016, we released a new four-point strategic plan, which was modestly updated in 2018. It really tells the story. One of the key issues that determined and continues to shape our strategic priorities is that there appears to be less interest among the potential cohort of learners in health careers than there has been historically. We know that beyond the demographic reasons and the concerns about debt burden, one of the reasons why people seem to be less interested in pharmacy is that they really don’t understand what pharmacists do and how that education prepares them to really help people. Part of that is the perception people have of the classic pharmacist —whether it’s in the grocery store or at CVS or Walmart or wherever else, that they don’t look like they’re having a really good time. And it’s hard for them to communicate to the public what’s really going on behind the scenes, whether that’s advocating for more affordable medicines for their patients or making sure the patient has the education and monitoring tools to optimize their health.
Our first strategic priority, therefore, is focused on the pipeline. We know that if we don’t have the right quality and quantity of learners, the profession will suffer, and patient care will suffer. This inspired our ‘Pharmacy is Right for Me’ campaign and other initiatives in recent years, which support our member institutions and get the word out to the potential applicant pool.
Strategic priority number two is focused even more broadly on the public, including through the ‘Pharmacists for Healthier Lives’ campaign. The audience for that effort is comprised of suburban parents, ages 35-55, and caregivers, ages 45-65. We target them with paid advertisements through social media channels. We’ve managed this national campaign, not ourselves, but in partnership with seven national pharmacy organizations and a growing number of state pharmacy organizations. Very rarely does an organization embark on a significant project by themselves and see that the project becomes successful. The most successful projects are collaborations. And the profession has never undertaken a campaign quite like ‘Pharmacists for Healthier Lives’ in any meaningful way, which is one of the reasons why people don’t know what pharmacists do and how they’re educated.
The third strategic priority is really going to kick into the highest gear in the coming year. We have to transform both education and practice in order to fully position pharmacists in the right practice activities. We’re not asking pharmacists to completely give up on the drug distribution responsibility, because they can’t delegate that. But they can oversee it differently so that they have time to perform direct patient care, especially with complicated patients who have multiple chronic conditions, and with people with lower literacy who need more help than the average educated consumer to understand how to use their medications properly.
The fourth priority is about expanding research and graduate education. Our Association’s incoming president is passionate about making sure we have a strong cadre of researchers across the whole spectrum of pharmacy-relevant research, but especially implementation science, to support and affirm the value of practice and education transformation.
Liaison: What have you learned is key to ensuring that professional associations have the greatest impact on their constituents?
LM: As a national organization, AACP can’t transform practice. But when we identify priorities that are clearly as highly strategic as the aforementioned issues are right now, we have to understand that our priorities should focus on what our members need help with. Then, we work very closely with our members. We have recruitment champions at most of the schools in order to help them expand the applicant pipeline, as well as brand ambassadors at the schools who have expressed an interest in working with us to extend the reach of public awareness about the pharmacy profession. We feel that now is an essential time to equip our schools with action plans that will allow them to enhance, enrich and expand their transformation. It’s all about understanding member needs, and then it’s being realistic about how a national organization can channel resources that will enable its members to be successful.
Liaison: What are the most surprising changes in pharmacy education that you’ve witnessed during your time serving this industry?
LM: When I started at AACP in 2002, there was a documented national shortage of pharmacists, and that impacted our members because when attractive non-academic job openings started to arise, we began to recognize that there was an acute shortage of leaders and faculty. We launched several projects in the early part of that decade to address the vacuum of leadership, as well as some programs designed to attract current students and younger practitioners into faculty roles. These programs reminded the schools that they have a responsibility to cultivate an interest in faculty positions, to cultivate leaders.
Across that decade, things began to equilibrate as there were new school openings. And when we started PharmCAS™, the Centralized Application Service (CAS™) with Liaison, the schools received more applicants than they could possibly efficiently process without us. But now, we are in a situation where there aren’t the same number of applicants for our available seats. There were only 84 schools of pharmacy when I started at AACP, and there are 60 more than that now, which means that we still have to look for new leaders and new faculty.
We also certainly can’t ignore technology. We’ve tried to stay on top of how technology was going to influence both higher education and practice. That change is going to happen much more rapidly in the future. I predict that the next shortage of pharmacists is going to come because physician offices and health systems have begun to see the value of integrating pharmacists not in dispensing roles, but in direct patient care roles as part of their interprofessional team. In turn, pharmacy schools need to make sure they’re equipping current graduates —and maybe past graduates — with the skills and the understanding of how to be successful in that relatively novel practice model.
Liaison: Based on your experience, what would you say are the trends that must be addressed in order to provide better patient care and better health for the world?
LM: We need the complete maturation of the concept of interprofessional teams. Pharmacists recognize that medication use is a team sport, and we just want you to understand the role we play on that team. Technology is also crucial, in terms of fully understanding that transformation and how to make sure that medication use doesn’t get lost in the shuffle, that it doesn’t get ceded to Amazon because they can get drugs very efficiently from point A to point B — because that’s not the whole story. The whole story is making sure the right drug is used for the right patient and that the patient is equipped to manage it properly, especially when you start talking about some of these hyper-expensive agents that won’t all necessarily be managed by pharmacies. For instance, gene therapy won’t necessarily be managed by a pharmacy, but pharmacists still need to understand the impact that those cutting-edge therapies have.
Liaison: The American Journal of Pharmaceutical Education recently published your commentary on the workforce dynamics over the last 20 years. Can you speak more about the long-term perspective that you take in the piece?
LM: I think that the shortage of pharmacists from the early decade of this century did damage to the profession because it stifled innovation — especially among the most notable and most visible pharmacy sector, which is the chain corporate pharmacy sector.
When I was at the American Pharmacists Association, one of the significant things that we embarked upon was pharmacy-based immunization. At that point in time, 20 years ago, you could probably count on two hands how many pharmacists felt they were authorized and empowered to administer a flu shot. And today it’s over 300,000. If APhA and our state partners hadn’t taken that on seriously, it would never have happened. But the Center for Disease Control and Prevention (CDC) was very frustrated with the low percentage of senior adults who had had their annual flu shot and pneumonia vaccine after the age of 65, and it was killing people. When they were able to see that pharmacists could do this and could open up countless access points, they really became champions for us, and the rest is basically history.
Now we need to ask, “What are those other things that pharmacists might be able to do?” It will help relieve the burden from complex chronically ill patients in physician offices, and by doing that, they’re probably keeping many of those people out of hospitals and emergency rooms.
I think that things are really aligning for health care. When you walk away from the fee-for-service payment model, and we begin to get pharmacists compensated for providing patient care, I think it’s one of the things that can change relatively rapidly, with value-based reimbursement and pay-for-performance approaches being implemented across much of the rest of the health care landscape. We just need to figure out how to share those savings and share those resources in order to be able to support the pharmacists in that practice model.