“Jack of all trades, master of none?” rethinking the value of diversity in pharmacy practice

Abstract

Objective

To understand how mentors and retail pharmacy managers perceive the influence of pharmacy practice diversification on pharmacists’ professional identity.

Methods

This qualitative study was carried out with mentors and retail pharmacy managers, selected by purposive sampling. Semi-structured interviews were conducted via videoconference by an experienced researcher. The study was approved by the Research Ethics Committee of Federal University of Sergipe (approval number: 4.169.752). The data were analyzed using categorical content analysis, supported by ATLAS.ti software.

Results

A total of 19 pharmacists participated in the study, including 10 mentors and 9 retail pharmacy managers. Both groups highlighted positive and negative aspects regarding the diversity of areas in the pharmacy education. The content analysis resulted in central categories, such as increased employability, addressing health needs, fragmentation of professional focus, and fragility in professional identity. Both groups recognized the importance of specialization and the need to reform the curriculum with more in-depth content organized by areas of knowledge.

Conclusion

The diversification of professional practice presents challenges for pharmacy education and pharmacists’ professional identity. The findings suggest the need for a structured educational model based on core professional practice areas and minimum knowledge standards, which can support the development of a solid professional identity responsive to the challenges of the Brazilian healthcare system.

Introduction

Over the decades, pharmacy has undergone transformations, evolving from the manipulation of natural substances to person-centered care [1, 2]. This transition reflects global trends underscoring the need for pharmacists with clinical competencies, capable of collaborating effectively within interdisciplinary health teams and focusing on patient-centered care [3–5]. In countries such as Canada, Australia, and the United Kingdom, this practice is more established, especially in the context of primary health care provided in community pharmacy settings [6]. However, in developing countries such as China, India, and Sri Lanka, curricula remain focused on the drug production [6].

In Brazil, over 400,000 pharmacists are currently in practice, and the Federal Council of Pharmacy recognizes 140 different specialties, most of which lie outside the traditional domains of community and hospital pharmacy. This diversification may contribute to a fragmented professional identity and may reduce the public understanding of the pharmacist’s role within the health system [7]. Since the late twentieth century, pharmacy in Brazil has undergone a process of redefinition, characterized by disputes over professional domains and the need to reposition itself within the health sector [8, 9].

In 2017, the revision of the National Curriculum Guidelines proposed a generalist teaching model structured around the axes of health care, technology, and management [10–12]. In this country, pharmacy education consists of a five-year undergraduate degree that combines teaching in healthcare, pharmaceutical technology, and management [13]. Upon graduation, pharmacists must register with the Federal Pharmacy Council to obtain a license to practice, which allows them to work across multiple sectors without mandatory postgraduate specialization. This generalist teaching model contributes to the broad scope of professional practice observed in this country [1].

Professional identity is a dynamic and socially constructed process that relates to how individuals understand their roles, values, competencies, responsibilities, and associated social expectations [13, 14]. The professional identity of pharmacists develops through education, workplace socialization, and interactions with health systems and societal needs [15]. The diversification of practice areas and the expansion of pharmacists’ roles within these areas shape these processes by broadening professional opportunities while challenging role clarity. In this context, diversification may introduce competing expectations, creating tensions between generalist teaching and demands for specialized expertise, and potentially leading to perceptions of a fragmented professional identity as professional boundaries become less clearly defined [16].

Despite the wide diversification of professional fields, 80% of Brazilian pharmacists work in retail pharmacy sector [17]. This sector has been identified as a strategic setting for expanding clinical pharmacy services, given its extensive reach and direct access to the population [18]. However, professional teaching lacks sufficient emphasis on the clinical and humanistic paradigm, with limited preparation for delivering structured clinical services or for interprofessional practice [19–21]. This scenario highlights tensions among the diversity of practice areas, educational guidelines, and actual practice in retail pharmacies.

Although the scope of practice varies across jurisdictions, several countries have made efforts to strengthen pharmacists’ roles in patient-centered care, whereas, in Brazil, there remains a lack of clarity regarding the three pillars of professional teaching: for whom, how, and where pharmacists should be educated [22, 23]. This gap may stem from a disconnect between academic teaching programs and workforce demands [24]. Even though pharmacy practice has diversified considerably, little is known about how this diversification, and the expansion of roles within these areas shapes, pharmacists’ perceptions of professional identity, particularly among those involved in teaching and workforce development in retail pharmacy settings.

