Fellowships and Residencies delay the inevitable

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I find this thread intriguing because I've had this internal conflict about pursuing a residency since I first applied to pharmacy school. I'm currently a PY2 in the PharmD/MBA program working 2 hospital jobs (1 small critical access hospital and the other a large academic teaching hospital affiliated with my college of pharmacy). Having picked the brains of every pharmacist that I've worked with, I still can't decide if a residency is "worth it." For what it's worth, I am a pessimist, and I've known that my college of pharmacy has been pumping out bull**** since the day I stepped foot on campus. So perhaps my opinion is biased about academia (applied first go around, didn't get in, yet my class has inherited 5 people that failed the year that I was denied and I'm doing fantastic in school as I'm arguably one of the busiest most involved students in my class, they push residencies like no other, they speak of all the possibilities your future beholds yet forget to mention most grads get stuck in the path that they take, etc etc)

Most of the staff pharmacists seem to think that a residency alienates the workforce. From my observations I agree with this statement. I see little if any difference between the clinical pharmacists at my academic institution vs the pharmacists at my critical access hospital. Non of the small hospital pharmacists are residency trained, yet their experience more than overcomes it. The ironic thing is, everyone seems to gun for the large academic institution jobs because they think it's the greatest thing since sliced bread. I think that is farther from the truth. The pay difference between the smaller hospital and the academic center is greater than the difference between retail "hospital," meaning, the smaller hospital pays a **** ton more than the larger institution. In addition, the pharmacy hours at the smaller hospital are 9-5 through the week, and 9-2PM on weekends, 1 weekend per month, and you don't have to put up with the "clinical segregation" that exists at the larger hospital. People are fighting tooth and nail to get into the residency programs at my larger hospital because the programs are arguably some of the best in the country, however you work a minimum of 80 hours/week, and once you graduate, you are looking at a job that doesn't necessarily pay too well (if you stay in house, which not many do)...and, not that the atmosphere is toxic, it's just the expectations and competition among pharmacists is so high because of it's reputation, it's just not they type of job that I see myself taking because I can't be "me."

My dilemma lies only upon what the outlook looks like in May 2016. I keep telling myself that if I have an institutional job offer at a non profit (I have 200K in debt so I will doing IBR with 10 year loan forgiveness), I would be stupid not to take it. Having said that, I don't want to get stuck in retail, so if I have to do a residency to end up in an institutional setting, I have no choice but to follow through with it. But...I discovered that you can do IBR repayment while in the residency program, so if that's the case, that changes things considerably. Financials aren't everything but this is what I'm looking at:

Staff Position: ~$100K/year
After Taxes: $72,000/year or $6,000/month
IBR Monthly Payment: $950
Take Home: $5,050 X 12 = $60,600 X 2 = $121,200 take home after taxes and loans working as a staff pharmacist right out of school

Residency Position: ~$40K/year (I'm assuming this, I have no idea what residencies pay these days)
After Taxes: $33,944/year or $2,828/month
IBR Monthly Payment: Starts at $285/month Finishes at $971/month 30 years later, so let's be conservative and say $350/month while in residency
Take Home: $2,478 X 12 = $29,736 X 2 = $59,472 take home after taxes and loans working as a resident (slave)
121,200 - 59,472 = ~$61,728 is an estimated difference in the "usable" dollars I would lose out on if I elected to do 2 years of residency
Unfortunately, this doesn't quantify personal satisfaction, social life, family time, etc etc as many of the residents I've talked to (residency specific) really don't appear to be happy due to the amount of time they spend working and what they are missing out on in life. To me, this is the biggest reason I don't want to do a residency. I've shoveled **** for the past 10 years just to get to where I'm at. I don't want to wait until I'm 30 to start reaping the rewards of my hard work. If I did do a residency, I feel like I would be able to overcome that $60K difference in the long run (I hope, with 3,000 new residents/year, that may not be possible, but I'm confident in my abilities), it's just I've alienated so many people already since pharmacy school began. I'm taking 25 credit hours, working 2 jobs which consumes every weekend per month except 1 which I then spend studying for block exams. I essentially have no life, and I'm ready to change that once I graduate. I feel like doing a residency will just further isolate myself from the rest of the world, and eventually I'll be consumed by my work because that's all I know.

