Fellowships and Residencies delay the inevitable

[confettiflyer]

Why aren't any of you addressing post # 94?

cuz this millennial is too busy getting down and dirty working two jobs to make up for the debt-laden, entitlement-ridden economy baby boomers gave us...it'll get read on my day off in 8 days.

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[Sans Crainte]

Plus, you young folks are witness to the digital revolution...it is eliminating whole industries like the newspapers and publishing...why do you think that careers in healthcare will be immune? Cost containment and technology are revolutionizing healthcare by the second. X-rays in Minnesota are being read by a radiologist in India, in real time, at 1/10th of the cost we can do it here. It's a flat world, boys and girls. How can you possibly delude yourself into thinking that a residency and a fellowship iare going to protect you? I hope you're smarter than that. Diversify.

 

[Sans Crainte]

cuz this millennial is too busy getting down and dirty working two jobs to make up for the debt-laden, entitlement-ridden economy baby boomers gave us...it'll get read on my day off in 8 days.[/quote

Plus, you young folks are witness to the digital revolution...it is eliminating whole industries like the newspapers and publishing...why do you think that careers in healthcare will be immune? Cost containment and technology are revolutionizing healthcare by the second. X-rays in Minnesota are being read by a radiologist in India, in real time, at 1/10th of the cost we can do it here. It's a flat world, boys and girls. How can you possibly delude yourself into thinking that a residency and a fellowship iare going to protect you? I hope you're smarter than that. Diversify.

Oh, a Tea Party Republican!!! Thank your lucky stars that you were fortunate enough to be in this position. And don't tell me how you worked hard and EARNED everything you got; no one is self-made. You may someday find yourself on the other end, needing some of those entitlements. Plus, the one's who received the most entitlements is our kids, like you. We gave you all too much.

 

[Sans Crainte]

Oh, a Tea Party Republican!!! Thank your lucky stars that you were fortunate enough to be in this position. And don't tell me how you worked hard and EARNED everything you got; no one is self-made. You may someday find yourself on the other end, needing some of those entitlements. Plus, the one's who received the most entitlements is our kids, like you. We gave you all too much.

 

[Sans Crainte]

Oh, a Tea Party Republican!!! Thank your lucky stars that you were fortunate enough to be in this position. And don't tell me how you worked hard and EARNED everything you got; no one is self-made. You may someday find yourself on the other end, needing some of those entitlements. Plus, the one's who received the most entitlements is our kids, like you. We gave you all too much.

 

[Sans Crainte]

cuz this millennial is too busy getting down and dirty working two jobs to make up for the debt-laden, entitlement-ridden economy baby boomers gave us...it'll get read on my day off in 8 days.

Oh, a Tea Party Republican!!! Thank your lucky stars that you were fortunate enough to be in this position. And don't tell me how you worked hard and EARNED everything you got; no one is self-made. You may someday find yourself on the other end, needing some of those entitlements. Plus, the one's who received the most entitlements is our kids, like you. We gave you all too much.

 

[rxlea]

I'm on the cusp of the millennial generation and in my day, not everyone received a trophy. I was also a latch key kid.

I don't think staffing (or retail for that matter) are positions that should be looked down on. You can do just as many clinical interventions as the pharmacists rounding with the team.

Everyone is apprehensive about suddenly being held accountable for ANY job. I think the advantage of residency is that you are somewhat eased into that role as a clinician. As I've mentioned before, you also gain skills in residency that school doesn't necessarily teach you. What's in the textbook is not always what you see in practice.

There are guidelines but not all people fall into those guidelines. A computer wouldn't be able to discern that really. At my school, they teach us not to chase numbers and constantly tell us to look at our patient. That's why I like rounding. A drug level might come back low but the patient is doing just fine. A computer can't look at a patient.

 

[Sans Crainte]

I'm on the cusp of the millennial generation and in my day, not everyone received a trophy. I was also a latch key kid.

I don't think staffing (or retail for that matter) are positions that should be looked down on. You can do just as many clinical interventions as the pharmacists rounding with the team.

Everyone is apprehensive about suddenly being held accountable for ANY job. I think the advantage of residency is that you are somewhat eased into that role as a clinician. As I've mentioned before, you also gain skills in residency that school doesn't necessarily teach you. What's in the textbook is not always what you see in practice.

There are guidelines but not all people fall into those guidelines. A computer wouldn't be able to discern that really. At my school, they teach us not to chase numbers and constantly tell us to look at our patient. That's why I like rounding. A drug level might come back low but the patient is doing just fine. A computer can't look at a patient.

You are obviously intelligent. But it surprises me that you doubt the abilities of technology? I'm the old dude who should be saying that. But there are some amazing things in the offing and I think that pharmacy, at this moment, is in a perfect storm; high wages, overlapping role with less costly providers, cost-containment pressures and a digital revolution. None of that can be ignored. I worked for the Cleveland Clinic for two years from my basement at home and none of the nurses or doctors had a clue where I was. they thought I was downstairs. I did EVERYTHING that the staff downtown did, at home, in the system, answered calls, did clinical interventions, interacted with providers at all levels. And did more actual work than the folks downtown. And that was almost 4 years ago. Things have progressed exponentially since then.
Lastly, what can you get from a residency, that you can't get from just getting a job and gaining experience? I learned more in my first six months out of school than I learned in the previous 5 years in school. I hold fast to the notion that you kids are frightened and THINK that the residency is preparing you. It isn't. You were over-educated and overqualified with your Pharm D degree.

