On rotations and not knowing who people are at the site.

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I was on an MTM rotation late last year. Was a pretty good rotation, and trying to get a job there doing MTM. They pay the paid interns based on how many cases they complete, somewhere like $20/case. On my rotations I was usually able to complete about a case every 20 minutes. (6-10 minutes on the phone with the patient, and filling out the stuff on the computer took another 10 minutes.)

My immediate supervisor said I was kicking ass with how I was knocking out cases very fast. They expect an intern on rotations to be able to complete about 5 cases a day, I was usually getting around 8-10 cases a day. However, the fact that I didn't know who some people were at the office might have hurt my job chances.

The set up over there was that each person is given a cubicle with a laptop and phone that you do your work on. My cubicle was next to some guy who was in an office. After completing 5 cases by 12, I'd usually derp around on the internet going on SDN or 9GAG or reading news articles for most of the rest of the day and occasionally do a case every hour or so.

The guy who was in the office with a window viewing out into the cubicles was my supervisors boss, and the COO of the company. He probably saw that I wasn't working at some times. So yeah, that could have screwed me over.

The hiring manager told me to go and talk to him the other day, and he mentioned that on my rotations, I showed flashes of really good potential for what they're looking for in interns/pharmacists, but that I was also very streaky and not on my "A" game at all times. I guess his mentality was that, if I'm there for 8 hours a day, and I finish 5-6 cases within the first 3 hours, why do I only end up with 9-10 cases the entire day. (If I was going hardcore at the cases all day, I'd probably end up with somewhere around 15-18 cases a day.) I figured that he probably saw me messing around the rest of the day once I met my quota.

I'm sure that if I'm there working for $$$, I'd be more motivated to bang out cases at my potential. (If I do 8 hours a day, and complete 20 cases a day, that's $400 in one day. Full-time, that's $2000/week.)

So question for you guys, has not knowing who someone was at the site ever bitten you in the ass?

Originally Posted by Sparda29

I was on an MTM rotation late last year. Was a pretty good rotation, and trying to get a job there doing MTM. They pay the paid interns based on how many cases they complete, somewhere like $20/case. On my rotations I was usually able to complete about a case every 20 minutes. (6-10 minutes on the phone with the patient, and filling out the stuff on the computer took another 10 minutes.)

My immediate supervisor said I was kicking ass with how I was knocking out cases very fast. They expect an intern on rotations to be able to complete about 5 cases a day, I was usually getting around 8-10 cases a day. However, the fact that I didn't know who some people were at the office might have hurt my job chances.

The set up over there was that each person is given a cubicle with a laptop and phone that you do your work on. My cubicle was next to some guy who was in an office. After completing 5 cases by 12, I'd usually derp around on the internet going on SDN or 9GAG or reading news articles for most of the rest of the day and occasionally do a case every hour or so.

The guy who was in the office with a window viewing out into the cubicles was my supervisors boss, and the COO of the company. He probably saw that I wasn't working at some times. So yeah, that could have screwed me over.

The hiring manager told me to go and talk to him the other day, and he mentioned that on my rotations, I showed flashes of really good potential for what they're looking for in interns/pharmacists, but that I was also very streaky and not on my "A" game at all times. I guess his mentality was that, if I'm there for 8 hours a day, and I finish 5-6 cases within the first 3 hours, why do I only end up with 9-10 cases the entire day. (If I was going hardcore at the cases all day, I'd probably end up with somewhere around 15-18 cases a day.) I figured that he probably saw me messing around the rest of the day once I met my quota.

I'm sure that if I'm there working for $$$, I'd be more motivated to bang out cases at my potential. (If I do 8 hours a day, and complete 20 cases a day, that's $400 in one day. Full-time, that's $2000/week.)

So question for you guys, has not knowing who someone was at the site ever bitten you in the ass?

You're asking the wrong question. You had a job to do - you met the minimum, not your potential. If I'm looking to hire, I'm looking for the person who does hard work all day and not the person who meets the quota and then calls it quits.