The only other fear I have is being stuck in a staff position that I don't like if I don't do a residency and simply take a staff position. I can see already that this is institution specific. The staffers at my larger hospital look like they HATE their life. Working 7 Christmas' in a row, all you do is right click to verify orders, stamp your name on every cart fill item/ Pyxis stock out. On the flip side, at the smaller hospital, they truly think they have a unicorn job (because they do). These "staff" pharmacists do everything that needs to be accomplished by a pharmacy department between 3 full time pharmacists. This means that they stay engaged in a variety of tasks, from order entry, to checking, to clinically intervening, to dosing. They don't do a lot of one thing, they do a tiny bit of everything, and they all love what they do and they all have amazing lives outside of work (vacations every 3 months, nice cars, nice homes, kids in private schools, yada yada). That's the kind of life I personally want, so I'm trying everything I can to set myself up for a position like that.

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I too cut my teeth at a critical access hospital - I worked for a management company who who had a variety of hospitals, all the way from small critical access hospitals like mine (average census of 10) to large 900+ bed hospitals. He told me you can take a pharmacist from a small hospital and put them in a large hospital and they will often succeed. But if you take a director from a large hospital and put them in a small hospital, they will likely fail, often miserably. And- yes I left that job 9 years, and I still do not make what the individual that took my position makes. He was making 135k back in 2005. Not bad.
 
I work in a primary care clinic (family medicine) with pharmacy services. We have clinical, direct patient care, and dispensing/counseling duties. We just hired a guy (after phone interview) based on his 30 years of experience in different pharmacy settings, including hospital, home infusion, and retail. What an utter disappointment once he gets here and is totally incapable of direct patient care. I guess the majority of his experience was in the basement, verifying orders. Remember-- direct patient care wasn't a requirement of the pharmacists education until 2008. This guy is a dinosaur, and even with 30 years experience as a pharmacist, lacks the skills and abilities needed to do the basic duties of this job. We won't make this mistake again. Next time-- Residency trained, all the way, if we can get one. I'm working on documentation needed to let him go. Looking forward to tweaking our interview process so that a turd like this won't be able to sneak through again.
 
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I work in a primary care clinic (family medicine) with pharmacy services. We have clinical, direct patient care, and dispensing/counseling duties. We just hired a guy (after phone interview) based on his 30 years of experience in different pharmacy settings, including hospital, home infusion, and retail. What an utter disappointment once he gets here and is totally incapable of direct patient care. I guess the majority of his experience was in the basement, verifying orders. Remember-- direct patient care wasn't a requirement of the pharmacists education until 2008. This guy is a dinosaur, and even with 30 years experience as a pharmacist, lacks the skills and abilities needed to do the basic duties of this job. We won't make this mistake again. Next time-- Residency trained, all the way, if we can get one. I'm working on documentation needed to let him go. Looking forward to tweaking our interview process so that a turd like this won't be able to sneak through again.

This is an over generalization - we hired somebody with similiar credentials and experience, and has worked out awesome in our ambulatory care center - residency trained does NOT equal competant- We also hired somebody right out of residency (at a highly respected residency) at the same time- and has been a miserable disaster - It goes both ways.

To hire somebody after only a phone interview is idiotic - you deserve what you get if you don't bring the person in for a live interview. You saw you are tweaking your interview process - you better overhaul it completely - if you are mgmt and hired this person - you are equally responsible.
 
The point is-- you know that if a candidate has completed a residency that there's NO QUESTION they have experience with direct patient care. Lots of pharmacy experience does not equate to success (or even competency) in an Am Care environment where communication skills and patient counseling is so important. You are right. It IS our fault. We are kicking ourselves. As for the phone interview-- due to our location and other issues unique to our practice site, in-person interviews were just not possible this time around. That may change in the future, but it wasn't in the budget. But man,... it was like an entirely different person on the phone...
 
Not only do I believe that community pharmacy residencies are scams but I disrespect every single community pharmacy resident. These are designed as ways to hire pharmacists at a lower cost and eventually move towards the hospital cry of "no residency = no job". Chain pharmacists are brainwashed and look no further than the state of Texas. Nearly every chain pharmacist was crying out in support of proposed rules that would eliminate pharmacist-to-tech citing "let pharmacists determine the ratio" and "more techs will allow me to be a pharmacist". Hahahaha! These idiots think they will have a say in how many techs will work in the pharmacy? These idiots really believe that more tech hours won't lead to fewer pharmacist overlap hours? What a joke. These guys have absolutely no idea what's going on in the real world and the same goes for people who support community pharmacy residencies. Shame on all of you for harming our profession.
 