 

[GoldfishPharmD]

A residency is preparing me for multiple things. I've learned so much from residency that I didn't learn in school. Also, you can learn on the job but in a lot if cases, especially in mine, the job I want I can't get without a PGY2.

Some staff positions are now requiring a PGY1. It's not like it was when you started. Basically no one is hiring inexperienced new grads outside of community. Yeah, some people get lucky but that's few and far between.

I really wish you would stop worshipping technology as if it's the end all and be all. Yes, it's great but it doesn't give you the whole picture of the patient.

Technology could probably take over our jobs IF every possible scenarios could be accounted for but it can't. Also, there is error in technology as well. I get flags all the time about interactions or under/over dosing, but I can use my judgment to make the correct call.

Lastly, I'd hate to live in a world where all my care is based off a computer program. If technology was in charge of everything that then who will be there to question what it's saying or will it turn into people that can provide no judgement outside of the program?

 

[OmiPharmD]

Here's a question for those of you who like to perform research: Liability insurance rates. You know how the rates are based on occupation and the scope of practice of that occupation? For example, the scope of practice of a Medical Doctor has more liability than that of a Nurse Practitioner. That being said; are liability insurance rates different for a pharmacist with a 4-year BS, a 5-year BS, a Pharm D, a PharmD with a residency or a Pharm D with a residency AND a fellowship? Do the insurers view the scope of practice differently for each group or do they base their rates on being a Registered Pharmacist only? For everyone. Because, if the residency and fellowship increase the scope of practice, as many of you seem to feel, you would think the cost of your liability insurance would be much higher than those without them. I think this would make an interesting research assignment.

OP,
my professional liability rate has not changed in the past 17 years. So since I've had it.

Interesting thread! I met a pharmacist today at a chain store who has a PGY1 in ambulatory care. He seemed like a smart young man. I hope he finds a better place to utilize his training.

 

[DanOSetron]

No content

 

[Sans Crainte]

A residency is preparing me for multiple things. I've learned so much from residency that I didn't learn in school. Also, you can learn on the job but in a lot if cases, especially in mine, the job I want I can't get without a PGY2.

Some staff positions are now requiring a PGY1. It's not like it was when you started. Basically no one is hiring inexperienced new grads outside of community. Yeah, some people get lucky but that's few and far between.

I really wish you would stop worshipping technology as if it's the end all and be all. Yes, it's great but it doesn't give you the whole picture of the patient.

Technology could probably take over our jobs IF every possible scenarios could be accounted for but it can't. Also, there is error in technology as well. I get flags all the time about interactions or under/over dosing, but I can use my judgment to make the correct call.

Lastly, I'd hate to live in a world where all my care is based off a computer program. If technology was in charge of everything that then who will be there to question what it's saying or will it turn into people that can provide no judgement outside of the program?

Well, I'm just one man, with one side of it, that's for sure. I believe in trends and the trend that I see in the world in general, is a digital revolution that will rank as one of the great seismic shifts in history. A transformative moment like the Industrial Revolution in England. The craftsmen who were displaced also felt that there would always be a need for hands-on, human endeavors. For 99% of them that was wrong. What we are experiencing today is the Industrial Revolution on steroids. It is a tsunami and pharmacy is more vulnerable than the cobbler in his cottage back in the day. Don't assume anything about what a computer and a low pay technician can accomplish. Once again, you are all chasing 5% of the jobs. And even those are vulnerable. PGY2???!!! God Bless You!!! I' sorry, but I think that is folly and so unproductive. You could have had an MBA in that time. Sorry.

 

[Sans Crainte]

OP,
my professional liability rate has not changed in the past 17 years. So since I've had it.

Interesting thread! I met a pharmacist today at a chain store who has a PGY1 in ambulatory care. He seemed like a smart young man. I hope he finds a better place to utilize his training.

That says it all, doesn't it. Overeducated, overtrained and no place to stretch your wings and fly. It's how it has been since 1976. Same story, different day. But the difference today is the complications of the digital revolution and the healthcare environment. Entire professions are going to disappear.

 

[GoldfishPharmD]

Well, I'm just one man, with one side of it, that's for sure. I believe in trends and the trend that I see in the world in general, is a digital revolution that will rank as one of the great seismic shifts in history. A transformative moment like the Industrial Revolution in England. The craftsmen who were displaced also felt that there would always be a need for hands-on, human endeavors. For 99% of them that was wrong. What we are experiencing today is the Industrial Revolution on steroids. It is a tsunami and pharmacy is more vulnerable than the cobbler in his cottage back in the day. Don't assume anything about what a computer and a low pay technician can accomplish. Once again, you are all chasing 5% of the jobs. And even those are vulnerable. PGY2???!!! God Bless You!!! I' sorry, but I think that is folly and so unproductive. You could have had an MBA in that time. Sorry.

