Fellowships and Residencies delay the inevitable

[Sans Crainte]

I graduated in 1976 with a BS in pharmacy, which was the based degree. I've been in hospital pharmacy for 36 years, owned a pediatric niche community pharmacy for 10 years, acted as a Pharm D preceptor and written and reviewed articles for JAPhA. I've worked for some prestigious hospitals, including the Cleveland Clinic. Young grads can call me an old crank, but I'm actually quite and admirer of the abilities of the new Pharm D grads. Not their abilities to actually perform the job of a pharmacist, but their abilities to do research, teach, investigate and try to find a role in the health care system that keeps them off the bench and out of the actual role of being a pharmacist. You young folks love residencies and fellowships, but not the actual job. That scares the bejezzus out of most of you. You know so much that you suffer from paralysis by analysis for even the most simple order. I put the blame squarely on the schools f pharmacy. They have promised you the moon, but given you no skills to actually perform in the real world. There are very few of you who would be suited to perform the staff duties of a pharmacist because all of you are so rigid in your thinking. If it isn't spelled out in black and white, you can't handle making a professional decision, even if the patient's life is in danger. Professionals get paid to operate in gray areas, where an informed decision is made and made quickly. No calls to the boss at 4am. You fear that area. Most of you could be great in academia. But those jobs are few and far between. There are a few of you out there who can make the grade. At most 10%. The rest are going to be a drag on most departments, if there are jobs available. My advice; instead of a fellowship or residency, go into computer science and data mining. Couple that with your pharmacy knowledge and you will be a valuable commodity. The job of pharmacist is not what you are capable of doing.

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[GoldfishPharmD]

I usually ignore posts like this that bash people that do residencies. I'd spend all day replying if I didn't, but it's really getting old. I guess I don't understand the dislike. Let people do what they want. I don't bash or think less of those that work in other areas of pharmacy because I believe it's all important. Why bash those that are pursuing their careers goals. Why does it seem to irk people so much even to the point that they have to sign up and have it be the topic of their first post?

I doubt many residents do a residency to "delay the inevitable" as you say. Many of us do it to get into the area that we want, make ourselves more competitive in the job market, etc. It's tough out there. Most places outside of community pharmacies aren't handing jobs to new grads (unless you have connections). So, what would you have us do?

 

[Sans Crainte]

I usually ignore posts like this that bash people that do residencies. I'd spend all day replying if I didn't, but it's really getting old. I guess I don't understand the dislike. Let people do what they want. I don't bash or think less of those that work in other areas of pharmacy because I believe it's all important. Why bash those that are pursuing their careers goals. Why does it seem to irk people so much even to the point that they have to sign up and have it be the topic of their first post?

I doubt many residents do a residency to "delay the inevitable" as you say. Many of us do it to get into the area that we want, make ourselves more competitive in the job market, etc. It's tough out there. Most places outside of community pharmacies aren't handing jobs to new grads (unless you have connections). So, what would you have us do?

I'm not "bashing" anyone for doing a residency. I'm telling you that your time would be better spent specializing in statistics and data mining. A residency doesn't make you any more competitive. You'll likely get a job from "who you know", rather than "what you know". But only the wisdom of age can tell you that. Right now you are gulping the kool-aid and don't want to hear the truth. If all of you new grads are doing residencies then how are any of you different? So that is where the fellowship comes in, I guess? And you know what else, the residency and the fellowship only makes you a worse staff pharmacist because you analyze everything instead of developing the skills needed to get the job done. You need to develop problem-solving skills to be a good staff pharmacist. Of course, none of you want to be staff. You want to head up the "drug-information" program somewhere. Here's a cold dip in the pool; as the pressure mounts for hospitals to cut costs, a pharmacist's salary sticks out like a sore thumb. We've over-priced ourselves. There is no cost-effective role for us, even as a lowly staff pharmacist, let alone in some made-up role the schools will have you believe is waiting for you. I could run a 200 bed hospital with one pharmacist on each shift. Technicians, armed with technology, can do just about everything that needs done. And out side of the department, where all of you clinical folks hope to make a differenc, it is even worse. There are so many others who can do our job for much less. Technology can replace the physician these days. What hope is there for a Pharm D even with a fellowship? I'm telling you guys the truth. There is no role for you. So trudge down to Walgreens and get a job before someone writes an app and 20,00o pharmacists lose their jobs. And forget that dream "role" they told you about in school. It doesn't exist. Hell, they told us the same stuff back in 1976.

 

[Sans Crainte]

If you don't believe me, believe this:
A Looming Joblessness Crisis for New Pharmacy Graduates and the Implications It Holds for the Academy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687123/

 

[GoldfishPharmD]

Sigh, I was going to reply but what's the point. You keep doing what you're doing. It's been working for you for this long. I'll keep gulping the kool-aid; it's pretty tasty.

 

[bacillus1]

I'd like to point out, as I often do, that many jobs now (including my current job) require residency. So if you don't have one, you can't get that job. So how does having a residency not make you a more competitive applicant then?