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Not only do I believe that community pharmacy residencies are scams but I disrespect every single community pharmacy resident. These are designed as ways to hire pharmacists at a lower cost and eventually move towards the hospital cry of "no residency = no job". Chain pharmacists are brainwashed and look no further than the state of Texas. Nearly every chain pharmacist was crying out in support of proposed rules that would eliminate pharmacist-to-tech citing "let pharmacists determine the ratio" and "more techs will allow me to be a pharmacist". Hahahaha! These idiots think they will have a say in how many techs will work in the pharmacy? These idiots really believe that more tech hours won't lead to fewer pharmacist overlap hours? What a joke. These guys have absolutely no idea what's going on in the real world and the same goes for people who support community pharmacy residencies. Shame on all of you for harming our profession.

I'm confused...are you talking about community pharm residents or pharamcists in TX cheerleading a ratio law?
 
I'm confused...are you talking about community pharm residents or pharamcists in TX cheerleading a ratio law?

I'm talking about community pharmacy residents. Did you even read my post?
 
Not only do I believe that community pharmacy residencies are scams but I disrespect every single community pharmacy resident.

Chain pharmacists are brainwashed...(in) Texas. Nearly every chain pharmacist was crying out in support of proposed rules that would eliminate pharmacist-to-tech citing "let pharmacists determine the ratio" and "more techs will allow me to be a pharmacist". Hahahaha!

It's like two completely different thought processes/posts. I was gearing up for some epic rant about useless community pharmacy residents/residencies, then you abruptly turned left and started talking about political lobbying in Texas of all places.

Da fuq man.
 
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It's like two completely different thought processes/posts. I was gearing up for some epic rant about useless community pharmacy residents/residencies, then you abruptly turned left and started talking about political lobbying in Texas of all places.

Da fuq man.

It's okay to admit you don't understand my comment. It's not two different thoughts but I'll break it down again. Community pharmacy residencies are scams > chain pharmacies use them as an excuse to pay pharmacists less > another example of chains trying to short change pharmacists are tech ratios > chain pharmacists are suckers and look no further than retail residencies.

Maybe my points didn't sit well with you? It's the truth regardless.
 
It's okay to admit you don't understand my comment. It's not two different thoughts but I'll break it down again. Community pharmacy residencies are scams > chain pharmacies use them as an excuse to pay pharmacists less > another example of chains trying to short change pharmacists are tech ratios > chain pharmacists are suckers and look no further than retail residencies.

Maybe my points didn't sit well with you? It's the truth regardless.

No, I was looking forward to a community residency rant.

I highlighted your post in red where the transition requires fuzzy logic. Plus you're misstating your own original post about TX pharmacists cheerleading a ratio law, now you're talking about chains who would cheerleader it (obvious they would).

I'll check back in here in a few days.
 
It's okay to admit you don't understand my comment. It's not two different thoughts but I'll break it down again. Community pharmacy residencies are scams > chain pharmacies use them as an excuse to pay pharmacists less > another example of chains trying to short change pharmacists are tech ratios > chain pharmacists are suckers and look no further than retail residencies.

Maybe my points didn't sit well with you? It's the truth regardless.

Haha you're so involved in being a pompous, condescending ass that you can't see the point confettiflyer was trying to make. Confetti is right. Yes, your two points both involve community pharmacists, but really don't have a whole lot to do with each other beyond that. Your transition/relation from point-to-point was weak...at best. Graduating students choosing to do a community residency and "being suckers" for agreeing to be a pharmacist for ~50% salary doesn't have a whole lot of effect on regular chain pharmacist's ability to decide # of technicians in their pharmacy. Also, being a idiot and saying things like "Did you even read my post" with sneering condescenion when you're in the wrong make me glad you're not my healthcare provider.
 
Haha you're so involved in being a pompous, condescending ass that you can't see the point confettiflyer was trying to make. Confetti is right. Yes, your two points both involve community pharmacists, but really don't have a whole lot to do with each other beyond that. Your transition/relation from point-to-point was weak...at best. Graduating students choosing to do a community residency and "being suckers" for agreeing to be a pharmacist for ~50% salary doesn't have a whole lot of effect on regular chain pharmacist's ability to decide # of technicians in their pharmacy. Also, being a idiot and saying things like "Did you even read my post" with sneering condescenion when you're in the wrong make me glad you're not my healthcare provider.