Understanding how stakeholders interpret this diversification is fundamental, as professional identity influences role clarity, career expectations, and educational priorities [25–27]. Thus, this study aimed to understand how mentors and retail pharmacy managers perceive the influence of pharmacy practice diversification on pharmacists’ professional identity.

Method

Study design

This was a qualitative, exploratory, and descriptive study, guided by the interpretive paradigm, conducted from August to October 2020. The methodology was informed by the Consolidated Criteria for Reporting Qualitative Research (COREQ), which provided guidance for the study design, data collection, analysis, and validation procedures [28, 29].

This study was part of a project that aimed to understand pharmacists’ perceptions of professionalism in retail pharmacy settings [24, 30, 31]. This paradigm was adopted because the study sought to explore how participants interpret professional identity within their professional context. The broader project employed a qualitative design to explore professionalism, career expectations, and workforce dynamics in Brazilian retail pharmacy settings through semi-structured interviews with key stakeholders, including pharmacists in leadership and teaching roles [32–34].

Although questions about practice areas were not originally planned, participants spontaneously related this topic to issues of role perception and professional identity. These themes were therefore incorporated inductively into the analysis [32, 33]. The interviews were conducted by a researcher with prior experience in pharmacy education research and qualitative methods. This background may have influenced data interpretation; therefore, reflexive discussions were conducted throughout the analytical process to critically examine assumptions and minimize potential bias [34].

Participants and recruitment

This study included mentors and managers from retail pharmacy chains listed in the 2020 edition in ranking of retail pharmacies in Brazil [35]. Although the exact number of eligible professionals could not be determined, the selected companies represent the largest retail pharmacy chains operating nationwide. In this study, ‘mentors’ are defined as pharmacists responsible for internal training processes, such as supervising interns, tutoring early-career professionals, or implementing technical training retail settings. Retail pharmacy managers were defined as pharmacists responsible for overseeing the operation, organization, and workforce management of community pharmacies. Purposive sampling was used to recruit participants with extensive experience in the retail sector.

Participant roles were confirmed through self-report during recruitment and verified at the beginning of each interview based on the professional responsibilities described by participants. Initial recruitment was conducted via email, with distribution of an invitation letter, informed consent form, and sociodemographic questionnaire. No prior relationship existed between the interviewer and the participants. After the first interviews, snowball sampling was employed to reach additional professionals recommended by participants, no participants withdrew after confirming their participation [32, 36]. Snowball sampling may have contributed to the recruitment of participants with similar professional network; however, efforts were made to include professionals from different regions and organizational roles.

Data collection continued until theoretical saturation was reached. Mentors and retail pharmacy managers were selected because they occupy strategic roles in professional socialization and workforce development, influencing how professional roles and identities are shaped within retail pharmacy practice. Data collection concluded when no new analytical insights emerged across consecutive interviews, indicating thematic saturation.

Interview guide development and data collection

Interviews were conducted remotely using the Zoom platform by a researcher experienced in the field and in the method employed. The semi-structured interview guide was developed through brainstorming sessions with experts in the field, based on thematic dimensions identified as gaps in the literature regarding the topic in Brazil [8, 37–39]. This led to the central research question of the study:

• How do you think diversification of pharmacy practice across multiple practice areas influence pharmacists’ professional identity?

The question used in this study was extracted from interview guide previously developed and applied in prior research by the authors. The guide followed the structure published in the articles “Reigns but does not govern”: A reflection on professionalism and the autonomy of the pharmacist and The academic formation challenges: what does retail expect from higher education institutions in pharmacy [24, 31]? . Interviews were audio-recorded with participants’ consent, fully transcribed, and organized in the ATLAS.ti software for subsequent analysis.

Data analysis

Data were analyzed using Bardin’s (2016) thematic content analysis method, conducted in three stages: (a) pre-analysis, (b) coding, and (c) categorization. Codes were derived inductively from participants’ narratives and organized semantically based on patterns of convergence and divergence. Coding was performed independently by three researchers, followed by consensus meetings. Analytical memos were developed throughout the coding process to document emerging interpretations and support the refinement of categories across iterative analytical cycles.