I don't want an MBA. If I wanted one, I would have gotten one. I'm doing this residency because I want to. If I didn't, I wouldn't have even if it meant me being more competitive for jobs. I feel like it's such a waste to go and do things just for the sake of doing them when you don't find enjoyment in them. Life's too short for all of that.

 

[Sans Crainte]

Sans Crainte, have you considered that most academia and pharm informatics positions require post-graduate training as well? At minimum a PGY1 +/- two year fellowship...

You speak very truthfully. I am worried about my long term job security as a clinical pharmacist (I am p4 currently)- I do believe that the future of pharmacy is all about justifying your salary and doing so by making clinical interventions to save money. I am contemplating a pgy1 with a 2 year fellowship to identify cost savings and outcomes research, or possibly even a dual PA degree. Job security is a MUST.

The only thing that can justify your role is the marketplace. If, with your considerable skills, you are not considered a "provider" by the marketplace, there is nowhere to go but down. Pharmacists in 1976 had your skills. Nothing has happened in the marketplace. The government won't pay for your services. Insurers don't recognize them. Hell, I had "provider" status in a pilot project with the Ohio Bureau of Children with Medical Handicaps from 2005 through 2007 for a pediatric asthma pilot project. I had a provider number and could bill like the physician on the HCFA 1500 form for six sessions with each patient. This, hopefully would lead to provider status for all pharmacists through Ohio Medicaid. We worked hard at it. But, at the end of the day, it was blocked. The economy demands a low-cost provider. Plus the docs, no matter how they say they "value" your services, don't want you encroaching on their turf. never have. never will. You guys are all just as hopeful that YOU will be the ones...the ones to break through. If the universe was just, you would be. You have the talent. But it isn't going to happen. It isn't hopeless. Just either get a job, make some money and ride the wave as long as possible or go back to school in a field that will compliment your pharmacy skills. Don't double-down with a residency or fellowship. Dead-end. One man's opinion.

 

[Sans Crainte]

I don't want an MBA. If I wanted one, I would have gotten one. I'm doing this residency because I want to. If I didn't, I wouldn't have even if it meant me being more competitive for jobs. I feel like it's such a waste to go and do things just for the sake of doing them when you don't find enjoyment in them. Life's too short for all of that.

You're right. Do what you want. You may end up just fine, individually. But as a profession, 99% doing a residency, let alone 2 years of it, are wasting time. There's a better way.

 

[Sans Crainte]

Sans Crainte, have you considered that most academia and pharm informatics positions require post-graduate training as well? At minimum a PGY1 +/- two year fellowship...

You speak very truthfully. I am worried about my long term job security as a clinical pharmacist (I am p4 currently)- I do believe that the future of pharmacy is all about justifying your salary and doing so by making clinical interventions to save money. I am contemplating a pgy1 with a 2 year fellowship to identify cost savings and outcomes research, or possibly even a dual PA degree. Job security is a MUST.

You don't have to do pharm informatics...just do informatics...no need for a residency and just as valuable...you already have the pharmacy part...

 

[TheBlaah]

You don't have to do pharm informatics...just do informatics...no need for a residency and just as valuable...you already have the pharmacy part...

Quite frankly, I don't believe a majority of schools expose their students to many non-traditional career paths. The average professor probably did a clinical residency years ago and worked as a clinical/research pharmacist for years, so they often teach geared towards their own experience in a clinical/academic capacity. Many of us students are simply uninformed on the possible other roles we can have unless we go out and find them ourselves, which in itself can be a little overwhelming. I suppose that's what organizations and rotations are for, but oftentimes you need to know about and be exposed to these pathways early on to begin gearing your experience for a specific career path. Having rotations the last year in pharmacy school does not help in that respect.

Anyway, I believe many students would find it daunting to explore new careers without the specific guidance (and networking) that well-worn residencies would provide. I mean, when you mentioned "data-mining," I had an idea of what it meant, but none whatsoever how I would begin learning it. Or even more to the point, how I would get my foot in the door and market such a skill for a job/company in that field.

In any case, I would like your opinion on PGY-1 residencies in managed care.

 

[Sans Crainte]

Quite frankly, I don't believe a majority of schools expose their students to many non-traditional career paths. The average professor probably did a clinical residency years ago and worked as a clinical/research pharmacist for years, so they often teach geared towards their own experience in a clinical/academic capacity. Many of us students are simply uninformed on the possible other roles we can have unless we go out and find them ourselves, which in itself can be a little overwhelming. I suppose that's what organizations and rotations are for, but oftentimes you need to know about and be exposed to these pathways early on to begin gearing your experience for a specific career path. Having rotations the last year in pharmacy school does not help in that respect.