I ran it by a couple of people and they completely understand my point so I'll just take this as you two being a bit inept. Maybe you're blind and refuse to listen to fair logic? Maybe my point intimidates you? Not sure. As far as the bold is concerned, yes it does. Community pharmacy residencies are ways to sucker retail pharmacists into accepting low salaries and cut hours just like increased tech ratios do. Isn't ASHP saying that all hospital pharmacists should have a residency by 2020 or something like that? What's going to happen when community residencies get more popular and APhA says the same thing about retail pharmacy? They're already trying to squeeze out pharmacists by demanding unlimited tech ratios. Idiot chain pharmacists think an unlimited ratio = more tech help. HAHA! Wrong! Unlimited ratios = more tech hours = less pharmacist overlap. Why pay for another pharmacist for an hour when you can pay a technician? It's all about the money and you guys are being suckered into it. It's not fuzzy logic, it's common sense. You guys just refuse to wake up and see what's going on.

Oooo that "sneering condescenion" sure does burn haha. You dork.


edit: Seriously. If you can't connect tech ratios increasing to community pharmacy residencies as ways chains are trying to get cheaper pharmacist pay then you're a *****. Or in denial. You're not going to weasel your way out of this fact by insulting me. Bring something to the table or don't waste your time.
 
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Too much **** to read. I thought this was gonna be good. Damn it. See you guys in the main forum.
 
I've been very impressed by the people I met who did community residencies.

One now runs a specialty HIV pharmacy.

Maybe this is because they were university affiliated programs and had affiliated amcare clinic time?
 
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I ran it by a couple of people and they completely understand my point so I'll just take this as you two being a bit inept. Maybe you're blind and refuse to listen to fair logic? Maybe my point intimidates you? Not sure. As far as the bold is concerned, yes it does. Community pharmacy residencies are ways to sucker retail pharmacists into accepting low salaries and cut hours just like increased tech ratios do. Isn't ASHP saying that all hospital pharmacists should have a residency by 2020 or something like that? What's going to happen when community residencies get more popular and APhA says the same thing about retail pharmacy? They're already trying to squeeze out pharmacists by demanding unlimited tech ratios. Idiot chain pharmacists think an unlimited ratio = more tech help. HAHA! Wrong! Unlimited ratios = more tech hours = less pharmacist overlap. Why pay for another pharmacist for an hour when you can pay a technician? It's all about the money and you guys are being suckered into it. It's not fuzzy logic, it's common sense. You guys just refuse to wake up and see what's going on.

Oooo that "sneering condescenion" sure does burn haha. You dork.


edit: Seriously. If you can't connect tech ratios increasing to community pharmacy residencies as ways chains are trying to get cheaper pharmacist pay then you're a *****. Or in denial. You're not going to weasel your way out of this fact by insulting me. Bring something to the table or don't waste your time.

Oh wow, seems like someone got a tad upset. Let's break this rant down piece by piece.

1) Obviously because someone disagrees with you, they must be inept, blind, and intimidated by your "sound logic". Sure, live your life believing that. Not enough room on this forum for everyone and your massively inflated ego. Also, "sneering condescenion" wasn't an insult. It was a description of the way you talk, but like I said, seems someone got his jimmies rustled a bit, so you took it pretty personally. Also, dork? Ouch. Come on bud, I know you have better insults in there, give me something good! I believe in you.

2) I never said that the two points you made weren't related. I said that the way in which you connected them in your original post post I responded to was very weak. The transition from point to point was mediocre, AT BEST. /RichardSherman

3) I suppose you're lumping me in with community residents when you say "you guys", which is a poor one to make. Never said anything about doing a community residency, I actually dislike community quite a bit. So there's that.

So continue arguing if you'd like but I won't respond because as cool as internet tiffs are, they're more fun when your opponent is of sound mind (<-- That WAS an insult, note the difference for next time) And I can't help notice it says you're a pharmacist, and I have got to tell you, that is a cryin' shame for our profession (<-- Oh, look! Another one!) So believe that I am leaving because it is tiresome to argue someone who chooses to insult and attempt to belittle whomever he is debating more than making a point, or think that I was like, suuuuper intimated of you and your amazing insight. I am 100% positive your ego will demand you believe the latter.
 
Oh wow, seems like someone got a tad upset. Let's break this rant down piece by piece.

