Currently associate dean of administrative affairs at the School of Pharmacy, Virginia Commonwealth University, Bill Smith has enjoyed a broad career in health system pharmacy and is widely regarded as a great visionary in pharmacy. Smith shares his thoughts on the future of pharmacy and what young pharmacists must do to bring positive change to the profession.

PharmacyNOW: Let’s start with one of your passions, the future of clinical pharmacy. What do we need to do as a profession and why?

Bill Smith: I think the profession is still struggling to try to identify what its core purpose or mission is. We continue to be dominated by the dispensing function and the "corporatization" of health care pharmacy. Therefore the organizations we work for have their own agendas and I think we have a clash between the cultures of the business versus a health profession. I think it comes down to deciding what we are all about. If you ask pharmacists or graduates from schools of pharmacy to articulate what they believe their basic purpose is, you do not get a very good answer. That needs to change. Frankly, I am disappointed that we haven’t gone farther in building clinical practice, either in hospitals or in other kinds of practice settings. So that is what I am going to focus on in whatever is left of my professional life!

I went to the University of California San Francisco and also completed a residency at UCSF in the medical center. I had an opportunity to plan and put a satellite pharmacy on the ninth floor of Moffitt Hospital, which was the beginning of decentralized clinical practice. Then I left to try the world of community practice and hospitals. I went to Long Beach Memorial in 1967 and was appointed director in 1968. I was able to recruit a great pharmacy staff and administrative team and we had a great ride from 1968 to the late 1980’s. Then, in the late 1980s, hospital administration changed, the census started dropping after changes in both state and Medicare in 1984, and the consultants thought our decentralized clinical program was not fitting in. I left after five years of hassling with administration and went back to graduate school in 1991 at the age of 51 and survived a very rigorous PhD program. I then made a career switch, moved across country from southern California to the cold winters of New England, and made an adjustment in academia. I have been in Virginia for five years and am having a lot of fun.

I’ll answer that question with an example. I taught an elective course to four third-year pharmacy students which focused on defining what practice should be, how to implement the new practice, how to manage it and then how to evaluate it. Those are the questions we need to answer.

As an associate dean, we have to look for the bigger picture. We have incredible talent sitting in the classrooms of pharmacy schools today. We have students at a time trying to learn the greatest number of drugs, drug products, drug information, biomedical information and pharmacy science information that has ever existed in the history of mankind and we are throwing the coursework at them. After we’ve done that, we try to get them into the clerkship year where they can begin to apply what they’ve learned. We try to give them some sense of newer types of practice, cognitive services and clinical practice, and give them some kind of tools on how to move forward and make it happen. It is too easy for students to chase the big bucks now. Then, many of them become very disenchanted. We try to set a bigger professional goal and find a way to get there. We want them to be willing to fight the battles, like us old people have done, at trying to change practice. There are still a lot of those battles that have to be fought.

In the initial plan of the ninth floor project (at Moffitt Hospital), the chairman of the department of surgery had converted the floor to be an innovative floor for any department in the hospital and so pharmacy got in the planning. Urology was one of the wings on the floor. During a planning meeting, we were talking about having pharmacists interview patients at admission time and at discharge. The head of urology said, "Not on our patients, we are tired of pharmacists giving the wrong information to our patients. " That was my first confrontation with that kind of reaction from a group of physicians. I experienced similar reactions to the satellite pharmacy program in the early years at Long Beach Memorial. I had physicians who thought it was crazy. I was told to go jump off the Long Beach pier. I was known as the maniac in Long Beach out to destroy the profession. Finally after three or four years, the medical people and physicians on several key committees came to realize the value of the pharmacist in clinical practice and they defended us against the surgeons and others in the medical center. After about five years, we had a lot of support from a medical staff that really came to our rescue in the late 80s when a consulting team and a new administrative team wanted to dismantle the whole clinical pharmacy program. From these experiences, I learned how important it is to be aware of what we are doing, what terms we are giving it and what the reactions are to it.

A lot depends upon the profession trying to figure out what it is all about. We have got to develop practice models. I think there ought to be a standard of practice that pharmacists are going to provide to patients who come into an acute care hospital or a community pharmacy or a geriatrics facility; we don’t have that. Where we are going depends upon our own self-determination of what we want it to be. Also, we have to come up with a way to educate more pharmacists to be capable managers in today and tomorrow’s world. We have done a dismal job of trying to develop management expertise within the profession and we are paying a price for that. And then we have to figure out how we are going to cope with another 350 to 500 new drugs that are going to be approved by the FDA, that are going to be even more complex, more potent, more tricky to use than what we have now.

I am a native Southern Californian. When I was a child, I just decided I was going to get an education. I had to go to work when I was in high school and, just by luck, started working in a one-man independent pharmacy. After four months there, I decided I was going to go into pharmacy because I was very turned on by job security, which was very important to me. I was the first person in our family to go to college. I have been determined not to be a financial burden on my kids and to financially assist my parents.

Through hard work and by giving up some things. I had a great passion for baseball, but I decided not to pursue a couple of inquiries I had to play college baseball. In retrospect, I wish I had done it. Instead, I have poured myself into youth baseball through the years with my son and now with my grandkids, who happen to live on our street. I did not spend a lot of time in service clubs or scouting or other things. I focused on what I was doing and I’d try to do it as best as I could. You have to recognize that you need to work for what you want; it just doesn’t land in your lap.

I think it would be serving other people. I recently spoke to a graduating class at Northeastern University. I gave them four suggestions for the future of their lives as pharmacists. Number one was to make sure that they were clinical drug experts. The second thing was to commit themselves to serving the needs of other people. The third thing was to develop their information technology skills because it would increase their efficiency and capability to practice. Number four was to be adaptable.

It was honesty, hard work and quality; she is always trying to do better. She has had a difficult life, but she continues to battle. She has multiple health problems at the age of 86, but she still continues on. She is a tough lady.

Professionally, it is Dr. Donald Brodie, who I had the privilege of meeting while I was at the University of California San Francisco; personally, my mother. Dr. Brodie, was an incredible individual, someone who served other people and was a tremendously devout Christian. He always said it doesn’t take talent to be average; it takes talent to be unique. Anybody who came in contact with him for any length of time could not help but be affected by his approach to his professional life as well as his personal life.

There are millions of patients every day in this country who are in drug therapy difficulty because of the failure of the pharmacy profession. How on earth can a profession that says we are drug experts, commanding the incomes we are making, stand by and allow the number of people who are in lousy drug therapy to continue? I can’t buy that. My goal is to do something to minimize those numbers. Otherwise, who needs us? That is what it is all about.

The future of the pharmacy profession, if you focus on the clinical piece of it, is extremely bright. I think it is exciting. I think it is challenging. I think it is personally and professionally satisfying. To move from where we are, to taking care of more and more patients and all the facilities, is just going to take a heck of a lot of work. One has to focus on it, dedicate to it and stick with it.

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