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Re-scoping scope

I’ve written before about how the phrase ‘practice to full scope’ confuses me. It still does a bit, but I’ve evolved in my thinking. I’ve had a few conversations in the past few weeks that have made me see it from a slightly different angle and challenged my thinking.

When I thought about it previously, I was pretty caught up in my own world. I heard people using these phrases about the profession and I assumed they were applying it to the profession as a whole (I am still not sure if they were or not?). Because I didn’t fit with what they were describing, I didn’t buy into what they were saying and assumed it was all bullshit. But I think that’s where I was wrong.

If we think about how much the profession has evolved over the years, we must keep in mind that the education provided to pharmacy undergraduates has also evolved. True, a graduate from 1995 might need extra training to conduct HMRs, but a graduate from 2019 has already been armed with the skills required. Similarly, other aspects of the curriculum have evolved and will continue to evolve to stay relevant to the times. I might need training to administer a vaccine, but there’s no reason why this couldn’t be addressed at an undergraduate level from now on. Scope of practice isn’t a generalised term.

Defining your individual scope of practice is the core component of what makes you a professional. It’s not about what everyone else can do, it’s about you. Setting your professional boundaries. Because you are an ethical professional you are expected to be able to self identify this. It’s what the whole CPD process is based upon and part of what you’re declaring when you renew your registration each year. I’m kind of a bit embarrassed that I forgot about this to be honest.

So for me sure, vaccinating isn’t within my current scope of practice. But neither is dispensing. I haven’t dispensed since 2011, and I was never very good at it. I am not a stickler for details, I am not meticulous enough and I make too many mistakes if I dispense over a long period. If I was to take on a role that had either of these as core duties I would request some sort of period of supervised practice for dispensing (from a liability perspective) and undertake training on giving vaccines so that I’d feel confident in my ability to perform those roles safely. But undertaking medication reviews, working in a GP practice or RACF? I’m confident they are well within my existing scope and that I have maintained my learning sufficiently to support this.

I think part of why this gets confused is because pharmacy is so obsessed with telling people what they can and can’t do. Certifying everything. Credentials for this that and the other. It’s become a business in itself. I’ve written before about my feelings toward the advanced practice credentialing, I’ve circled around a bit, and I’m back to the original question of what exactly is the point? Where is the public interest? Doesn’t the practice of CPD and being a registered professional mean that all pharmacists should be advancing their practice? Doesn’t telling people exactly what they should do diminish their professional autonomy?

If I apply for a job, I want the panel to assess my merit based upon the evidence supplied in my CV, the quality of my application and whatever interview or presentation they ask me to do. The idea of being judged by the superficiality of my post-nominals doesn’t do it for me. And I’m saying that acknowledging that I am working toward completing a PhD, possibly one example of a post-nominal that has the most variability in quality, other than maybe an MBA. If I provide a service to you, judge me on whether or not I met your needs sufficiently, not on whether I have a certificate showing I’ve completed a workshop. Registration matters, of course. Maintaining CPD matters, of course. Lifelong learning matters. To me, the other bits are either vanity metrics of ways of ensuring you get paid. A humble (or not so humble) brag. Get registered, define your scope of practice, do the work well, and continue to work to do it better. Lets stop over complicating it.