The Argument for BPS Certification of EM Pharmacists: Looking forward, not back. 

EM Pharmacists are indispensable assets to modern healthcare. This petition for EM recognition by BPS is an anthology of the amazing efforts of EM pharmacists that have transformed emergency care. Each pharmacist innovating practice in EDs has established high levels of care, earned recognition on merit, and has been regarded in the medical community as experts. They have accomplished these feats despite board certification. I would contend that the articles outlined in the referenced petition establish the argument that BPS certification is not necessary.

Below I will outline my objections specific to each criterion.

Criteria A: Need

This criterion asks for evidence to demonstrate a need for pharmacists in with specialty practice that is not currently met by generalized practice pharmacists, pharmacists practicing in other specialty areas, or other health professionals. However, it does not address the reality that pharmacists are already, in fact, practicing in this area. For the majority of the remainder of this petition, these experts and their efforts will be outlined: all of which have been accomplished without BPS certification. The report does not address how BPS certification would meet this need.

Criteria B: Demand

An outline of employer demand for board certification. This section does not address the market pressures of pharmacists’ excess and job shortages. Of course, employers will prefer more training, it shifts their need for job training. This implicit bias was not controlled for in any assessment of the need for board certification. Appropriate market research should be sought rather than a survey of opinion of job recruiters and direct beneficiaries of deferred job training. 

Criteria C: Number & Time

This article demonstrates there are approximately 8000 – 10000 EM pharmacists already practicing, without board certification. This would represent an approximate 20% increase in the total number of BPS credentialed pharmacists. What this does not delineate is how BPS will utilize their financial gain for the profession. For the examination fee: $600 x 8000 = $4,800,000, plus $125 maintenance fee/year x 8000 = $1,000,000/year. There is no delineation of the plan to spend, invest, or otherwise manage these funds.

Criteria D/E: Specialized knowledge and skills

Defined as not applicable since BPS put this petition out. It would be hard to assess this via current BPS examination methods. Multiple-choice examinations are ineffective tools for measuring knowledge. They are best for assessing recall of facts. As outlined in the petition, the dynamic nature and complex knowledge required of EM pharmacists would call for an alternative examination process. Such alternatives should include written (essay), practical (simulated patient cases), or oral patient case assessments.

Criteria F: Education/training

ACPE already states the criteria exist within PharmD curricula: Provide direct patient care in a variety of health care settings (practice-ready) and contribute as a member of an interprofessional collaborative patient care team (team-ready). Any practice need is a deficiency of ACPE standards by Colleges/Schools of Pharmacy, not responsible for external organizations.

Criteria G: Transmission of knowledge

As described, numerous publications, guidelines, book chapters, etc have been authored by EMPs without board certification. It has not been delineated how transmission of knowledge would improve other than direct continuing education requirements to maintain this proposed certification.

Proposed changes

Rather than looking back to form the basis of credentialling, let us look forward. The changing healthcare landscape can be predicted to prioritize more outpatient care, shift to wellness rather than illness, leveraging technology (AI/IT) and virtual care options, and value-based care with novel insurance models. [Deloitte, CMS, forbesThe BPS committee should analyze what impact these strategies and technologies will have on EM pharmacists, craft strategic plans to capitalize on these innovations, then craft an exam AND curricula to prepare EM pharmacists to continue to innovate care.

There has been recent experience with the direct negative consequences of poor industry predictions. [Trends in the Pharmacist Workforce and Pharmacy Education] Specifically with regard to the generation of entry-level PharmD, vanishing job shortage, and excess new graduates. Let us not continue to make the same mistakes and use this as an opportunity for proper change.

Of course, this is an unprecedented change in the manner with which BPS conducts its business. However, there has been no demonstrable proof that the ~40,000 pharmacists who have a BPS credential have advanced practice because of, or despite board certification. 

The argument for BPS certification of EM pharmacists is perhaps one of the most important issues we will face professionally. It’s a choice to stay the course, settle for existing results, or innovate and achieve new heights. I firmly believe that utilizing our collaborative nature, we can establish such an examination that would further the specialty, rather than simply celebrate its past.