It has started... PGY3's in newest AJHP

[tungsten87]

It is all about competition now. Everyone is trying to get the upper hand (PGY1, PGY2, MBA, fellowship, etc.). In the mean time, everyone is piling more and more debt.

But do you know what have not changed? our work and our salary.

I disagree - at my previous institution I saw the number of clinical specialists increase significantly over the course of 2 years (mostly in ED, oncology, peds, and critical care), and many of these practitioners have a lot of autonomy and respect from the team. Again, not everyone is in it for the money and if you can graduate with a reasonable amount of debt I see no problem with this path. Folks who accrue 150K+ though on the other hand...

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[oldstock]

PGY-2s have been around for quite some time now, and I wouldn't call it a trend based on the fact that two folks from UC Denver published one article suggesting that PGY-3s may be beneficial for certain positions. The main thing that bothers me about it is that for some of the PGY-3s they suggest, many already exist as PGY-2s and I believe that this is already enough to generate competent practitioners.

exactly. Why do they want PGY3 for those positions/jobs that have been doing ok with PGY2 for years now all of a sudden ?? Even they are not in bed with employers, employers will certainly use this idea the next time someone is applying for suck position.

The same thing could be said about BSPharm vs PharmD. It is surely not about generating competent practitioners imho...

 

[oldstock]

It is all about competition now. Everyone is trying to get the upper hand (PGY1, PGY2, MBA, fellowship, etc.). In the mean time, everyone is piling more and more debt.

But do you know what have not changed? our work and our salary.

agreed 100% with everything you've just said there !!

 

[oldstock]

I disagree - at my previous institution I saw the number of clinical specialists increase significantly over the course of 2 years (mostly in ED, oncology, peds, and critical care), and many of these practitioners have a lot of autonomy and respect from the team. Again, not everyone is in it for the money and if you can graduate with a reasonable amount of debt I see no problem with this path. Folks who accrue 150K+ though on the other hand...

it is becoming harder, or not already hard, for most people to graduate pharmacy schools with less than 150+. The average tuition for pharmacy schools is ~ 30K per year x 4 years = ~ 120K, not including living expenses. So what are they going to do ??

 

[BMBiology]

I disagree - at my previous institution I saw the number of clinical specialists increase significantly over the course of 2 years (mostly in ED, oncology, peds, and critical care), and many of these practitioners have a lot of autonomy and respect from the team. Again, not everyone is in it for the money and if you can graduate with a reasonable amount of debt I see no problem with this path. Folks who accrue 150K+ though on the other hand...

Let me point out: (1) increase in number does not mean our work has changed; (2) our autonomy is dictated by pharmacy law, not by team so there are limits to what we can and cannot do

When are you going to get it? This increase in "training" is due to competition and pharmacy saturation. Hospitals and pharmacy schools know this and they are abusing it. It's simple as that.

 

[oldstock]

It is all about competition now. Everyone is trying to get the upper hand (PGY1, PGY2, MBA, fellowship, etc.). In the mean time, everyone is piling more and more debt.

But do you know what have not changed? our work and our salary.

none of the competitions would have happened if we had been able to stop the expansion of school...

 

[BMBiology]

Everybody needs to realize that academia needs you to survive. Why do you think they teach you all of this irrelevant crap over a 4 year period? Because you are their primary source of income since they can't bill for the clinical services they provide.

 

[tungsten87]

Let me point out: (1) increase in number does not mean our work has changed; (2) our autonomy is dictated by pharmacy law, not by team so there are limits to what we can and cannot do

When are you going to get it? This increase in "training" is due to competition and pharmacy saturation. Hospitals and pharmacy schools know this and they are abusing it. It's simple as that.

I don't think you read my post closely enough; I never said increase in numbers meant that the work had changed. However, the level of autonomy that pharmacists had at that institution, and even more-so at my current institution, was quite surprising to me. While the pharmacy laws are generally set in stone, these can be circumvented with collaborative practice agreements and hospital protocols. While I agree in part that more training is secondary to competition/saturation, I would also argue that pharmacist duties in certain settings have also increased with this level of training.

 

[BMBiology]

What can a pharmacist do today that he can't do 5 years ago?

