A competence- and achievement-based advancement program developed for pharmacists at The Moses H. Cone Memorial Hospital, a 530-bed community teaching hospital, is described. In 1985 pharmacy management recognized the need to provide an incentive program to reward achievements by staff clinical pharmacists, recognize their increased responsibilities, and increase the department's ability to retain qualified practitioners. Adding another rung to the existing administrative career ladder was not desirable, so a new job category, pharmacist II, was created. Employees are evaluated for promotion to pharmacist II on the basis of tenure, performance, and elective professional and service activities. A point system is used to objectively score achievements; to be promoted, an employee must accumulate 50 points during a two-year period. The number of staff pharmacists who can advance is limited not arbitrarily but rather by the application of challenging criteria. Employees are responsible for submitting documentation of their achievements to a review committee, which meets quarterly to evaluate applications and award points. Of 13 applicants since 1985, 10 have been promoted. Because of problems in evaluating the performance of pharmacist II employees, providing them time to conduct research, and incorporating specialty practice areas into the program, plans are being made to institute a more structured career ladder system with separate managerial, clinical, and educational tracks. A competence- and achievement-based advancement program with a single step was an improvement over the former system but lacked the balance and comprehensiveness offered by more structured career ladder programs.