"You’re always going to hear those anecdotal things," says Patricia Harris, executive director of the California State Board of Pharmacy, "and pharmacists are always going to lose jobs if they’re not capable, and then they’ll blame anyone and anything." Harris oversees a system that includes statewide registration of technicians, "but it’s not competency-based. We’re having an informational hearing at an upcoming board meeting on the issue of certification, to try to figure out where we stand on that process."
Nationwide certification of pharmacy technicians is the newest attempt at imposing cohesiveness in what’s been a divisive and misunderstood issue. A consortium of the American Pharmaceutical Association, the American Society of Health-System Pharmacists, the Illinois Council of Hospital Pharmacists, and the Michigan Pharmacists Association resulted in the Pharmacy Technician Certification Board (PTCB), a non-profit agency overseeing the development and implementation of voluntary certification. At a recent briefing in Washington, D.C., the agency announced the designation of "CPhT" for technicians who pass a nationwide certification test.
"By being a voluntary process, it’s left to the technician to decide to seek certification," says PTCB executive director Melissa Murer. "But those credentials then assert that the person has mastered a core level of knowledge and skills."
APhA and ASHP have long been opposed to any kind of mandatory technician testing. The official APhA position emphasizes the importance of pharmacist control over all aspects of technician performance – to the point of encouraging pharmacists to develop written guidelines that specify a technician’s functions and the pharmacist’s supervisory controls.
When the PTCB began examining the kind of certification that would satisfy requirements throughout the country, as well as in all the many types of pharmacy, it borrowed the APhA’s caution and added some precedent: specifically, the certification testing already conducted in Michigan and Illinois.
Larry Nesmith is a both a pharmacy technician and a technician trainer based in San Antonio, and served on the PTCB’s certification council. "That statewide certification tests that began in Michigan and Illinois in the 1980s were popular enough that by last year they were being given in 25 states and overseas," he explains. "So those tests set the standard. The council studied pharmacists’ tasks as well as technicians’ tasks, and developed a survey that we sent to technicians across the country to be sure the tasks we identified were valid on a nationwide scale. When the results came back in we were able to develop our part of the national certification process."
From there, the proposed test went to the New York-based Professional Examination Service (PES), which specializes in developing credentialing for the healthcare industry and other professional services, for its final shaping. The first examination will be given at over 120 locations across the country June 29 (see sidebar: The Road to Certification).
Technicians, then, are here to stay. Some pharmacists believe that they’re needed more than ever. The managed care environment demands diversification of the traditional pharmacist’s role, and with more and more states requiring patient counseling, the technician can take over a pharmacist’s busy work. Nesmith observes that the certification process "is a way of standardizing across the states. Even though a technician may have learned a lot on the job or gone through one of the formalized programs offered by colleges and hospitals, it doesn’t indicate that they’ve met the criteria we look at in certification."
The Pennsylvania-based Institute for Safe Medical Practices was formally organized in January 1994 after 20 years of grassroots work, with a mission of promoting safe medication practice by educating both the public and professionals about potential problems. Institute president Michael Cohen, himself a pharmacist with over 25 years’ experience, is cautiously enthusiastic about the part technicians can play.
"Having technicians working alongside pharmacists is a good idea," he says. "The safest dispensing practice includes techs, giving you that extra pair of eyes. And if there’s a disagreement about medication, whether brought up by the technician or the pharmacist, the good thing is that a red flag goes up. The use of technicians should give the pharmacist more time for patient counseling and drug screening. The only thing we’re concerned about is that techs should not be used to the point where they’re doing dispensing or entering ordering information."
And he likes the idea of testing. "We’re very much in favor of certification. Given the kind of society we live in, it’s natural to expect there to be some kind of certification."
Another watchdog group is the People’s Medical Society, founded 12 years ago by the late Robert Rodale to provide consumers with more ways of obtaining information about medical practices and medication. "One of his chief concerns back then was the $300 billion a year that was spent on medication," says Michael Danio, the society’s director of projects. "This year it’s expected to be $1 trillion." Rodale also started Prevention and Organic Gardening magazines, among many other titles, and his publishing company still provides hundreds of titles about good health and better living.
"In hospitals, techs have a place in dispensing and storage," Danio says. "Techs who assist a pharmacist provide an extra pair of hands and an extra pair of eyes, but it’s the pharmacist who’s in charge and who takes responsibility. If the techs are pulling from the shelf or counting out medication, you want supervision. Even if the job is just stocking and storing, there has to be assurance that things are going into the right bins. But if a technician can say to the pharmacist, ‘Hey, check me out on this, Harry,’ you have that extra security level, and that extends to making sure that somebody didn’t mis-read a prescription or a label."