 

[oldstock]

What can a pharmacist do today that he can't do 5 years ago?

or even 15-20 years ago ?? hmmm

 

[BMBiology]

^^his argument would have been better if he can claim that the increase in training has led to an increase in salary since pharmacists can now bill for their clinical services.

While money may not be a deciding factor but you always have to follow the money. If what you are doing doesn't generate revenue, it is likely not going to last.

 

[oldstock]

^^his argument would have been better if he can claim that the increase in training has led to an increase in salary since pharmacists can now bill for their clinical services.

While money may not be a deciding factor but you always have to follow the money. If what you are doing doesn't generate revenue, it is likely not going to last.

well said !!

talking about following the money, you would easily see why things are the way they are now...

 

[owlegrad]

What can a pharmacist do today that he can't do 5 years ago?

Vaccines come to mind.

 

[oldstock]

Vaccines come to mind.

do we need a PharmD degree and years of residency to do that ??

 

[BMBiology]

Vaccines come to mind.

Not in California. And yes, it was directly due to pharmacists doing a residency. Apparently you need to do a residency in order to administer vaccination.

 

[BMBiology]

That is the beautiful part about living in California. You are one step ahead of other states.

 

[oldstock]

That is the beautiful part about living in California. You are one step ahead of other states.

was it UCSF who started the whole PharmD thing ?? and this http://www.slate.com/articles/technology/robot_invasion/2011/09/will_robots_steal_your_job_2.html ?? and that Cali is the only state where all pharm schools use no PCAT for admission...

What a trendsetter... (sigh)

 

[oldstock]

was it UCSF who started the whole PharmD thing ?? and this http://www.slate.com/articles/technology/robot_invasion/2011/09/will_robots_steal_your_job_2.html ?? and that Cali is the only state where all pharm schools use no PCAT for admission...

What a trendsetter... (sigh)

my bad as the credit for that went to USC... it was USC (not UCSF) who started the nation's 1st PharmD program, according to Wikipedia and USC's websites,

"The first Pharm.D. program was established at the University of Southern California School of Pharmacy in Los Angeles, California in 1950.[1]"

http://en.wikipedia.org/wiki/Doctor_of_Pharmacy

"1905
The USC College of Pharmacy is established, offering a two-year pharmacy graduate degree (PhG) with a mission to “create a means for higher pharmaceutical education, and supply a broader foundation for the student’s future professional career by providing systematic instruction, and special training in those subjects requisite for the successful practice of pharmacy.” Tuition and fees are $75 per year.

...

1950
USC establishes the nation’s first PharmD program.

1968
The School launches the nation’s first clinical pharmacy program and the first MS in radiopharmacy program.

1970
The School becomes the first to offer clinical clerkships.

1974
The School relocates to the Health Sciences Campus, providing faculty and student access to multidisciplinary medical facilities and the LAC+USC Medical Center, one of the world’s largest teaching hospitals.

1988
USC establishes the nation’s first PharmD/MBA dual-degree program, providing training in both science and business administration."

https://pharmacyschool.usc.edu/about/facts/history/

note the 75 dollars figure... how time has changed...

 

[tungsten87]

What can a pharmacist do today that he can't do 5 years ago?

This is not a relevant timespan IMO. While I agree that the profession largely is not how they make it seem in school (> 60% of pharmacists work in community - not all hospital jobs are "clinical"), I think the huge expansion of clinical services in the past 20-30 years is critical. Some institutions have added clinical coverage 5 days a week, and the staff become so reliant on it that some have expanded to 7 days a week. ED is a great example - this field of pharmacy is blowing up, along with many others such as informatics, oncology, and pediatric (+ sub-specialties). However, specialties like critical care and ID are troublesome due to the lack of jobs.

^^his argument would have been better if he can claim that the increase in training has led to an increase in salary since pharmacists can now bill for their clinical services.

While money may not be a deciding factor but you always have to follow the money. If what you are doing doesn't generate revenue, it is likely not going to last.

I disagree. Drugs are extremely expensive (one of the highest expenses at a given hospital). A pharmacist in an oncology setting can easily justify his/her salary by simply encouraging rational use of growth factors, not to mention the other potential savings of using expensive TKIs, antibodies, etc appropriately. Also, millions can be saved via prevention of ADEs. One of the components of my residency is to keep a record of interventions and cost savings - I will of course report back at the end of the year.

