A pharmacy technician is a person who works under the supervision of a licensed pharmacist.  Many pharmacy-related tasks and functions are handled by them, even some that one expects to be the tasks for the pharmacist himself.  They are not simply assistants to the pharmacist, as we will see in this article.

It can differ in some countries, but for the most part they are not qualified to counsel patients on the prescription and proper use of their medication.  One exception is the United Kingdom, where continuing professional development allows them to give advice on medication to patients.  There are also specialist clinics that are run by them, and these are mainly maintenance drug administration duties.

For most pharmacy technicians, the provision of drug and other health care products to patients is their primary duty.  They are knowledgeable enough to dispense the right medicines as prescribed by doctors or licensed pharmacists.  They are also the ones who handle inventory, perform cashier tasks, restock shelves, answer phone calls, and enter data in computer databases.  The mundane tasks of the drug store, so to speak.  These duties are the ones that most people believe make up the entire job description of pharmacy technicians, though their contribution is no small matter.  They are the lifeblood of drug stores, and daily operations of such facilities depend highly upon them.

Sometimes, they are allowed to compound medicines.  Simple compounding which involves few ingredients and less-dangerous substances may be done by these workers.  The final product still goes under the watchful eye of the pharmacist though, to ensure quality and consistency of the product, as well as to make sure that the recipes were followed properly.  This is especially helpful when the pharmacist has other duties to attend to and a batch of drugs must be made ready and available.  What the technicians do allows the pharmacist to perform other important duties, meaning that performance rests on the backs of workers.

There are two kinds of pharmacy technicians, distinguished by where they work.  Most of them work in retail pharmacies, both independently owned and those that are part of a retail chain company.  The others work in assisted living facilities like hospitals and nursing homes.  The latter type has additional responsibilities, such as reading patient record charts in together with verified prescriptions.  Following which, they prepare the various medications and drugs as required in the prescription before handing it out to nurses for the actual administration.

They are also responsible for labeling bottles or sets of medication, either by hand or with a labeling machine of some description.  Doing this ensures that the receiver knows what the container holds within before opening it or accidentally taking in the wrong medicine.

Pharmacists are increasingly required to be present and available for patient consultations, meaning that their time and energy allotted to the pharmacy are becoming more and more limited.  Pharmacy technicians are there to pick up the slack and keep everything running as they should.  The demand for skilled medical experts like them will continue to increase.

Various recently published studies about the relationship between low dose radiation and cancer fanned again the discussion about risk and benefits of modern diagnostic techniques and in particular Computer Tomography (CT). According to an article recently published in IMAGE (Marie H. Meynadier, Vol. 21, no. 10 – March 10, 2008), it is predictable that in a few decades up to 2 percent of cancers in the United States could be linked to the administration of diagnostic x-rays, even if the ability to monitor the increase in cancer related to radiation exposure will be very difficult as radiation-induced cancer can take up to 20 years to develop.

Since many years the relationship between cancer development and radiation exposure has been studied and there are hundreds if not thousands of publications related to this topic. The problem is that a third of all people get cancer anyway, at some time in their lives, and hence it is quite difficult to find evidence that low doses of radiation cause cancers that would not have otherwise occurred. Even for the 80,000 to 90,000 survivors of the atomic bombs exploded over Hiroshima and Nagasaki, exposed to very large radiation doses, it has been hard to find a direct relationship between excess cancer development and radiation exposure. According to Japanese statistics, from the people who were exposed in 1945 (and did not die immediately) nearly half are still alive. A statistically significant increase in cancer was found at relatively high exposure level of 50 millisieverts (mSv is the unit commonly used to measure the effective dose in diagnostic medical procedures), which is about 16 times the current annual average for Americans from medical exams and about 21 times above the average natural background effective dose in the USA. But these numbers need to be analyzed with care. There is a controversy between scientists if levels below 50 mSv can be considered as safe and about the real (and statistically proven) rest-risk of low radiation exposure.

The most widely used mathematical model in estimating radiation risk is known as the linear-nonthreshold dose-respond model. This model assumes that there is no safe dose of radiation and that there is a linear and direct relation between cancer risk and genetic damage with radiation exposure. But this model is in discussion since a long time. For some scientists the linear model is the best way to estimate radiation risk, but for others there exist a threshold below which radiation poses no hazard to health.