Criteria for validity were adopted, including category homogeneity, mutual exclusivity, relevance, and productivity [40]. Interpretations were theoretically anchored in the literature on professional education, pharmacist identity, and models of health practice. Also, semantic categorization was performed, as the units of meaning adopted were thematic. Besides, codes were organized and differentiated by contrast, then grouped according to patterns of similarity and causality [32]. Coding discrepancies were discussed during iterative meetings until analytical consensus was reached among the researchers, ensuring consistency and rigor in the analytical process.

The study was approved by the Research Ethics Committee of Federal University of Sergipe (approval number: 4.169.752). Participants were identified by codes (e.g., G1, G2 for managers and M1, M2 for mentors) to preserve anonymity.

Results

Participant characteristics

A total of 19 semi-structured interviews were conducted: 10 with mentors and 9 with retail pharmacy managers. The average duration was approximately 42 min, totaling 805 min of recorded material. The sample was predominantly female (52,6%) and over 40 years of age, as shown in Table 1. Professional experience ranged from 6 to 32 years, with a predominance of participants with more than 15 years of practice, suggesting perspectives grounded in long-term professional trajectories. Postgraduate training was more common among managers (61%), particularly in Management, whereas mentors more frequently reported training in Clinical Pharmacy. This profile is consistent with national workforce data indicating that retail pharmacy leadership positions are predominantly occupied by experienced pharmacists.

Table 1.

Sociodemographic characteristics of the participants

Managers (n = 9)		Mentors (n = 10)
Characteristic	N (%)	Characteristic	N (%)
Occupation		Occupation
CEO*	3 (33)	Corporate consulting	5 (50)
Managers	6 (67)	Individual consulting	2 (20)
		Individual and corporate consulting	3 (30)
Sex		Sex
Male	4 (44)	Male	5 (50)
Female	5 (56)	Female	5 (50)
Age		Age
< 30	1 (12)	< 30	0 (0)
< 40	2 (22)	< 40	3 (30)
< 50	2 (22)	< 50	6 (60)
> 50	4 (44)	> 50	1 (10)
Professional experience (years)		Professional experience (years)
5–15	1 (11)	5–15	2 (20)
26–30	6 (67)	26–30	7 (70)
> 30	2 (22)	> 30	1 (10)
Region		Region
North	0 (0)	North	0 (0)
Northeast	5 (56)	Northeast	1 (10)
South	3 (33)	South	6 (60)
Southeast	0 (0)	Southeast	2 (20)
Midwest	1 (11)	Midwest	1 (10)
Highest degree obtained		Highest degree obtained
Bachelor’s degree	1 (11)	Bachelor’s degree	0 (0)
Master’s degree	0 (0)	Master’s degree	3 (30)
PhD	1 (11)	PhD	3 (30)
Postgraduate specialization	7 (78)	Postgraduate specialization	4 (40)

*Chief Executive Officer

Emergent categories

Firstly, we generated eight codes, which were subsequently grouped into thematic categories through iterative analytical discussions conducted by three researchers experienced in qualitative analysis, resulting five thematic categories that reflect the ambivalences and tensions surrounding the multiplicity of pharmacists’ professional roles. The conceptual relationships among the five emergent categories show how perceived advantages and disadvantages converge toward curricular structuring. This framework highlights how the perceived advantages of diversification coexist with concerns about professional identity fragmentation, leading participants to propose curricular structuring as a mediating strategy.

1. Increased employability

2. Capacity to respond to health care demands

3. Fragmentation of professional focus

4. Fragility in professional identity

5. Need for curriculum standardization

Increased employability refers to participants’ perception that diversification expands career opportunities and professional mobility. Capacity to respond to healthcare demands reflects the understanding that multiple practice areas allow pharmacists to address unmet societal needs. In contrast, fragmentation of professional focus describes the perceived dilution of professional expertise, which participants associated with fragility in professional identity. Together, these categories illustrate a tension between the opportunities created by diversification and the challenges it poses to professional coherence and identity. Finally, the need for structured curricular pathways across practice areas emerged as a proposed strategy to reconcile diversity with professional coherence.