1) Obviously because someone disagrees with you, they must be inept, blind, and intimidated by your "sound logic". Sure, live your life believing that. Not enough room on this forum for everyone and your massively inflated ego. Also, "sneering condescenion" wasn't an insult. It was a description of the way you talk, but like I said, seems someone got his jimmies rustled a bit, so you took it pretty personally. Also, dork? Ouch. Come on bud, I know you have better insults in there, give me something good! I believe in you.

2) I never said that the two points you made weren't related. I said that the way in which you connected them in your original post post I responded to was very weak. The transition from point to point was mediocre, AT BEST. /RichardSherman

3) I suppose you're lumping me in with community residents when you say "you guys", which is a poor one to make. Never said anything about doing a community residency, I actually dislike community quite a bit. So there's that.

So continue arguing if you'd like but I won't respond because as cool as internet tiffs are, they're more fun when your opponent is of sound mind (<-- That WAS an insult, note the difference for next time) And I can't help notice it says you're a pharmacist, and I have got to tell you, that is a cryin' shame for our profession (<-- Oh, look! Another one!) So believe that I am leaving because it is tiresome to argue someone who chooses to insult and attempt to belittle whomever he is debating more than making a point, or think that I was like, suuuuper intimated of you and your amazing insight. I am 100% positive your ego will demand you believe the latter.

I told you to bring something to the table or don't waste your time. You haven't refuted anything I said in my previous posts, just doing the typical know-it-all student act that is so tiring. You also seem to lack the skill of comprehension thinking that "you guys" is not referring to the two people who responded to me.

You have a lot to learn, kid. Too bad you're a troll who is failing miserably at trying to insult me. Is anyone impressed? Just keep insulting me and making yourself look like the foolish pharmacy student that you are. Where do you go to school? I'm sure the Dean of your college of pharmacy would love to see how their students are embarrassing their profession with their lack of substance.

You leave because you are a coward. Thank you for giving me the last laugh at a fool like you.
 
I don't have a residency or fellowship, but I'm not making that drip unless I see a order from the doctor without a diluent, concentration, or dose rate.

Necro-bump

In a critical situation, you really are going to ask for that?

When the OR nurse is at the pharmacy window looking for some stat Factor VII because the patient is bleeding out on the table, are you going to page the trauma surgeon for a verbal.
We get paid what we get paid to make these decisions, sometimes you gotta do what's best for the patient.


I must say this thread was a totally fascinating read. Where is Sans now?
 
I too cut my teeth at a critical access hospital - I worked for a management company who who had a variety of hospitals, all the way from small critical access hospitals like mine (average census of 10) to large 900+ bed hospitals. He told me you can take a pharmacist from a small hospital and put them in a large hospital and they will often succeed. But if you take a director from a large hospital and put them in a small hospital, they will likely fail, often miserably. And- yes I left that job 9 years, and I still do not make what the individual that took my position makes. He was making 135k back in 2005. Not bad.


Did you work for Owen Healthcare/Cardinal?
 
I have to ask this question, because it's not one that I can ask to a current resident or "clinical pharmacist" without getting the stink eye. Do you clinical pharmacists out there REALLY like what you do?

I feel like those on a rounding service are equivalent to physician secretaries + slightly more influence. My rounding rotation days consist of
-Dose Vanc
-Pt X has not had BM in 3 days, recommend bowel regimen
-Pt Y's blood sugars are elevated in ICU, and nurse used 12 units correction factor in past 24hr, recommend increasing bolus insulin
-Pt Z has been on propofol for nearly a week with no CK or triglycerides, recommend getting those labs
-Pt XX has C.Diff, they stopped broad spectrum abx 3 days ago, we need stop dates for flagyl + PO vanc added
-Pt XY was put on heparin 5000unit q8 DVT prophylaxis but they are 140kg, recommend increasing to 7500U
-Pt XZ blood cultures came back as staph aureus, recommend de-escalation of Flagyl + Cefepime
-Pt YZ just got extubated, recommend stopping GI prophylaxis
-Pt ZZ's tube feeds are at goal, recommend stopping D10
-Clean up the MAR's on all patients whose drips have stopped
-Dose another vanc
-Attending Z always adds double coverage empirically for G - / pseudomonas until cultures come back....Aminoglycoside note time...global RPh time
-Do we have a plan for those steroids yet?

