The Road ahead for the PharmD Program in India.
PCI has introduced the Pharm.D (Doctor of Pharmacy) academic program in 2008 with an objective to contribute to patient care and to actively take part in the healthcare system both in India as well as globally; on the other hand, lots of questions have arisen in the minds of students pursuing the Pharm.D degree. This has thrown up challenges for the profession, especially to those pioneer-Pharm.D graduates who would be facing the brunt of the initial teething problems as the Pharm.D profession strives to create its own niche in the realm of the Indian healthcare system. The present article attempts to answer these questions arising from the students’ point of view and also looks to find viable solutions for the challenges that lie ahead of this profession. The article takes a look at existing measures taken by the PCI as well as potential recommendations in relevant areas such as internships, course syllabus, job opportunities, placements, academic opportunities, professional examinations, opportunities for specialization in areas like cardiology, oncology etc, and other pertinent issues like acceptance of the Pharm.D professional by the greater Indian healthcare community
Sivaram Hariharan*, V. Sankar, and M. Ramanathan
PSG College of Pharmacy, Coimbatore.
The PharmD professional degree program was recently introduced in India by the PCI in 2008 with a view to improve the quality and level of patient care as well as to introduce Practicing Pharmacy This program was introduced in two equivalent forms; one as a three year post-baccalaureate degree program after the completion of the existing 4-year B. Pharm degree and the other as a regular 6-year degree program after the completion of the Higher Secondary Certificate (HSC). Both educational trajectories lead to the same destination of the degree of Doctor of Pharmacy. The three years of the post-baccalaureate program are analogous to the years 4, 5, and 6 of the regular Pharm.D program with slight modifications in its syllabus. The aim of the PCI in introducing the Pharm.D program was to create a venue to increase the clinical and
practicing dimensions of Indian pharmacists. In contrast to countries like the USA2, where the PharmD degree is an established program, in India this brand new program is still in its infancy. As a result,minor teething problems as well as major challenges lie ahead for the PharmD program before it creates its own niche in the Indian healthcare system and becomes a mainstream profession.
Challenges facing the PharmD Profession (as seen through the student’s eyes)
There are various current challenges facing the pioneer PharmDs as they step out into the real world of the global healthcare system. These challenges are both major and minor and the areas that they encompass are both mutual and exclusive. Some of the major challenges are listed below.
- The acceptance of the PharmD graduates as part of the greater
Indian healthcare system3.
- The actual role of PharmD graduates in the Indian hospitals.
- The recognition of the Indian PharmD degree overseas and job
- Jobs for PharmD graduates within India.
- Campus placement opportunities for PharmDs before they
complete their graduation and their implementation.
- Job in the public sector as well as the prospects in the Indian
- Generation of awareness of the PharmD program by the Indian
- Opportunities for PharmD graduates in specialist fields like clinical trials, drug analysis, pharmacokinetics, and pharmacodynamics and also to specialize in specialist medical areas like cardiology, oncology, and paediatrics.
- Academic opportunities (teaching) for PharmD graduates.
- Questions concerning the PharmD syllabus and the relevant
- Need for a distinction to be established between PharmDs and M. Pharm (Pharmacy Practice) graduates.
- The matter of internship and the precise role of the PharmD
student during his or her internship.
- Eligibility of the PharmD student for a stipend during the
- Overseas exposure during the internship period
- Legal aspects like the requirement and the exact procedure for
registration of PharmD graduates
- Need for strong legislative support backing the profession.
- Eligibility to sit for public service examinations in order to qualify
for Government jobs.
Challenges met so far
While there is a lot that needs to be done to successfully nand smoothly streamline PharmDs into the Indian healthcare system, some concrete measures have already been taken by the authorities in this regard. Since the PharmD program, at a practicing professional level, is only at its infancy, acceptance levels are certainly expected to grow with time after some initial hiccups.Regarding the acceptance of the Indian PharmD degree overseas, one has to realize that the impetus for starting the PharmD degree in India was ruling in 2003 that no 4-year degree holder is eligible for the FPGEE (Foreign Pharmacy Graduate Examination)
Therefore, it was decided by the PCI to increase and improve the clinical and practice component of the course and increase the years of study to a minimum of 5 years. With this in mind the PharmD program was introduced in India. Post Baccalaureate PharmD degrees are also now accepted overseas based on the length and quality of clinical training of the candidate on an individual case by case basis. In India, the PharmD degree is classified as an Integrated PG Degree program by many universities with the submission of a research project work by the student during his/her 5th year of the curriculum. Consequently, these students are eligible to directly enroll for PhD programs on completion of their PharmD degree. Regarding the PharmD syllabus1 and its development, it is our own opinion that a modified syllabus by 2014, incorporating changes to include more clinical subjects and new technology into the course content, will make it at par with international standards
Challenges to be resolved
Inspite of a lot being achieved so far, there still remain a lot of issues that needs to be effectively addressed. In the area of job opportunities for the PharmD graduate within India, lots of steps need to be taken. Recently, PCI has come up with a set of guidelines that defines the role of a PharmD within the hospital setup
and make the greater healthcare community aware of this role. In the Indian public sector there is a need for Drug Information Centres/Drug Interaction Chemists in Government hospitals as well as the need for pharmacovigilance in District HQ Hospitals all over the nation. Additional registration of the clinical pharmacist in this regard could then be required. Therefore, the authorities need to find ways of creating these positions in the public sector for which effective campaigning needs to be done for getting the necessary and adequate legislation passed in this regard. Regarding opportunities in the Indian pharmaceutical industry, we need to create awareness for this new PharmD program within the industry and the vital roles that PharmDs could play within the industrial setup especially in important areas like clinical trials, drug discovery, pharmacokinetics,pharmcodynamics and pharmacometrics. Once the utility potential