Perceived advantages: diversity as an opportunity

Mentors were the main advocates for the diversification of practice areas as an advantage. They highlighted increased opportunities as motivating and adaptive factors in response to market complexity, suggesting that diversification is perceived as a strategy for professional flexibility and employability in uncertain labor contexts. They also viewed diversity of roles as a strategic response to the multiple demands in healthcare:

Increased employability

M1: “When I open up this range of opportunities… I show that if pharmacists don’t want to work in community pharmacy, they still have other options.”

M3: “Having all these areas I think is fantastic in terms of opportunities.”

Capacity to respond to health care demands

This perception indicates that diversification is also understood as a way to align the profession with evolving societal and healthcare needs.

M2: “The market can accommodate all these practice roles. […] If there’s demand, let’s see the glass as half full.”

G1: “ It’s great to know that pharmacists can work, for example, in acupuncture. It’s interesting, pharmacists being involved in integrative health practices. I think that’s wonderful.”

Perceptions of disadvantage: fragmentation and fragile professional identity

In contrast, managers expressed more pointed criticisms of the fragmentation of professional practice, identifying it as a factor that weakens the pharmacist’s professional identity.

Fragmentation of professional focus

G4: “I believe having multiple areas of practice can be harmful when the pharmacist lacks focus, priorities or defined goals. Without focus, it becomes difficult to excel in any area.”

G3: “The fact that there are so many practice areas brings the risk of the pharmacist becoming what I call a ‘duck professional’: it swims kind of well, runs kind of well, flies kind of well".

This metaphor reflects participants’ perception of professional fragmentation, in which the diversification of practice areas may dilute professional identity and depth of expertise. It also suggests concerns about superficial competence across multiple areas, rather than the development of deep expertise in a defined field.

Fragility in professional identity

G2: “A profession with many practice areas struggles to have a clear identity”.

G4: “Several historical events weakened the profession, causing it to lose its professional identity. This weakening led to the incorporation of new areas of practice.”

The G4 statement may refer to historical processes such as changes in pharmaceutical regulation, the separation between clinical and industrial roles, and shifts in the recognition of pharmacies as healthcare establishments in Brazil. These perceptions reinforce the idea that diversification may challenge the development of a coherent professional identity, particularly when role boundaries become unclear. Futhermore, mentors, although fewer in number, acknowledged the difficulty of achieving technical depth:

M3: “It’s humanly impossible to be good at everything. Undergraduate education doesn’t make you excel at anything”.

Standardization as a reconciling pathway

Despite disagreements, there was consensus on the need for a minimum curricular structure in each practice area. Participants indicated that specialization and the development of structured learning pathways within each practice area can address the gap left by a generalist undergraduate education, particularly for recent graduates.

Need for structured curricular pathways across practice areas

M1: “When you have a specialized profession, when you’re good at it, you become really strong”.

G3: “I think that when there are many options, each one should have a structured curriculum”.

Table 2 shows the frequency of mentions by group and category, highlighting that mentors addressed the topic with greater nuance, while managers maintained a more critical and homogeneous stance. Frequencies are presented for descriptive purposes only and do not represent quantitative weighting of qualitative findings.

Table 2.

Frequency of mentions of 'Practice Areas' categories among managers and mentors.Table designed by the author

Categories	Managers	Mentors	Total
Advantages
Increased employability	1	9	10
Capacity to respond to health care demands	0	2	2
Disadvantages
Fragmentation of professional focus	5	7	12
Fragility in professional identity	1	0	1
Recommendations
Specialization	1	4	5
TOTAL	8	22	30

Discussion

Unlike developed countries, where economic growth was accompanied by the consolidation of universal health systems, Brazil has experienced unstable development cycles over the past 60 years, marked by frequent changes in public health policies and sanitary legislation [41–43]. The enactment of Law No. 5,991/1973 and, subsequently, Law No. 13,021/2014, which recognized the pharmacy as a healthcare establishment, illustrates this delayed trajectory in the regulation of pharmaceutical retail and the professional repositioning of pharmacists [44, 45]. Although these interpretations extend beyond participants’ direct statements, they help contextualize the findings within the Brazilian healthcare system.

