Is PGY3 the Future of Clinical Pharmacy Training?

[Chalupa_Batman86]

http://www.pharmacytimes.com/contri...clinical-pharmacy-training?utm_source=Informz

He cannot seriously believe a PGY-3 is useful..... ?

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[Corpseman]

This is just another way pharmacist jobs are being created to curb the perceived 'saturation'--- APHA

 

[confettiflyer]

Didn't we discuss/beat this with a dead horse last year?


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[gwarm01]

Didn't we discuss/beat this with a dead horse last year?


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Yeah. Yet every so often another pharmacist with more titles than common sense will write an article advocating for a PGY3 while ignoring the real problems facing our profession. At least this guy pays lip service to some arguments against it.

I like that he specifically mentions that his PGY2 was not sufficient training to get to the level required by his job, and he only really gained competency after years of experience. I see that as an argument for getting out there and gaining that experience, not one for yet more training at reduced pay.

 

[njac]

Yeah. Yet every so often another pharmacist with more titles than common sense will write an article advocating for a PGY3 while ignoring the real problems facing our profession. At least this guy pays lip service to some arguments against it.

I like that he specifically mentions that his PGY2 was not sufficient training to get to the level required by his job, and he only really gained competency after years of experience. I see that as an argument for getting out there and gaining that experience, not one for yet more training at reduced pay.

Yes, but if the surgeons trained with a pharmacist at that level they will be displeased when a newly minted pgy2 shows up and isn't practicing at that level yet.

I don't think all positions require the additional training, but there are some super specialized areas that would benefit.

Again, not for your average adult internal medicine spot.


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[Digsbe]

Stuff like this makes me shake my head... Who are they marketing too? The pharmacy world or the outside? Many practitioners and physicians don't even know that pharmacists can do a residency, heck many don't even know it's a 4 year doctorate.

With a PGY3 you've literally done the years and training a physician does with none of the pay and none of the privileges in a practice act. At that point you've done undergrad, 4 years of a doctoral program and 3 years in residency. Unless it pays better, expands a pharmacists scope, or somehow meaningfully advances the profession I see it as overkill and a way to super-specialize for jobs that might not even exist. If you get that much education and still can't change tablets to capsules or practice beyond dispensing then it's not worth it.

Pharmacists and pharmacy organizations should be less focused on pushing residency and PGY3 and focusing more on actual issues like pharmacist reimbursement (provider status in all areas, not just undeserved), expanding scopes of practice, and dealing with market saturation and wage stagnation. If you do 3 years of residency post PharmD and still have less area to practice than a mid-level then just go to PA school, it would be faster and when you're done you can actually modify medications and have a legal scope to practice more meaningfully.

 

[gwarm01]

Yes, but if the surgeons trained with a pharmacist at that level they will be displeased when a newly minted pgy2 shows up and isn't practicing at that level yet.

Hey, I have worked with a PGY2 trained pharmacist that I thought wasn't adequate to staff and verify routine orders. There's a certain level of competency that you just don't get until you are in the trenches handling the routine and complex cases day after day.

I've always been a supporter of on the job training for pharmacists. For one, I look out for my profession and hate to see the days of being trained at full salary go away just so you can get a few extra letters on your e-mail signature. Also, I feel like the focused nature of our job is such that multi-year post-graduate training is really necessary to become proficient in any one area.

Lol, how pissed would you be doing 3 years of residency to make 110-115K/year vs a CVS robot making 130K+??

Not nearly as pissed as I will be when they come out with PGY4 in 10 years and my 28 year old director decides I'm no longer qualified for my job! Of course, I will be even more pissed when I have to train my replacement for six months because they can't do my job.

Damn, I'm still bitter about what happened to my friend a couple years ago.

Stuff like this makes me shake my head... Who are they marketing too? The pharmacy world or the outside? Many practitioners and physicians don't even know that pharmacists can do a residency, heck many don't even know it's a 4 year doctorate.

With a PGY3 you've literally done the years and training a physician does with none of the pay and none of the privileges in a practice act. At that point you've done undergrad, 4 years of a doctoral program and 3 years in residency. Unless it pays better, expands a pharmacists scope, or somehow meaningfully advances the profession I see it as overkill and a way to super-specialize for jobs that might not even exist. If you get that much education and still can't change tablets to capsules or practice beyond dispensing then it's not worth it.