of the PharmD is realized by the industry, then campus placements and interviews automatically follow. Regarding the payment of stipends during internship for PharmDs; this could be considered as service because sufficient training has already been provided to the PharmD students during the curriculum, especially in the 5th year, where along with regular subjects they also do clerkship and project work. Consequently, the PharmD students will be mostly rendering service in the hospital during their internship. Therefore, a recommendation of residential internship with stipend (like other professions) by the concerned
authorities will tremendously motivate our students and also help the profession to be viewed from a better perspective. International exposure during internship would also be very helpful for the PharmD student to get a global perspective of his profession
The Road ahead
PharmD is a new program that has entered the realm of the Indian Healthcare and it would certainly take some time to carve its own indelible position in the healthcare system. And for this to happen,PharmDs need that all important initial acceptance in our society that has so far functioned in their absence without any apparent hitch. A positive outlook, a never-say-die attitude, and most importantly complete mastery in the field of drug interactions and prescriptions would be extremely vital to gain the acceptance and the respect of the greater healthcare fraternity across this nation of ours. But we also need very strong legislative support and action to make PharmDs a mandatory part of the hospital and healthcare system in India. Within the hospital setup, the PharmD can help with dose adjustment and potential drug interactions in regards to the treating physician. He/she can help the nurses with dose reconstitution and help the patients with counselling and render them advice concerning their lifestyle. The PharmD should explore all potentials and capabilities, especially those areas like pharmacokinetics and those areas not touched by the other healthcare team members like pharmacometrics and pharmacoeconomics. The PharmD could also help in extemporaneous formulations for paediatric medications. Then there are niche areas of super specialization like cardiology and oncology where the PharmD could be extremely invaluable.
As professionals, we have to look in the ways of getting all the above done and as starters could start sending flyers to all major hospitals across the nation to portray the incoming PharmD graduates and their role as important cogs in the healthcare wheel. The PharmD professional should be portrayed as an added and a complete team-player in the healthcare team rather than someone that competes with the physician in aspects of therapeutics, drug interactions and prescriptions. There are lots of opportunities for PharmDs in the hospital and clinical areas. Again, it is the responsibility of the individual PharmD graduate to develop expert competency during the learning phase with synergistic emphasis from teachers and institutions.Another exciting area is the role of Community Pharmacist working in drug stores. The past image stigma of working in a drug store should be discarded as the pharmacist has an invaluable and respected role to play in a community setup. This has been proven time and again in developed nations overseas. The role of the PharmD as an important component of society as a community pharmacist cannot be overlooked and there is an urgent need to elevate the profession of Community Pharmacy to a very high level.Moreover, this has always been the traditional role of the pharmacist since olden times, the primary contact of society with medicines. Strengthening this role would significantly enhance the role of the pharmacist in our healthcare system. An important reality of our times is the increasing global nature of the healthcare industry which has given rise to new paradigms like medical tourism, which countries like India are embracing vigorously5. With this arises the requirement of many of our hospitals to be internationally accredited to fully participate in this medical tourism industry. According to new international regulations, clinical pharmacy services are mandatory for securing International Hospital Accreditation6. The PharmD would then become very important for an Indian hospital seeking such accreditation. There are also some unexpected areas like the booming Indian health insurance industry where the PharmD graduate could play a pivotal role in the evaluations of claimant prescriptions and establishing their veracity for the all important purpose of patient
bill reimbursement in a fair, competent, and professional manner. This would elevate the quality of the Indian health insurance industry to high levels.
The current scenario
Recently, the first batch of PharmD students (Post-Baccalaureate) have graduated and there have been some very encouraging developments. Some of these graduates, on a strictly case by case basis, have since become eligible for the FPGEE exam, on completion of which, they will be eligible to do internship in the
USA and henceforth become qualified to write the NAPLEX (North American Pharmacist Licensure Examination). Some have found work in the Indian pharmaceutical industry in drug database research and management and also on the clinical aspects (both industrial and hospital). Some are working as PharmD faculty in the various pharmacy colleges across the nation conducting the PharmD program. Also, it would be a very big shot in the arm for the PharmD graduates, if those pharmacy colleges that have their own hospitals, absorb some of their own PharmD graduates into their workforce as Clinical Pharmacists. Consequently, other pharmacy colleges that do not have their own hospitals could have on-campus placement interviews for their PharmD graduates with various hospitals. All these would ensure robust growth in the career as well as educational development of the PharmD program and instil vital confidence amongst those students pursuing this exciting degree program.
In conclusion, most of the problems and uncertainties, especially those concerning the future life paths of PharmD graduates, come across as teething problems which would certainly be expected to get better with time. The regulatory bodies should adopt stringent and concrete steps to improve the quality of PharmD education at par with international standards which will give a global healthcare focus to our PharmDs. The above suggested roles of the PharmD should be given a wide publicity in the society and amongst other
healthcare professionals in order to increase the awareness and importance of this profession. If this could be achieved, the first solid foundation could be laid on this long but beautiful road of making the PharmD an integral part of the Indian healthcare team.
The authors are profoundly thankful to the expert panel members for their invaluable inputs during the panel discussion session of the conference on Emerging Opportunities for Clinical Pharmacists held recently at the PSG College of Pharmacy on 9th of July 2011.