A CHANGING HEALTH-CARE ENVIRONMENT - ITS IMPACT ON UCSF GRADUATES PRACTICE PATTERNS AND PERCEPTIONS

Rapid penetration of managed care in California earlier this decade pr ompted the UCSF School of Pharmacy to embark on an intensive review an d revision of its entry-level PharmD curriculum. To help insure that t he School continues to provide students with the competencies needed t o practice over a professional lifetime, we assessed the external envi ronment and invited feedback from employers and alumni. This included surveying graduates from 1980-1994 to determine how managed care had i mpacted their practice patterns and perceptions of the profession. Of the 1,453 graduates mailed the questionnaire, 754 (52 percent) respond ed. Relative to a previous (1988) survey, fewer graduates were practic ing in hospitals (46 vs. 62 percent) and community pharmacies (13 vs. 18 percent). Twice as many (42 vs. 20 percent) were employed in ambula tory clinics, health maintenance organizations (HMOs), home infusion p harmacies, and other practice settings. Fewer reported performing trad itional administrative functions (48 vs. 59 percent). Most had positio ns with multiple functions: 83 percent were involved in direct patient care and 60 percent initiated or modified drug therapy per expanded s cope of practice laws in California; 74 percent participated in drug d istribution or dispensing; and 57 percent performed administrative dut ies requiring clinical skills. One-half had a specialized practice, bu t only seven percent were formally certified. A majority of respondent s (74 percent) indicated that recent changes in health care delivery h ad altered their job responsibilities to a moderate or great extent, b ut they were evenly split between viewing these changes as positive or negative. Graduates generally remained satisfied with their education and were optimistic about the profession. Although managed care has c reated a stressful working environment, our graduates are finding new opportunities to use their clinical expertise.