 

[joetrisman]

I guess all those clinical interventions I made today were a figment of my imagination

 

[Sans Crainte]

I guess all those clinical interventions I made today were a figment of my imagination

"Clinical Interventions"...LOL!!! Thank God you were there to prevent that patient from getting chewable aspirin instead of enteric coated aspirin!! I've seen the "clinical interventions" for years...all much ado over nothing... at the Cleveland Clinic its impossible to get a physician to respond to a page from pharmacy over something truly important.because you "clinical interventionists" call them over EVERYTHING...in trying to justify your time spent in a residency or fellowship all that you do is alienate the gatekeepers...there is nothing wrong with improving your credentials...it is just that you begin to think too much of yourselves and not enough about the patient or the other professions that truly have a role in patient care. Pharmacists are neither fish nor fowl, and the health care system is getting wise to the wasted money. If all of these "clinical interventions" are making any difference why haven't we seen evidence of the savings? Costs are out of control. Lastly, you pups will find out, painfully, over the next five years as the door is closing on this farce of an over-educated, over-paid, redundant profession.

 

[GoldfishPharmD]

 

[Sans Crainte]

You're smarter than that, I hope. No one is trolling. Make an argument that makes sense. You can't. Use your "clinical" skills.

 

[GoldfishPharmD]

Yeah, you seem to be trolling. Why didn't you respond to bacillus1's statement about a lot of jobs requiring a residency? You skipped over his reasonable question to bash Joe's comment about making clinical interventions today... Trolling

 

[thephoenician88]

"Clinical Interventions"...LOL!!! Thank God you were there to prevent that patient from getting chewable aspirin instead of enteric coated aspirin!! I've seen the "clinical interventions" for years...all much ado over nothing... at the Cleveland Clinic its impossible to get a physician to respond to a page from pharmacy over something truly important.because you "clinical interventionists" call them over EVERYTHING...in trying to justify your time spent in a residency or fellowship all that you do is alienate the gatekeepers...there is nothing wrong with improving your credentials...it is just that you begin to think too much of yourselves and not enough about the patient or the other professions that truly have a role in patient care. Pharmacists are neither fish nor fowl, and the health care system is getting wise to the wasted money. If all of these "clinical interventions" are making any difference why haven't we seen evidence of the savings? Costs are out of control. Lastly, you pups will find out, painfully, over the next five years as the door is closing on this farce of an over-educated, over-paid, redundant profession.

I agree to an extent about what you're saying, but there's also a different side to things.

1. I agree that some "pharmacists" opt for residencies because they're scared of the real pharmacy world. One girl in my class cried at every interview for a pharmacist job, in the end she ended up in some community residency in a different state. Is that what she wanted or is it just what she felt most comfortable in? I'm not sure, but she's doing her thing and hopefully she'll learn more.

2. For others, I think it's a stepping stone. It's a way to get to those "who you know" situations. It's a means to a different position, maybe one that you'll enjoy. A friend is doing a critical care residency, would a newly grad pharmacist be put an ICU and asked to help? Hell no. Would those doctors respond to a page from the newly grad pharmacist about aspirin? Hell no. I believe they would respond, though, to a pharmacist who has proven they can be helpful, which you wouldn't be without the experience.

Yes i'm sitting out a year, yes it sucks to get paid less and not always be 100% productive, but no it's not a waste of time. If **** hits the fan with this profession, will I be in trouble? Probably, but at least I will have built more of my "who you know" and "what you know" areas to move into a better position.

I honestly can't wait for the actual "job." I just see myself building the skill set I need for that position.

 

[thephoenician88]

And what do you know about cost/cost-effectiveness?

Please enlighten me.

I know pharmacists that have saved their institutions over a million dollars.

not to mention these clinical interventions, in some way or form, lead to increased quality of care...does that not matter anymore?

In fact, it matters 10x more when it comes to stars and reimbursement.

 

[Sans Crainte]

Ok, lets take each argument, one at a time:
1. Yes, some jobs do require a residency. But ask yourself, why do they require the residency? It wasn't enough that you were overqualified by having the Pharm D, now you need more education. The last time I looked, to practice as a pharmacist, you need to pass the board test in your state. The last time I looked, that did not require anything but a degree from an accredited institution...whether that is a 4 year BS or a 5 year BS or a Masters or a Pharm D. Nothing else, I'm afraid. The "requirement" for a residency is in response to the glut of pharmacists from the schools over-building.
2. Phoenician88...your first post spoke some truths. Can't argue with networking opportunities. But at what cost? each day that goes by you are losing money that won't be made up in the future. Salaries are going down with the glut of pharmacists.
3. rlxea...glad u brought that up...i owned a business for 10 years...real world experience in cost-effectiveness....about 25 years ago I had a cost-saving suggestion that saved my institution over $350,000...they gave me a $10,000 award for doing so...so i guess i have some cred in that area...your anecdotal story on cost-saving of over 1 million is a sweet dream that EVERY clinical pharmacist claims...an urban legend...I can save any hospital far more by eliminating non-productive staff and using techs and technology to institute programs that improve patient care and save money...
4.Phoenician...your heart is in the right place, but there is no such thing as "quality of care" in the U.S. healthcare system...it is all just business...dollars and cents...the patient, sad to say, is a commodity. The truth is, we spend more per patient than any industrialized country in the world and have terrible outcomes...Pham D's with residencies and/or fellowships just add to the cost while they kid themselves that they are making a difference...human nature...

