User Voice : From Dr.Vtharavath : D Pharm Pharm D going to replace doctors
A speech by a senior official of IPA forced me to write this article: I request you to spend few minutes for reading this article.
Is there anybody clearly aware of the PharmD course? If not, here are some points and it is the time to think about it.( Another headache for the doctor community.)
It is approved by the Government of India, Ministry of Health vide letter No. V.13013/1/2007-PMS dated 13th March 2008 announced in the Gazette on India dated 10th May 2008.
Being a doctoral degree, a person with PharmD qualification can keep Dr. as the prefix to his name. So he becomes a Doctor. It is a course of six year duration after +2 (more than that of MBBS course and imagine the situation of BRMS course!!!) and it should be conducted in a teaching hospital. It is a clinically oriented, community pharmacy course. According to the rules and regulations given by the PCI, the institutions which are starting the PharmD course should provide 300 bed hospital facilities. It is as good as starting a medical college.
As per the PCI guidelines: For PharmD Courses
Hospital posting. Every student shall be posted in constituent hospital for a period of not less than fifty hours to be covered in not less than 200 working days in each of second, third & fourth year course. Each student shall submit report duly certified by the preceptor and duly attested by the Head of the Department or Institution as prescribed. In the fifth year, every student shall spend half a day in the morning hours attending ward rounds on daily basis as a part of clerkship. Theory teaching may be scheduled in the afternoon.
One can understand the truth behind it while going down this article.
According to IPA, the justification for introducing this course is that (recently I came across a speech by a senior official of IPA) in the present days the pharmacists are not getting the required acceptance from the public and health community, because of the existing structure of syllabus and curriculum of the pharmacy courses. According to him there are around 60000 formulations in modern drugs. Hence it is difficult to remember all these formulations and its dosages by a doctor (will it be possible by a compounder to remember all these formulation and its dosages? If he is that much intelligent enough to remember all these formulations, he would not have become a compounder) and hence to eliminate any possible medical errors, the pharmacists must be well equipped with the subject that is clinically oriented and hence the new course. It is designed in such a way that it is more clinically oriented, community based pharmacy course. According to him main job of a PharmD person is to function as an interface between the doctor and the patients and to be with the doctors always during the consultation of patients. That means – that a PharmD person will be always with a doctor to advice the patients on drugs and its dosages.
He said that the Pharmacists are the back bones of the health care system (that means the doctors are peripheral isn’t it?) I heard the above quoted words directly from the IPA official’s speech. That indicated their ambitions and future plans. In practical, according to them, the doctor should only diagnose the disease and give a note to the so called PharmD doctors about the disease and health condition of the patients. Then these pharma doctors will prescribe the medicines (Imagine the situation of the doctor?).
Some of the roles of PharmD (community) pharmacists are as follows:
1. Patient medication history interview
2. Medication order review
3. Patient counseling regarding safe and rational use of drug
4. Adverse drug reaction monitoring
5. Drug interaction monitoring
6. Therapeutic drug monitoring
7. Participating in ward rounds – (what are they going do to there??)
8. Providing drug information at the drug information and poison information centre
That means ultimately doctors are going to loose the entire control of medicines and so called pharma doctors are going to gain the total control of medicines. In such a situation no medical representatives are going to meet the doctors and there will not be any up gradation in the drug information to a doctor. A doctor in the future is going to be unaware of any drug formulations. Doctors need only to diagnose the disease or carry out any clinical procedures and rest will be done by these Pharma doctors. Now the said course is introduced in India as if it is a doctoral qualification for pharmacy students and also to upgrade the Indian pharmacy education standard to the International level. But see that each improvement in this field is, definitely, at the expense of professional importance and freedom of doctors.
Actually this is to bifurcate or to reduce the medical importance of present day’s doctor. Definitely these pharma doctors are the old wine in a new bottle. In olden days when the doctors were less the compounders were practicing modern medicines. I have seen in my child hood days many compounders practicing modern medicine. I believe that this is the latest move by PCI to bring back the extinct “medicine practicing compounders” again. Definitely a tough competition between doctors and pharma doctors will be created in respect of powers, position and importance in the health sector, in the future.
Really we should be ashamed of speaking about our greatness after degrading ourselves by promoting a 3 1/2 year BRMS course. Considering the PharmD course, our MBBS degree must be renamed as DBBS— Bachelor of Diagnosis and Bachelor of Surgery!!! This situation must be considered and must be thought of at the beginning itself. A remedy must be formulated to save the future of the entire doctor community.
It is high time to reorganize and upgrade the structure of modern medicine. Why we are not taking any positive steps in this regard? While every sector in the health care system are trying to upgrade or reorganize their structure and curriculum, we are traveling in the reverse gear— Going down for 31/2 year BRMS course.