Pharmacists and pharmacy organizations should be less focused on pushing residency and PGY3 and focusing more on actual issues like pharmacist reimbursement (provider status in all areas, not just undeserved), expanding scopes of practice, and dealing with market saturation and wage stagnation. If you do 3 years of residency post PharmD and still have less area to practice than a mid-level then just go to PA school, it would be faster and when you're done you can actually modify medications and have a legal scope to practice more meaningfully.

This is why it's so frustrating. All it does is created a hierarchy in pharmacy that no one else recognizes or cares about. A motivated and intelligent new pharmacist could get a job at a hospital, staff for year one, move into more clinical duties for year two (ICU coverage, evening clincal position etc), then begin working in a CVICU in year three. If they care anything at all about their job, I guarantee you they will be just as competent as anyone completing a PGY3 if not more so. The only pharmacist I know who would not agree with this are those that act like their residency has somehow elevated them to a status that no one else can ever achieve.

I understand why hospitals would advocate for residency, as it allows them pharmacist labor at a discounted price. I would say it takes the burden of training off of them, but that hasn't been my experience for many new hires. Workflow and policy can be so different between institutions, and that is always a consideration for pharmacists.

I understand why the academy would advocate for residency, because it is an attractive story to sell students and further the fevered dream of new and emerging jobs, pharmacists with prescriptive authority, provider status, running your own clinic etc.

I just don't understand why any pharmacist would get behind the idea of a PGY3. PGY1 and 2 are here to stay, but why would you want to put more burden on the individual? It wasn't that long ago that a PharmD was enough to get your foot in anywhere, and it was expected that your employer would provide training and you would learn as you go along. I understand market pressures, and I understand why a new grad would want to pursue a residency since a PGY1 is basically a requirement to staff these days, but I'll never understand people who are happy about it. We are basically getting the same jobs for more personal sacrifice. It's a poor deal. It would make much more sense if we did expand our scope of practice.

 

[BenJammin]

A PGY-3 would signal the end of the profession. I'm not kidding either.

 

[gwarm01]

A PGY-3 would signal the end of the profession. I'm not kidding either.

I could have saved myself a huge rant by just say that, hah.

 

[confettiflyer]

PGY-X has shortened our training and on-boarding time inpatient-wise. We still have to "trench train," of course....but they're generally able to move into specialized roles much quicker than new grad hires.

That's a huge intangible for existing staff...training is mentally consuming. Tangible benefit is reduced costs to train, fewer clinical errors vs. PGY-less new grads, and faster time to production.

Don't really care about everyone's residency bashing or profession paranoia, I just want efficiency, quality, and cost benefits from the employer perspective.

Outsourcing the first year of practice to pGY-1 has been a boon. Insourcing has been an even bigger boon...we get the option to a fully trained/functioning pharmacist on July 1st whose training was spread out over a whole year at reduced cost.


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[njac]

I know that I'm a minority thinking the pgy3 isn't a terrible idea. But I think in specific practice environments it does have a place.

My current community hospital has PGY1 residents, and about halfway through the year they're useful for covering 2 staffing shifts every 3rd weekend. Other than that, they honestly increase our workload more than decrease it, on a daily basis. It's nice to offload things like formulary reviews on them, but actually having them on rotation is a huge decrease in overall productivity. Maybe I just utilize them poorly.


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[Humble Sloth]

http://www.pharmacytimes.com/contri...clinical-pharmacy-training?utm_source=Informz

He cannot seriously believe a PGY-3 is useful..... ?

PGY 1, 2 and 3 are all a joke. It's a construct designed by pharmacy schools to lure more students (hint: MONEY) in under the false pretense of a 'clinical position'. Clinical pharmacy never took off. NP, PA and RNs fought too much to protect their bread and butter.

 

[njac]

PGY 1, 2 and 3 are all a joke. It's a construct designed by pharmacy schools to lure more students (hint: MONEY) in under the false pretense of a 'clinical position'. Clinical pharmacy never took off. NP, PA and RNs fought too much to protect their bread and butter.

I agree to disagree.

I've never regretted my PGY-2. While there are institution-specific operational pearls that I will openly defer to someone who has been there longer, I regularly have pharmacists with 20-25+ years of experience ask me clinical questions.