 

[VCU07]

I don't necessarily agree with most jobs asking for residency or equivalent experience. There are hospitals within my city that require residency. They don't even care about experience. It's not fair to those of us that graduated at a different time and have worked our way up. To me it's a way to phase in residency....or phase out those of us that have experience depending on how you want to think about it. I know it's all about competition, but this is what is going on indirectly.

 

[genesis09]

sounds like you have been drinking the Kool-aid (technically flavor-aid - I feel bad Kool Aid got all that bad pub because of some crazy wack job in south america)

Sigh, they didn't use kool-aid. They use flavor-aid.

 

[xiphoid2010]

Drugs are extremely expensive (one of the highest expenses at a given hospital). A pharmacist in an oncology setting can easily justify his/her salary by simply encouraging rational use of growth factors, not to mention the other potential savings of using expensive TKIs, antibodies, etc appropriately. Also, millions can be saved via prevention of ADEs. One of the components of my residency is to keep a record of interventions and cost savings - I will of course report back at the end of the year.

Oncology is a huge profit center for hospitals right now, which is why hospitals are are buying out doctor's offices and infusion clinics. Not necessarily a good thing in term of societal health-care cost since hospitals can bill higher. But when the reimbursement system is setup this way...

 

[tungsten87]

Oncology is a huge profit center for hospitals right now, which is why hospitals are are buying out doctor's offices and infusion clinics. Not necessarily a good thing in term of societal health-care cost since hospitals can bill higher. But when the reimbursement system is setup this way...

Agreed, but this is occurring globally in healthcare.

 

[BMBiology]

That is the fallacy in your reasoning. Hospitals get extra rebate from the manufacturers depending on how much oncology drug they ordered. So there is a financial incentive to keep on ordering expensive medications. I agree with you that a pharmacist may improve patient care but it is going to cost the hospital money in term of lost rebate. And remember, hospitals can't bill for the services the pharmacist is providing.

 

[anewmanx]

That is the beautiful part about living in California. You are one step ahead of other states.

Unfortunately you have to put up with the delusional and materialistic cali culture.

I'd rather carve my eyes out with a hot spoon.

 

[BMBiology]

Unfortunately you have to put up with the delusional and materialistic cali culture.

I'd rather carve my eyes out with a hot spoon.

I dont know why (nor do I care) some people hate California. Internationally, what is the U.S. known for? Its technology and movies. Both are in California. If you don't like California, move to somewhere hotter, cheaper like Texas.

 

[anewmanx]

I dont know why (nor do I care) why some people hate California. Internationally, what is the U.S. known for? Its technology and movies. Both are in California.

Many of the good movies of today are being produced in Canada... more favorable tax structure. As for technology, the importance of Silicon Valley has significantly waned in the last decade.

As for why I despise the delusional California culture and attitude, I'm from the Pacific Northwest and spent the better part of 20 years putting up with people from Cali that moved north. There were a plague, like cockroaches. The kind of people that go for a 15 minute jog, then drink a 1000 calorie 100g of sugar drink from starbucks and wonder why they didn't lose any weight. The kind of people that think we can just hug and hold hands with extremist terrorists and don't understand why the world doesn't hug bunnies and love one another. If there's one thing I learned working as a soldier and previously as a correctional officer in maximum security prison, it's that not all human beings are the same. Some people are just not good. There is nothing good in them, and they will kill you with a smile on their face. That kind of thinking seemed to be foreign to every person I've ever talked to from California. I find that they are significantly out of touch with the harshness of this world as a whole... I especially saw them struggle when they were faced with the unfair rigors of basic training, mass punishment, etc... most of them just couldn't adjust.

Buuuut, everyone is entitled to their opinion. That one happens to me mine, and I am aware that it's harsh and offensive. I'm a harsh and offensive person.

 

[BMBiology]

That is why they moved out of California. Out with the bad and in with the good.

Besides, why do you care so much about what others do with their lives? A little less judgmental would go a long way for you.

 

[anewmanx]

That is why they moved out of California. Out with the bad and in with the good.