10 times out of 10, I'll take the person who works hard and tries to do better over the person who gets the job the job done but doesn't care about doing better. You can train a person to be better, it's much harder to train a person not to be lazy. Spend your extra time doing QI or something beneficial, not farting around on Know Your Meme.

If you screwed yourself out of a job, it's your own fault - not a lack of connection. Before you bring up the "I can do better, I chose not to" argument, realize that these have been constant issues throughout your schooling. While I think you might have the potential to do great things with your career, I'm not convinced you have the drive.

I agree with prazi, you weren't screwed because you didn't know anyone (though they probably know you as the one who slacked off), you screwed yourself by slacking off after you finished your work. Although you may be efficient and can get cases done quicker, that doesn't mean you should be entitled to goof off the rest of the day. A good employee will look for other things to do, there's always other things that can be done. Just because you weren't being paid doesn't mean you only have to do the bare minimum. You should have wowed them by finishing all your assigned cases and ask them for more and do the 15-18 cases you could have done for the entire day rather than just do expected minimum of 5 cases; they probably would have offered you a job if you did that... I wouldn't hire you either if I was the hiring manager.

Sparda, what ARE you going to do come June? I mean, you've been so open about your slacking and less than ideal work ethic....to the point that at one time I thought you were a clever troll. Then I realized that you really don't seem to care. Can't say I blame the dude for not giving you a shot.

Dude...rule #1...


...always at least appear to be working hard on rotations. You never know when they might be hiring. That's pretty much how I got my first job.

Let this be a lesson for the youngsters. Rotations where you aren't around faculty can be great job opportunities.

I didn't quite get this until it was almost too late myself.

I also disagree with "effort over talent 10 times out of 10" up there.

You say you can train people but not fix lazy...

...I say you can't fix stupid and expect brilliance out of mediocrity, but you can give incentives to the talented.

Your paradigm is indicative of someone who has poor leadership skills.

Gimme talent and I'll make them want to run through a wall for me. It'll beat your little engines that could every day of the week.

Sent from my SPH-D710 using SDN Mobile

To Sparda's direct question... Yes. The manager of the entire city loan operations (few hundred people at least) used to come work remote at our satellite site about once a week (Fridays), because it was closer to his house. I know of some gals that got written up, then fired, near the time he started doing this because they didn't realize who he was & thought he was a manager from out of town or someone outside our reporting structure needing to use a cube. (The office was not, at that time, otherwise assigned.)

I have worked in several environments where big wigs visiting or borrowing cubes was not uncommon. If you're going to screw around, at least have the common sense to make sure your screen is facing the wall / you can see people walk up to you before they see the screen.

Originally Posted by WVUPharm2007

Your paradigm is indicative of someone who has average leadership skills.

This is more consistent with my experience. I've only known a couple supervisors / managers (not even my one-up) that could correctly identify motivators on this level. Reading the disparity of what people say and what they actually think / do is not a skill that people often possess at this proficiency. You must be very talented.

Playing devil's advocate: You have to admit that they didn't set Sparda up for success, leadership-wise - he is motivated by a) least effort for optimal direct success (measured in this case by grade) or b) money (not offered to interns on rotation, presumably). Any big wigs I've ever met assume that the go-getters they want can see far enough that a potential job is enough of a carrot to not screw off (or at least to convince the COO they aren't, anyway).

If you'd bought the hiring dood a $1000 amazon gift card then taken him to a strip joint to get him hammered and bought lap dances for him, he'd have hired you.

Originally Posted by WVUPharm2007

I also disagree with "effort over talent 10 times out of 10" up there.

You say you can train people but not fix lazy...

...I say you can't fix stupid and expect brilliance out of mediocrity, but you can give incentives to the talented.

Your paradigm is indicative of someone who has poor leadership skills.

Gimme talent and I'll make them want to run through a wall for me. It'll beat your little engines that could every day of the week.