 

[Sans Crainte]

Lastly, most Pharm D's with lists of credentials spouting the attributes of these ineffective programs suffer from the Dunning-Kruger Effect...look it up

 

[DrWrong]

I'm not "bashing" anyone for doing a residency. I'm telling you that your time would be better spent specializing in statistics and data mining. A residency doesn't make you any more competitive. You'll likely get a job from "who you know", rather than "what you know". But only the wisdom of age can tell you that. Right now you are gulping the kool-aid and don't want to hear the truth. If all of you new grads are doing residencies then how are any of you different? So that is where the fellowship comes in, I guess? And you know what else, the residency and the fellowship only makes you a worse staff pharmacist because you analyze everything instead of developing the skills needed to get the job done. You need to develop problem-solving skills to be a good staff pharmacist. Of course, none of you want to be staff. You want to head up the "drug-information" program somewhere. Here's a cold dip in the pool; as the pressure mounts for hospitals to cut costs, a pharmacist's salary sticks out like a sore thumb. We've over-priced ourselves. There is no cost-effective role for us, even as a lowly staff pharmacist, let alone in some made-up role the schools will have you believe is waiting for you. I could run a 200 bed hospital with one pharmacist on each shift. Technicians, armed with technology, can do just about everything that needs done. And out side of the department, where all of you clinical folks hope to make a differenc, it is even worse. There are so many others who can do our job for much less. Technology can replace the physician these days. What hope is there for a Pharm D even with a fellowship? I'm telling you guys the truth. There is no role for you. So trudge down to Walgreens and get a job before someone writes an app and 20,00o pharmacists lose their jobs. And forget that dream "role" they told you about in school. It doesn't exist. Hell, they told us the same stuff back in 1976.

I agree with your points related to our salary sticking out like a sore thumb. Fortunately, at my place of employment (large teaching hospital), pharmacists have the ability to make a difference. Physicians WANT us on their team to round and help. Pharmacists are also heavily involved in policy developement--whereby we've been able to restrict a lot of high cost drugs (IVIg, IV APAP, etc) and make subtle, but meaningful differences in the care of patients. Sure, some staff jobs are probably oversalaried, but I like to think I make a difference. I at least try to make up for my salart with interventions.

Converting 10 doses of IV APAP to PO -- $1000
Getting alvimopan stopped 2 days early -- $400
Patient doesn't meet criteria for KCentra -- Cha-Ching!
Patient doesn't meet criteria for tPA -- $4000
D/C that antibiotic so pt doesn't get C. diff -- ??? (decreased hospital LOS, increased pt QOL, decreased cost associated with flagyl/PO vanc)

I think I covered my salary for the month.

 

[Sans Crainte]

this just happened: the unit secretary called from ER and said that an RN just yelled out from a patient room to call pharmacy for a levophed drip...all i was given was the patient's name...there was no order...just a an RN hollering for a needed med...nothing else...what would you Pharm D's with residencies and or fellowships do? It is very simple...

 

[Sans Crainte]

I agree with your points related to our salary sticking out like a sore thumb. Fortunately, at my place of employment (large teaching hospital), pharmacists have the ability to make a difference. Physicians WANT us on their team to round and help. Pharmacists are also heavily involved in policy developement--whereby we've been able to restrict a lot of high cost drugs (IVIg, IV APAP, etc) and make subtle, but meaningful differences in the care of patients. Sure, some staff jobs are probably oversalaried, but I like to think I make a difference. I at least try to make up for my salart with interventions.

Converting 10 doses of IV APAP to PO -- $1000
Getting alvimopan stopped 2 days early -- $400
Patient doesn't meet criteria for KCentra -- Cha-Ching!
Patient doesn't meet criteria for tPA -- $4000
D/C that antibiotic so pt doesn't get C. diff -- ??? (decreased hospital LOS, increased pt QOL, decreased cost associated with flagyl/PO vanc)

I think I covered my salary for the month.

Well, let's dissect this:
A software prompt can automatically change IV to PO if the criteria is met without a pharmacist,
Once again, a software prompt can stop alvmopan if the criteria is met without a pharmacist,
Once again...software prompt for criteria for KCentra
Once again...software prompt for tPA
Once again...software prompt for ATB d/c to prvent C.diff
You see, you guys live and breath in this world of technology, but hubris (look it up) and vanity make you think you are somehow indispensable...healthcare of the future is going to be more technicians, more technology, more Nurse Practitioners, more Nurses and less pharmacists and less physicians...medicine is all algorithms and cookbook recipes...instead of Pharm D's, the colleges of pharmacy should have made a two year Pharmacist Practitioner degree...no residency or fellowship required

 

[rxlea]

not to mention these clinical interventions, in some way or form, lead to increased quality of care...does that not matter anymore?

In fact, it matters 10x more when it comes to stars and reimbursement.

No kidding

 

[rxlea]

Well, let's dissect this:
A software prompt can automatically change IV to PO if the criteria is met without a pharmacist,
Once again, a software prompt can stop alvmopan if the criteria is met without a pharmacist,
Once again...software prompt for criteria for KCentra
Once again...software prompt for tPA
Once again...software prompt for ATB d/c to prvent C.diff
You see, you guys live and breath in this world of technology, but hubris (look it up) and vanity make you think you are somehow indispensable...healthcare of the future is going to be more technicians, more technology, more Nurse Practitioners, more Nurses and less pharmacists and less physicians...medicine is all algorithms and cookbook recipes...instead of Pharm D's, the colleges of pharmacy should have made a two year Pharmacist Practitioner degree...no residency or fellowship required

You've yet to answer my question.