Anyway, I believe many students would find it daunting to explore new careers without the specific guidance (and networking) that well-worn residencies would provide. I mean, when you mentioned "data-mining," I had an idea of what it meant, but none whatsoever how I would begin learning it. Or even more to the point, how I would get my foot in the door and market such a skill for a job/company in that field.

In any case, I would like your opinion on PGY-1 residencies in managed care.

A PGY-1 residency in managed care is excellent! That has value in the marketplace. That combines the skills you have with a job that has staying power. Great choice! It is the traditional, hospital-based, residencies that, in my humble opinion, are going to lead to quite a bit of disappointment, and more than likely, financial ruin.
But, if you want to explore other fields, like informatics, go on Coursera. It's free, at your pace, and taught by the best of the best. Explore all the possibilities there. You guys are smart and imaginative. the sky is the limit. Good luck to you. You are on the right track.

 

[Sans Crainte]

One last post: I have 66 posts on this subject (now 67). I have left all of you quite a lot to consider if you want to take the time to read and think about what I have said; one man's primer on the future of pharmacy. 95% of which, I'm afraid, will come to pass. I am pleased to see that there are some of you out there who already are a bit uncomfortable with the current track in the current environment enough to question things. You are the ones with insight. You will be alright.
The others, who rationalize, who deny the role of technology, who deny the trends in the digital revolution and the economics of healthcare, who think that THEY are going to be the ones to show the marketplace their value, or who are simply too frightened at this point to actually perform in the workplace, there is nothing I can tell you. Double-down with the residencies and the fellowship and get back to me in 5 years. So, unless you have a specific question about a career path, this old dude is done.

 

[Silent Cool]

One last post: I have 66 posts on this subject (now 67). I have left all of you quite a lot to consider if you want to take the time to read and think about what I have said; one man's primer on the future of pharmacy. 95% of which, I'm afraid, will come to pass. I am pleased to see that there are some of you out there who already are a bit uncomfortable with the current track in the current environment enough to question things. You are the ones with insight. You will be alright.
The others, who rationalize, who deny the role of technology, who deny the trends in the digital revolution and the economics of healthcare, who think that THEY are going to be the ones to show the marketplace their value, or who are simply too frightened at this point to actually perform in the workplace, there is nothing I can tell you. Double-down with the residencies and the fellowship and get back to me in 5 years. So, unless you have a specific question about a career path, this old dude is done.

Sans,
Do you have any experience with operating an independent pharmacy? What do you think of this path? There are quite a few profitable pharmacies for sale nationwide. That seems like a good career path, especially if one expands into DME and offers specialty services.

What are your thoughts?
thanx
-sc

 

[Sans Crainte]

Sans,
Do you have any experience with operating an independent pharmacy? What do you think of this path? There are quite a few profitable pharmacies for sale nationwide. That seems like a good career path, especially if one expands into DME and offers specialty services.

What are your thoughts?
thanx
-sc

Funny you should ask; in 1999 myself and two partners opened a pediatric niche pharmacy called Kids'n Cures. It gained quite a bit of attention, almost world-wide. We hoped to franchise the concept as we thought it had many advantages over the Medicine Shoppe type concepts. Most people don't realize that children, six and under, are the highest utilizers of medications outside of seniors. And most of those illnesses are acute in nature; they need the medicine today and so the business was not hurt by mail-order as anyone's insurance will work for acute illness. The costs of opening a Kids'n Cures was less as well since your inventory was targeted. We hoped that we would make a large part of our revenue through "cognitive reimbursement" and we had 4 semi-private consulting booths and a completely private counseling room. Two pharmacists had provider status with the Ohio Bureau of Children with Medical Handicaps and billed for service on the HCFA 1500 form. The biggest disappointment was not being successful with cognitive reimbursement. We ran into a lot of folks protecting their territory..diabetes educators, respiratory techs, etc. We also did quite a bit of compounding; many cutting edge things like transdermal therapy. Our key demographic was new moms. We helped them immensly with their new babies; breastfeeding, etc. But mostly we were an information-rich resource for the family. We had handouts for things as weird as vesicouretal reflux that we could just hand to mom and she would understand the therapy and disease. We had Toys-R-Us look at us as a an add-on to their stores. They were going to give us a pilot project in Arizona, but they went bankrupt. We were visited by pharmacists from Israel who wanted to put a KNC there. It could be there right now for all I know. We expanded to three stores but were done in by the banking crisis as all of our credit lines dried up overnight. We sold to a chain and they did nothing with the concept. Kids'n Cures was a darling of the colleges. We had quite a few Pharm D's come through over 10 years. I'm proud of Kids'n Cures. It would probably still be around if I liked retail more. I'm a hospital guy.
But getting back to your original question; maybe owning your own place is a good idea if you serve a niche, like children or women. Keep it small and specialized and you could have a great career. Use your imagination. You're smarter than I am!

 

[Sans Crainte]

One other

Sans,
Do you have any experience with operating an independent pharmacy? What do you think of this path? There are quite a few profitable pharmacies for sale nationwide. That seems like a good career path, especially if one expands into DME and offers specialty services.

