Clinical vs Community Pharmacists: What’s the Difference?

TYPICAL TRAINING

By training, all pharmacists have a Doctor of Pharmacy* degree. Most clinical pharmacists have at least one year of residency, and many have two years of residency training. Many clinical pharmacists pursue board certification in their field. Additionally, the practice settings in which clinical pharmacists are located tend to provide them with significant advantages for learning clinical skills on-the-job as well as employer-funded training opportunities to further their education.

Although less common than in the clinical setting, there are one and two-year pharmacy residency opportunities in the community setting. Often, the 2nd year community pharmacy residency has an administrative focus. Additionally, community pharmacists can also pursue board certification. On the job training to enhance clinical skills can and does occur, but may often not take priority due to staffing shortages, workflow concerns, and/or revenue considerations.

PRACTICE SETTINGS AND ACTIVITIES

Clinical pharmacists typically work in hospitals, clinics, or other healthcare settings where they may be integrated into a healthcare team. Their activities focus on direct patient care, complex medication management, disease state management, therapeutic outcomes, medication consults, and medication-related teaching, protocols, and procedures within their settings.

On the other hand, community pharmacists work in retail settings (independent or chain) that sell and dispense medications to patients. Community pharmacists focus on providing pharmaceutical care services directly to the patients within the community setting. They frequently interact with patients and customers and serve as one of the most accessible healthcare advisors in the community.

ROLES

Clinical pharmacist roles often include physician medication consults, overseeing their own patient panel for disease-specific or medication-specific management (e.g. anticoagulation, diabetes), collaborating with healthcare providers to develop patient treatment plans, monitoring medication efficacy or safety, providing medication education and counseling, participating in clinical rounds, integration into area-specific teams (transitions of care, ER, oncology), conducting research, quality improvement initiatives, and evidence-based practice within the healthcare institution.

Community pharmacist roles often include dispensing medications, handling prescription processing and insurance claims, managing pharmacy inventory, providing medication counseling, education, and monitoring, addressing barriers to medication adherence, offering over-the-counter medication recommendations and advice, vaccine counseling and administration, CLIA waived test administration (e.g. rapid strep A test), prescribing specific in-scope prescription medications (laws vary by state, e.g. hormonal contraception), and collaborating with healthcare providers for prescription issues and patient care.

Even though the above descriptions are significantly different, there is significant overlap between these two groups. While it is true that the majority of pharmacists who participate in traditionally “clinical pharmacist roles” operate within clinic or hospital settings, there are many pharmacists within community settings who are more than qualified to take on clinical roles.

Pharmacists in both traditional clinical settings and community settings have the same strong foundational training in medication management and pharmacotherapy. Clinical pharmacists tend to differentiate themselves from community pharmacists by receiving post-doctoral training and board certification to elevate their clinical knowledge and skills. However, with the right tools and training, there is no reason why community pharmacists can’t use their knowledge base to elevate their care for their patients.

BARRIERS TO CLINICAL WORKFLOWS IN COMMUNITY PHARMACIES

Unfortunately, creating the opportunity for community pharmacists to serve as effective providers for patients requires a systematic expansion of their role beyond the traditional dispensing of medications. For them to do this, there must be 1) support from national and state governing bodies 2) some kind of reimbursement for their activities 3) integration of their EHR within local EHR systems 4) support from local providers, clinic/hospital administration, and community pharmacy management.

It may seem like an impossible feat, but if we can get these four elements to align, opening the door to community pharmacist providers would significantly expand access to primary care services, especially in rural and frontier communities, help solve one underlying issue concerning the great pharmacy exodus**, and create numerous higher satisfaction job opportunities for pharmacists.

IDAHO-SPECIFIC OPPORTUNITIES

In Idaho, pharmacists have one very big thing going for them. Item number one, support from state governing bodies is in full effect. Idaho currently has the most advanced pharmacist practice laws in the nation. To date, Idaho pharmacists may autonomously diagnose and prescribe as long as their actions fall within their education and training, and they follow current Idaho prescribing law which includes notifying the patient’s provider when prescribing takes place.

Additionally, Idaho Medicaid will reimburse pharmacists for specific services including CPT codes for new and established patients (99202-99205; 99211-99215), Remote Patient Monitoring (RPM), smoking cessation, and some others. A few other plans are also willing to credential and reimburse pharmacists including plans under St Luke’s Health Partners and Bright Path. SLHP and Bright Path do not restrict which codes credentialed pharmacists may bill for.

It is an exciting time to be a pharmacist in Idaho. And, while Idaho consistently ranks at or near the bottom on lists showing ability for patients to access care, our state law has created a huge opportunity to improve patient outcomes and enhance the overall quality of care using pharmacists (including and especially community pharmacists) by expanding their clinical abilities and roles within the communities they serve.

*In 2003, it became US law for students to complete a Doctor of Pharmacy to become a licensed pharmacist. Pharmacists who graduated prior to 2003, could earn their degree through a Bachelor of Science in Pharmacy (a minimum 5-year professional degree) or a Doctor of Pharmacy (a minimum 6-year professional degree). https://www.studentdoctor.net/2012/01/11/pharmacy-a-brief-history-of-the-profession/

**The great pharmacy exodus: “Nearly a third of independent pharmacy owners may close their stores this year under pressure from plunging prescription reimbursements by big insurance plans and their pharmacy benefit managers,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA. “This is an emergency. And if Congress fails to act again, thousands of local pharmacies could be closed within months and millions of patients could be stranded without a pharmacy.” https://ncpa.org/newsroom/news-releases/2024/02/27/local-pharmacies-brink-new-survey-reveals