It is not difficult to identify the most important sources of man-made or anthropogenic radiation. Most of the collective dose from diagnostic radiology comes from procedures such as CT, interventional radiology and barium enemas. Advances in radiological diagnostic technology have radically transformed medical practice in recent years and there has been a rapid increase particularly in the application of CT. Effective dose estimates of CT scans and nuclear medicine studies are in the range of 10 to 25 mSv for a single study, which is about 100 times larger than those from conventional radiological procedures such as chest x-rays. Although CT scanners contribute to only 12 percent of all medical radiation procedures, the number of CT scans is on the rise. In the United States for instance, no more than 3 million studies using CT were performed in 1980 and in 2006 this number was already above 60 million. Overall, the mean effective dose in the US from all medical x-rays has increased about seven-fold over this period and the situation in Europe is not very different. There are several scientific studies proving a relationship between small radiation doses and cancer formation.

One of these studies, already published in the year 2000 (Spine, Morin Doody et al, Volume 25(16) August 15, 2000), was conducted with 5,573 females aged 20 and younger from 14 orthopedic medical centers in the United States who had been diagnosed with scoliosis between 1912 and 1965. Scoliosis is a medical condition in which a person’s spine is curved from side to side, and may also be rotated. The goal of the study was to evaluate breast cancer mortality patterns among women with scoliosis and the risks associated with diagnostic radiographic exposure. Doody and coworkers showed that exposure to multiple diagnostic radiographic examinations during childhood and adolescence may increase the risk of breast cancer among women with scoliosis. Even if this study addresses radiology exams taken on older technology, the issue is still relevant, as scoliosis patients usually receive repeated radiographic exams and CT scans for therapy and treatment. As scoliosis generally is diagnosed even before adolescence, these susceptible young patients are already exposed to relatively high radiation doses during their growth period.

As discussed in an other recently published study (Hall et al., British Journal of Radiology 81, 362-378, 2008), the relevant organ doses during CT scans are in the range for which there is now direct credible epidemiological evidence of an excess risk of cancer, without the need to extrapolate risks from higher doses. However, even for high-dose radiological procedures, the risk to the individual patient is small, so that the benefit/risk balance is generally in the patients’ favour. Concerns arise when CT examinations are used without a proven clinical rationale, when alternative modalities could be used with equal efficacy, or when CT scans are repeated unnecessarily. According to this study, it is assumed that about one-third of all CT performed in the US could be avoided using alternative diagnostic tools. According to Hall, “at this time, the benefit/risk balance for any of the commonly suggested CT screening techniques has yet to be established.”

In the United States, Physician Assistants (PAs) are non-physician clinicians licensed to practice medicine with a physician’s supervision. This supervision, in most cases, need not be direct or on site and many PAs practice in remote or underserved areas in satellite clinics. PAs can treat patients and, in most states, prescribe medicine, and in some states in the US they carry a DEA number that gives them authority to prescribe controlled medications like narcotics. PAs in surgical practices also serve as first assists in surgery. PAs provide medical services that are reimbursed under Medicare and third party insurances.

Physician Assistants held about 65,000 jobs in 2005. The number of jobs is greater than the number of practicing PAs because some hold two or more jobs. For example, some PAs work with a supervising physician, but also work in another practice, clinic, or hospital. According to the American Academy of Physician Assistants, there were about 58,665 certified PAs in clinical practice as of January 2006.

Just over 56 percent of PAs worked in the offices and clinics of physicians in 2005, either allopathic or osteopathic. About 36 percent were employed by hospitals. The rest were mostly in public health clinics, nursing homes, schools, prisons, home health care agencies, and the United States Department of Veterans Affairs. According to the American Academy of Physician Assistants, about 17 percent of all PAs provide health care to rural communities and those with fewer than 20,000 residents, in which physicians may be in limited supply.

In 2006, there are more than 130 accredited PA programs in existence in the United States. They are all accredited by one body — the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). A majority of them are master’s degree programs (requiring GRE for entry), but some are available as an undergraduate major. A number of these undergraduate programs are making a transition to graduate level training.