Besides, why do you care so much about what others do with their lives? A little less judgmental would go a long way for you.

Eh, I find our American culture toxic and irritating. I suppose over the years I've become somewhat bitter/jaded. Then again, there is something to be said for the concept of the tyranny of the majority. I found that the massive influx of Californians during the 90's really poisoned and changed the culture, and not in a positive way. It seems the influence has significantly subsided the last few times I've been back up there to visit family though. Rather refreshing!

 

[confettiflyer]

I'm from the Pacific Northwest

ah that explains it all

yeah we screwed you guys over in the late 90's/early 00's, oh well.

 

[confettiflyer]

^Agree with confetti above (in fact to disagree with confetti is just admitting you are wrong so I recommend to never do that)

Ah you're too kind.

Employers would have never been in the position to take advantage of new pharmacists if there had not been too many schools opening.

This is a depressing means to an end. And pathetic !!

(no offense to anyone here but this is what exactly what I feel seeing all these...)

No offense taken, and generally agree with you about supply and demand. But for the average new grad, such a discussion is useless. It's like listening to old grandpa talk about the good old days when people left their doors unlocked and business deals were sealed with a handshake.

This is 2014...my advice to new grads is to differentiate and overcredential. Sure, you're playing a game, but the consequences of not doing so are dire.

That is the beautiful part about living in California. You are one step ahead of other states.

I love setting the de facto national standard across the U.S. Feels good, doesn't it?

 

[confettiflyer]

Let me point out: (1) increase in number does not mean our work has changed; (2) our autonomy is dictated by pharmacy law, not by team so there are limits to what we can and cannot do

When are you going to get it? This increase in "training" is due to competition and pharmacy saturation. Hospitals and pharmacy schools know this and they are abusing it. It's simple as that.

It's interesting being on the other side now....this oversaturation and training has been a boon to us. We haven't dropped salaries, per se....but everyone coming through the door is so much more qualified than years and years ago when hospitals would scramble throw money at the next available body coming out of Rx school.

I really believe at the end of the day....the most qualified individuals will be employed, there's always a need for high quality pharmacists. That said, there's a huge disconnect and delusion that many students and new pharmacists have regarding their own skills.

Just browse the "I'm an unemployed pharmacist" type threads on LinkedIn and you'll see what I'm talking about.

 

[anewmanx]

ah that explains it all

yeah we screwed you guys over in the late 90's/early 00's, oh well.

 

[BMBiology]

Just browse the "I'm an unemployed pharmacist" type threads on LinkedIn and you'll see what I'm talking about.

link?

 

[confettiflyer]

link?

I don't wanna post it here because it's real names and stuff, but it's the RPhOnTheGo staffing group on LinkedIn, one of the recent "I'm job hunting" threads. Really bad grammar going on...if you click through to some of the profiles, it's like, "Well now I see why no one's calling you back."

I dunno, maybe I'm just really big on owning your online presence like it were a resume/CV (because it is!)

 

[confettiflyer]

I've actually instructed clients to remove their California license plates ASAP when relocating up there.

 

[anewmanx]

I've actually instructed clients to remove their California license plates ASAP when relocating up there.

Well, you're not wrong for doing that. The Northwest does not adjust to you, you adjust to the Northwest. That's one of the first hard lessons to learn after moving out of happy unicorn rainbow land. On the other hand, if you get a job in academia in the Pacific Northwest, blind and unrealistic idealism helps you fit right in. The more vomit inducing your beliefs, the more they will cherish you. A great place for gender studies and art history majors for sure....

 

[gwarm01]

Residency was just a means to an end, just the millennial version of this quaint thing called "on the job training" that employers used to do to people with degrees right out of school.

This is what gets me. Not that long ago we would be hired out of school and given training to fill these jobs. A PharmD and a little bit of ambition was all it took to eventually become any sort of clinical specialist. I know several people who were hired by hospitals out of school, worked and received training at full pay for a few years, and then took over specialty positions as they became available. Now you are expected to work more hours at a significantly reduced salary only to struggle to find a staffing job in a small city? It's a shame. Pharmacy isn't heart surgery. Four years of school is more than enough to prepare you for staffing, assuming you aren't a total idiot and can adapt to your new job. After that any competent pharmacist should be able to mold themselves to fit a niche in their institution, all while receiving full pay.

