Pharmacy Division Ramathibodi Hospital


Physicians' Expectations of Pharmacists

William E. Smith, Max D. Ray, and David M. Shannon

Am J Health-Syst Pharm 59(1):50-57, 2002. © 2002 American Society of Health-System Pharmacists

Abstract and Introduction


Physicians' current and future expectations of and current experiences with pharmacists were studied.

A three-part questionnaire was mailed to 2600 practicing physicians in California, including office-based practitioners, hospital-employed (nonhouse staff) physicians, and medical residents. A 5-point Likert scale was used to measure respondents' level of agreement with statements in each part; part 1 dealt with current expectations, part 2 with current experiences, and part 3 with future expectations. Respondents were asked to confirm their practice setting (office-based, hospital-based, medical resident, or other) and to indicate the number of years since graduation from medical school.

The mean values of physician agreement with each statement were reported. There was neither strong agreement nor strong disagreement with any statement regarding physicians' current and future expectations of and current experiences with pharmacists. There was no correlation between practice setting and level of agreement with statements in any part of the questionnaire. There was a correlation between the number of years since graduation from medical school and the level of agreement with statements about current and future expectations; in both cases those physicians who graduated from medical school less than 10 years ago had higher expectations of pharmacists than those who graduated 10 or more years ago.

Overall, physicians do not know what to expect from pharmacists. Physicians expectations of pharmacists were most strongly correlated with the number of years since graduation from medical school and least strongly correlated with physicians' practice settings.


For centuries, pharmacy has supported medicine -- pharmacists have provided services for physicians' patients. In the historical model, physicians diagnosed and prescribed, while pharmacists compounded and dispensed medications. This model continues to exist today, although with some notable variations, and undoubtedly serves as the basis for what many physicians, and a large segment of the general public, expect of pharmacists today.

Given that prescribing is still almost exclusively in the physician's domain, the utility of pharmacists' input about managing drug therapy ultimately depends on physicians' willingness to accept it. It is important, therefore, that pharmacists understand what physicians expect of them and how receptive physicians are to the contributions that pharmacists seek to make to patients' pharmaceutical care.

Hynniman and Lamy[1] and Williamson and Kabat[2] found that, although a majority of physicians are receptive to an expanded role for pharmacists as drug information experts, most physicians' believed that very few pharmacists were performing this service in any meaningful way. Their expectations of pharmacists were therefore quite limited.

In addition, several investigators found that physicians are receptive to specific clinical services provided by pharmacists, such as therapeutic drug monitoring, patient counseling, and recommendations for therapeutic agents.[3-12] The level of physician acceptance of these services was found, in several of these studies, to be related to the degree of exposure physicians have to pharmacist-provided services. Several other investigators found that physicians are generally receptive to a wide range of clinical pharmacy services provided in an inpatient setting, if provided in a consultative or supportive role.[13-18] Most physicians were found to oppose autonomous decision-making responsibility for pharmacists. Sulick and Pathak[19] found that, although physicians are receptive to the consultative and educational services provided by pharmacists in an inpatient setting, the receptivity by individual physicians to those services is related to the value the physician attaches to the service and the physician's perception of the pharmacist's competence. Bradshaw and Doucette[22] found that there is good support among physicians for the provision of certain patient-oriented services by community pharmacists, including drug therapy recommendations, patient monitoring, and patient education; physicians were less favorable toward independent decision-making roles for pharmacists, such as adjusting drug therapies under protocols and changing drug dosage forms. Similar findings were reported by Ranelli and Biss.[21]

Bailie and Romeo[22] found that most physicians favor patient counseling by pharmacists but are opposed to pharmacist prescribing, even limited prescribing under protocol. They also found little support among physicians for the provision of health-screening services by pharmacists. Two studies in the United Kingdom found similar information. [23,24] Segal and Grines[25] found that opposition to pharmacist prescribing is reflected in the official policy of state medical associations. However, according to a newspaper report, the American Medical Association (AMA) supports pharmacy's efforts to provide disease management services.[26]

Hirsch et al.[27] found that physicians expect pharmacists to provide patient medication counseling, but pharmacists are not providing this service to the extent assumed by physicians. Campbell and Saulie[28] and Sardinha[29] found that there is strong acceptance of pharmacists by physicians in group practice settings in which pharmacists participate in collaborative patient care.

Physicians' attitudes toward expanded roles for pharmacists are reflected from time to time in the medical literature. Several such reflections have openly questioned pharmacists' competence to provide direct patient care services, such as patient education and drug therapy recommendations. [30-33] Although such comments may be viewed as isolated opinions, they cannot be entirely discounted.