A Physician Assistant may use the post-nominal initials PA, RPA, PA-C or RPA-C, where the R indicates Registered and the C indicates “Certified.” The “R” designation is unique to only a couple of states; most Physician Assistants use the PA-C. The certification is granted by one certifying body, the National Commission on Certification of Physician Assistants (NCCPA).

Physician Assistants and Nurse Practitioners both provide similar services in most states, the major distinction being that nurse practitioners are registered nurses by trade. Nurse Practitioners require more training than physicians assistants, such as a Masters Degree in nursing. Both are also known as Advanced Practice Clinicians (APCs) or mid-level practitioners (MLPs).

PAs should not be confused with Medical Assistants, who perform routine clinical and clerical tasks in a physician’s office. A Medical Assistant (MA) is a multi-skilled allied healthcare practitioner who is competent in both a wide variety of clinical and laboratory procedures, as well as many administrative roles. Medical assistants have been described as healthcare’s most versatile, multifaceted professionals. Medical Assisting is an allied health profession whose practitioners function as members of the health care delivery team and perform administrative and clinical procedures.

Formal education of medical assistants usually occurs in vocational or technical institutes, community colleges, proprietary schools, or junior colleges. The course length usually ranges from 1 to 2 year programs, complete with externships. The curriculum presented must always be accredited if its graduates plan to become either certified or registered. In 2002, there were 495 medical assisting programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and about 170 accredited by the Accrediting Bureau of Health Education School (ABHES). Accreditation by either CAAHEP or ABHES usually requires that the schools curriculum provide sufficient classroom, lecture, and laboratory time (if applicable) to each of the courses below.

Administrative Courses

Computer Applications

Manual Recording of Patients’ Data

Scheduling Appointments

Maintaining medical Records

Word Processing/Typewriting/Keyboarding

Coding/Insurance

Telephone Triage

Personnel Management

General Courses

Anatomy and Physiology

Behavioral Psychology

Pathophysiology

Medical Terminology

AIDS/HIV

Patient Education

Medical Law and Ethics

Clinical Courses

Phlebotomy

l Medical Asepsis/Infection Control

Pharmacology/Administration of Medications

Assisting Techniques/Physical Examination

Assisting with Minor Surgery

Basic Laboratory Procedures/Routine Blood and Urine Testing

Cardiopulmonary Resuscitation (CPR)

X-Ray Theory and Positioning

Electrocardiogram (EKG)

Certification is a voluntary process which is strongly backed by the AAMA and a number of other well respected certification bodies in the USA as a way to guarantee competency of a medical assistant at a job-entry level. However, in order to be eligible for certification one must attend a school which has been accredited by either CAAHEP or ABHES.

Certification is usually achieved by taking a test issued by the National Board of Medical Examiners and AAMA, or AMT, or NHA and is offered twice yearly, simultaneously, at over 200 different test sites across the United States.

Successful completion of the rather intense exam earns the taker the proper credentials to become a Certified Medical Assistant, or CMA. National certification is legally required in order for any medical assistant to adhere to CMA status. The title CMA then follows postnominally.

Recertification must occur every 5 years in order for one to maintain their credentials. There are two ways to do this; one may either continually earn continuing education hours by attending CMA meetings, conventions and seminars, or by completely retaking the initial exam to prove they still possess a certain level of knowledge.

A medical assistant may choose another possible credential over CMA, and become a Registered Medical Assistant (RMA) instead. Again, credentialing is completely voluntary. The American Technologists (AMT) agency is responsible for certifying MAs who choose this course.

AMT first began offering this certification in 1972 on the months of June and November, through a computerized exam, much like the one offered by the AAMA. AMT therefore has its own conventions and committees, bylaws, state chapters, officers, registrations and revalidation examinations.

To become eligible to hold the title of RMA a student must be at least 18-years-old, pass a medical assisting curriculum at a school accredited by either ABHES or CAAHEP and possess a minimum of 5 years experience. The initials RMA then follow the individual’s name.

RMAs have historically been very active in legislation, seeking protection for medical assistants, as well as continuously encouraging improved educational curriculums.