Education matters much more than convenience. It is the keystone of high-quality care and patient safety. Patients know it too—more than 90% say a physician’s years of education and training are vital to optimal patient care.
Nevertheless, some legislation seeks to allow pharmacists to diagnose and treat patients over the pharmacy counter, relying only on the results of a laboratory test. But this would put patients at risk, as an isolated lab test depicts only a sliver of a patient’s overall health—not enough to determine a course of treatment. In addition, pharmacists are not trained to diagnose patients.
Lawmakers should therefore exercise extreme caution when considering legislation that would expand scope of practice for pharmacists.
The AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety.
Trained to do different things
One of the most obvious things that distinguishes physicians from pharmacists is the length, focus and depth of their training.
Pharmacists get four years of post-graduate education, which includes 1,740 hours of clinical training. They have no residency requirement.
By contrast, physicians get four years of post-graduate education plus three to seven years of residency. Included in this is some 12,000–16,000 hours of clinical training—which is, at minimum, more than six times as much as what pharmacists get. All of that is preceded by the four years it typically takes to earn a bachelor’s degree.
In addition, physician education includes performing differential diagnoses, treating patients for a broad range of illnesses and diseases, and caring for patients during each phase of the lifecycle. Pharmacist training does not include making a diagnosis, being exposed to patients with any specific medical conditions or even conducting a physical examination.
Pharmacist education is focused on learning about medications and includes much scientific laboratory study, but not training in providing medical care to patients.
The patient-care activities in pharmacy school include “interacting with patients, ensuring continuity of care, educating patients on the use of medications,” but do not include making a diagnosis or developing a differential diagnosis, performing a physical or mental examination, or managing chronic disease.
Meanwhile, pharmacy-school curriculum standards do not require exposure to patients with any specific medical conditions or exposure to patients of any particular age. This is of concern because the test-and-treat laws often proposed to expand pharmacists’ scope of practice would allow these nonphysicians to treat any patient over the pharmacy counter for conditions they may not have ever seen before.
The upshot: Pharmacists are medication experts, but they are not trained to take on the role of primary care physician.
That having been said, there are arrangements known as collaborative practice agreements that—when used correctly—can be a viable solution to allow pharmacists to manage medication safely on a physician-led team. A collaborative practice agreement should be specific to a single patient, an individual physician, and an individual pharmacist.
Learn more with the AMA about what sets apart physicians and nonphysicians.
No room for expanded scope
Stay up to date on fight against scope creep
See how the AMA defends against scope of practice expansions that threaten patient safety.
While pharmacists play a vital role in the health care team, the best way to support high-quality care is to keep physicians as the leaders.
In fact, pharmacists are already dangerously overburdened. According to a 2019 Pharmacy Workforce Center report, 91% of pharmacists in chain settings rated their workload as high or excessively high, and 75% said that they have so much work to do that everything cannot be done well.
And even pharmacies themselves agree that it’s not the business of pharmacists to practice as physicians.
“While pharmacists are highly trained and licensed professionals, they did not attend medical school and are not trained as physicians,” lawyers for CVS—the second-largest pharmacy chain by number of pharmacists—have written. “They do not examine or diagnose patients. They do not write prescriptions. And with only very limited exceptions permitted by law, pharmacists are bound to respect a prescribing doctor’s professional medical judgment about which medications are appropriate to treat a particular patient under the doctor’s care.”
Visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.
Learn more with the AMA about great resources that set the record straight for policymakers on scope of practice. The AMA is one of the only national organizations that has created hundreds of advocacy tools for medicine to use when fighting scope creep.
