What I Wish I Knew: Alternative and Evolving Career Pathways in Psychiatric Pharmacy

The “What I Wish I Knew” series of articles is a service of CPNP’s Resident and New Practitioner Committee. Articles are intended to provide advice from experts for students, residents, and new practitioners. Articles are not intended to provide in-depth disease state or pharmacotherapy information nor replace any peer-reviewed educational materials. We hope you benefit from this “field guide” discussing approaches to unique problems and situations.

Dr. Bishop is Professor of Experimental and Clinical Pharmacology at the University of Minnesota (UMN). He conducts psychiatric pharmacogenomics research activities in the UMN College of Pharmacy Pharmacogenomics Laboratory with a primary focus on symptom response, cognitive response, and side effects to medications. He has clinical experience in the treatment of psychosis and mood disorder populations and is also a contributing member to the Clinical Pharmacogenetics Implementation Consortium, the University of Minnesota Institute for Personalized Medicine, and the Pharmacogenomics Global Research Network (PGRN) Implementation Working Group..

What are some newly created or evolving alternatives in psychiatric pharmacy?

Practice environments for psychiatric pharmacists have existed for some time in the hospital setting. Traditionally this has been in the context of working with inpatient treatment teams. However, there have been increasing opportunities for psychiatric pharmacists to practice within hospital-based outpatient clinics, injection clinics, and emergency departments. There are also a growing number of medications with unique FDA Risk Evaluation and Mitigation Strategies (REMS) that may present opportunities for pharmacist-focused or pharmacist-led clinics to improve the accessibility of these medications. There continues to be a great need for individuals well-versed in psychiatric pharmacy to contribute to the care of individuals in community environments, including involvement in both primary care and assertive community treatment (ACT) team settings. With notable shortages of mental health care providers, particularly in rural areas, there is a growing opportunity for pharmacists to support both primary care providers and psychiatric specialists. The number of psychiatric pharmacists utilizing collaborative practice agreements in outpatient clinics continues to increase, as do the opportunities for pharmacists to be reimbursed for the provision of medication therapy management-related services. For patients who may struggle with mental health and other medical conditions with complex medication regimens, the optimization of drug therapy is essential.

What does the future hold for career paths in psychiatric pharmacy?

According to the most recent available pharmacist workforce survey (Mott, 2025), there have not been major shifts in the distribution of pharmacist practice environments from 2019-2024. The survey does not specifically delve into therapeutic area specialties, so it is challenging to determine whether this is generalizable to psychiatric pharmacists. One potentially generalizable finding is that the two practice areas with the greatest job satisfaction are hospital and ambulatory care settings. 

Advances in mobile technologies and point of care testing are now providing increased opportunities for medication, symptom monitoring, and communication. Telepharmacy and video consultation opportunities have been expanding for psychiatric pharmacists just as they have for psychiatrists and other health care providers in this new era of remote assessments. This will increase the availability of pharmacists for both prescriber and patient consultations, particularly in rural areas or in regions with lower densities of psychiatric pharmacy specialists. This along with the pre-pandemic growth of ambulatory care pharmacy collectively predicts a growing role for the psychiatric pharmacist in the community/ambulatory care environments.

Pharmacist prescribing already exists in some environments like Veteran’s Administration Medical Centers. Whether there are going to be broad near-term expansions of pharmacist prescribing beyond that environment is not clear, but I anticipate that there will be an increase in collaborative practice agreements which will provide opportunities for limited prescriptive activities.

One element of rapidly advancing technology that will certainly impact psychiatric pharmacy moving forward, albeit in uncertain ways, is artificial intelligence (AI). Out of my own curiosity and potential interest to WIWIK readers, I queried Google Gemini and ChatGPT with the following prompt for AI-generated insights: “how will artificial intelligence impact the field of psychiatric pharmacy in the next five years?” 

From Google Gemini: “Over the next five years, artificial intelligence will fundamentally reshape psychiatric pharmacy. Rather than replacing the human touch essential to mental healthcare, AI will act as a powerful co-pilot—absorbing administrative burdens and processing vast amounts of data so psychiatric pharmacists can focus on direct patient care, complex clinical judgment, and medication safety… Ultimately, the true impact of AI will be a consolidation around human accountability. Because large language models can still confidently hallucinate or misinterpret clinical nuances, the ultimate clinical judgment and ethical ownership of a patient's regimen will rest entirely on the pharmacist.”