Tell me about cost effectiveness

 

[Sans Crainte]

No kidding

all can be done with less cost through technology or less costly providers than pharmacists...

 

[Sans Crainte]

You've yet to answer my question.

Tell me about cost effectiveness

you need to learn to read in your next "residency"

 

[DrWrong]

Well, let's dissect this:
A software prompt can automatically change IV to PO if the criteria is met without a pharmacist,
Once again, a software prompt can stop alvmopan if the criteria is met without a pharmacist,
Once again...software prompt for criteria for KCentra
Once again...software prompt for tPA
Once again...software prompt for ATB d/c to prvent C.diff
You see, you guys live and breath in this world of technology, but hubris (look it up) and vanity make you think you are somehow indispensable...healthcare of the future is going to be more technicians, more technology, more Nurse Practitioners, more Nurses and less pharmacists and less physicians...medicine is all algorithms and cookbook recipes...instead of Pharm D's, the colleges of pharmacy should have made a two year Pharmacist Practitioner degree...no residency or fellowship required

Haha, you're out of your mind. These software prompts may be able to do some of this stuff, but the criteria isn't that simple and requires clinical judgement.

You're an idiot if you think a software prompt can replace clinical judgement. I dont' think we're capable of making algorithms complicated enough to answer half of these judgement calls.

Not sure what type of hospital you're at, but you seem to have a very limited role.

 

[Sans Crainte]

Haha, you're out of your mind. These software prompts may be able to do some of this stuff, but the criteria isn't that simple and requires clinical judgement.

You're an idiot if you think a software prompt can replace clinical judgement. I dont' think we're capable of making algorithms complicated enough to answer half of these judgement calls.

Not sure what type of hospital you're at, but you seem to have a very limited role.

Love it!!! Oh my. The definition of hubris. And a prime example of the Dunning-Kruger effect. Right...it requires clinical judgement to see that the patient is taking oral meds. It requires clinical judgement to stop an ATB at the proper time. Software cannot possibly replace you!!! LOL!!! What universe are you living in??? I worked for the Cleveland Clinic...not many hospitals in the world better and yet if you ask any rational person about their pharmacy department...with all of the "credentialed" Pharm D's and fellows underfoot everywhere...the stories of the waste and dysfunction are epic...hubris to think that I have had a "limited role' in 37 years...but the proof is in the pudding, as they used to say...even as we speak the Cleveland Clinic is examining the role of all of their pharmacists and in January will begin cuts and reorganization...once they do, the rest of the hospitals will follow across the country...go back to trade school and become a welder...there's a future in that...

 

[Sans Crainte]

Haha, you're out of your mind. These software prompts may be able to do some of this stuff, but the criteria isn't that simple and requires clinical judgement.

You're an idiot if you think a software prompt can replace clinical judgement. I dont' think we're capable of making algorithms complicated enough to answer half of these judgement calls.

Not sure what type of hospital you're at, but you seem to have a very limited role.

One other thought for you; are you certain that your interventions lead to positive outcomes for the patient? You "interventionists" trumpet your work as all positive without proof of efficacy or cost effectiveness. Do you follow each patient for a period of time afterwards? Do you know if the quality of their life has improved? Or is it your own fantasy that makes you think you are making a difference? There are a lot of aspects to care that go unexamined and are merely anecdotal evidence. Its all smoke and mirrors.

 

[Sans Crainte]

Haha, you're out of your mind. These software prompts may be able to do some of this stuff, but the criteria isn't that simple and requires clinical judgement.

You're an idiot if you think a software prompt can replace clinical judgement. I dont' think we're capable of making algorithms complicated enough to answer half of these judgement calls.

Not sure what type of hospital you're at, but you seem to have a very limited role.

Lastly, ask yourself this; are your skills recognized as being valuable by the marketplace? Can you bill Medicare or private insurance for your "interventions"? Ar you considered a "provider". That is the gold standard. Or is pharmacy a profession in serach of a role. A bridesmaid, but never a bride.

Haha, you're out of your mind. These software prompts may be able to do some of this stuff, but the criteria isn't that simple and requires clinical judgement.

You're an idiot if you think a software prompt can replace clinical judgement. I dont' think we're capable of making algorithms complicated enough to answer half of these judgement calls.

Not sure what type of hospital you're at, but you seem to have a very limited role.

Here's a simple test for all of you out here beating your chests as to the value of your services; are your skills recognized as being valuable by the marketplace? Can you bill Medicare or private insurance for your "interventions"? Are you considered a "provider"? That is the gold standard, being able to bill for service because the marketplace is convinced that it has value. Money talks. BS walks. You can claim to “save” your hospital money. But do your services “produce” revenue? Do the insurance companies give you provider status after doing a residency or achieving a fellowship? Or is pharmacy a profession in search of a role, in spite of all the efforts to dress it up. A bridesmaid, but never a bride. The colleges tried to hoodwink the marketplace by creating the “Doctor” of Pharmacy. The payers didn't buy that. A "Doctor" is a "Doctor". A Registered Pharmacist is a Registered Pharmacist. Not a provider in anyone's definition.