With pharmacist supervision so important, the ratio of pharmacists to technicians is debated from state to state. The PTCB’s Murer won’t name any ideal figure: "We’ll see as the process evolves. It’s really up to the pharmacists because they’re the authority figures and technician has to work under the pharmacist’s purview." But a new wrinkle has been added in some hospitals, she adds. "A number of states are instituting ‘technician check techs’ programs in their hospitals, which allows them a higher ratio. The state of Washington has one, and Minnesota and Michigan are both looking at it."
Cohen is similarly guarded. "We believe that there’s a limit to the number of techs who can safely be used in a pharmacy. I don’t know what that magic number is, but obviously the key here is supervision. Some hospitals have situations where pharmacy techs check other pharmacy techs, which can be good – but some drugs are so dangerous that they should never be dispensed in that manner."
California is one state that imposes a ratio, says Harris: "In the community pharmacies, there’s a one-to-one technician to pharmacist ratio. In the in-patient hospitals, it’s two-to-one." Even so, she doesn’t see pharmacies using technicians as efficiently as hospitals. "There’s been a major change in pharmacies in that pharmacists are now required to get out and consult, and we’re seeing a transition of traditional functions of pharmacists being passed to technicians, and not a lot of them feel real safe with that. But I think it’s getting there. We’ve had a couple of incidents where the problem was caused by a technician who didn’t fill a prescription properly, but ultimately it’s the pharmacist’s responsibility to check it. So if anyone is going to be cited, it’s the pharmacist."
The use of techs obviously increases a pharmacist’s vulnerability, but is there another, more subtle threat to pharmacists from techs who decide to go after a pharmacist’s degree? Larry Nesmith has seen it happen: "A lot of our technicians who’ve been in the profession for a while decide that they would like to continue on in pharmacy school. But there are many who choose to stay in the field as a technician." He points to his own 30 years as a technician, beginning with an Air Force-sponsored technician training program and including work in both VA and civilian hospitals. "It can be a very worthwhile career."
With the beginning of nationwide certification, what has been a state-by-state free-for-all over the past 30 years is quickly getting standardized. Individual states are in the midst of studies to determine the best way to accommodate the certification process, and the kind of uncertainty that existed even a year ago is vanishing. Far from being a questionable addition to a pharmacy staff, the technician is proving to be increasingly essential.
The Road to Certification
If you’ve been certified using one of the Michigan or Illinois exams, you can apply for a certification transfer. This requires completion of an application form and payment of a $25 fee. Transfer applications must be completed by December 1996.
Otherwise, testing will take place this year on July 29, September 9, and December 9. To be eligible, you must have a high school diploma or a GED. Most state pharmacy associations have copies of the Candidate Handbook, which contains the application and instructions for applying to take the exam; if your state isn’t among them, you can get one from the PTCB office (see below). The handbook also gives an outline of the exam’s content to help you develop a plan of study. Look for a review of generic names, compounding and other topics that show knowledge of pharmacy operations.
Over 120 locations across the country have been designated as testing centers. If religious beliefs prevent you from taking one of the Saturday exams, alternate arrangements can be made. The application fee for the exam is $95, and certification is good for two years. The renewal fee will be $25, and requires proof of at least 20 hours of continuing education.
Three more examinations are planned for 1996; by 1997, according to one of the developers of the exam, it will move from pencil and paper to a computer-based testing process.
If you do take the test this year, you’ll join about 6,000 others who also are expected to go for certification. And you’ll be able to wear the designation "CPhT" after your name, a designation confirmed by the certificate and wallet card you’ll receive six to eight weeks after the exam.
Eighteen states already have agreed to participate in this program through both their hospital societies and pharmacy associations. They have the extra incentive of $15 for each candidate whose application properly identifies a host state; for the 13 additional states where a hospital society or a pharmacy association has come on board, the bonus is $10 per candidate.
If your sights are set on a technician job with a community pharmacy, a handy study guide has been developed by the Community Retail Pharmacy Working Group, a coalition of the NARD and the NACDS. Their Community Retail Pharmacy Technician Training Manual covers the basics of work in that environment, presented in an updatable format so that employers can customize the manuals to meet any special training needs. Call NARD at 703-683-8200 or NACDS at 703-549-3001 for more information.
Certification remains a voluntary process, and is intended as an identifying device. You shouldn’t lose out on work if you’re properly qualified but lack the CPhT. Still, it may prove to be an impressive badge of accomplishment.
"I don’t know how it will affect the marketplace," says PTCB director Melissa Murer, "but a lot of states have been picking up on the certification program, and I think we’re seeing situations where certified technicians are placed on different career ladders."
– Some Pharmacy-Specific Magazine, around May 1995
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