A changing health care environment: Its impact on UCSF graduates' practice patterns and perceptions

American Journal of Pharmaceutical Education, Fall 1998 by Sauer, Barbara L, Koda-Kimble, Mary Anne

In the context of this dynamic environment, the faculty embarked on an intensive curricular review process to insure that we were providing our graduates with the skills they needed to practice over a professional lifetime. The faculty took into account sweeping changes in health care delivery, the pace and nature of scientific discovery and the escalating rate of technological advances.

In 1995, the faculty drafted a new curriculum comprised of core basic science and clinical courses (2/3 of the curriculum) and three pathways (1/3 of the curriculum). The pathways selected (Pharmaceutical Care, Pharmaceutical Policy and Management, and Pharmaceutical Sciences) were perceived to meet the needs of the external environment and marketplace. The goal was to keep the curriculum flexible and contemporary and to incorporate new teaching methods that emphasize student learning. To identify the competencies required of future graduates and validate the pathways they had selected, faculty reviewed the literature(6-9), performed an informal market survey of current and potential employers, and surveyed recent graduates. The alumni survey provided an opportunity to better understand the impact that a rapidly changing health care delivery system was having on our graduates' practices. Our primary purpose here is to report the results of the 1995 alumni survey pertaining to the impact of managed care. We describe shifts in our graduates' practice patterns, their opinions regarding the impact of health care delivery changes on their practices, and the knowledge and skills they believe will be needed to succeed professionally in the rapidly changing healthcare environment. We also report the opinions of Doctor of Pharmacy students surveyed near completion of the professional curriculum, as they pertain to these same issues.

METHODS

This 1995 Alumni Survey (1980-1994 graduates) was the third in a series that has been used to gather information about our graduates' practice patterns and attitudes towards their education and the profession. The first was in 1982 (1970-1981 graduates)(10) and the second was in 1988 (1970-1986 graduates)(11). Between 1980 and 1994, 1634 individuals received the entry-level PharmD degree from UCSF; of these, accurate addresses were identified for 1453 individuals or 89 percent. A 36-item questionnaire (eight pages), which included many of the same questions as in the 1988 questionnaire (49 items, 20 pages), was mailed in October 1995. One reminder postcard was sent three weeks later.

As before, graduates were asked to rate their satisfaction with their education and the profession and to describe their first and current practice situations. The latter included practice settings, payroll titles and the percentages of time spent in performing major job functions (managerial, operational, clinical-administrative, clinical-direct patient care, and teaching). To clarify a previous observation that a high percentage of graduates were involved in administrative responsibilities, we expanded the current survey to distinguish between administrative activities related to patient care (e.g., formulary management) and traditional managerial functions such as personnel and fiscal management. Graduates were also queried about whether they had specialized, whether they were certified as a specialist, and whether or not they exercised prescriptive authority in their current positions as allowed by expanded scope of practice laws in California. The current survey was further augmented to capture graduates, opinions regarding the impact of managed care on their practices and the extent to which they agreed with an expanded list of practice competencies under consideration by the faculty.