In my opinion, MBBS should be of 7 1/2 years duration and the curriculum should be modified to compete with and to maintain the importance of the doctors in the health care system of India.
Or even abolish the Bachelor degree and make the medical degrees as an integrated postgraduate specialized degree instead of mere MBBS graduation.
We cannot stop others from changing, but we have to reorganize or restructure ourselves to go atleast one step in front of others.
In the pdf file (also attached herewith) you can see the following sentences: The file is from the following link:
While going through the above file, one can judge to what extent a doctor will be loosing his freedom, importance and involvement in the health care of the people.
•The perception of government toward pharmacists received a setback when in the year 2002, when a Government committee suggested review of the licensing conditions that there is no requirement of pharmacists in distribution and sale of drug.
•If the kind of regulation proposed by the Government of India comes to force probably medicines will be distributed by trained assistants through public Distribution System shops (Ration shops).???????
These words shows that they are really scared of their future and the sentences imply that the govt was planning to take off the licensing system for trading drugs. They are well aware that this situation is going to arise in the future. It is very clear, that the pharmacists are trying to find out some means for their existence in the future. Hence they try to enter in to the clinical practice by modifying their structure of curriculum to more clinically oriented ,saying some justifications for defending any objections or resistance from any side. They will definitely have a claim on clinical practice too; similar to the one they are having now for dispensing medicines. It is the fundamental behavior of Indian pharmacists which spurts out of their egos.
You may please concentrate on the answer of first question in the above link which I quote below. What does it mean?
“This experience will enable the pharmacist to advise, consult & help doctors in dispensing medicines to patients, to play a role that is based on KNOWLEDGE and NOT JUST POSITION of the individual and also provide the pharmacist with a role at par with doctors.”
That is their ambition.
They are really at par with the doctor at least as per the guidelines by the PCI. It is neither mentioned any where in the guidelines stipulated by the PCI nor in the PharmD syllabus that a student must “help” or “assist” (they purposely avoided the word “help” or “assist”) the doctor during their hospital postings. They are trying to be “at par” with the doctors.
Came to know that PCI is having a plan to, gradually, phase out BPharm Degree in few years, by giving opportunity for existing BPharm Graduates to attain PharmD by some method, as done in USA earlier.
The pharmacist’s associations and their community itself working hard towards the firm existence of their future and better placements of future pharmacists, but in the contrary, doctors are not even aware of their present situations. Many of the doctors may be feeling that they have achieved every thing but are not aware of what they are loosing gradually. By introducing PharmD course (no one can say no to it) the pharmacists widened their scope of the profession in the manufacturing and trading drugs and also in the clinical side of the health care system. They are trying to become the back bone of the health care system. Apart from the above, the following are some of the numerous and diverse career options available to PharmD Graduates:
v Community Pharmacy
v Hospital Pharmacy
v Pharmaceutical Industry
v Pharmacy Education
v Bio-medical research
v Geriatric Pharmacy
v Governmental Agencies
v Home Healthcare
Where are we, the doctors???
The doctors should be the back bone of the system. No body should try to be or even dream to be at par with the doctors. We have to take the initiative to force the govt to redesign the MBBS curriculum immediately otherwise no one can predict the doctor’s fate in the future, because…. we live in India.
Please be kind enough to patiently go through the article in the following links.
From the above link few sentences are quoted below.
“A closer look at the current pharmacy practices would make it clear that there are either very slow or no reforms in laws affecting pharmacy profession in the country. There is no separation between prescribing and dispensing.”
“There is an urgent need for integrating pharmacy training, education and human resource planning. Such a move can bring in the dignity and equity to pharmacy profession on par with other health care professionals. Such a dignity would automatically sensitize the population on the ”legitimate need” for having pharmacists as an integral part of the health care system.”
Also see the following link
From this link the message is:
“The pharm D course will enable graduates to assist doctors in clinical practices and help them suggest better drug protocols and dosages”
“Unlike the existing three-year B Pharm course which limits the role of pharmacy graduates to the industry or the drug store, the new course will enable pharmacists to assist doctors in clinical practices and help them suggest better drug protocols and dosages. This would make them competent to measure blood pressure and glucose levels or even suggest alternate brands of the drugs to patients. “
If it is so, then there is no need of representatives of medical manufacturers to enter into the OP of a doctor. Doctor’s situation will be just like the
“JADAYU IN RAMAYANA”- The wings chopped off
Whatever the philosophy the pharmacists speak, the requirements and ambitions of the pharmacists are very clear from the above few quotes from the respective links shown.
My language and expressions may be different, but I will be much privileged, if this mail becomes an eye-opener to our community.
If you are interested, may please go through the site shown below. One can see how much the pharmacists are active and involved in health matters, nationally and inter nationally, trying to keep their importance always in the forefront.