Everyone has their personal strength.


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[TheBlaah]

I know that I'm a minority thinking the pgy3 isn't a terrible idea. But I think in specific practice environments it does have a place.

My current community hospital has PGY1 residents, and about halfway through the year they're useful for covering 2 staffing shifts every 3rd weekend. Other than that, they honestly increase our workload more than decrease it, on a daily basis. It's nice to offload things like formulary reviews on them, but actually having them on rotation is a huge decrease in overall productivity. Maybe I just utilize them poorly.

Specific environments...like what? What kind of environment could possibly be specific and difficult enough to require a PGY3 yet be marketable enough for them to reasonably obtain a job? Enough to sacrifice 3 years for this specialty, mind you.

And yeah...a huge decrease in overall productivity does sound like you might be utilizing them poorly. The residencies I know have them staffing a little more frequently and earlier (basically a weekend off every 2 weeks). Work around 60 hrs a week and often are on-call.

 

[Carboxide]

I think part of the issue is that most students entering pharmacy aren't really aware of the options post-graduation until they're well into it. I know I hadn't even realized residencies were a thing despite looking into pharmacy in general. So when you are already 2 years into pharmacy school and decide you don't want to work retail, it is not like you can just say "well medical school is better then." You are already 2 years in and would lose another at minimum applying, plus you have the loans from at least 2 years of professional school. So that is when students say "Well I better do a residency then." So if the PGY3 is added, people will do them because they don't want to do retail and they didn't realize the commitment to get out of retail before starting.

 

[Chalupa_Batman86]

Lol, how pissed would you be doing 3 years of residency to make 110-115K/year vs a CVS robot making 130K+??

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#retail!

 

[Chalupa_Batman86]

There's strawberry Kool-Aid. Then there's the confettiflyer Kool-Aid. I kid. It's a win-win for the employer, no doubt about it.

 

[confettiflyer]

There's strawberry Kool-Aid. Then there's the confettiflyer Kool-Aid. I kid. It's a win-win for the employer, no doubt about it.

Haha...oh trust me, I know it sucks for students. Six-figure hospital jobs for fresh grads just don't exist anymore. Gotta do more grunt work.

But we're millennials...we should be used to flying to get to where previous generations simply walked to. Hey remember when you could work your way through school and graduate debt free without being a trust fund baby? Yah...that and travel agents and 8-track tapes.


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[MatCauthon]

"Consider our advancement from the Bachelor of Pharmacy degree to the PharmD, from PGY1 to PGY2, and from PGY2 to pharmacy fellowships. To me, PGY3 pharmacy residencies seem like the natural next step in our impressive evolution as a profession."

This sentence should be posted to the homepage of every pharmacy school. Then pharmacy students can wonder why the hell they go to pharmacy school and not medical school.

 

[gwarm01]

"Consider our advancement from the Bachelor of Pharmacy degree to the PharmD, from PGY1 to PGY2, and from PGY2 to pharmacy fellowships. To me, PGY3 pharmacy residencies seem like the natural next step in our impressive evolution as a profession."

This sentence should posted to the homepage of every pharmacy school. Then pharmacy students can wonder why the hell they go to pharmacy school and not medical school.

I'm glad he doesn't explain how or why this is a good thing.

 

[wagrxm2000]

"Consider our advancement from the Bachelor of Pharmacy degree to the PharmD, from PGY1 to PGY2, and from PGY2 to pharmacy fellowships. To me, PGY3 pharmacy residencies seem like the natural next step in our impressive evolution as a profession."

This sentence should posted to the homepage of every pharmacy school. Then pharmacy students can wonder why the hell they go to pharmacy school and not medical school.

I'm out of the loop when it comes to residencies. So do these pharmacists make significantly more? What about the guy in the article, what do you think his position pays?

 

[txpharmguy]

I'm out of the loop when it comes to residencies. So do these pharmacists make significantly more? What about the guy in the article, what do you think his position pays?

Probably way less than you'd make as an rxm.

 

[wagrxm2000]

Probably way less than you'd make as an rxm.

Sorry I mean the positions they get after their residencies.

 

[gwarm01]

Sorry I mean the positions they get after their residencies.