I mean, I knew that this is what clinical pharmacy was like. I didn't need rotations to tell me this as a student. For me it's the complete opposite extreme of retail. Retail slams you and never rewards you for the time or knowledge that you've gained while in school. With being a clinical pharmacist, literally of the 8 hours of your day, you could spend 4-5 of those hours rounding. Talk about inefficient and a waste of resources. Sometimes your input is needed, most of the time there are 1-2 small things that you need to bring up to the team, but nothing that I personally feel makes a huge difference in the overall outcome other than the fact we are judiciously monitoring and managing everything medication related. Again it's needed, but do people really enjoy it? I don't think these "interventions" make a difference. We help the medical residents who are new to this by dosing things for them, putting in orders etc, but wait until they are attendings and know everything about the specialty, and in many cases know just as much as we do about the pharmaceuticals used, with of course some zebra exceptions.

I see that there is a need for us on services, but it's not a fun job or a rewarding job to me. Just curious how the truly clinical people out there feel, and what makes you like what it is that you do everyday?

edit: to add to the rant, I enjoy working with the medical residents. They are really chill, down to earth and awesome to work with. The pharmacy residents on the other hand...they freak out about everything and are very up tight/stressed. Medical resident life I know sucks, but the pharmacists look miserable (at least they act miserable).
 
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I have to ask this question, because it's not one that I can ask to a current resident or "clinical pharmacist" without getting the stink eye. Do you clinical pharmacists out there REALLY like what you do?

I feel like those on a rounding service are equivalent to physician secretaries + slightly more influence. My rounding rotation days consist of
-Dose Vanc
-Pt X has not had BM in 3 days, recommend bowel regimen
-Pt Y's blood sugars are elevated in ICU, and nurse used 12 units correction factor in past 24hr, recommend increasing bolus insulin
-Pt Z has been on propofol for nearly a week with no CK or triglycerides, recommend getting those labs
-Pt XX has C.Diff, they stopped broad spectrum abx 3 days ago, we need stop dates for flagyl + PO vanc added
-Pt XY was put on heparin 5000unit q8 DVT prophylaxis but they are 140kg, recommend increasing to 7500U
-Pt XZ blood cultures came back as staph aureus, recommend de-escalation of Flagyl + Cefepime
-Pt YZ just got extubated, recommend stopping GI prophylaxis
-Pt ZZ's tube feeds are at goal, recommend stopping D10
-Clean up the MAR's on all patients whose drips have stopped
-Dose another vanc
-Attending Z always adds double coverage empirically for G - / pseudomonas until cultures come back....Aminoglycoside note time...global RPh time
-Do we have a plan for those steroids yet?

I mean, I knew that this is what clinical pharmacy was like. I didn't need rotations to tell me this as a student. For me it's the complete opposite extreme of retail. Retail slams you and never rewards you for the time or knowledge that you've gained while in school. With being a clinical pharmacist, literally of the 8 hours of your day, you could spend 4-5 of those hours rounding. Talk about inefficient and a waste of resources. Sometimes your input is needed, most of the time there are 1-2 small things that you need to bring up to the team, but nothing that I personally feel makes a huge difference in the overall outcome other than the fact we are judiciously monitoring and managing everything medication related. Again it's needed, but do people really enjoy it? I don't think these "interventions" make a difference. We help the medical residents who are new to this by dosing things for them, putting in orders etc, but wait until they are attendings and know everything about the specialty, and in many cases know just as much as we do about the pharmaceuticals used, with of course some zebra exceptions.

I see that there is a need for us on services, but it's not a fun job or a rewarding job to me. Just curious how the truly clinical people out there feel, and what makes you like what it is that you do everyday?

edit: to add to the rant, I enjoy working with the medical residents. They are really chill, down to earth and awesome to work with. The pharmacy residents on the other hand...they freak out about everything and are very up tight/stressed. Medical resident life I know sucks, but the pharmacists look miserable (at least they act miserable).



Haha. That made me laugh U of K. I do all of that and I work third shift. You know, the shift where there is no one to hold your hand. I dose vanc. like a gladiator too. Nocturnists are awesome where I work. I love my job. Mix of dispensing/clinical.
 
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I have to ask this question, because it's not one that I can ask to a current resident or "clinical pharmacist" without getting the stink eye. Do you clinical pharmacists out there REALLY like what you do?

