Compulsory Service for New Pharmacy Graduates ? Is It Necessary?
by Dato? Dr. Anis
The Ministry of Health has recently announced that it will be compulsory for new pharmacy graduates to serve the Ministry for a period of three years before they are allowed to practice in the private sector.
The necessary amendment to the Registration of Pharmacists Act 1954 is currently being tabled in Parliament and the relevant provisions will be enforceable in 2004. The main reason for this move is to fill up the chronic vacancies existing in the pharmaceutical services of the Ministry. In doing so, the pharmaceutical services will be able to provide a service par excellence to its clients which not only include the patients of the government hospitals but also the general public.
Although there have been general support for this move, particularly from the Malaysian Pharmaceutical Society, there are also questions raised by the local pharmaceutical industry about the necessity of this move, especially when there is a dire need for pharmacists to spearhead the expansion of the local pharmaceutical industry to meet the challenges of globalisation.
To fully understand the necessity of this move, it is necessary to reflect on the growth of the pharmacist population in the country, especially in relation to the training of pharmacists. Although the first register of pharmacists was opened in 1952 with 40 pharmacists on the register, it was only after 1975 when the Universiti Sains Malaysia started to produce its graduates that the population of pharmacists began to grow substantially in the country.
In 1980 the population of registered pharmacists has grown to about 500. This number increased to around 1,500 in early 1990 and to about 2,500 in year 2000. Before 1975, the population of pharmacists grew at the rate of less than 50 per year. In 2000, the growth rate of pharmacists increased to around 200 per year. By end 2003, the output of pharmacy graduates is expected to be around 400 per year.
The standard training of pharmacists involves 4 years undergraduate training at Universiti Sains Malaysia or any other universities recognised by the Pharmacy Board. This is followed by one year pupilage training at places recognised by the Pharmacy Board, such as selected pharmaceutical retail outlets, manufacturing facilities as well as places in the Ministry of Health. Over the past few years the number of such training places in the private sector has not increased in tandem with the increase in the number of pharmacy graduates. This is probably because the Pharmacy Board has imposed a comprehensive requirement before allowing a premise to be recognised as a training place for pupil pharmacists. For a retail pharmacy to be recognised by the Board as an approved training centre for pupil pharmacists, the Board requires, among others, that the pupil master has several years experience in retail, the outlet processes a certain number of prescriptions per month and reference materials in the outlet are adequate.
In year 2000, only 44 retail pharmacy outlets were recognised by the Board as pupilage training centres. In addition, the industrial pharmacy sector provided an additional 16 places whilst private hospitals provided an additional 13 places. The Ministry of Health takes the responsibility of training the rest of the pupil pharmacist that cannot find places in the private sector. Thus, available training places for pupil pharmacists in the Ministry of Health have to be increased to absorb the growing number of pharmacy graduates.
It is generally recognised that the Ministry of Health provides the best all-round training for pupil pharmacists. The schedule of training covers all aspects of pharmacy including pharmaceutical care in hospital pharmacy and enforcement activities of the pharmacy services. In the Klang Valley, pupil pharmacists are trained in regulatory pharmacy as well. Pharmaceutical Care involves in-patient and out-patient pharmacy services, patient counselling, clinical pharmacy practices as well as purchasing and inventory control.
Training in enforcement pharmacy involves understanding all the relevant pharmacy laws and its implementation in the practice of pharmacy. The pupil pharmacists has to learn to enforce the pharmacy laws and one has to know the law thoroughly before being able to enforce them.
Regulatory pharmacy provides the opportunity to have an in depth knowledge of the working of the Drug Control Authority including the registration of pharmaceutical products, quality assurance through the application of Good Manufacturing Practices as well as post-marketing surveillance of pharmaceutical products.
It is estimated a one-year attachment to each of the above units will provide the pharmacists with comprehensive knowledge of how the pharmacy profession is managed in this country. Therefore a three-year stint in the Ministry of Health?s Pharmacy division will better prepare a pharmacist to stand on his own in the private sector so that they are able to serve their clients in a more professional manner and in conformance with the current legislations.
A three-year compulsory service in the government sector will provide all new pharmacists with this opportunity. The need for this three-year stint is also necessary when one considers the varying content of pharmacy courses offered at various universities worldwide. The Pharmacy Board recognises at least 62 universities from 17 countries. In addition there are at least 7 local institutions that offer degrees in pharmacy either on its own or in the form of twinning programmes with local or overseas institutions.
Even though there is a process of accreditation before these degrees are recognised by the Pharmacy Board, a re-evaluation is also conducted on an ad-hoc basis. This is needed as it is difficult for the Pharmacy Board to ensure that the curriculum approved during the accreditation exercise is maintained by the universities concerned. Therefore, in order to prepare a new graduate for practice in the public and private sectors, it is prudent for the Pharmacy Board to manage the pupilage and post-pupilage training programmes.
Currently, the best approach towards this end is to require the pupilage to be undertaken at the Ministry of Health, followed by relevant exposure in the various activities of the Pharmaceutical Services in the Ministry for a period of three years. In essence, a three-year stint in the government services will undoubtedly increase the level of competence of pharmacists before they are allowed to venture into the private sector where in a majority of cases, they operate as lone pharmacists. In this way the public will be assured that pharmacists in the private sector are well trained to practice their profession.
The compulsory service can therefore be regarded as an extension of the pharmacist?s professional training programmed that will increase the professional competency of pharmacists before they are allowed the privilege to serve the public.
It cannot be denied that the implementation of compulsory public sector service for pharmacists will result in an acute shortage of pharmacists needed in the private sector. The growth of the retail pharmacy sector will slow down to almost a standstill for the next three years and local pharmaceutical manufacturers will not be able to recruit new pharmacists for their industry.
However, the proposed amendments to the Registration of Pharmacists Act 1954 do provide the Ministry of Health with certain powers of exemption with regard to its implementation. Therefore, it is prudent for certain sectors of the pharmaceutical industry to organise themselves and forward proposals to the Ministry of Health so that implementation of the Act does not critically jeopardise the growth of the local pharmaceutical industry.
Source: Courtesy of Zeullig Pharma Mail Issue no 25, Dec 2003