Probably way less than you'd make as an rxm.

 

[MatCauthon]

I'm out of the loop when it comes to residencies. So do these pharmacists make significantly more? What about the guy in the article, what do you think his position pays?

Not sure how much he makes, but probably not much more than any other pharmacist. At my institution, residents make about 5-10k higher than the other pharmacists on a starting wage scale.

 

[Dred Pirate]

dude - I don't have a residency - yet I have pgy-2's that report to me - I think it is funny.

I also have pgy-1's report to me who have more years of experience.

It is not about the title, it is about the drive and ability

I

 

[confettiflyer]

Sorry I mean the positions they get after their residencies.

My post graduate/pre-PGY 1 offer in PA was like ~$50/hr, my post-PGY 1 offer in CA was somewhere between $65-$80/hr. How much of that is attributed to geography is up for debate, but remember geography also guides whether PGY-1 is required, preferred, or not a significant contributing factor.

 

[ChalupaBatman86]

Lots of people get a professional degree and then do 3 years of residency...they're called doctors

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[TheBlaah]

My post graduate/pre-PGY 1 offer in PA was like ~$50/hr, my post-PGY 1 offer in CA was somewhere between $65-$80/hr. How much of that is attributed to geography is up for debate, but remember geography also guides whether PGY-1 is required, preferred, or not a significant contributing factor.

How long ago did you graduate? I'm sure, if it was long enough, that timing was large factor in that offer as well especially if it was during the "golden age". None of the PGY1's I know of make any significant amount more money than staff.

Let's not forget. The number of residency positions have increased over 50% over that last 5 years (from ~2000 to ~3000). That's around 15-20% of each graduating class. Employers can afford to pay them less because let's face it: there's probably not enough jobs for every resident.

Edit: Now that I think about it, the number of residency positions is increasing much faster than the number of yearly graduating students. With the pharmacy job growth plateauing, it really does seem like residencies (or at least those who "regulate" it) are doing a service to its applicants.

 

[njac]

My post graduate/pre-PGY 1 offer in PA was like ~$50/hr, my post-PGY 1 offer in CA was somewhere between $65-$80/hr. How much of that is attributed to geography is up for debate, but remember geography also guides whether PGY-1 is required, preferred, or not a significant contributing factor.

I'd say a lot of that is geographic.

I interviewed for a specialist position at a hospital in Philadelphia for a $15/hr difference in pay from my specialist job in California.


CA has some golden handcuffs going on - it's not a 1:1 conversion. My coresident started a specialist job in NYC the same time I did for almost $20K/yr less than I was offered.


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[confettiflyer]

How long ago did you graduate? I'm sure, if it was long enough, that timing was large factor in that offer as well especially if it was during the "golden age". None of the PGY1's I know of make any significant amount more money than staff.

Let's not forget. The number of residency positions have increased over 50% over that last 5 years (from ~2000 to ~3000). That's around 15-20% of each graduating class. Employers can afford to pay them less because let's face it: there's probably not enough jobs for every resident.

Edit: Now that I think about it, the number of residency positions is increasing much faster than the number of yearly graduating students. With the pharmacy job growth plateauing, it really does seem like residencies (or at least those who "regulate" it) are doing a service to its applicants.

2012, about one of the worst times to graduate, the post-PGY 1 offer came in 2013. So time wise not very different, but geographically very different.

But again, my institution just does not hire new grads, we either hire those just completing PGY-1 or PGY-2, or those with 5-10 years solid inpatient experience. Increasingly now, those 5-10 year experienced persons have completed a residency, too. They're the real gold.

 

[gwarm01]

My post graduate/pre-PGY 1 offer in PA was like ~$50/hr, my post-PGY 1 offer in CA was somewhere between $65-$80/hr. How much of that is attributed to geography is up for debate, but remember geography also guides whether PGY-1 is required, preferred, or not a significant contributing factor.

Lol come on dude. It's pretty common knowledge that California inpatient jobs pay substantially higher than any other state in the country, and that the NE is overstated and tends to have lower pay. I know you know this!

 

[W19]

If one has to do 3-year residency, why not go to med school. If you feel compelled to dispense drugs, I just found out physicians can also do that in most states. It seems crazy to me that some states grant MD/DO/DDS/DPM/NP/PA that kind of privilege.

