Toward Intrapreneurship in Pharmacy Education.

To the Editor. We would like to commend Hermansen-Kobulnicky and colleagues regarding their paper on furthering research into entrepreneurship among student pharmacists.1 Innovating and growing novel products and services to enhance patient care is an integral part of the pharmacy profession. For more than 30 years, pharmacy educators have embraced entrepreneurship as a necessary quality of student pharmacists.2 However, with shrinking prescription drug margins, increasing industry regulation, and generic pricing woes, it is more difficult than ever for an entrepreneur to open or operate a viable independent community pharmacy practice. In fact, declining reimbursement rates and rising business costs contributed to a 15% decline in rural independent pharmacies between 2003 and 2010.3 It is likely these external barriers to pharmacy ownership and entrepreneurship, rather than internal ineptitude or lack of entrepreneurial prowess, redirect students to other areas of practice unrelated to their true entrepreneurial passion and skill set. As pharmacy educators, we contend that too much emphasis is placed on entrepreneurship development alone and misses a second dimension of the broader concept of innovation: intrapreneurship, or the use of entrepreneurial behaviors within an existing organization. Considering the number of pharmacists practicing in large health-systems and chain pharmacies, we believe it is an underused and underresearched idea in the profession. In fact, a search of PubMed for “intrapreneurship and pharmacy” yielded only one result, and it was from 1987. Intrapreneurship is, however, a well-researched concept in the business world. It is through this research that we know that entrepreneurship drive alone is not sufficient for one to succeed as an intrapreneur within an organization. Although behaviors and characteristics of the entrepreneur and intrapreneur are similar, the keys to their success may be different. Specifically, the intrapreneur often experiences internal barriers within the structure of their organization for which they may be unprepared. These challenges may be insurmountable for the new practitioner who may lack the business and social intelligence to navigate bureaucracy, multiple superiors, and internal politics – barriers not necessarily inherent to a new or small business. In this way, we are leaving students stranded between two worlds, and belonging to neither. Unbeknownst to most students and educators is the fact that entrepreneurial skills that would have allowed them to thrive as small business owners half a century ago are still applicable in modern practice when applied to intrapreneurship. Pharmacy would not be the first health profession to embrace the balance between entrepreneurship and intrapreneurship. The profession of nursing has published on this concept, citing the many benefits of intrapreneurial activity, including the ability of large organizations to absorb risk, provide resources, and quickly disseminate novel ideas.4 Moreover, Taylor and colleagues stated in their report of the American Association of Colleges of Pharmacy (AACP) 2014-2015 Professional Affairs Standing Committee, “Pharmacy practice thrives on innovation, intrapreneurship, and entrepreneurship; [and] helps to identify where pharmacy practice should evolve to address future health care needs.”5 Widespread scalability of innovation is perhaps the largest advantage of developing skilled intrapreneurs. We envision a community pharmacist engaging face-to-face with patients, developing new patient care services, and serving as a health care resource for their communities. Although this is important for the patients of the immediate community surrounding that entrepreneur, the widespread scalability of novel, efficient, and accessible care often never occurs. Accelerated ramp-up of these services and products becomes a real, major advantage to intrapreneurship in large-sized and medium-sized organizations over smaller, independent operations. Ideally though, both should exist to optimize innovation and patient care. The United States now ranks twelfth among developed nations in business startup activity, and the rate of new business startups has been declining since the 1970s to the point that more businesses are closing than new ones are being created.6 It is time for us to evolve our approach to educating the next generation of pharmacists so that they can significantly contribute to the reversal of such a trend. To thrive in today’s practice environment, we must prepare entrepreneurs to succeed on their own, as well as within larger, established organizations as intrapreneurs. Furthermore, we should partner with organizations that hire students to provide environments that empower and encourage intrapreneurs through means such as continuing education and preceptor development. We call for a three-pronged approach to this end: structured education on intrapreneurship within the doctor of pharmacy curriculum; continuing education and residency preceptor development education focused on empowering intrapreneurs; and intrapreneurial-related research to further our understanding in this area.