In this study, participants associated the diversification of practice areas with tensions between generalist education and lack of clarity in professional roles, as reflected in the categories “fragmentation of professional focus” and “fragility in professional identity” which reflects broader curricular reforms observed in Brazil. In response to the need to align with Brazil’s new public health model, pharmacy curricula were revised following the publication of the National Curriculum Guidelines in 2002 and their update in 2017. These guidelines proposed a generalist, humanistic, critical, and reflective education [11, 46], aligned with the principles of the Sistema Único de Saúde (SUS), the Unified Health System, and with the universality and comprehensiveness of care through the development of multiple competencies, including clinical ones [47–49].

In this study, mentors identified the expansion of practice areas as a strategic response to healthcare demands and employability, consistent with the categories “increased employability” and “capacity to respond to healthcare demands” identified in the results. Although the international literature highlights advantages related to the versatility and employability offered by this model, the practical implementation of these guidelines has faced significant structural and pedagogical challenges in Brazil [47, 48]. Among these challenges are the rapid growth of low-quality private and distance-learning pharmacy programs, as well as a notably academic faculty profile, disconnected from the practices carried out in the public healthcare system and community pharmacies [24, 49, 50]. These interpretations extend beyond participants’ narratives but help contextualize findings within the Brazilian healthcare system.

The lack of practical experience among these faculty members, combined with the mercantilist view of pharmaceutical retail, discourages students from pursuing careers in this setting. Moreover, legislative proposals over recent decades have suggested eliminating the mandatory presence of pharmacists in pharmacies, calling into question their technical and social role [51–53]. Although such bills have not been enacted, they reveal the profession’s legal vulnerability by framing the pharmacist as a non-essential cost. Therefore, this analysis suggest precarious working conditions in community pharmacy can boost the diversification of practice areas as a strategy to improve pharmacists’ employability in the country.

Participants’ perceptions regarding professional focus and education may reflect broader institutional dynamics shaping pharmacy practice in Brazil. For example, the role of professional councils, professional associations, and academic institutions, which have often prioritized individual or sectoral interests over societal needs and scientific evidence. Within these institutions, the diversification of practice areas has been influenced by power struggles between globally recognized fields, such as community and hospital pharmacy, and those present in only a limited number of countries, such as clinical laboratory services. Therefore, the creation and maintenance of these practice areas may better reflect the vested interests of specific groups more than the strengthening of the pharmacist’s professional identity in community pharmacies [54, 55].

According to Kellar [14], the pharmacist’s professional identity remains diffuse, partly due to the absence of a clear professional repositioning oriented toward addressing social needs, as highlighted by managers. In contrast, professions such as medicine and nursing have developed curricula centered on clinical care and aligned with the healthcare system, which has contributed to their social recognition and professional consolidation [56]. To strengthen the pharmacist’s professional identity, the international agenda has advocated for specialized education focused on patient care, supported by continuing education and interprofessional practice [7].

Similar tensions have been reported in studies of professional identity formation among community pharmacists internationally, where role ambiguity and expanding practice expectations influence identity consolidation [16, 57, 58]. These findings are consistent with the perceptions observed among participants, particularly those related to “fragmentation of professional focus” and concerns about identity coherence in the present study. One pathway suggested involves postgraduate specialization programs, allowing undergraduate education to preserve a generalist foundation while professional identity develops through advanced teaching.

In the United States and Canada, the PharmD degree has emphasized clinical teaching and interprofessional integration [57, 58]. Although the European Union has a more diverse educational model, it requires supervised practice experience to work in multiple settings, including community and hospital pharmacy [22, 59, 60]. In addition, the establishment of pharmacy residencies has fostered professional development and optimized patient care processes [61]. These countries also require mandatory continuing education for license renewal, ensuring that pharmacists remain aligned with both technological (hard) and practice-based (soft) innovations [23, 58]. Consistent with these perspectives, participants in the present study emphasized specialization as a mechanism to reconcile professional diversity with role clarity, as reflected in the category related to structured curricular pathways. By enabling pharmacists to develop deeper expertise within defined fields, specialization may strengthen professional identity while maintaining the broader scope of the profession.