 

[thephoenician88]

I think we're moving away from the main point of this thread, the reason for a residency. You answered it an earlier post though, due to the glut of pharmacists getting out there, more positions are requiring a residency. Yes pharmD's require a lot of work, but the same happened in the past with bachelors of pharmacy, many in high positions went back for their pharmD.

That being said, if you don't want to stay in retail, then a residency may be your best option. I don't want to stay in retail. I don't see myself being there for xxx years. Short term, it's fun, long term, it's not.

I also don't see myself in a hospital staffing situation and maybe even a clinical one, but if i did, i sure as hell would hope that i had a residency/ experience to know what to do when a nurse yells down for a levophed drip. Curious though, what did you do?

since it was an emergency situation i would have sent up a standard cardiac arrest dose and had them adjust flow rate? **i'm not in hospital, but in routine business/retail, I've learned never to assume, and don't***

 

[rxlea]

Love it!!! Oh my. The definition of hubris. And a prime example of the Dunning-Kruger effect. Right...it requires clinical judgement to see that the patient is taking oral meds. It requires clinical judgement to stop an ATB at the proper time. Software cannot possibly replace you!!! LOL!!! What universe are you living in??? I worked for the Cleveland Clinic...not many hospitals in the world better and yet if you ask any rational person about their pharmacy department...with all of the "credentialed" Pharm D's and fellows underfoot everywhere...the stories of the waste and dysfunction are epic...hubris to think that I have had a "limited role' in 37 years...but the proof is in the pudding, as they used to say...even as we speak the Cleveland Clinic is examining the role of all of their pharmacists and in January will begin cuts and reorganization...once they do, the rest of the hospitals will follow across the country...go back to trade school and become a welder...there's a future in that...

One other thought for you; are you certain that your interventions lead to positive outcomes for the patient? You "interventionists" trumpet your work as all positive without proof of efficacy or cost effectiveness. Do you follow each patient for a period of time afterwards? Do you know if the quality of their life has improved? Or is it your own fantasy that makes you think you are making a difference? There are a lot of aspects to care that go unexamined and are merely anecdotal evidence. Its all smoke and mirrors.

Lastly, ask yourself this; are your skills recognized as being valuable by the marketplace? Can you bill Medicare or private insurance for your "interventions"? Ar you considered a "provider". That is the gold standard. Or is pharmacy a profession in serach of a role. A bridesmaid, but never a bride.

Here's a simple test for all of you out here beating your chests as to the value of your services; are your skills recognized as being valuable by the marketplace? Can you bill Medicare or private insurance for your "interventions"? Are you considered a "provider"? That is the gold standard, being able to bill for service because the marketplace is convinced that it has value. Money talks. BS walks. You can claim to “save” your hospital money. But do your services “produce” revenue? Do the insurance companies give you provider status after doing a residency or achieving a fellowship? Or is pharmacy a profession in search of a role, in spite of all the efforts to dress it up. A bridesmaid, but never a bride. The colleges tried to hoodwink the marketplace by creating the “Doctor” of Pharmacy. The payers didn't buy that. A "Doctor" is a "Doctor". A Registered Pharmacist is a Registered Pharmacist. Not a provider in anyone's definition.

I also worked at a big name hospital known around the world (arguably more known but who's measuring ) and I'm sorry your experience at Cleveland Clinic led you to believe that pharmacists are essentially useless. That was not my experience where I worked. Pharmacists were valued and needed. They saved the institution millions, made thousands of clinical interventions that a computer would not be able to discern, and prevented errors on a daily basis.

In my state, pharmacists are recognized as providers. The physicians and nurses appreciate us. On every clinical rotation thus far, I've been thanked multiple times for the interventions I've made and I've been told: "I'm really glad we have you guys."

you need to learn to read in your next "residency"

And yes, I can read. I get paid by a "big name" institution on the east coast to read and review cost-effectiveness studies. I also write them. So again, tell me what you know about cost-effectiveness. Because the studies I've read show that pharmacists are valued.

 

[rxlea]

I think we're moving away from the main point of this thread, the reason for a residency. You answered it an earlier post though, due to the glut of pharmacists getting out there, more positions are requiring a residency. Yes pharmD's require a lot of work, but the same happened in the past with bachelors of pharmacy, many in high positions went back for their pharmD.

That being said, if you don't want to stay in retail, then a residency may be your best option. I don't want to stay in retail. I don't see myself being there for xxx years. Short term, it's fun, long term, it's not.

I also don't see myself in a hospital staffing situation and maybe even a clinical one, but if i did, i sure as hell would hope that i had a residency/ experience to know what to do when a nurse yells down for a levophed drip. Curious though, what did you do?

since it was an emergency situation i would have sent up a standard cardiac arrest dose and had them adjust flow rate? **i'm not in hospital, but in routine business/retail, I've learned never to assume, and don't***

We stocked levophed drips in Pyxis for that reason. In a true emergency, they crack open the code cart.

As for residency, I've debated for some time whether to do one since I changed my focus two years ago.

There are things gained in residency that you may never get just staffing. Some of the dinosaurs I worked with over the almost 10 years I've worked in pharmacy have said that they're glad pharmacists are learning so many additional skills these days. There is definitely a difference between those with residency and those without.

My reason for pursuing residency might be different than most people's reasons, though. I'm not going to be heading directly into a clinical position afterwards.