I feel like those on a rounding service are equivalent to physician secretaries + slightly more influence. My rounding rotation days consist of
-Dose Vanc
-Pt X has not had BM in 3 days, recommend bowel regimen
-Pt Y's blood sugars are elevated in ICU, and nurse used 12 units correction factor in past 24hr, recommend increasing bolus insulin
-Pt Z has been on propofol for nearly a week with no CK or triglycerides, recommend getting those labs
-Pt XX has C.Diff, they stopped broad spectrum abx 3 days ago, we need stop dates for flagyl + PO vanc added
-Pt XY was put on heparin 5000unit q8 DVT prophylaxis but they are 140kg, recommend increasing to 7500U
-Pt XZ blood cultures came back as staph aureus, recommend de-escalation of Flagyl + Cefepime
-Pt YZ just got extubated, recommend stopping GI prophylaxis
-Pt ZZ's tube feeds are at goal, recommend stopping D10
-Clean up the MAR's on all patients whose drips have stopped
-Dose another vanc
-Attending Z always adds double coverage empirically for G - / pseudomonas until cultures come back....Aminoglycoside note time...global RPh time
-Do we have a plan for those steroids yet?
QUOTE]

Yep, I do all this, plus lots of transitions of care stuff such as med rec on admission and discharge, as well as discharge counseling. Discharges actually take up a good chunk of my day, as we provide all discharge meds, including supplies. I also verify orders and carry a tablet on rounds to do so. I haven't had rounds last more than 3 hours, and I usually do I feel like I am busy all day, even when I'm rounding. I'll update you on what I'll think of my purely clinical position without order verification once I start in a few months...should give me more time to thoroughly review my patients so I am not too rushed in assessing their therapy and can hopefully make more interventions...we'll see. I like the work I do now, but I can seem pretty miserable because we can get super understaffed with double-covering, not enough time for lunch, etc., so more to do with how the department is run rather than the work itself. I feel like pharmacists everywhere are expected to do more and more with less staffing
 
We have pharmacy techs do med rec upon admission in ER. The d/c rec was done by staff pharmacists until staff cuts had it fall back to nurses. Yeah. You're not expendable.
 
We have pharmacy techs do med rec upon admission in ER. The d/c rec was done by staff pharmacists until staff cuts had it fall back to nurses. Yeah. You're not expendable.

We used to have discharge med rec/counseling done by outpatient staff pharmacists, until the hospital found out they didn't have time to do proper med rec and didn't do a very good job, therefore our staffing model came about. I know a lot of hospitals don't have the same staffing model as ours does, but I feel pretty secure working for the government.

This is not a competition. Let people do what they want to do. Residency isn't for everyone, but it does open some doors. My current and future job both require residency.
 
Let me know how things go. And you're right it isn't a competition. If the same scene was like this int the mid-90s I would probably think I need to do a Residency too. The thing that rubs me the wrong way is some of the attitude of the residents. Some think they are the Lewis and Clark of hospital pharmacy. It's laughable. The staff pharmacists are what holds the hospital together (and good technicians). I have worked with some phenomenal residents (I was ops manager in a 800 bed hospital), but the ones who were most productive and engaging to me (and to hospital/medical staff) were the PGY2 trained ones..one in ER, Cards, Peds, and CC. All four were awesome. Some of the PGY1 trained ones we hired throughout the years ...some were good...quite a few were arrogant to the point if being dangerous. A few were let go. I guess it's all in the person.

Good luck. It's a scary world for all of us.
 
I have to ask this question, because it's not one that I can ask to a current resident or "clinical pharmacist" without getting the stink eye. Do you clinical pharmacists out there REALLY like what you do?

I feel like those on a rounding service are equivalent to physician secretaries + slightly more influence. My rounding rotation days consist of
-Dose Vanc
-Pt X has not had BM in 3 days, recommend bowel regimen
-Pt Y's blood sugars are elevated in ICU, and nurse used 12 units correction factor in past 24hr, recommend increasing bolus insulin
-Pt Z has been on propofol for nearly a week with no CK or triglycerides, recommend getting those labs
-Pt XX has C.Diff, they stopped broad spectrum abx 3 days ago, we need stop dates for flagyl + PO vanc added
-Pt XY was put on heparin 5000unit q8 DVT prophylaxis but they are 140kg, recommend increasing to 7500U
-Pt XZ blood cultures came back as staph aureus, recommend de-escalation of Flagyl + Cefepime
-Pt YZ just got extubated, recommend stopping GI prophylaxis
-Pt ZZ's tube feeds are at goal, recommend stopping D10
-Clean up the MAR's on all patients whose drips have stopped
-Dose another vanc
-Attending Z always adds double coverage empirically for G - / pseudomonas until cultures come back....Aminoglycoside note time...global RPh time
-Do we have a plan for those steroids yet?

