When I qualified too many years ago, there were definite sectors you chose to work in and that defined you. You were a community, hospital or industrial pharmacists. Switching, whilst not impossible was tricky and most pharmacists seemed to settle into their roles in the knowledge that they would have a secure role for life.
Times have changed with the introduction or more sectors, including prison, CCG and GP practice role and the advancement of technology making information sharing easier. So we now have more sectors but I think less differentiation. I think we now have only two types of pharmacist, clinical and commercial.
I floated this thought on Twitter (@shaunhockey) over Christmas and received some vociferous responses stating that “All pharmacists are clinical ” but I think we all know that are a significant number of pharmacists are much more commercially focused than they are clinical.
My definition of a clinical pharmacist is one whose first thought when they are faced with a prescription or medication query is about what’s best clinically and conversely a commercial pharmacists is ones whose first thought is the costs/profit implication.
Is a clinical pharmacist better than a commercial pharmacist? Depends on the setting. If i’m at death’s door I want the clinical pharmacist fighting my corner not the commercial one because I know meds at the end of life can be expensive. If I’m a regional manager for a large multinational with tight targets I want my pharmacists focusing on maximising sales and profits.
So what makes a pharmacist clinical or commercial? I think most pharmacists enter schools of pharmacy wanting a clinical role although there are definitely some who see it as a means to an ends for pharmacy ownership. I think the community pharmacy contract and Drug Tariff forces many pharmacists in community pharmacy to be more commercial than they would like to be and I think the conflict between commercial and clinical is at it’s most obvious when we consider the DT. Pharmacy contractors will endeavour to maximise their sales and profits by choosing pack-sizes or formulations that maximise their sales and that’s fine from commercial standpoint. From a clinical standpoint, the cost is not the focus but the outcomes for patients are and if local providers are struggling due to budget constraints then choices that maximise costs are a serious issue.
Can we be both clinical and commercial? I think a clinical focus with commercial acumen is our USP among healthcare professionals. It’s massively valued when you work in GP practices and for CCGs as budgets are really tight and it’s always been important in community pharmacy.
So we have more sectors and more information and definitely more pressure. We are one profession wherever we work and the analogy I would use it that of the balance on a stereo where you can move the sound from one speaker to the other. The role you undertake will dictate where the dial is turned and the secret is getting the dial in the right place.