What are your thoughts?
thanx
-sc

One other thing; not DME..too many competitors doing it cheaper. Think of other areas.

 

[Silent Cool]

One other

One other thing; not DME..too many competitors doing it cheaper. Think of other areas.

Sans,
Thanks for the heads up. So it sounds like independent pharmacy is a viable option for the entrepreneurial minded. Frankly, I think that many of the grads on here should look into it. There are a lot of pharmacies out there selling for ~300K and netting the owner half that. That would be, IMO, a good place to start and then try to grow that business. At least, it *seems* like a good opportunity.

 

[Sans Crainte]

Funny you should ask; in 1999 myself and two partners opened a pediatric niche pharmacy called Kids'n Cures. It gained quite a bit of attention, almost world-wide. We hoped to franchise the concept as we thought it had many advantages over the Medicine Shoppe type concepts. Most people don't realize that children, six and under, are the highest utilizers of medications outside of seniors. And most of those illnesses are acute in nature; they need the medicine today and so the business was not hurt by mail-order as anyone's insurance will work for acute illness. The costs of opening a Kids'n Cures was less as well since your inventory was targeted. We hoped that we would make a large part of our revenue through "cognitive reimbursement" and we had 4 semi-private consulting booths and a completely private counseling room. Two pharmacists had provider status with the Ohio Bureau of Children with Medical Handicaps and billed for service on the HCFA 1500 form. The biggest disappointment was not being successful with cognitive reimbursement. We ran into a lot of folks protecting their territory..diabetes educators, respiratory techs, etc. We also did quite a bit of compounding; many cutting edge things like transdermal therapy. Our key demographic was new moms. We helped them immensly with their new babies; breastfeeding, etc. But mostly we were an information-rich resource for the family. We had handouts for things as weird as vesicouretal reflux that we could just hand to mom and she would understand the therapy and disease. We had Toys-R-Us look at us as a an add-on to their stores. They were going to give us a pilot project in Arizona, but they went bankrupt. We were visited by pharmacists from Israel who wanted to put a KNC there. It could be there right now for all I know. We expanded to three stores but were done in by the banking crisis as all of our credit lines dried up overnight. We sold to a chain and they did nothing with the concept. Kids'n Cures was a darling of the colleges. We had quite a few Pharm D's come through over 10 years. I'm proud of Kids'n Cures. It would probably still be around if I liked retail more. I'm a hospital guy.
But getting back to your original question; maybe owning your own place is a good idea if you serve a niche, like children or women. Keep it small and specialized and you could have a great career. Use your imagination. You're smarter than I am!

PPS. There are a lot for sale for a reason. Business is difficult enough. When you are at the mercy of insurance contracts, it is damn near impossible. Find a way to do it without the insurers playing a large role.

 

[Sans Crainte]

Sans,
Thanks for the heads up. So it sounds like independent pharmacy is a viable option for the entrepreneurial minded. Frankly, I think that many of the grads on here should look into it. There are a lot of pharmacies out there selling for ~300K and netting the owner half that. That would be, IMO, a good place to start and then try to grow that business. At least, it *seems* like a good opportunity.

It is a great opportunity. But you have to be creative and honest with yourself. Don't get carried away with an idea that seems to make sense to you, because it is the buying public that it has to make sense with in order to make money.

 

[Silent Cool]

It is a great opportunity. But you have to be creative and honest with yourself. Don't get carried away with an idea that seems to make sense to you, because it is the buying public that it has to make sense with in order to make money.

Gotcha.
So, I'm curious, why don't you stick with buying out a couple of independents and run them? Too much work or what?

thanx

 

[Sans Crainte]

Gotcha.
So, I'm curious, why don't you stick with buying out a couple of independents and run them? Too much work or what?

thanx[/quo
Two reasons: age and I hate retail. you'll see when you get older, you just get tired of people...most of them are nuts...but some people love it...so don't go by me

 

[Sans Crainte]

Gotcha.
So, I'm curious, why don't you stick with buying out a couple of independents and run them? Too much work or what?

thanx

Two reasons: age and I hate retail. you'll see when you get older, you just get tired of people...most of them are nuts...but some people love it...so don't go by me

 

[MedAffairer]

The only thing that can justify your role is the marketplace. If, with your considerable skills, you are not considered a "provider" by the marketplace, there is nowhere to go but down. Pharmacists in 1976 had your skills. Nothing has happened in the marketplace. The government won't pay for your services. Insurers don't recognize them. Hell, I had "provider" status in a pilot project with the Ohio Bureau of Children with Medical Handicaps from 2005 through 2007 for a pediatric asthma pilot project. I had a provider number and could bill like the physician on the HCFA 1500 form for six sessions with each patient. This, hopefully would lead to provider status for all pharmacists through Ohio Medicaid. We worked hard at it. But, at the end of the day, it was blocked. The economy demands a low-cost provider. Plus the docs, no matter how they say they "value" your services, don't want you encroaching on their turf. never have. never will. You guys are all just as hopeful that YOU will be the ones...the ones to break through. If the universe was just, you would be. You have the talent. But it isn't going to happen. It isn't hopeless. Just either get a job, make some money and ride the wave as long as possible or go back to school in a field that will compliment your pharmacy skills. Don't double-down with a residency or fellowship. Dead-end. One man's opinion.