 

[oldstock]

Ah you're too kind.

No offense taken, and generally agree with you about supply and demand. But for the average new grad, such a discussion is useless. It's like listening to old grandpa talk about the good old days when people left their doors unlocked and business deals were sealed with a handshake.

This is 2014...my advice to new grads is to differentiate and overcredential. Sure, you're playing a game, but the consequences of not doing so are dire.

I love setting the de facto national standard across the U.S. Feels good, doesn't it?

I agree with you about new grads need to do more or have more credentials to get a job these days. That is just the reality. But it is not the point. The point it that we all let them to inflate this school/credential bubble in the first place to begin with. Not like we could not or cannot do anything about this situation. But nobody cared or fought then. Nobody actually get together to fight or fix that trend of bubble forming now. At some point, market will correct for you, and that will be ugly. And too late.

 

[pharm B]

I don't think credentialing and extra training are bad for the profession. I think they're better. I also don't think they're some kind of consequence of the boom in pharmacy schools.

How would you have opposed the opening of the new schools? ACPE's job isn't to prevent saturation of the market, so let's not bother bringing them up. Articles in (pharmacy-specific) journals? That's been done.

You sure know a lot about this for a pre-pharm.

 

[oldstock]

I don't think credentialing and extra training are bad for the profession. I think they're better. I also don't think they're some kind of consequence of the boom in pharmacy schools.

How would you have opposed the opening of the new schools? ACPE's job isn't to prevent saturation of the market, so let's not bother bringing them up. Articles in (pharmacy-specific) journals? That's been done.

You sure know a lot about this for a pre-pharm.

I learn from googling, reading, and reasoning. Also I come from a family of healthcare professionals (which is including many pharmacists and PharmDs). I need to learn as much as I can before coming in. I see that we have a problem having no mechanism to control or safeguard against this credential inflation/school expansion while you think there is all good in the hood... Remember AACP voted to mandate the PharmD degree to begin all this...

But let time and market tell us

 

[confettiflyer]

Remember AACP voted to mandate the PharmD degree to begin all this...

Arguably, this action was the single most important driver in reducing pharmacist supply both artificially during the transition and organically by raising the standards required to open a pharmacy school.

 

[PharmDCandidate2014]

yup, but wait until they make "community residency" a mandate to work at CVS or Walgreen

These are the bosses' reaction in CVS:

 

[Digsbe]

Until pharmacists get provider status and until additional training correlates with increased salary or billable services there shouldn't be a PGY3. Sure it's more education, but unless there is a billable demand for it this shouldn't happen. Let's focus on being able to actually use advanced training first before requiring more of it. I'm not explicitly against it, but I think the priority and timing isn't right. What's the point in doing as many years of schooling and residency as a physician when you still don't have any expanded scope and will likely make less than retail colleagues?

 

[oldstock]

Until pharmacists get provider status and until additional training correlates with increased salary or billable services there shouldn't be a PGY3. Sure it's more education, but unless there is a billable demand for it this shouldn't happen. Let's focus on being able to actually use advanced training first before requiring more of it. I'm not explicitly against it, but I think the priority and timing isn't right. What's the point in doing as many years of schooling and residency as a physician when you still don't have any expanded scope and will likely make less than retail colleagues?

Agree with you 110% here.

Unfortunately, as there are more and more schools opening and more and more new graduates, and thus more competition, they are going to create more barriers regardless those barriers are justified/unjustified or fair/unfair.

Demand and supply is the ultimate force to determine whether it is ridiculously easy or stupidly hard to get in a school or get a job. If there are more schools, people will be able to get in pharm school with 0s GPA and 0s PCAT. More schools --> more pharmds + most wants hospital jobs = PGY-10

Seriously, the more I think, the more I see there is nothing we can do but let the Mother Market take care of this problem. Most people simply ignore this problem and do not want to band together to do anything.

For the ones who are in, try to get out as soon as you can. For the ones that are not in, try not to get in this mess in the first place. Pharmacy is Law School 2.0 !!

 

[BF7]

to

Agree with you 110% here.

Unfortunately, as there are more and more schools opening and more and more new graduates, and thus more competition, they are going to create more barriers regardless those barriers are justified/unjustified or fair/unfair.