This is a interesting paper about non-pharmacist dispensing!
https://www.nabp.net/system/rich/rich_files/rich_files/000/000/338/original/munger-202.pdf

Your organizations are running your profession into the ground while other healthcare professions such as NP/PA are doing a lot less and getting more out of the system.

 

[Digsbe]

Honestly... Why not do what the nurses did and develop a practitioner degree and get that noticed? Some kind of pharmacy driven post PharmD that incorporates pharmacy education and develops practitioner skills. Really we already get that in a PharmD program, but if they want to develop some masters degree tailored to pharmacists to be practitioners that makes more sense than all these residencies. It could be adding on some aspects of PA school and accepting credit earned from a PharmD program to make a PharmD/PA type of practitioner (not saying they'll have the title of PA or the degree, just an example. Maybe APP for Advance Practice Pharmacist?

 

[rph3664]

"Consider our advancement from the Bachelor of Pharmacy degree to the PharmD, from PGY1 to PGY2, and from PGY2 to pharmacy fellowships. To me, PGY3 pharmacy residencies seem like the natural next step in our impressive evolution as a profession."

This sentence should be posted to the homepage of every pharmacy school. Then pharmacy students can wonder why the hell they go to pharmacy school and not medical school.

What percentage of pharmacists, prospective or currently active, does this apply to? 5% at most.

The one pharmacist I know of who did a fellowship is a full-time professor. Had she pursued some other field, she probably would have gotten a Ph.D.

 

[rph3664]

Lol come on dude. It's pretty common knowledge that California inpatient jobs pay substantially higher than any other state in the country, and that the NE is overstated and tends to have lower pay. I know you know this!

The cost of living in California is substantially higher than almost every other place in the country, too.

 

[njac]

The cost of living in California is substantially higher than almost every other place in the country, too.

Yes and no.

As someone who likes living in a city, my rent is going to be about the same, if not more, almost anywhere I live (I've looked).


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[PharmDBro2017]

It's hard enough to chose whether or not to sacrifice another year to do PGY1... I'll pray for mental clarity for the over achievers that want PGY3.

 

[njac]

Specific environments...like what? What kind of environment could possibly be specific and difficult enough to require a PGY3 yet be marketable enough for them to reasonably obtain a job? Enough to sacrifice 3 years for this specialty, mind you.

And yeah...a huge decrease in overall productivity does sound like you might be utilizing them poorly. The residencies I know have them staffing a little more frequently and earlier (basically a weekend off every 2 weeks). Work around 60 hrs a week and often are on-call.

Well, like Dr. Jennings' position - working with advanced heart failure/LVADs/artificial hearts/heart transplant - there are elements of cardiology and transplant and critical care all playing together. The pharmacotherapy involved with many of these patients is pretty intricate, and to learn it "on the job" you may need to be at a very busy center for years to get exposed to multiple scenarios. I don't think the PGY3 concept would be for entry level positions. It would be for the motivated candidate who wants to be a leader in their niche. I believe there are some post-PGY2 neurocritical care fellowships out there for those interested in critical care research. Again, it's a niche. The people who choose to pursue those positions likely won't be at your community hospital, they're probably on a faculty track or will end up at academic centers.

Every residency is a little different. My PGY-2 was one of the on-call programs, but those are few and far between. If it were up to me, our PGY-1s would staff every other, or at least every 3rd, weekend, but it's not up to me (and I'm very ok with that). They may be working on things 50 or so hours per week, but it's not decreasing my individual workload.

 

[njac]

dude - I don't have a residency - yet I have pgy-2's that report to me - I think it is funny.

I also have pgy-1's report to me who have more years of experience.

It is not about the title, it is about the drive and ability

I

Dude, you also graduated what, 10 years ago? I graduated 7 years ago and it's already a different world.

I work with several fantastic pharmacists who didn't do residencies, I've also worked with terrible pharmacists who did.

I'm not saying you can't get the experience without a residency, I've never said that. But it's definitely a way to cram more patient hours in to that year or two (or three...) and optimize the experience.

