Ambulatory Care experiences

[HealingTouch23]

Hi. I'm currently a pharmacy student who is trying to gather information on career paths. Would anyone have ambulatory care experiences that they could share? I've volunteered in a outpatient hospital once and shadowed a pharmacists in an anti-coag clinic. I thought it was pretty interesting to get to talk to patients one on one.

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[Apotheker2015]

Try to get an ambulatory care rotation at the VA. Pharmacists collaborate with MDs and truly work at the top of their license.

 

[HealingTouch23]

Is the VA one of the few hospitals that has ambulatory care?

 

[PumpkinSmasher]

IHS, county clinics, VA, and many health system and academic medical centers in my area have amb care pharmacists. Overall when considering number of pharmacists in the city, amb care makes up a very very small percentage. Limited job opportunities and usually require residency. Once people get these sweet gigs practicing at top of scope, they rarely leave.

I work as an amb care pharmacist at outpatient clinic. Love it

 

[gwarm01]

I did a rotation through an amb care clinic and the job was pretty sweet. The location was bad but it seemed like a great job. They are just few and far between so you need to be very competitive and very willing to move wherever it takes to get the job.

That's basically good advice for any area of pharmacy. Make it your goal to achieve X and be willing to go anywhere to do it, take less than favorable jobs to get the experience, and always been hunting. Most people who complain about not finding their dream job usually follow up with something like "well I can't leave Boston because..."

 

[HealingTouch23]

Are pharmacists full time ambulatory care pharmacists or is that just a part of their day? Would they just be working at an outpatient pharmacy most of the day?

 

[lord999]

Are pharmacists full time ambulatory care pharmacists or is that just a part of their day? Would they just be working at an outpatient pharmacy most of the day?

It depends on the environment and the particular pharmacy's culture. In VA, there's models where there are clinical specialists where all they do all day is that brand of care (Greater Los Angeles and Portland do it that way). There's a model where everyone rotates through the dispensing and clinical so that everyone is exposed and even the outpatient dispensing pharmacists get some time at clinical (San Diego and Houston do it that way). There's a model where you get assigned patients in a panel (Chicago Lakeside (Jesse Brown) and West Palm Beach do it that way). There's a model where you staff and you get whatever patients show up that day (Palo Alto does it that way). It has a lot to do with cultural norms within the department and relations. Clinical pharmacists do migrate between different stations due to wanting to practice in one sort of setup versus another.

I'm going to say something sacrilegious though. The VA's use of ambulatory care pharmacists has always had problems justifying itself at the VHACO level for the patient-centered medical home. "Workload credit" is a continual conversation that I have to have with VA pharmacies in terms of making sure that the effort that the clinical pharmacist does counts toward the department's resources. I think an ambulatory care pharmacist that's willing to be flexible to consider doing anticoagulation (some places consider it separate) or one of the other clinical areas like inpatient or CLC nursing home, they'll be a happier bunch in their career and not subject to reassignment unless they work for a branch outpatient clinic (we call those Community Based Outpatient Clinics or CBOCs). CBOC clinical pharmacists are rarer and are expected to have generalist skills in case a dispensing is needed and do a little of everything as they are alone out there, but there's plenty of actual normal clinical work.

If you're on summer vacation right now and happen to live in a city with a VA, consider contacting the VA pharmacy in the area and requesting information on the VALOR program that introduces pharmacy student interns into the way VA works (with pay). For some, it works, for others, it doesn't. We are as happy when an intern figures out that the VA would be a bad fit if they're well-meaning. There's also other fields that the VA represents at the main hospital in the system such as technology pharmacists (ADPACs for internal pharmacy technology and CACs for coordinating between professions), clinical program coordination (CC), formulary management (PE), quality and safety (QM) that you may want to see their day-to-day lives as well. I hate to say that it is not as well-paid as retail, but I'm here for both the professional benefits of having a decent job (I'm in VACO now) and the benefits of having a position that is fairly impregnable to downsizing with a health care system that is less concerned about making money (though the bureaucracy can offset that).

 

[sakigt]

Academic center. Basically you worked like a doc. Talked to the patient, wrote up your note, had an MD sign off on the script and reschedule the patient for next time. Nice business hours.

Personally Id rather poke my eyes out with a stick but some people like that sort of stuff.