 

[GoldfishPharmD]

I don't regret going into pharmacy, but this is really one aspect that I hate about my chosen profession. There's this divide and constant war between those that are about residencies and trying to advance the profession and those that say how futile doing a residency is and it's a waste of time. I honestly don't see this with other health professions.

What's the point of this thread? Anyone tries to tell you their experience and you just laugh and huff away that their points are invalid? We should just be staff pharmacists or work at Walgreens? Luckily for you, it's not your time or money that's being wasted, so what point are you trying to make with this thread. Many of us are invested in our careers and aren't going to let some random person on the internet sway our decisions, so once again, what's the point? Lastly, what is SO wrong with us trying to make our profession more valuable to those that do the hiring?

 

[GoldfishPharmD]

Oh, by the way, there's a bunch of people that feel the same way you do in the regular pharmacy forums. You can join them and grumble together about how dumb a residency is because most of the people here don't share your beliefs, so you can stop wasting your breath.

 

[confettiflyer]

I've seen the opposite.... Residents are better suited to operate in gray areas vs new grads stuck in rigid thinking. Exceptions apply, and residency programs differ...but I manage non residency PharmD grads at my health system and most of them have issues with non-guideline gray area issues.

The differences even out at about the 3-4 year mark, however.

 

[Sans Crainte]

I

I think we're moving away from the main point of this thread, the reason for a residency. You answered it an earlier post though, due to the glut of pharmacists getting out there, more positions are requiring a residency. Yes pharmD's require a lot of work, but the same happened in the past with bachelors of pharmacy, many in high positions went back for their pharmD.

That being said, if you don't want to stay in retail, then a residency may be your best option. I don't want to stay in retail. I don't see myself being there for xxx years. Short term, it's fun, long term, it's not.

I also don't see myself in a hospital staffing situation and maybe even a clinical one, but if i did, i sure as hell would hope that i had a residency/ experience to know what to do when a nurse yells down for a levophed drip. Curious though, what did you do?

since it was an emergency situation i would have sent up a standard cardiac arrest dose and had them adjust flow rate? **i'm not in hospital, but in routine business/retail, I've learned never to assume, and don't***

It's nice to reply to someone who has some depth and insight. You will do fine in your profession. What did I do about the levophed? The same thing I do when a doc in OR after hours phones from the OR needing a stat vasopressin drip. I MAKE THEM IMMEDIATELY. NO QUESTIONS ASKED. A patient is going sour. There is no time for anyone to write an order. Mix it quickly in a standard concentration, hand-write a label and get it where it's needed. The sad thing is that 95% of the Pharm D's out there today are paralyzed when confronted with a real life situation that doesn't follow normal procedure...a written order that can be verified and checked aginst parameters...they can't make a decision even when a patient's life is in jeopardy because they need EVERYTHING to be in order, in black and white, so that they are not at risk. Good luck. You will do well.

 

[Sans Crainte]

I don't regret going into pharmacy, but this is really one aspect that I hate about my chosen profession. There's this divide and constant war between those that are about residencies and trying to advance the profession and those that say how futile doing a residency is and it's a waste of time. I honestly don't see this with other health professions.

What's the point of this thread? Anyone tries to tell you their experience and you just laugh and huff away that their points are invalid? We should just be staff pharmacists or work at Walgreens? Luckily for you, it's not your time or money that's being wasted, so what point are you trying to make with this thread. Many of us are invested in our careers and aren't going to let some random person on the internet sway our decisions, so once again, what's the point? Lastly, what is SO wrong with us trying to make our profession more valuable to those that do the hiring?

Here is the point; you are all going down a blind alley and it is not to late to salvage a career. Residencies and Fellowships are just delaying the inevitable. The colleges of pharmacy know that they went in the wrong direction by overbuilding and over-promising. There is no role for the majority of you. Your training makes you all more suited to academia, not the current healthcare environment. You were over-eductaed for your role with your Pharm D. Hell, I was overeducated with a BS back in 1976. Instead of a residency or a fellowship, get an MBA or a degree in data analysis or hospital administration or public health. Don't double -down on a dying profession. The colleges of pharmacy realize that they caused a perfect storm and you poor kids are going to be hung out to dry.

 

[Sans Crainte]

I've seen the opposite.... Residents are better suited to operate in gray areas vs new grads stuck in rigid thinking. Exceptions apply, and residency programs differ...but I manage non residency PharmD grads at my health system and most of them have issues with non-guideline gray area issues.

The differences even out at about the 3-4 year mark, however.

I just worked with a resident who had to work today as staff. he tiptoed around everything, as if the keyboard had manure on the keys. He was not equipped to enter the most simple order. He could round with docs, but he can't proved patient care.

 

[Sans Crainte]

I also worked at a big name hospital known around the world (arguably more known but who's measuring ) and I'm sorry your experience at Cleveland Clinic led you to believe that pharmacists are essentially useless. That was not my experience where I worked. Pharmacists were valued and needed. They saved the institution millions, made thousands of clinical interventions that a computer would not be able to discern, and prevented errors on a daily basis.

In my state, pharmacists are recognized as providers. The physicians and nurses appreciate us. On every clinical rotation thus far, I've been thanked multiple times for the interventions I've made and I've been told: "I'm really glad we have you guys."



And yes, I can read. I get paid by a "big name" institution on the east coast to read and review cost-effectiveness studies. I also write them. So again, tell me what you know about cost-effectiveness. Because the studies I've read show that pharmacists are valued.