In a historical review of the relationship between pharmacists and physicians, Cowen[34] notes that, although conflict has existed between the two professions throughout the centuries, considerable progress toward harmony has been made. He attributes this, in part, to the increasing dependence of physicians on pharmacists for drug-related information.

These studies and commentaries suggest that physicians' attitudes toward and acceptance of pharmacists' clinical services have gradually improved over the past 30 years, physician acceptance of pharmacists' clinical services is related to the level of exposure physicians have had to those services, and physicians are generally receptive to consultative and educational services provided by pharmacists but are opposed to pharmacists having independent decisionmaking authority.

Questions not answered by these studies include the following:

  1. What do physicians expect of pharmacists? Most of the studies cited address physicians' attitude toward, or acceptance of, specific services provided by pharmacists. They do not help us understand what physicians generally expect pharmacists to do.

  2. Does the current level of pharmacy practice match physicians' expectations? We assume that many physicians have developed certain expectations of pharmacists on the basis of their experiences with specific pharmacists; however, these expectations may not be met by all pharmacists.

  3. What do physicians expect pharmacists to do in the future? It is not known if physicians have any particular expectations of what pharmacists will do in the future. It is conceivable that physicians could have fairly limited expectations of pharmacists today while holding higher expectations of what pharmacists will do in the future. It is also conceivable that physicians have no expectations about pharmacists' duties in the future beyond those they have today.

Our study attempts to answer these questions.


A three-part questionnaire was developed for administration to a randomly selected group of physicians in California. Each part included a set of statements for which respondents were asked to indicate their level of agreement using a 5- point Likert scale where 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree. In addition, one question required a "yes" or "no" response. Part 1 measured physicians' current expectations of pharmacists, part 2 measured their actual experience with pharmacists, and part 3 measured their future expectations of pharmacists. Demographic information collected included the respondents' practice category (office-based, hospital-based [nonhouse staff], or medical resident [house staff]) and the number of years since graduation from medical school. The questionnaire was validated for content by a panel of five practicing physicians.


This study was conducted from March 1998 through June 1998. The questionnaire was mailed to 2600 physicians in California who were randomly selected from lists maintained by the AMA. The practicing physicians on these lists were not limited to AMA members. The breakdown of questionnaire distribution was as follows: 2000 to physicians listed as office-based practitioners, 400 to physicians listed as hospital-based practitioners (excluding radiologists, pathologists, and other nondirect patient care specialists), and 200 to medical residents. The questionnaire allowed respondents to confirm their practice category; one additional choice was provided for "other."

A postcard was sent to all physicians 10 days before the first questionnaire was mailed to acquaint them with the nature of the study and to let them know to expect the questionnaire. Three separate mailings of the questionnaire, each with an appropriate cover letter, were sent out at three-week intervals. The second and third mailings were sent only to those who had not responded to previous mailings. Control numbers on the postage-paid return envelopes allowed us to track those who had responded. Returns were accumulated in batches, and the envelopes in a particular batch were opened by a secretary once they had been checked off, thus protecting the anonymity of individual responses.

Data Analysis

The data were first analyzed descriptively, computing frequencies, means, and standard deviations for each item on the questionnaire. Second, internal consistency reliability analysis and confirmatory factor analysis were used to evaluate the psychometric properties of the three measurement scales. Finally, multivariate analysis of variance (MANOVA) was used to examine differences among physician practice settings and years since graduation for the three dependent variables (i.e., current expectations, current experiences, and future expectations). Internal reliability was measured for each part of the questionnaire.

The first MANOVA was conducted between the independent variable (years since graduation from medical school) and the dependent variables (current expectations, current experiences, and future expectations). A second MANOVA was conducted between the independent variable (practice setting) and the dependent variables (current expectation, current experiences, and future expectations). The dependent variables were the harmonic means of the items in part 1 (current expectations), part 2 (current experiences), and part 3 (future expectations). Significance was determined by the F test with analysis of variance tests. Post hoc comparisons were made with Tukey's test. The level of significance was set at 0.05. Statistical analysis was performed with SPSS version 9.0 (SPSS, Chicago, IL).


Sixty-five (2.5%) questionnaires were returned as undeliverable, leaving 2535 that were assumed to have been delivered. Another 130 (5.1% of those assumed delivered) were returned by recipients who did not complete them, either because they had retired or were in areas of practice that did not involve direct patient care. The remainder (2405) was used as the denominator when calculating percent response; 463 usable questionnaires were returned, representing a response rate of 19.3%.