In Brazil, the precarious nature of the profession drives an incessant pursuit of individual recognition and validation, which may have contributed to the growth of diverse practice areas. These analysis may suggest that, the profession remains in constant reorientation, lacking a consolidated identity and fragmented across multiple roles, with limited social recognition. This interpretation suggests that the pharmacist’s role in community pharmacy may be perceived as influenced by a predominantly commercial logic, a perception indirectly reflected in participants’ concerns about professional recognition and role clarity [31, 62]. Although these interpretations extend beyond participants’ direct statements, they help contextualize the findings within the Brazilian healthcare system.

It is worth noting that in Brazil, the country with the highest number of community pharmacies in the world, practice in this setting may be perceived as marginalized by professionals, often viewed as an ‘entry-level job’ or ‘temporary alternative’ [63, 64]. Thus, the lack of motivation and specialized teaching diminishes the perception of pharmacists as essential professionals among retail pharmacy managers and mentors. Therefore, the findings of this study highlight challenges related to professional identity and role clarity, which, when considered alongside existing literature, suggest the need to reflect on educational models capable of supporting professional identity development grounded in patient care, scientific practice, and social commitment [65].

Given the above, developing a coherent educational framework aligned with societal needs, one that prepares pharmacists to play a leading role in advancing healthcare in Brazil, can be considered essential. To this end, the adoption of hybrid curricula, offering elective courses from the early semesters, encouraging participation in extension projects, academic leagues, extracurricular internships, and postgraduate programs (lato and stricto sensu), has been proposed in the literature as a promising pathway to address these challenges [57, 66, 67]. Another important approach discussed in the literature is the implementation of mandatory or incentivized continuing education programs to ensure professionals remain up to date and able to respond to emerging demands within the healthcare system [24, 68].

Limitations

This study has limitations. Participants were restricted to mentors and retail pharmacy managers, which may not represent perceptions from other pharmacy sectors. Additionally, discussions on practice diversification emerged inductively rather than from predefined interview questions, which may have limited deeper exploration of professional identity dimensions. As a qualitative study conducted within the Brazilian context, the findings are not intended for statistical generalization but for analytical transferability, and should be interpreted within this specific context. Data collection occurred during the COVID-19 pandemic, requiring remote interviews, which may have influenced participants’ reflections on professional roles due to ongoing changes in healthcare delivery and workforce demands during this period. Although data were collected in 2020, the structural characteristics of pharmacy education and professional regulation in Brazil have remained largely unchanged, which may support the continued relevance of these findings; however, temporal changes in practice should be considered.

Conclusion

The findings of this study suggest that the diversification of practice areas may contribute to perceptions of a fragile professional identity among participants as healthcare providers. Education continues to be affected by the lack of formal requirements for specialization in community pharmacy, as well as by the influence of corporate interests in the retail pharmacy settings. Professional education remains shaped by the lack of formal requirements for specialization in community pharmacy and by corporate interests within the retail pharmacy sector. These findings suggest that a coordinated effort may be needed among educational institutions, professional councils, public policy makers, and the profession itself. The future of the profession demands more than piecing together a ‘patchwork of possibilities’: it requires redefining priorities. Therefore, it is essential to reposition the pharmacist as a key player in healthcare in Brazil, through a balanced curriculum, clear educational standards, a solid clinical foundation aligned with retail pharmacy practice, and above all, an ethical commitment to society.

Authors’ contributions

FLF: Conceptualization, Methodology, Investigation, Formal Analysis, Data Curation, Writing - Review & Editing.ASD: Conceptualization, Methodology, Investigation, Formal Analysis, Data Curation, Writing - Review & Editing.FCAN: Conceptualization, Methodology, Investigation, Formal Analysis, Data Curation, Writing - Review & Editing.LGS: Methodology, Investigation, Data Curation.DMMP: Methodology, Investigation, Formal analysis, Data Curation, SupervisionLJSCV: Formal Analysis, Data Curation, Writing - Review & Editing.DPLJ: Conceptualization, Methodology, Investigation, Formal analysis, Data Curation, Supervision, and Project administration.

Funding

The authors did not receive support from any organization for the submitted work.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the Federal University of Sergipe nº 4.169.752. The procedures used in this study adhere to the tenets of the Declaration of Helsinki. All participants provided informed consent and agreed to record the interviews as well as publish the data generated.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.