I mean, I knew that this is what clinical pharmacy was like. I didn't need rotations to tell me this as a student. For me it's the complete opposite extreme of retail. Retail slams you and never rewards you for the time or knowledge that you've gained while in school. With being a clinical pharmacist, literally of the 8 hours of your day, you could spend 4-5 of those hours rounding. Talk about inefficient and a waste of resources. Sometimes your input is needed, most of the time there are 1-2 small things that you need to bring up to the team, but nothing that I personally feel makes a huge difference in the overall outcome other than the fact we are judiciously monitoring and managing everything medication related. Again it's needed, but do people really enjoy it? I don't think these "interventions" make a difference. We help the medical residents who are new to this by dosing things for them, putting in orders etc, but wait until they are attendings and know everything about the specialty, and in many cases know just as much as we do about the pharmaceuticals used, with of course some zebra exceptions.

I see that there is a need for us on services, but it's not a fun job or a rewarding job to me. Just curious how the truly clinical people out there feel, and what makes you like what it is that you do everyday?

edit: to add to the rant, I enjoy working with the medical residents. They are really chill, down to earth and awesome to work with. The pharmacy residents on the other hand...they freak out about everything and are very up tight/stressed. Medical resident life I know sucks, but the pharmacists look miserable (at least they act miserable).

Global RPh.....
 
I have to ask this question, because it's not one that I can ask to a current resident or "clinical pharmacist" without getting the stink eye. Do you clinical pharmacists out there REALLY like what you do?

I feel like those on a rounding service are equivalent to physician secretaries + slightly more influence. My rounding rotation days consist of
-Dose Vanc
-Pt X has not had BM in 3 days, recommend bowel regimen
-Pt Y's blood sugars are elevated in ICU, and nurse used 12 units correction factor in past 24hr, recommend increasing bolus insulin
-Pt Z has been on propofol for nearly a week with no CK or triglycerides, recommend getting those labs
-Pt XX has C.Diff, they stopped broad spectrum abx 3 days ago, we need stop dates for flagyl + PO vanc added
-Pt XY was put on heparin 5000unit q8 DVT prophylaxis but they are 140kg, recommend increasing to 7500U
-Pt XZ blood cultures came back as staph aureus, recommend de-escalation of Flagyl + Cefepime
-Pt YZ just got extubated, recommend stopping GI prophylaxis
-Pt ZZ's tube feeds are at goal, recommend stopping D10
-Clean up the MAR's on all patients whose drips have stopped
-Dose another vanc
-Attending Z always adds double coverage empirically for G - / pseudomonas until cultures come back....Aminoglycoside note time...global RPh time
-Do we have a plan for those steroids yet?

I mean, I knew that this is what clinical pharmacy was like. I didn't need rotations to tell me this as a student. For me it's the complete opposite extreme of retail. Retail slams you and never rewards you for the time or knowledge that you've gained while in school. With being a clinical pharmacist, literally of the 8 hours of your day, you could spend 4-5 of those hours rounding. Talk about inefficient and a waste of resources. Sometimes your input is needed, most of the time there are 1-2 small things that you need to bring up to the team, but nothing that I personally feel makes a huge difference in the overall outcome other than the fact we are judiciously monitoring and managing everything medication related. Again it's needed, but do people really enjoy it? I don't think these "interventions" make a difference. We help the medical residents who are new to this by dosing things for them, putting in orders etc, but wait until they are attendings and know everything about the specialty, and in many cases know just as much as we do about the pharmaceuticals used, with of course some zebra exceptions.

I see that there is a need for us on services, but it's not a fun job or a rewarding job to me. Just curious how the truly clinical people out there feel, and what makes you like what it is that you do everyday?

edit: to add to the rant, I enjoy working with the medical residents. They are really chill, down to earth and awesome to work with. The pharmacy residents on the other hand...they freak out about everything and are very up tight/stressed. Medical resident life I know sucks, but the pharmacists look miserable (at least they act miserable).
It may seem like not a lot until one day you make an intervention that literally saves someone's life.

Try to get patient interaction. Explain their meds to them. Talk to the family of patients in ICU and explain why the physicians are prescribing different things (if within HIPAA). On the internal medicine floors, try to visit your new admits especially if they are complicated. You can learn so much from them.
 
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