Reliability (coefficient alpha) was estimated for each of the three dependent variables. The highest coefficient (0.903) was found for the "current expectations" scale. The remaining two scales ("current experiences" and "future expectations") resulted in reliability estimates of 0.877 and 0.820, respectively.

The results of part 1 of the questionnaire are shown in Table 1. There were only three items (4, 12, and 16) in part 1 for which the mean response was greater than 4 (agree). For one item (item 11), the mean response was less than 3.

The results of part 2 of the questionnaire (current experiences) are shown in Table 2. There was one item in this set (item 1) with a mean value greater than 4. For three items, the means were between 3 and 4. The means for five items were less than 3. Less than one fourth (23.2%) of respondents indicated that they had a prior-approval relationship with pharmacists for adjustments in patients' medications.

The results of part 3 of the questionnaire (future expectations) are shown in Table 3. Responses to each of the five items in this part were close to 3, and there was neither strong agreement nor strong disagreement with any of these statements regarding physicians' future expectations of pharmacists.

Table 4 shows the breakdown of respondents by practice setting and by years since graduation from medical school and the MANOVA results to determine significance of the three dependent variables. No significant difference between the physicians' practice settings and their current expectations, current experiences, or future expectations was revealed (Wilks' lambda = 0.975, p = 0.364). However, a significant difference did exist between the years since graduation from medical school and both current and future expectations of pharmacists (Wilks' lambda = 0.965, p = 0.030).


We now return to our original questions that were not answered by previous studies.

What do Physicians Expect of Pharmacists?

Most of the mean values in Table 1 were between 3 and 4, suggesting that (1) physicians have no strong expectations that pharmacists will provide any of the services or reflect any of the behaviors described in this part of the questionnaire, and (2) they have no strong negative expectations. This might be interpreted to suggest that physicians are not sure what they expect of pharmacists.

There was good agreement with item 4 ("I expect pharmacists to be knowledgeable drug therapy experts"). Considering the responses to other items, however, it appears that physicians have no clear expectations of how pharmacists apply that knowledge in practice.

Respondents differed in their expectations of hospital pharmacists and community pharmacists in designing drug treatment plans. The mean level of agreement with item 5 (pertaining specifically to hospital pharmacists) was 3.60; the level of agreement with item 11 (pertaining specifically to community pharmacists) was 2.57. On the other hand, they indicated a lower degree of expectation that hospital pharmacists would provide patient medication education than would community pharmacists (means, 3.81 and 4.12, respectively).

There was a slightly higher expectation that hospital pharmacists would monitor patients' response to drug therapy (items 7 and 13) and that they would know the specific indications for each drug prescribed (items 8 and 14). In all cases, however, the mean values were between 3 and 4.

Respondents indicated that they do expect community pharmacists to assist patients in selecting appropriate nonprescription drugs (mean, 4.17). There was no corresponding statement in the instrument concerning physicians' expectations of hospital pharmacists.

The physicians' practice settings did not seem to have a bearing on their current expectations of pharmacists. However, younger physicians (those who graduated within the past 10 years) appeared to have higher expectations of pharmacists than those who graduated more than 10 years ago. This may reflect the changing level of pharmacy practice in more recent years in those settings where physicians do their residency training.

Does the Current Level of Pharmacy Practice Match Physicians' Expectations?

Part 2 of the questionnaire measured physicians' actual experiences with pharmacists, regardless of what they may expect of pharmacists. Responses to these items provided an indication of the current level of pharmacy practice.

Item 1 was the only item in this set with a mean value greater than 4 (agree). This undoubtedly accounts for the respondents' strong expectation that pharmacists are knowledgeable drug therapy experts (Table 1). However, the mean value for item 2 (related to clinical drug information) was somewhat lower. Respondents' experience, then, is that pharmacists do a better job providing nonpatientspecific drug information than providing information tailored to individual patients' clinical situations.

Items 3 (patient counseling) and 4 (problems with prescriptions) had a mean value between 3 (neutral) and 4 (agree). With regard to patient counseling, pharmacists appear not to be measuring up to physicians' expectations. The mean value for respondents' experience with pharmacists in this area is 3.47. This is somewhat lower than their expectation (means, 3.81 and 4.12 for hospital pharmacists and community pharmacists, respectively).