Demand and supply is the ultimate force to determine whether it is ridiculously easy or stupidly hard to get in a school or get a job. If there are more schools, people will be able to get in pharm school with 0s GPA and 0s PCAT. More schools --> more pharmds + most wants hospital jobs = PGY-10

Seriously, the more I think, the more I see there is nothing we can do but let the Mother Market take care of this problem. Most people simply ignore this problem and do not want to band together to do anything.

For the ones who are in, try to get out as soon as you can. For the ones that are not in, try not to get in this mess in the first place. Pharmacy is Law School 2.0 !!

But for the ones who already have 10+ years invested into their pharmacy careers (but still a LONG way from retiring), and who also have a better than average tolerance for risk, now is a great time to jump into ownership to reduce your long term risk to job market saturation while also being able to utilize that market force to your advantage.

http://www.ncpanet.org/conferences-events/ownership-workshop/pharmacy-ownership-workshop

here is who to partner with for financing:

http://www.liveoakbank.com/

as a rule of thumb, for every $100K that you take out in a loan, your monthly payment over 11 years is roughly $1000.

The SBA loan typical requires 20% down; for those stores that are in the $million dollar Plus range (if you buy an existing store) the selling owner often will put up 15% for the buyer in the form of a separate loan that is payable upon the start of year #2 of your ownership and is typically done over 10 years.

If you are going to start a store from scratch(assuming you are leasing a space) you'll only need $250-$300K.(- about $50K for store shelving etc, $20K if you are buying your rx computer system, $5K for a phone system, $7 K for security cameras, etc with about $120K in working capital) your drug wholesaler will also typically give you 6 months of dating on a new startup drug inventory.

 

[type b pharmD]

Well, you're not wrong for doing that. The Northwest does not adjust to you, you adjust to the Northwest. That's one of the first hard lessons to learn after moving out of happy unicorn rainbow land. On the other hand, if you get a job in academia in the Pacific Northwest, blind and unrealistic idealism helps you fit right in. The more vomit inducing your beliefs, the more they will cherish you. A great place for gender studies and art history majors for sure....

Rofl! As a new resident of this region I agree completely

 

[spacecowgirl]

I heard this at residency graduation last May. Totally insane.

 

[PharmDCandidate2014]

Agree with you 110% here.

Unfortunately, as there are more and more schools opening and more and more new graduates, and thus more competition, they are going to create more barriers regardless those barriers are justified/unjustified or fair/unfair.

Demand and supply is the ultimate force to determine whether it is ridiculously easy or stupidly hard to get in a school or get a job. If there are more schools, people will be able to get in pharm school with 0s GPA and 0s PCAT. More schools --> more pharmds + most wants hospital jobs = PGY-10

Seriously, the more I think, the more I see there is nothing we can do but let the Mother Market take care of this problem. Most people simply ignore this problem and do not want to band together to do anything.

For the ones who are in, try to get out as soon as you can. For the ones that are not in, try not to get in this mess in the first place. Pharmacy is Law School 2.0 !!

Lawyer vs pharmacist. The former, you have the option of being a criminal lawyer or a CRIMINAL lawyer. Hint: Better call Saul! (Breaking Bad Season 2)

You can't put a brilliant twist to a sentence with the word 'pharmacist.' It won't sound as cool.

Anyway: a rather recent career fair with guests from CVS and Wag's asked the students who, if any, were interested in a community residency. I was STUNNED to see the high number of hands raised. This begs the following questions:

(1) Are more and more current students becoming increasingly charitable with their time or lack sense of the real world, even common sense?
(2) Is community residency going to be the next "requirement" in obtaining a staffing position at Rite-Aid, CVS, Wag's when the number of graduates really rears its ugly head circa 2020?

 

[zelman]

(1) Are more and more current students becoming increasingly charitable with their time or lack sense of the real world, even common sense?

Yes.

(2) Is community residency going to be the next "requirement" in obtaining a staffing position at Rite-Aid, CVS, Wag's when the number of graduates really rears its ugly head circa 2020?

Nope, but huge corporations aren't stupid. They'd rather have people work for grad intern rates for the first year when they can get it.