I do try to share clinical pearls with the staff on a regular basis. If I see something particularly cool or an unorthodox treatment I'll often put together an email with references and send it out. It does get a little old when people say things like "teach me everything that you know!" and I want to say "no, bitch! You go put in the 50-60 hr weeks for 2 years and learn it yourself!" but instead I smile and nod. Because ain't nobody got time for that.

 

[confettiflyer]

Lol come on dude. It's pretty common knowledge that California inpatient jobs pay substantially higher than any other state in the country, and that the NE is overstated and tends to have lower pay. I know you know this!

Oh I know, but what I'm getting at is that while geography drives pay, it can also drive job requirements. California is saturated to all high hell too, but most inpatient jobs within an hour of the coastline and south of the Jefferson rebellion region are closed to anyone without PGY-1 or 5+ years of experience.

So I guess a better example is... my offer in the NE was $50/hr, my offer in California was unemployment (or retail, earning much less than inpatient pay). ::

 

[confettiflyer]

The cost of living in California is substantially higher than almost every other place in the country, too.

Not really, I'm paying slightly less than when I lived in Philadelphia/NE corridor.

Philly has this weird wage tax thing that really dings people making < $40k/yr. I remember being in PA, my first dollar earned as an intern was taxed at ~6% or so (PA state flat tax & philly wage tax). In California, your first dollar is taxed at 1%. NJ property taxes are insane, I might add.

That and utilities in the region are stupid expensive...I remember living in Southern California with 3 other people and our water bill + electric bill was < $100/mo. Granted, we never really used a/c during the summer/heat in the winter.

 

[TheBlaah]

As someone who likes living in a city, my rent is going to be about the same, if not more, almost anywhere I live (I've looked).

Not sure what you mean here. Anywhere you live as in any city in the US or anywhere in California? I can assure you there's major metropolitan cities with rent right in downtown area that's ~1/2 of California.

Not really, I'm paying slightly less than when I lived in Philadelphia/NE corridor.

Well, in his defense, he did say more than almost anywhere. You're right, that whole northeast area cost of living is very high cost of living as well.

 

[wagrxm2000]

Rent is almost as high as my mortgage payment. Congrats on paying for nothing Californians.

 

[confettiflyer]

OH oh oh sorry sorry, I mean to say....yes, it's very expensive to live in California 99.999% of my income goes to housing. The other 200% goes to taxes. I'm literally negative 500% vs. living in Nevada.

Stay away everyone.....don't come here. We're closed. Lots of Mexicans.

mmmmm....Mexican food.....oh wait, did I say that out loud?

Yeah, stay away!

 

[gwarm01]

So I guess a better example is... my offer in the NE was $50/hr, my offer in California was unemployment (or retail, earning much less than inpatient pay). ::

Hah, that's more accurate. I just didn't want some student to read that, completely misunderstand, then be shocked when they aren't offered $70/hr on the east coast. You know how students can be.

 

[Chalupa_Batman86]

I am reading the boards on reddit and the majority of those pharmacy students are absolutely clueless. If there was a PGY 3 in specialty informatics (on top of the PGY 2), those poor souls would go running on that train. Too bad it's not a gravy train that they make it out to be.

 

[gwarm01]

I am reading the boards on reddit and the majority of those pharmacy students are absolutely clueless. If there was a PGY 3 in specialty informatics (on top of the PGY 2), those poor souls would go running on that train. Too bad it's not a gravy train that they make it out to be.

Speaking of informatics, someone on Reddit was asking how to get into it and had people saying you have to have a PGY2, you have to have a masters degree in informatics. Kind of makes me chuckle as a 2013 grad with no residency who is currently working in that field.

 

[y0ssarian87]

OH oh oh sorry sorry, I mean to say....yes, it's very expensive to live in California 99.999% of my income goes to housing. The other 200% goes to taxes. I'm literally negative 500% vs. living in Nevada.

Stay away everyone.....don't come here. We're closed. Lots of Mexicans.

mmmmm....Mexican food.....oh wait, did I say that out loud?

Yeah, stay away!

Ugh. I miss good Mexican food possibly more than anything else. The Mexican food in Baltimore is pretty bad.


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[confettiflyer]

Ugh. I miss good Mexican food possibly more than anything else. The Mexican food in Baltimore is pretty bad.


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I feel for you, brother. I really do.

4 years of deprivation over here...whenever I landed in California, it was the only thing I would think about until I ate.


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