Well, share some of those "studies". "Appreciation" is not being a provider. Providers bill for services. The government pays them. Insurers pay them.

 

[Sans Crainte]

Hey rxlea...you've done studies??? Let's hear about them? That is what you are equipped to do, "studies". You can't proved cost-effective patient care. You are the poster-child for the arrogance of the over-educated and self-absorbed millennials.

 

[GoldfishPharmD]

Here is the point; you are all going down a blind alley and it is not to late to salvage a career. Residencies and Fellowships are just delaying the inevitable. The colleges of pharmacy know that they went in the wrong direction by overbuilding and over-promising. There is no role for the majority of you. Your training makes you all more suited to academia, not the current healthcare environment. You were over-eductaed for your role with your Pharm D. Hell, I was overeducated with a BS back in 1976. Instead of a residency or a fellowship, get an MBA or a degree in data analysis or hospital administration or public health. Don't double -down on a dying profession. The colleges of pharmacy realize that they caused a perfect storm and you poor kids are going to be hung out to dry.

Once again, what's it to you? What do you get out of trying to discourage people? If you think you're being helpful, you're not. Like I said, most people here have their minds made up and a random Internet person isn't going to make them change it and if it did, a residency probably isn't for them anyways.

 

[Sans Crainte]

Here is the point; you are all going down a blind alley and it is not too late to salvage a career. Residencies and Fellowships are just delaying the inevitable. The colleges of pharmacy know that they went in the wrong direction by overbuilding and over-promising. There is no role for the majority of you. Your training makes you all more suited to academia, not the current healthcare environment. You were over-educated for your role with your Pharm D. Hell, I was over-educated with a BS back in 1976. Instead of a residency or a fellowship, get an MBA or a degree in data analysis or hospital administration or public health. Compliment your pharmacy degree or just go and get a job. Don't double -down on a dying profession. The colleges of pharmacy realize that they caused a perfect storm and you poor kids are going to be hung out to dry.

 

[GoldfishPharmD]

Yes, I'm going to commit professional suicide, quit my residency, and see if Walgreens will hire me. I'm going to get right on that right now!

 

[Sans Crainte]

Once again, what's it to you? What do you get out of trying to discourage people? If you think you're being helpful, you're not. Like I said, most people here have their minds made up and a random Internet person isn't going to make them change it and if it did, a residency probably isn't for them anyways.

Can you read? Either go and get a job and make some money or continue in school for a degree that compliments what you have with your Pharm D. Not more of the same with a residency or fellowship.

 

[Sans Crainte]

Yes, I'm going to commit professional suicide, quit my residency, and see if Walgreens will hire me. I'm going to get right on that right now!

No need for suicide. You're obviously very talented. All of you kids in pharmacy are. It is just a shame to waste that talent.

 

[DrWrong]

I just worked with a resident who had to work today as staff. he tiptoed around everything, as if the keyboard had manure on the keys. He was not equipped to enter the most simple order. He could round with docs, but he can't proved patient care.

I think this shows how ignorant you are. When I round, I do PROVIDE patient care.

I think your problem is that you just sit in your satellite pharmacy all day giving your right finger a workout by clicking verify, verify, verify, verify. You're scared to stand up to a physician and question their orders--something that definitely needs to be done at a teaching hospital where you have MD/DOs fresh out of school.

You're a dinosaur. Times are changing. You should probably go ahead and retire and let someone step in that will add a little value to the position.

By the way, a pharmacist I work with now used to work at the Cleveland Clinic. He told me how you guys get Sh*& on all the time. That's why he's working at my place of employment now.

 

[Sans Crainte]

I think this shows how ignorant you are. When I round, I do PROVIDE patient care.

I think your problem is that you just sit in your satellite pharmacy all day giving your right finger a workout by clicking verify, verify, verify, verify. You're scared to stand up to a physician and question their orders--something that definitely needs to be done at a teaching hospital where you have MD/DOs fresh out of school.

You're a dinosaur. Times are changing. You should probably go ahead and retire and let someone step in that will add a little value to the position.

By the way, a pharmacist I work with now used to work at the Cleveland Clinic. He told me how you guys get Sh*& on all the time. That's why he's working at my place of employment now.

Wow! Where to begin? You seem to really have me figured out! What insight into where I am and what I have accomplished over 37 years! Maybe you should get a job guessing weight at an amusement park. There is nothing that YOU can provide in the patient care area that couldn't be done much more cost-effectively by an RN, a Nurse-practitioner or a technician armed with an IPad. The new MD's and DO's get more from working with skilled RN's than they do with you. If YOUR services are so valuable, why aren't they recognized in the marketplace? Who "pays" for your valuable services? Are you a "provider"? Can you bill for service? No, No and let's see, No! And quit referring to yourself as "Doctor". You are a pharmacist. Don't knock the guy in a satellite somewhere. He's actually providing care that isn't nebulous. He is putting his career on the line with each and every order. That is why cowards like you avoid the staff role at all costs.

