Pharmacy specialties: Have you found your niche?

Three years ago, Shoppers Drug Mart pharmacist owner Fabio De Rango put a challenge out to all his full-time pharmacists: find a passion within the realm of pharmacy and develop a patient service around it that could be delivered in a community pharmacy. Not only did he pay for any additional education and certification needed for his staff to specialize, he offered the space and time for these new services in each of his three locations in Oakville and Burlington, Ont.

Fabio De Rango

“We’re never going to improve health until we develop the relationships needed to help patients change their lifestyles,” says De Rango, who is a certified diabetes specialist himself. “Let’s face it, I can’t compete on products because everyone can sell what I sell, but you can’t replace those relationships that develop when you sit down with patients and offer a valuable service.”

Inspired by De Rango’s challenge, these Shoppers stores now offer pharmacist-driven point-of-care screening (e.g., cholesterol, A1C, strep throat etc.), nutrition consultations, diabetes management and smoking cessation among other services. Most of the cost is covered through expanded scope, although patients do pay for some services like nutrition consults. “We provide the first session for free and then charge for follow ups,” says De Rango, adding that most consults are booked for a half hour and then extended as needed.

De Rango is part of a growing group of pharmacists who are realizing that specialization is the only way to survive in an increasingly competitive pharmacy market. With an expanding scope of opportunities for pharmacist to provide patient care, many see it as a way for pharmacists to secure their role as most trusted and accessible healthcare provider.

“I say you can’t afford not to invest in this area because the margins in pharmacy from dispensing are just getting smaller and smaller,” says De Rango. “This has definitely helped me grow my business, plus my team members are more engaged as they really feel like they are part of the business.”

Derek Desrosiers

Derek Desrosiers, a pharmacy business consultant and former director, Pharmacy Practice Support at the BC Pharmacy Association, echos a similar sentiment about the need for specialization in the aftermath of government cuts to health care. “Specialization creates a destination pharmacy that people will come to,” he says. “When you offer services they can’t get elsewhere, patients are willing to travel to you and that creates an opportunity for transferring the rest of their business to you too.”

Desrosiers points to various areas of specialization that are ripe for pharmacists to hone in on now as the medication experts. “Compounding is #1, and even within that there is specialization of certain types of compounding needed,” he says. “This is a lucrative one because not all pharmacies will make the investment in the necessary equipment for compounding, but all will see prescriptions for compounded medications coming in at some point.”

He also points to the benefits of healthcare coaching/management for various disease states such as cardiovascular disease, asthma and diabetes, as well as expertise in areas like travel medicine. “I know one pharmacy in Vancouver that provides diabetes management in Mandarin which is the native language of many patients in the area,” says Desrosiers. “That pharmacy attracts a lot of customers because of that.”

Specializing boosts job satisfaction

On an individual pharmacist level, specialization can have far-reaching benefits as well.

Winnipeg-based pharmacist Kristine Petrasko credits specializing early on for opening up a wealth of opportunities throughout her career to date. A certified respiratory educator, she has expertise in asthma, allergies and chronic obstructive pulmonary disease, among other specialities. She’s currently working at a methadone clinic two days a week, and picking up a whole new area of expertise in the process.

Petrasko says having a speciality “opened up doors” at the University of Manitoba ’s Faculty of Pharmacy, where she was a pharmacy practice instructor for four years. It also helped her in landing a job at the Winnipeg Regional Health Authority where she spent five years as a Regional Pulmonary Rehabilitation Program Educator. “In order to stand out, you need to specialize; it certainly gave me an edge,” she says. (According to the Canadian Network for Respiratory Care, there are currently 289 pharmacists who are certified respiratory educators in Canada, and 109 who are certified asthma experts.)

In an era where more and more people will be graduating with PharmDs (and a vast amount of clinical knowledge to their credit) Petrasko says finding an expertise in pharmacy practice is more important than ever to maintain your value in the workforce. “Why keep waiting until everything changes and you’re stuck in a rut,” she says. “Pharmacists need to reinvent themselves now.”

