The pursuit of legitimacy and professionalism: the evolution of pharmacy in Ontario.

The Pursuit of Legitimacy and Professionalism: The evolution of pharmacy in Ontario Jennifer D. Beales and Zubin Austin Leslie Dan Faculty of Pharmacy, University of Toronto, Canada This paper explores the development of pharmacy practice in Ontario, Canada and outlines its initial professionalisation and the landscape in which the profession has evolved: reshaping and redefining itself against the push and pull of internal and external forces that have situated it amongst the health care professions, but also differentiated it from medical practices. In their pursuit to propel pharmacy from a trade to a profession, early Ontario pharmacists simultaneously embedded pharmacy within the history of Canadian health care. The history of health care in Canada is a dynamic story that details Canadians’ plight in attaining health as we know it today. The success of this story can be gauged by the superior level of health that many Canadians have come to take for granted. This level of health could not have been attained without the assistance of health care providers who disseminate health and medical knowledge to the public. The story of Canadian health care is also an account of the evolution of health care providers, and this story would be incomplete without discussing the role of pharmacy, and its place within the history of health care. The profession of pharmacy has been muted in literature on professions in general, and in the history of health care in particular. This paper seeks to address this oversight by providing an examination of the development of pharmacy practice in Ontario. From its inception to the present, the pharmacy field has experienced both internal and external pressures to its legitimacy (and status) in Canadian professional society. Internal debates stem from the apparent contradiction between pharmacy’s mandates 1 and the nature of the profession as a business activity. Similarly, the quest for external legitimacy and relevance to modern health care means that pharmacy practice is constantly shaped by social, political, and economic factors – all of which dictate the precarious position of pharmacy in Canadian fields. This paper explores these fundamental conflicts, as I discuss the origins of Ontario pharmacy, and outline its initial professionalisation, and the landscape in which the professional project 2 has evolved — reshaping and redefining itself against the push and pull of internal and external forces 3 that have situated it amongst the health care professions, but also differentiated it from medical practices. This continual professionalisation is attributed to a number of factors: on the one hand, social, economic and political environments have changed over time and influenced the role of pharmacy in Canadian society. On the other hand, pharmacy’s close relationship with medicine has meant an interconnected association in business activities that has been fundamental (at times detrimental) to the pharmacy profession. The forthcoming discussion of pharmacy’s evolution in Ontario demonstrates how these forces have helped shape the profession, and clarifies pharmacy’s previous struggles to both attain and retain social legitimacy, and how this challenge is still relevant in present Canadian society.