Sent from my SPH-D710 using SDN Mobile

Except most pharmacists aren't stupid nor does it take brilliance to be an effective pharmacist. That's why 10 out of 10 its better to hire a hard working motivated pharmacist than a lazy ass brilliant one.....who will most likely lower the morale of the department.

OK...is it just me? How is pharmacy/healthcare setting that pays base salary by work units completed, conducive to patient safety or optimal care?

When I say I didn't know who someone was, I don't mean that I didn't have a networking connection and that's what screwed me. What I'm saying is, I just didn't realize the guy sitting in the office there was a rather important guy (my preceptor's boss). Not to mention, served on the board of pharmacy a few times.

There was no nameplate or anything on his door/window so I thought he was some random IT guy. They used to tell me to send him an IM on their communication system if I was having tech problems with the software.

Originally Posted by SpirivaSunrise

OK...is it just me? How is pharmacy/healthcare setting that pays base salary by work units completed, conducive to patient safety or optimal care?

The insurance companies pay this company to complete cases for them. I believe the current rate is somewhere around $100/case. If the pay was hourly, then you're not gonna have any motivation to complete cases. Half the time, I feel like a telemarketer when I was there. Patients have no idea who you are or anything, you're just given their phone number, med lists and whatnot and you have to convince them to spare 10 minutes of their time for MTM.

Back to the original thing, I don't think he ever saw me just surfing the internet. He probably just looked at the numbers and extrapolated that the pace that I was completing cases changed after lunch. Half the time when I was there, I was working on my final research paper for school.

Originally Posted by SpirivaSunrise

OK...is it just me? How is pharmacy/healthcare setting that pays base salary by work units completed, conducive to patient safety or optimal care?

Its just you

Originally Posted by Its Z

Its just you

Good! I'll take some comfort in that.

Originally Posted by Its Z

Except most pharmacists aren't stupid nor does it take brilliance to be an effective pharmacist. That's why 10 out of 10 its better to hire a hard working motivated pharmacist than a lazy ass brilliant one.....who will most likely lower the morale of the department.

Exactly. And why should I waste my time motivating someone who SHOULD have some sort of intrinsic self motivation to do a good job, by this point in his/her life? Almost every pharmacist has the minimum skills/ability to do the job. I don't need to spend time coddling the brilliant but lazy slacker who would rather be playing video games. I am dealing with this VERY issue right now in my new company. I'll take hardworking any time over brilliant.

Originally Posted by SpirivaSunrise

OK...is it just me? How is pharmacy/healthcare setting that pays base salary by work units completed, conducive to patient safety or optimal care?

It's pretty common for MTM. I have an MTM consulting business and it's paid on a units completed basis. I guess that they assume the pharmacist is ethical and will do the necessary work to complete the case competently, and not just rip through to make more money. You have to watch rotation students pretty carefully in that type of setting, because (as Sparda has demonstrated) they WILL rush through the cases so they can do other stuff. A good preceptor will evaluate students not on the number of cases completed, but on how thoroughly they do the assessment and plan, and will spend time discussing each case with the student so there is actual learning going on.

Originally Posted by SpirivaSunrise

Good! I'll take some comfort in that.

Worked 12 hours came home fell asleep at 8 and got up at 4. I rock!

Originally Posted by All4MyDaughter

Exactly. And why should I waste my time motivating someone who SHOULD have some sort of intrinsic self motivation to do a good job, by this point in his/her life? Almost every pharmacist has the minimum skills/ability to do the job. I don't need to spend time coddling the brilliant but lazy slacker who would rather be playing video games. I am dealing with this VERY issue right now in my new company. I'll take hardworking any time over brilliant.



