Barriers to pharmacy practice change

The practice of pharmacy has seen major changes in the past decade. Today, pharmacists from coast to coast can extend prescriptions and make therapeutic substitutions. Many pharmacists can also provide influenza vaccinations and in some cases initiate drug therapies (i.e., prescribe). However, it has also been well established that the integration of many of these services by pharmacists into practice has been slow and incomplete. As pharmacy regulatory and advocacy groups continue to push for pharmacists’ larger role within the health care system, these efforts are hampered by the lack of widespread adoption and integration of these services within practice. Therefore, we need to more carefully consider why pharmacy practice change has been so challenging. In 2010, we wrote a commentary titled “Are Pharmacists the Ultimate Barrier to Pharmacy Practice Change?” In that article, we suggested that pharmacists’ personality traits, including lack of confidence, fear of new responsibility, paralysis in the face of ambiguity, need for approval and risk aversion, were the heretofore unspoken barriers to practice change. Using this commentary as a starting point, the purpose of this editorial is to discuss the issue of whether it is our innate personality traits (“nature”) or our professional pharmacy culture (“nurture”) that holds us back.