The mean value for items 5-8 and 10 were between 2 (disagree) and 3 (neutral). This suggests that, based on respondents' experiences, pharmacists perform these activities less than half of the time. This finding is somewhat surprising with respect to the response to items 5 and 6 (Table 2). It may suggest a lack of alignment of incentives between pharmacists and payers. The finding may also suggest that pharmacists' workload does not permit them to routinely follow up with prescribers on such matters. In either event, the finding was surprising, given our impression that most pharmacists devote inordinate amounts of time to contacting physicians to change prescriptions to less costly alternatives.

The responses to item 7 (clarification of drug therapy objectives) were difficult to interpret. They may suggest that drug therapy objectives are usually sufficiently clear to pharmacists, or that pharmacists neglect to clarify the physician's intent.

For item 8 (problems with patients' medications), respondents' experience with pharmacists may not fulfill the expectations they have of them in this area. The mean value for actual experience in this area was 2.48; the mean value for the expectation that pharmacists will provide such information was 3.51 for hospital pharmacists and 3.15 for community pharmacists (Table 1).

Less than one fourth (23.2%) of respondents indicated that they had a prior-approval relationship with pharmacists for adjustments in patients' medications (Table 2). The fact that this percentage is so small may mean that there is an opportunity for greater participation by pharmacists in collaborative drug therapy management. It may also be related, in a number of ways, to the relatively low level of expectations physicians have of pharmacists, as reflected in Table 1.

Perhaps one of the more damaging findings of our study is the response to item 10 (regarding pharmacists taking responsibility for resolving problems). The mean response was 2.94. This was considerably below the mean for physicians' expectations (mean, 3.53) (Table 1). We think it is likely that physicians' experience with pharmacists' lack of willingness to take "ownership" of patients' drug-related problems lies at the base of their limited expectations of pharmacists.

What Do Physicians Expect Pharmacists to Do in the Future?

Item 1 in part 3 measured respondents' support for having pharmacists routinely provide three specific services in the future: "adjust the drug therapy for some of my patients, using protocols that I have approved"; "monitor and document my patients' response to drug therapy"; and "be on-call to my patients for questions about their medications." The response to the first two items was slightly below 3 (neutral), indicating that physicians are leaning away from having pharmacists perform these services in the future. The response to the third item was more positive (mean, 3.42). However, in all three cases the responses indicated neither strong opposition to nor strong support for these particular pharmacist-provided services.

It was interesting to note that respondents did not favor pharmacists having a greater share of financial or legal responsibility for drug therapy in the future (items 2 and 3; means, 2.68 and 2.85, respectively). One possible interpretation of these results is that physicians are opposed to pharmacists having any greater degree of personal relationship with patients than they have currently.

It appears that physicians do not know what to expect of pharmacists. It is clear that there is a gap between the theory of practice espoused by pharmacy and the current reality of practice, especially when viewed through the eyes of physicians. It appears that pharmacists need to improve their credibility with physicians by accepting greater personal responsibility for patients' drug therapy outcomes.

The most encouraging finding of our study is that physicians are not strongly opposed to having pharmacists more directly involved in patient care. For pharmacists who have encountered strong physician opposition in the past, this seems to be a very positive statement. On the other hand, our study shows that physicians are not yet clamoring for greater contributions by pharmacists.

The fact that younger physicians have higher expectations of pharmacists than do their older colleagues suggests an encouraging prospect for pharmacy's future. We point out again, however, that respondents' current experience with pharmacists does not, in most cases, meet their expectations, suggesting that pharmacists will need to close the gap between what physicians perceive pharmacists do and what they expect them to do in order to gain future physician support for a more responsible role in patient drug therapy management.

Limitations of Study

The results of this study cannot be generalized to all physicians, since the sample was limited to physicians in California. Also, there may be a potential response bias because of the 19.3% response rate. Despite these limitations, the large sample size (n = 2600) leads us to believe that these results provide useful insight into physicians' experiences with and expectations of pharmacists.


Overall, physicians do not know what to expect of pharmacists. Physicians' expectations of pharmacists were most strongly correlated with the number of years since graduation from medical school and least strongly correlated with physicians' practice setting.


Table 1.

Table 2.

Table 3.

Table 4.


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William E. Smith, PH.D., is Associate Dean and Associate Professor, School of Pharmacy, Virginia Commonwealth University, Richmond, VA. Max D. Ray, Pharm.D., is Dean and Professor, College of Pharmacy, Western University of Health Sciences, Pomona, CA. David M. Shannon, PH.D., is Professor, College of Education, Auburn University, Auburn, AL.

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