It's pretty common for MTM. I have an MTM consulting business and it's paid on a units completed basis. I guess that they assume the pharmacist is ethical and will do the necessary work to complete the case competently, and not just rip through to make more money. You have to watch rotation students pretty carefully in that type of setting, because (as Sparda has demonstrated) they WILL rush through the cases so they can do other stuff. A good preceptor will evaluate students not on the number of cases completed, but on how thoroughly they do the assessment and plan, and will spend time discussing each case with the student so there is actual learning going on.

The cases I did were complete and not rushed, full assessment/plan notes and all. I'm just saying that once I hit the magic # of 5 for the day, that's when I'd slow down and either work on my school stuff or browse and try to pass the time. If I was doing 20 cases a day, I'd be burned out by Wednesday,

Originally Posted by Its Z

Worked 12 hours came home fell asleep at 8 and got up at 4. I rock!

Fishing pole in hand now?

Originally Posted by SpirivaSunrise

Fishing pole in hand now?

No...gonna go to the mountain to sled. Like 10 feet of snow up there...picking up the boat tomorrow. How UGA?

Originally Posted by Sparda29

The cases I did were complete and not rushed, full assessment/plan notes and all. I'm just saying that once I hit the magic # of 5 for the day, that's when I'd slow down and either work on my school stuff or browse and try to pass the time. If I was doing 20 cases a day, I'd be burned out by Wednesday,

OK, I'm not sure what type of MTM you were doing, but I am very experienced at MTM and I can't consistently do a full patient interview + assessment/plan in twenty minutes. What MTM system were you using?

Originally Posted by rxlea

Sparda, what ARE you going to do come June? I mean, you've been so open about your slacking and less than ideal work ethic....to the point that at one time I thought you were a clever troll. Then I realized that you really don't seem to care. Can't say I blame the dude for not giving you a shot.

June? Take the exams. Planning on working at hospital as a staff pharmacist. Oh, and he is giving me a shot. I'm at that site for a different rotation (they have many different departments), so it's essentially a 2 week job interview now. Kicking ass at it so far.

Originally Posted by Its Z

No...gonna go to the mountain to sled. Like 10 feet of snow up there...picking up the boat tomorrow. How UGA?

She's good! Unlike you, maybe partied too hard last night?

Originally Posted by All4MyDaughter

OK, I'm not sure what type of MTM you were doing, but I am very experienced at MTM and I can't consistently do a full patient interview + assessment/plan in twenty minutes. What MTM system were you using?

Those were my thoughts...

That's one wrinkly sharpei like drunk looking dog.

Originally Posted by All4MyDaughter

OK, I'm not sure what type of MTM you were doing, but I am very experienced at MTM and I can't consistently do a full patient interview + assessment/plan in twenty minutes. What MTM system were you using?

You just suck at mtm. You should strive to be as good and efficient as sparda.

Originally Posted by All4MyDaughter

OK, I'm not sure what type of MTM you were doing, but I am very experienced at MTM and I can't consistently do a full patient interview + assessment/plan in twenty minutes. What MTM system were you using?

Think it was called Mirixa. The assessment/write-up usually took me about 15 minutes to complete depending on if the software is lagging or not.

As for the patient interview, it really depended on the patient on how long it would take. The optimal patient who has a full updated medication list and, is organized, and knows their stuff, and who can actually speak fast, that interview went by pretty quick.

There were a couple of times when the interview took me 30 minutes because the patient was absolutely senile or didn't speak much English and didn't have a caregiver who could do this for them. Once I had the med list and confirmed how they were taking it, I'd check for interactions and see if they know about them, find out if they are taking BP/BG/spirometry tests at home and how the meds are working for them.

If there was anything of concern, I'd shoot a fax over to the prescriber.

Originally Posted by Its Z

That's one wrinkly sharpei like drunk looking dog.

Don't ya just wanna squeeze her? And she's getting wrinklier with age! Like you?

Originally Posted by SpirivaSunrise

Don't ya just wanna squeeze her?

No she will probably bite me and won't let go. But I want to tug on her wrinkles.

Originally Posted by Its Z

No she will probably bite me and won't let go. But I want to tug on her wrinkles.

