Why Doctors Don’t Understand Compounding - and How Education Can Change That
Mar 18, 2025
Doctors often misunderstand pharmacy compounding, impacting patient care. Why? Limited training, misconceptions, and poor doctor-pharmacist communication. Here’s how we can fix it:
What is Compounding? It’s creating custom medications for specific patient needs, like adjusting dosages or removing allergens.
The Problem: Many doctors lack knowledge about compounding safety, quality, and regulations. For example, compounded drugs have shown potency variations up to 300%, and costs have surged by 130% between 2012–2013.
Why the Gap? Only 21% of pharmacy schools offer courses on compounding, and time constraints limit collaboration between doctors and pharmacists.
Solutions: Professional training programs, better communication tools, and tech like medical apps and 3D simulations can bridge the gap.
Doctors and pharmacists working together can improve outcomes, reduce errors, and personalize care. Let’s focus on education to make this happen.
Creating a State-of-the-art Pharmaceutical Compounding Learning Center
Main Barriers to Doctor Understanding
Medical education and workplace environments often limit physicians' understanding and use of compounding services. These limitations show up in specific areas that need focused solutions.
Gaps in Medical School Training
Only 21% of U.S. pharmacy schools offer dedicated courses on compounded sterile preparations (CSPs), and just 13% of graduates feel adequately trained in this area. Furthermore, only 27% of institutions have proper sterile compounding facilities.
"Most (88.7%) believed that students could only become fully competent in these skills over time in actual practice".
This lack of training contributes to ongoing misconceptions about compounding.
Misconceptions About Compounding
These misunderstandings aren't just due to limited training - they're also fueled by myths about the safety and quality of compounded medications. For example, a 2006 FDA survey revealed that 33% of compounded drugs failed quality tests, while Missouri data from 2006–2009 showed a 20% failure rate.
Dr. Devin Patel, PharmD, explains the issue:
"A lot of physicians don't understand different pharmacy services...Physicians have such limited time in the day, and they struggle dealing with prior authorizations, and all these nuances."
Challenges in Doctor-Pharmacist Communication
Physicians spend an average of 15–16 minutes per patient, with just 49 seconds dedicated to discussing medications. This time constraint makes collaboration between doctors and pharmacists difficult.
Katherine Capps, Executive Director of GTMRx, highlights the problem:
"We must find a better way to optimize medication use to avoid life-threatening and wasteful overuse, misuse and underuse."
Yet, despite these challenges, 90% of physicians agree that pharmacists' recommendations add clinical value. This suggests that better education and communication could significantly improve the use of compounding services.
The table below outlines key communication barriers and their effects:
Barrier | Impact | Prevalence |
|---|---|---|
Time Constraints | Medication discussion limited to 49 seconds per visit | Affects most patient visits |
Professional Silos | Hinders integrated, patient-centered care | Reported by 25% of healthcare leaders |
Information Access | Poor system interoperability | A major issue in many settings |
HIPAA Constraints | Restricts data sharing between providers | Varies by practice relationship |
Education Methods for Doctors
Bridging the knowledge gap in compounding requires targeted educational approaches that fit within physicians' busy schedules. These methods lay the groundwork for more structured, program-based learning opportunities.
Professional Training Programs
The American College of Apothecaries (ACA) provides hands-on pharmaceutical compounding training at its national facility in Bartlett, Tennessee, offering practical instruction in compounding techniques. Similarly, the FDA's Compounding Quality Center of Excellence offers courses on topics like environmental monitoring and quality management. These programs tackle common misconceptions by presenting evidence-based, actionable strategies.
Learning Materials and Guides
Data reveals that 76% of independent pharmacies and nearly all hospitals rely on compounding, which accounts for an estimated 1–3% of U.S. prescriptions. Educational materials explain how compounding meets specific patient needs, such as allergen-free medications, pediatric dosing, and personalized formulations. In addition to self-study resources, collaborative programs help integrate compounding expertise into everyday clinical practice.
Joint Medical-Pharmacy Programs
Studies show that pharmacist involvement improves medication management for 90% of physicians, with an economic benefit of over $4 for every $1 invested in pharmacist integration. These programs include activities like case reviews, shared patient consultations, collaborative prescription planning, and ongoing medication therapy management. Integrated pharmacy teams have successfully identified and resolved drug-related issues for 93% of patients, uncovering an average of 2.1 medication discrepancies per patient. This teamwork not only improves prescription accuracy but also addresses communication gaps between healthcare providers.
Tech Tools for Doctor Education
Technology has made it easier than ever for doctors to access interactive learning tools, even within their busy schedules.