Sans, I agree with you on many things regarding pharmacy/clinical-related functions and the future of what retail/clinical pharmacy will be. But what do you know about pharmaceutical fellowships?

Fellowships are a way to help recent graduates "redefine" themselves into roles that are perhaps less clinical, but more managerial and centered around the commercial side of business just like an MBA is used by engineers and people with technical backgrounds to "redefine" themselves. There are fellowships that help PharmDs get into the "data mining" side of things that you have mentioned several times. Heath economics and outcomes (HEOR)/pharmaeconomics has been a big thing in the past decade, and one thing I learned working in industry is that having a background in biostatistics is very important not only in assessing clinical endpoints, but also cost-effectiveness and reimbursement/pricing.

 

[Sans Crainte]

Sans, I agree with you on many things regarding pharmacy/clinical-related functions and the future of what retail/clinical pharmacy will be. But what do you know about pharmaceutical fellowships?

Fellowships are a way to help recent graduates "redefine" themselves into roles that are perhaps less clinical, but more managerial and centered around the commercial side of business just like an MBA is used by engineers and people with technical backgrounds to "redefine" themselves. There are fellowships that help PharmDs get into the "data mining" side of things that you have mentioned several times. Heath economics and outcomes (HEOR)/pharmaeconomics has been a big thing in the past decade, and one thing I learned working in industry is that having a background in biostatistics is very important not only in assessing clinical endpoints, but also cost-effectiveness and reimbursement/pricing.

Those types of fellowships are valuable; however, I think that taking the direct route is more valuable and more beneficial. For example, once you attain the Pharm D degree, forgo the residencies and fellowships and just get an MBA or a degree in informatics or in hospital administration, etc. This gives a grad broader appeal across many industries. You are pigeon-holing yourself with the fellowship. You already have the pharmacy part of things.

 

[confettiflyer]

lol, did i just get called a tea party republican?

 

[Sans Crainte]

lol, did i just get called a tea party republican?

Bro...you were crying about working so hard to pay for "entitlements" ...Tea Party talk...Bro, you don't know what "hard work" is and you don't realize how much the rest of society has contributed to YOU having the opportunity that YOU have...save the sanctimonious BS and quit crying about your tax money going to help the common good...get over yourself...Bro!! LOL!!!

 

[GoldfishPharmD]

Aren't you a little too old to be using "bro"?

 

[Sans Crainte]

Aren't you a little too old to be using "bro"?

That's called, "irony"...Bro!!!...I'm too old to use "LOL!", too...LOL!

 

[Sans Crainte]

Aren't you a little too old to be using "bro"?

and a bit of sarcasm...Bro!

 

[GoldfishPharmD]

and a bit of sarcasm...Bro!

I know you were being sarcastic. I was joking with you.

 

[Sans Crainte]

Aren't you a little too old to be using "bro"?

Plus its Friday night...you should be out having fun...not messing with some old man online...Bro...but I forgot...you're in a pharmacy residency...you're looking at vanco troughs tonight!!! Bro!! LOL!!!

 

[Sans Crainte]

I know you were being sarcastic. I was joking with you.

hey...me too...when you get old, you joke about everything

 

[GoldfishPharmD]

Plus its Friday night...you should be out having fun...not messing with some old man online...Bro...but I forgot...you're in a pharmacy residency...you're looking at vanco troughs tonight!!! Bro!! LOL!!!

I'm a girl, not a bro!

 

[Sans Crainte]

I'm a girl, not a bro!

I'm sorry!!

 

[PractPharm]

So I have been following this forum for quite a while, and I came across this rather interesting thread.

I completed two years of residency training after earning my PharmD. Those two years were no doubt, the best years of my life. The learning curve from day 1 to day 730 was huge...so much so that I truly am amazed by how much I've grown from the experience. I was trained in an institution where that there was no clear distinction between "staff" versus "clinical" pharmacists. The staff pharmacists were awesome and were street smart- something that I see many new grads of both pharmacy school and those with fellowship and residency training lack. They knew how to communicate with prescribers, and they put their foot down on certain orders when it was necessary, and they approached the prescribers with their concerns about orders with such ease. I am sick of hearing about "clinical interventions"- I am sorry, but the pharmacist who does that is more of a police officer than anything. More often than not, when they see you, the prescriber becomes frantic and wonders, "Oh, no, what did I do wrong?" Do your really want that as an impression of yourself when physicians see you? I wouldn't for sure.

If you want to spend all of your time rounding with the team and creating protocols, more power to you. Frankly, I find that boring, and more importantly, how do you measure the effectiveness of those duties? You can create protocols all you want, but your staff in the pharmacy verifying the orders are the ones who will be ensuring that the protocols are being followed appropriately by prescribers for those patients. Protocols need to be REVIEWED after implementation to determine where are the cracks and what can be improved, and moreover, if patients are actually getting optimal therapy because of it compared to what was previously in place. I don't see a whole lot of the follow up portion going on by those who design and implement the protocols to begin with.