“By automating the "information-processing layer" of the job, AI will give psychiatric pharmacists the gift of time—allowing them to lean heavily into what AI cannot replicate: counseling vulnerable patients, assessing substance use disorders, building therapeutic trust, and managing complex behavioral health crises.”

“The intersection of AI and psychiatric pharmacy (often called pharmacointelligence) is poised to shift the field in several key areas by 2031:”

1. Advanced Precision Medicine and Pharmacogenomics
2. Population Health and Predictive Risk Flagging
3. Vaporizing the "Medication-Access Bureaucracy"
4. Digital Phenotyping and Real-Time Monitoring
5. Accelerating Neuro-Psychiatric Drug Discovery

From ChatGPT: “Over the next five years, artificial intelligence (AI) is likely to transform psychiatric pharmacy less through fully autonomous clinical decision-making and more through augmentation of pharmacist expertise. The greatest impact will come from integrating large language models (LLMs), multimodal foundation models, predictive machine learning, and real-world data into medication management, pharmacogenomics, and population health.” Notable categories of influence include:

1. AI-assisted psychopharmacology decision support
2. Pharmacogenomics becomes clinically actionable
3. Biomarker-driven precision psychiatry
4. Automated therapeutic drug monitoring (TDM)
5. Clinical documentation
6. Conversational AI for patients
7. Accelerating drug development

While each AI tool has its own take on this question, there are some similar themes. Notably it was nice to read that AI currently states that its role will be one of pharmacist support or augmentation versus an approaching singularity or takeover.

How will precision medicine and pharmacogenetic (PGx) testing fit into psychiatric pharmacy in the next 5-10 years?

Precision medicine continues to be a popular concept. The spirit of ‘precision medicine’ is to incorporate additional technologies to improve treatment by making them more ‘precise’. Current trends include the study of incorporating mobile (e.g., wearable monitors, ‘smart’ watches, smartphone applications, etc,), or biological (e.g., genetic data or real time monitoring of drugs or other substances in the body) technologies into patient care (Bond 2023).

One aspect of precision medicine that is gaining a lot of popularity, but remains controversial in some settings, is that of PGx testing. We have a growing understanding of how genetic variation influencing drug metabolism and pharmacodynamics may influence dosing or drug selection. This is particularly relevant to psychiatric pharmacy for a couple of reasons. The first is that in the absence of a robust pipeline for novel developments for mental health conditions, we need to optimize the treatments that are currently available. Many patients require multiple medication trials to find a drug that is tolerable and efficacious. The second is that many commonly used medications in psychiatry are antidepressants and antipsychotics, most of which undergo extensive hepatic metabolism through enzymes with notable genetic variation (Bishop, 2018). We can now very reliably identify those who are genetic fast or slow metabolizers with clinical pharmacogenetic tests and there is growing evidence to support the use of this information to inform drug selection and dosing when it is available (Bousmman 2023, Beunk 2024, ClinPGx.org).

This has resulted in a dramatic increase in commercial testing companies with PGx testing products for psychiatric medications. The caveat to this is that there are many clinically available tests that are all slightly different. Furthermore, the application of the test results to patient care requires some knowledge of what the test results mean in the context of current and potential future drug selections for the patient (Bishop 2024). To make these tests ‘user friendly’ the test results are often accompanied by decision support tools that try to simplify the findings. But these tests are often ordered for clinical scenarios which are complicated. In my mind this necessitates an additional level of interpretation, and perhaps education (to both patients and prescribers) that the psychiatric pharmacist is well positioned to provide. The Veterans Affairs Healthcare Association is an example of one large national organization that has targeted hiring or training clinical pharmacy specialists to provide pharmacogenetic test interpretation (Wu 2024). Most of the PGx testing relating to mental health is occurring in outpatient clinics, reinforcing a potential role for psychiatric pharmacists in the ambulatory care environment. The use of PGx tests will likely continue to increase over time and as the technologies improve, and the costs are lowered, there will be an evolution of current ‘reactive’ testing to more ‘prospective’ testing where genetic/pharmacogenetic information will be readily available to guide patient care, likely with additional information gathered from novel mobile monitoring technologies. We as a psychiatric pharmacy community need to be prepared for this.