Medical Reference Apps
Medical apps offer instant access to compounding information right at the point of care. For example, MDCalc boasts a 4.9-star rating from nearly 50,000 users. Similarly, DynaMed and Skyscape Medical Library maintain excellent ratings of over 4.8 out of 5, offering detailed pharmaceutical references.
Dr. Manish Naik, Chief Medical Information Officer at Austin Regional Clinic, explains:
"Medical reference apps promote the practice of evidence-based medicine and give both patients and providers confidence in the diagnosis and treatment plans being chosen".
In one case from December 2017, Dr. Naik used a medical reference app to reassure a patient hesitant about getting a flu vaccine due to an egg allergy. After reviewing study data together, the patient agreed to receive both flu and pneumonia vaccines.
Beyond mobile apps, advanced tools like 3D simulations are reshaping hands-on medical training.
3D Training Simulations
3D simulations provide a safe, hands-on environment for learning compounding techniques. Tools like the LabQuest system have shown better outcomes compared to traditional methods. While 70% of PharmD programs require sterile compounding competency, only 20% offer dedicated courses. These simulations allow repeated practice without risk, helping learners build skills faster and with more confidence.
In addition to these interactive tools, prescription support systems play a crucial role in ensuring precise and evidence-based compounding.
Prescription Support Systems
Clinical Decision Support Systems (CDSS) integrate seamlessly into healthcare workflows, improving the accuracy of compounding prescriptions. These systems use patient data and evidence-based guidelines to assist in treatment decisions. Core features include:
Real-time Data Integration: Instant access to patient records and drug interaction details
Evidence-based Guidelines: Helps ensure compliance with current compounding standards
Team Collaboration: Enhances communication between doctors and pharmacists
Educational Tools: Provides access to the latest research and best practices
One standout example is UpToDate, a leading CDSS platform accessed over 1 million times daily. It influences treatment decisions in 30% of consultations and offers individual subscriptions starting at $499, making it accessible for independent practitioners.
These technologies are helping doctors close the gap in compounding knowledge, ultimately improving patient care.
Results of Education Programs
These education programs and technology tools are starting to show clear improvements.
Testing Doctor Knowledge
A study from D'Youville College tracked compounding accuracy at three points: it started at 57.8%, rose to 92.2%, and later dropped to 75%.
Evaluations included:
Hands-on tests to measure compounding accuracy
Written exams to assess calculation and labeling skills
Follow-ups to check how well skills were retained over time
Prescription Pattern Changes
In 2016, medication-induced death rates were 7.5 per 100,000. Educational efforts have led to better dosing practices, fewer drug interactions, improved compound choices, and greater attention to individual patient needs.
Doctor-Pharmacist Relations
A collaborative effort between a community pharmacy and a family practice resulted in an average of four pharmacist recommendations per patient. All were accepted through EHR communication. This highlights the importance of teamwork in healthcare, especially since 75% of medication-related problems are tied to poor prescribing and lack of care coordination.
Conclusion
Action Steps for Pharmacists
Pharmacists play a key role in bridging the gap between compounding and traditional prescriptions. Partnering with PCAB-certified compounding pharmacies ensures access to reliable and high-quality prescriptions. Interestingly, some pharmacists have shared that the profit from 10 compounded prescriptions matches that of 50 traditional ones.
Highlighting documented outcomes is another way to showcase the value of compounding. For example, Memorial Health reported a drop in 30-day readmissions from 21% to 4% thanks to pharmacist-led clinics.
"Compounding gives pharmacists the chance to do pharmacy again. Compounding is the art of pharmacy, it's how pharmacy started. What drives me is being able to get great patient outcomes by what we do, not by what we put into a bottle." - Donnie Calhoun, CEO of the American College of Apothecaries
Building Professional Networks
Beyond improving prescription practices, building strong professional networks can help expand compounding education. Michelle Jeon, PharmD, Assistant Professor at the University of Health Sciences and Pharmacy in St. Louis, Missouri, emphasized this point:
"I believe there often is a disconnect between the patient care that pharmacists and physicians provide, especially in the community pharmacy setting"
Strengthening these professional relationships can improve understanding and application of compounding. Pharmacists can take the following steps to enhance collaboration:
Start with a focus: Choose one specialty area to develop expertise before broadening services.
Educate effectively: Share insights about proper compounding practices and address physicians' questions about risks and benefits.
Showcase results: Use documented patient outcomes (with consent) to demonstrate the effectiveness of compounded medications.
When pharmacists and physicians collaborate effectively, patient care outcomes can see a dramatic improvement. For instance, heart failure clinics have reported an increase in medication adherence rates from 51% to 88% through coordinated care efforts.