The weekends that I worked as part of my residency requirement were the absolute best- I learned so much about what it takes to really practice as a pharmacist, and I was able to get the hands-on training and skill set necessary to perform my job now. So much so that I suggested to my program director to increase the staffing requirement so that future residents get more experience so that they don't have the deer in the headlights look or approach when verifying orders or attending a code where a STAT drip is required to be made. I ask those of you on this thread reading this: How many of you have ever titrated an IV drip of medication for a critically ill patient? Sure, you may know the titration schedule of the medication off the top of your head and that's fine...there are apps and references available at hand where you can easily look up the information. But how many of you have actually stood at the bedside of a critically ill patient and physically titrated a drip on an infusion pump and monitored the response of the patient once you have made the recommendation to your team?

I hear crickets.

Here's the thing. Pharmacy schools across the nation are opening left and right. Not only that, but they paint a picture of how great it is to become a clinical pharmacist, and the opportunities available when it comes to services such as MTM, collaborative practice, prescriptive authority. To be quite honest, there are a number of individuals in the profession who want to take on those functions, and that is fine and well for them. To each, his or her own. But those job opportunities are far and few in between, and require years of experience and yes, "who you know", to obtain. I am not sure if having the residency experience will be the be all and end all to obtaining those positions, especially if comparing candidates to those who have had years of experience in practice.

Moreover, why do we have to re-invent the wheel for prescribing authority when there are already processes in place for us to go about that route? It's called medical school and/or PA school, in case you have never heard of it. I heard PA school is only three years long, too.

But it seems like every other day, we are dealing with lots of issues related to medication safety (namely, medication errors) reported by ISMP and other organizations that quite frankly makes us look bad- really bad. For instance, where were we when the pediatric patient in the ICU received the wrong dosing rate and schedule of dexmedetomidine [http://www.hindawi.com/journals/ijpedi/2010/825079/]? Or when vincristine was prepared in syringe instead of a bag, leading to inadvertent intrathecal administration and death secondary to neurological damage [http://www.ismp.org/newsletters/acutecare/showarticle.asp?id=58]? We cannot even perform in our day-to-day functions as pharmacists- so how in the world will we have the capability to prescribe medications to patients?

I am proud to be a pharmacist. I am proud to be able to do what I do, even if some of my functions may not seem so glamorous to some people. It keeps me satisfied, and I know that what may seem like small measures to some, I am making a difference in the lives of my patients by providing care in ways that doctors, nurses, and other healthcare professionals cannot. The patient is the end goal, and our job is to provide direct care to the patient, with the right dose of medication and at the right time.

 

[confettiflyer]

Residency got me to a certain geographic location and a career point that would have taken me 3-4+ years to achieve had I taken an inpatient staff offer right out of school.

n = 1, though. I had a different tack than your most students, to borrow a sailing term.

But you got me...I've got a libertarian streak, but that might DQ me as a tea bagger.

 

[confettiflyer]

And this thread confuses me, I'm gonna do pass off, head home, and have a beer.

 

[GoldfishPharmD]

Residency got me to a certain geographic location and a career point that would have taken me 3-4+ years to achieve had I taken an inpatient staff offer right out of school.

n = 1, though. I had a different tack than your most students, to borrow a sailing term.

But you got me...I've got a libertarian streak, but that might DQ me as a tea bagger.

Doesn't matter! Technology is going to take over your job! COMPUTERS RULE!

 

[Sans Crainte]

So I have been following this forum for quite a while, and I came across this rather interesting thread.

I completed two years of residency training after earning my PharmD. Those two years were no doubt, the best years of my life. The learning curve from day 1 to day 730 was huge...so much so that I truly am amazed by how much I've grown from the experience. I was trained in an institution where that there was no clear distinction between "staff" versus "clinical" pharmacists. The staff pharmacists were awesome and were street smart- something that I see many new grads of both pharmacy school and those with fellowship and residency training lack. They knew how to communicate with prescribers, and they put their foot down on certain orders when it was necessary, and they approached the prescribers with their concerns about orders with such ease. I am sick of hearing about "clinical interventions"- I am sorry, but the pharmacist who does that is more of a police officer than anything. More often than not, when they see you, the prescriber becomes frantic and wonders, "Oh, no, what did I do wrong?" Do your really want that as an impression of yourself when physicians see you? I wouldn't for sure.

If you want to spend all of your time rounding with the team and creating protocols, more power to you. Frankly, I find that boring, and more importantly, how do you measure the effectiveness of those duties? You can create protocols all you want, but your staff in the pharmacy verifying the orders are the ones who will be ensuring that the protocols are being followed appropriately by prescribers for those patients. Protocols need to be REVIEWED after implementation to determine where are the cracks and what can be improved, and moreover, if patients are actually getting optimal therapy because of it compared to what was previously in place. I don't see a whole lot of the follow up portion going on by those who design and implement the protocols to begin with.