She only bites pink panthers.

Originally Posted by SpirivaSunrise

She only bites pink panthers.

Bad dog...

Originally Posted by Its Z

Bad dog...

Smart dog...

Originally Posted by Sparda29

Think it was called Mirixa. The assessment/write-up usually took me about 15 minutes to complete depending on if the software is lagging or not.

As for the patient interview, it really depended on the patient on how long it would take. The optimal patient who has a full updated medication list and, is organized, and knows their stuff, and who can actually speak fast, that interview went by pretty quick.

There were a couple of times when the interview took me 30 minutes because the patient was absolutely senile or didn't speak much English and didn't have a caregiver who could do this for them. Once I had the med list and confirmed how they were taking it, I'd check for interactions and see if they know about them, find out if they are taking BP/BG/spirometry tests at home and how the meds are working for them.

If there was anything of concern, I'd shoot a fax over to the prescriber.

Mirixa cases do pay about $100, but they are supposed to take about an hour. I suppose they take less if you do the bare minimum... but that's not what I expect from my students.

I love the irony of the thinking on here.

Essentially, "I'm too lazy to motivate the unchallenged people with great potential. So I'll just hire a person who's gleefully hardworking, mindless, and average. Because its easier for me."

This is why management everywhere sucks. You are avoiding helping a hypothetically superior worker overcome and issue with "laziness" (aka your inability to make them want to work) due to your own damned laziness.

Of course, I suppose you could just find self motivated, high level thinkers. They do exist.

Originally Posted by WVUPharm2007

I love the irony of the thinking on here.

Essentially, "I'm too lazy to motivate the unchallenged people with great potential. So I'll just hire a person who's gleefully hardworking, mindless, and average. Because its easier for me."

This is why management everywhere sucks. You are avoiding helping a hypothetically superior worker overcome and issue with "laziness" (aka your inability to make them want to work) due to your own damned laziness.

Of course, I suppose you could just find self motivated, high level thinkers. They do exist.

We are not dealing with 18 year old athletes. We are dealing with healthcare professionals. Job of management includes motivating employees of course. But by the time you finish rx school and licensed we expect a level of professionalism and a strong work ethic.at that level its not my job to micromanage and instill work ethics to lazy asses. Its not because Im too lazy to train them. Its because I know once you're a lazy ass you will always be a lazy ass. Of course there are exceptions.

I want to snuggle with that bulldog. That is my only contribution to this thread since I didn't even understand the original question.

Originally Posted by Its Z

We are not dealing with 18 year old athletes. We are dealing with healthcare professionals. Job of management includes motivating employees of course. But by the time you finish rx school and licensed we expect a level of professionalism and a strong work ethic.at that level its not my job to micromanage and instill work ethics to lazy asses. Its not because Im too lazy to train them. Its because I know once you're a lazy ass you will always be a lazy ass. Of course there are exceptions.

Agree with all of this. What's wrong with expecting people to be mature and self motivated? I don't want a hypothetically better worker that I have to babysit. And those "brilliant but lazy" workers often have other flaws, like sloppy work habits. No thanks. Frequently, these types are a whole lot less "brilliant" than they think they are, anyway.

Originally Posted by All4MyDaughter

Mirixa cases do pay about $100, but they are supposed to take about an hour. I suppose they take less if you do the bare minimum... but that's not what I expect from my students.

It took me an hour the first time I did them, but that was because I wasn't familiar with the computer system. Once you're familiar with it and can navigate it, it works faster. I usually have like 10-20 tabs open at once so you don't have to go back and forth to look for stuff.

I suppose writing out the Medication Action Plan for the patient can take a while if you're really writing it out. Thankfully, one of the previous interns at the site developed a computer program where you click on the medications the person is on, and the program generates a MAP for you to just copy and paste into the Mirixa system.