 

[DrWrong]

• Wow! Where to begin? You seem to really have me figured out! What insight into where I am and what I have accomplished over 37 years! Maybe you should get a job guessing weight at an amusement park. There is nothing that YOU can provide in the patient care area that couldn't be done much more cost-effectively by an RN, a Nurse-practitioner or a technician armed with an IPad. The new MD's and DO's get more from working with skilled RN's than they do with you. If YOUR services are so valuable, why aren't they recognized in the marketplace? Who "pays" for your valuable services? Are you a "provider"? Can you bill for service? No, No and let's see, No! And quit referring to yourself as "Doctor". You are a pharmacist. Don't knock the guy in a satellite somewhere. He's actually providing care that isn't nebulous. He is putting his career on the line with each and every order. That is why cowards like you avoid the staff role at all costs.

Haha. My services are recognized in the marketplace (i.e, I currently have a job and am respected by the medical team).

I've never referred to myself as doctor. Never have and never will. I despise pharmacists that call themselves doctor. I also do not wear a lab coat.

I'm not knocking the guy in the satellite. In fact, I sometimes work in a satellite when I'm not working on a unit.

As a matter of fact, I'm sitting in a satellite right now, putting my career on the line with every order.

 

[njac]

I just worked with a resident who had to work today as staff. he tiptoed around everything, as if the keyboard had manure on the keys. He was not equipped to enter the most simple order. He could round with docs, but he can't proved patient care.

Cut the kid a break. He's a new grad.
It's early November - most programs staff every other weekend -
So at most he's worked 8 shifts as a staff pharmacist.

I see your point. I don't agree with you. But I think this was a crappy example.

 

[Stjny1234]

You sign up on Friday, make one thread that merely bashes the profession you have spent such a "valiant, dedicated, and clinically based" career practicing in, and then throw out a bunch of words such as "hubris," and each time tell everyone to look it up, automatically insulting the intelligence of every person in this generation that you supposedly "have so much respect for their knowledge. The fact that anyone gives you the time of day is utterly shocking. In a day and age where pharmacy is evolving and people need to find new niche corners of practice to establish themselves in to keep the profession alive, someone like you who insults every deviation from the typical staff pharmacist is exactly what has been holding pharmacy back for so many years. When my medical team asks for a dose of a medication used off label in a rare disease and the clinical pharmacist knows off the top of their head the ONE case report that exists, that is knowledge. The typical staff pharmacist would have smoke coming out of their ears or have their managers on speed dial for a question of that nature. Live and let live. Do your dream job and let others chase theirs. Don't **** on others to make yourself feel good. You're an embarrassment to the profession, and I hope you realize that before you become an embarrassment to yourself.

 

[GoldfishPharmD]

Cut the kid a break. He's a new grad.
It's early November - most programs staff every other weekend -
So at most he's worked 8 shifts as a staff pharmacist.

I see your point. I don't agree with you. But I think this was a crappy example.

This. He uses an example of how crappy residents are at staffing, but yet he fails to realize that we just barely graduated. It hasn't even been a full year for the majority of residents. How is a new grad with no residency going to be any different from one that is in a residency?

I will admit, I was super nervous for staffing because there are still things that I need to learn (which is why I'm doing a residency). I'm not comfortable with IVs and drips because we don't really learn that stuff in pharmacy school. It takes experience. I would hope you with your 37 years of experience would outshine a new grad, residency or not...

 

[Sans Crainte]

You sign up on Friday, make one thread that merely bashes the profession you have spent such a "valiant, dedicated, and clinically based" career practicing in, and then throw out a bunch of words such as "hubris," and each time tell everyone to look it up, automatically insulting the intelligence of every person in this generation that you supposedly "have so much respect for their knowledge. The fact that anyone gives you the time of day is utterly shocking. In a day and age where pharmacy is evolving and people need to find new niche corners of practice to establish themselves in to keep the profession alive, someone like you who insults every deviation from the typical staff pharmacist is exactly what has been holding pharmacy back for so many years. When my medical team asks for a dose of a medication used off label in a rare disease and the clinical pharmacist knows off the top of their head the ONE case report that exists, that is knowledge. The typical staff pharmacist would have smoke coming out of their ears or have their managers on speed dial for a question of that nature. Live and let live. Do your dream job and let others chase theirs. Don't **** on others to make yourself feel good. You're an embarrassment to the profession, and I hope you realize that before you become an embarrassment to yourself.

Actually, my advice is solid and that is why it upsets you so. I started the thread to spur discussion. I have not seen anyone on here validly refute my claims. Some have made constructive comments and I have recognized them. Others have had a very defensive response. Like yourself. If the "truth" makes your react in such a way as to call me an "embarrassment to the profession", it is you who have issues. If the accomplishments of my career are an embarrassment, then the rest of you should hope to attain that level of "embarrassment".

 

[Sans Crainte]

This. He uses an example of how crappy residents are at staffing, but yet he fails to realize that we just barely graduated. It hasn't even been a full year for the majority of residents. How is a new grad with no residency going to be any different from one that is in a residency?

I will admit, I was super nervous for staffing because there are still things that I need to learn (which is why I'm doing a residency). I'm not comfortable with IVs and drips because we don't really learn that stuff in pharmacy school. It takes experience. I would hope you with your 37 years of experience would outshine a new grad, residency or not...

I'm not saying how "crappy" residents are. I'm saying that all of you are chasing 5% of the jobs. Your residencies and fellowships prepare you for these esoteric roles of playing junior doctor somewhere. I have seen maybe 10% of new grads who are capable of performing staff functions. The rest are suited for academia. Staff functions scare you to death.