The weekends that I worked as part of my residency requirement were the absolute best- I learned so much about what it takes to really practice as a pharmacist, and I was able to get the hands-on training and skill set necessary to perform my job now. So much so that I suggested to my program director to increase the staffing requirement so that future residents get more experience so that they don't have the deer in the headlights look or approach when verifying orders or attending a code where a STAT drip is required to be made. I ask those of you on this thread reading this: How many of you have ever titrated an IV drip of medication for a critically ill patient? Sure, you may know the titration schedule of the medication off the top of your head and that's fine...there are apps and references available at hand where you can easily look up the information. But how many of you have actually stood at the bedside of a critically ill patient and physically titrated a drip on an infusion pump and monitored the response of the patient once you have made the recommendation to your team?

I hear crickets.

Here's the thing. Pharmacy schools across the nation are opening left and right. Not only that, but they paint a picture of how great it is to become a clinical pharmacist, and the opportunities available when it comes to services such as MTM, collaborative practice, prescriptive authority. To be quite honest, there are a number of individuals in the profession who want to take on those functions, and that is fine and well for them. To each, his or her own. But those job opportunities are far and few in between, and require years of experience and yes, "who you know", to obtain. I am not sure if having the residency experience will be the be all and end all to obtaining those positions, especially if comparing candidates to those who have had years of experience in practice.

Moreover, why do we have to re-invent the wheel for prescribing authority when there are already processes in place for us to go about that route? It's called medical school and/or PA school, in case you have never heard of it. I heard PA school is only three years long, too.

But it seems like every other day, we are dealing with lots of issues related to medication safety (namely, medication errors) reported by ISMP and other organizations that quite frankly makes us look bad- really bad. For instance, where were we when the pediatric patient in the ICU received the wrong dosing rate and schedule of dexmedetomidine [http://www.hindawi.com/journals/ijpedi/2010/825079/]? Or when vincristine was prepared in syringe instead of a bag, leading to inadvertent intrathecal administration and death secondary to neurological damage [http://www.ismp.org/newsletters/acutecare/showarticle.asp?id=58]? We cannot even perform in our day-to-day functions as pharmacists- so how in the world will we have the capability to prescribe medications to patients?

I am proud to be a pharmacist. I am proud to be able to do what I do, even if some of my functions may not seem so glamorous to some people. It keeps me satisfied, and I know that what may seem like small measures to some, I am making a difference in the lives of my patients by providing care in ways that doctors, nurses, and other healthcare professionals cannot. The patient is the end goal, and our job is to provide direct care to the patient, with the right dose of medication and at the right time.

It's all good and you have accomplished quite a lot; but none of those accomplishments are RECOGNIZED in the marketplace!!! You are not a provider; your scope of practice is limited. No one will PAY you for your services. You may serve a complimentary role, show your considerable skills, have the docs or the RN or the patient throw you a bone and give you a warm feeling inside from assisting. But, as a profession, not as individual, anecdotal accounts of how "you are making a difference", there is no recognition. An no matter how you try to dress the profession up with residencies or fellowships or whatever, there is no role for you. The AMA sees to it that you have no role by limiting your scope of practice. The digital revolution and the economic pressures in the current healthcare environment will finish the job. In today's workplace, pharmacists are an overeducated, over-paid profession with no role for the 95% of you. It makes me sad to say that, because you are the best this profession has ever seen, but you are all heading down the rabbit hole by doubling-down with residencies and fellowships. Get on Coursera and explore some complimentary skills that could make you all very valuable to the marketplace. I'm not a "crank" or a "troll". The changes to the profession are coming and very fast. Five years or less for some very big, downhill, changes.

 

[Sans Crainte]

Doesn't matter! Technology is going to take over your job! COMPUTERS RULE!

Laugh about it. You'll be crying very, very soon when you are looking for a job and none are available.

 

[Sans Crainte]

Residency got me to a certain geographic location and a career point that would have taken me 3-4+ years to achieve had I taken an inpatient staff offer right out of school.

n = 1, though. I had a different tack than your most students, to borrow a sailing term.

But you got me...I've got a libertarian streak, but that might DQ me as a tea bagger.

Son, the fact that you can discuss the situation and realize that having a beer may be the best thing to do, shows that you have promise. Just don't forget to work for the common good. Even libertarians work for the common good. I've paid taxes for over 37 years in the profession and I realize how lucky I've been to have a good paying job that keeps me and my family comfortable. Paying taxes, so that society benefits, is just saying thanks to the universe for my good fortune. I really should help more than I do.

 

[GoldfishPharmD]

Laugh about it. You'll be crying very, very soon when you are looking for a job and none are available.

No, I won't.

 

[confettiflyer]

Though I'm amused that the amount of federal taxes I am withholding exceeds my former residency salary, hahaha.

But rest assured I'm no bright-eyed/bushy-tailed kool-aid drinking cheerleader of pharmacy idealism...it's my goal every day to instill a sense of reality to my students and residents I precept/train.