Ron Pohar, an Edmonton-based pharmacist who has been specializing in mental health and addiction for more than two decades, says he’d likely be out of the profession already if he hadn’t found his niche. “I don’t think I’d find it nearly as professionally satisfying,” he says. “I’ve been able to take this skill set from pharmacy to pharmacy and it’s always been viable.”

He first considered pursuing this specialty while providing medication management services for an inner-city Salvation Army in Edmonton. “It was there I realized the connection between those with addiction issues and symptoms of mental illness,” he says. “Mental health and addiction is a still an under-serviced area where pharmacists can have a big impact,” he says, noting that tobacco addiction in marginalized populations is a big issue.

Women’s health is another area that more pharmacists should consider developing expertise in, says Irene Stronczak-Hogan who is based in Hamilton, Ont. Her more than 25 years in women’s health and natural medicine has culminated in her first book deal this year about how to survive menopause, and a series of online workshops she is developing on women’s health based on her years of counselling sessions on the topic. In fact, the book titled Hot Chix, Hot Sex, has become a best seller on Amazon.

“We’re still doing clinics and getting nurses to come in and present on topics that pharmacists should be doing,” says Stronczak-Hogan. “I started off by talking to one doctor about hormone replacement and eventually started offering sessions for women’s health one day a week at the [independent] pharmacy where I was working.” Even when a big chain took over and dropped the women’s health program altogether, she continued offering private consultations that patients willingly paid for.

When it comes to specializing, getting sufficient training is only half the process, adds Stronczak-Hogan. “People get certified and say there’s nothing out there but you have to show patients what you can do and build your network from there,” she says. “I went out on a limb and found [an environment] where I could provide my services.”

In the meantime, educators are also recognizing that specialization is an increasingly necessary aspect of pharmacy training. “We don’t train students to be specialists off the bat, but through their elective courses and co-op placements, they get exposure to areas of pharmacy off the mainstream that they may end up pursuing,” says David Edwards, professor and Hallman Director at the University of Waterloo’s School of Pharmacy. While there are many established specialty residencies available for pharmacy students in the U.S., he says Canada only has a handful due to lack of funding.

The University will be launching a Clinical Masters program in 2020 designed to develop “high-level clinicians,” and the University of Toronto has a similar program in the works. “[Students] won’t necessarily be in speciality practice, but they’ll definitely have the skills to be experts in certain areas,” says Edwards.

He also believes specialization in pharmacy will continue to increase as a way to set pharmacies apart from their competitors, especially as patient needs get more complicated. “These days you’re seeing an increase in pharmacies devoted to complex biologic medications, for example, and that’s a direct result of the complexity of those patients and the drugs required to treat them,” he says. “The complexity of patients and medications really does lend itself to specialization.”

Starting in March, we’ll be regularly profiling pharmacists across Canada who have a practice specialty. To submit profile suggestions, contact [email protected].

Recognizing specialties in pharmacy

The U.S. Board of Pharmacy Specialties, established in 1973, provides certification to pharmacists in the following areas:

• Ambulatory Care Pharmacy
• Critical Care Pharmacy
• Geriatric Pharmacy
• Nuclear Pharmacy
• Nutrition Support Pharmacy
• Oncology Pharmacy
• Pediatric Pharmacy
• Pharmacotherapy
• Psychiatric Pharmacy

There is no process in place this side of the border yet to formally recognize pharmacy specialties across Canada, however, a report on pharmacy specialization in Canada was released in 2015 and stakeholders are further exploring the concept. In the meantime, however, there are numerous ways in which Canadian pharmacists can obtain specialty certification, whether through the U.S. Board or through various disease and health organizations. We’ll look at some of those in future articles.

READ ABOUT MORE THAN A DOZEN PHARMACY SPECIALITIES IN OUR DEDICATED SECTION.