Another thing is that I fill out the medication screens as I'm going along during the patient interview instead of writing it down on a piece of paper or typing it on a Word document to transcribe later. That saves a lot of time. Only problem is that this sometimes generates awkward silences because if the program is running slow, then I have to wait for the program to let me enter all info before allowing the person to continue reading off their list.

In my limited experience, you cannot fix lazy and you will burn yourself out trying. Knowledge/training issues can be fixed, mostly, character defects only very rarely.

Originally Posted by SpirivaSunrise

OK...is it just me? How is pharmacy/healthcare setting that pays base salary by work units completed, conducive to patient safety or optimal care?

How many RX can a retail pharmacist fill in an hour? How many patients can a doc see in an hour? Same thing here.

No, it isn't the best for the patients, but unfortunately that's how the system is running.

Originally Posted by Ackj

How many RX can a retail pharmacist fill in an hour? How many patients can a doc see in an hour? Same thing here.

No, it isn't the best for the patients, but unfortunately that's how the system is running.

Since when? What retail pharmacy pays pharmacist directly based on # of scripts filled?

Originally Posted by SpirivaSunrise

Since when? What retail pharmacy pays pharmacist directly based on # of scripts filled?

Independent pharmacy where you're the owner/pharmacist.

Sparta's stories are so over the top they have to be true. THEY HAVE TO BE TRUE.

Sparda - if you were smart about it since you are interested in working there... You should have done as many cases as you could to impress them instead of wasting time on the internet.

Originally Posted by Sparda29

Independent pharmacy where you're the owner/pharmacist.

Nah...regardless if you're the owner or not, if set up as a corporation the owner should still be paid a set amount of salary not a salary based on number of scripts filled. Though it may be an interesting way to set up a titration based salary per volume, it would be based upon the net profit not the number of scripts. And typically bonuses and or profit sharing would be set up this way not salary.

This thread makes me sad about some of the students that are entering the profession.

Originally Posted by cycloketocaine

This thread makes me sad about some of the students that are entering the profession.

Are you really?

They probably also pulled your internet records and saw the things you posted and probably figured you were a libility if they hired you. If you signed on to Sdn using their computer they knew your post history and it's doubtful anyone would hire your based on yours posts

With 20 minute MTM...are you talking about doing a complete medication review, or just dealing with one indicated concern? 1 concern, I could see being done in an average of 20 minutes (some taking more, some taking less.) I can't see doing a complete medication review in 20 minutes.

As Z pointed out, internet surfing is not private at work.

Originally Posted by npage148

They probably also pulled your internet records and saw the things you posted and probably figured you were a libility if they hired you. If you signed on to Sdn using their computer they knew your post history and it's doubtful anyone would hire your based on yours posts

I mean...if I get a resume from a 2012 Touro NY grad with internship at CVS and Costco with some of the rotations he's described....I would have a pretty good idea who it is.

Originally Posted by BidingMyTime

With 20 minute MTM...are you talking about doing a complete medication review, or just dealing with one indicated concern? 1 concern, I could see being done in an average of 20 minutes (some taking more, some taking less.) I can't see doing a complete medication review in 20 minutes.

As Z pointed out, internet surfing is not private at work.

If he was using Mirixa, it's all CMRs as far as I know. You interview the patient, complete the clinical information (same for every patient), go over health measurements (BP, labs, etc), ask disease state specific questions (customized for your patient), resolve safety and cost alerts and then fill out all the required documentation including assessment and plan. I'm pretty confident in saying that it can't be done completely in 20 minutes.

I can resolve an Outcomes TIP (focused concern) in < 10 minutes (assuming I can reach the patient on the first try) and I can do a targeted med review (TMR) that looks only for pre-specified issues and doesn't involve talking to the patient in about 10 minutes. But I'm fast. I've been doing this for a year and am probably approaching the 1000 encounter mark.

I call BS on 20 minutes for a CMR, especially if a patient interview is involved. I have had patients I couldn't GET off the phone with. But what do I know? I'm just a pharmacist who owns my own MTM company!