Ambulatory Care Pharmacists

[rx4beauty]

Is anyone an Ambulatory Care Pharmacists? I'm a first year pharmacy student interested in working in a community setting after graduation. I just wanted to know what qualifications (i.e residency, certifications, etc.) I need to pursue a career in an ambulatory care clinic. And, if you do work in ambulatory care or know about working in a similar environment, could you write a little about it? Muchos Gracias!

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[dgroulx]

Is anyone an Ambulatory Care Pharmacists? I'm a first year pharmacy student interested in working in a community setting after graduation. I just wanted to know what qualifications (i.e residency, certifications, etc.) I need to pursue a career in an ambulatory care clinic. And, if you do work in ambulatory care or know about working in a similar environment, could you write a little about it? Muchos Gracias!

I start my ambulatory care rotation on May 1st. I'm at a clinic in a rural area that serves a lot of migrant workers. I'll try to post some info about it once I get some experience with the setting.

 

[Poland]

I am looking forward to hearing about this, too. Ambulatory care sounds exciting and I have thought alot of this particular area. With as much Discovery and TLC that I watch about ER care, I wish there was more information about pharmacists in this setting.

 

[ultracet]

i'll start a residency in june that is very very heavy in am care.

inorder to do am care i think you pretty much have to have a residency

the VA has a great am care system too...

 

[ultracet]

miss not being able to delete double posts.....

 

[Requiem]

I am looking forward to hearing about this, too. Ambulatory care sounds exciting and I have thought alot of this particular area. With as much Discovery and TLC that I watch about ER care, I wish there was more information about pharmacists in this setting.

Ambulatory care is amazing. As a professional pharmacist in an ambulatory care setting, you get to be a part of the ambulance and ER setting.

Imagine riding in an ambulance with a critical patient and being able to give him meds to treat him? sensational. Then, you get to go into the ER setting and follow-up treatment with ambulatory doctors & nurses.

To Poland, who mentioned he/she was learning about the topic on TLC/Discovery: excellent idea. Discovery does a great job at portraying ER Pharmacists (ambulatory care) in their medical shows, as does TLC. This is basically real life except for a few little details, the acting and precise day-to-day job routine is astonishing similar.

So, to those interested: seriously just check out discovery and tlc a lot. you'll learn so much about ambulance pharmacy/ er pharmacy (ambulatory).

 

[ultracet]

Ambulatory care is amazing. As a professional pharmacist in an ambulatory care setting, you get to be a part of the ambulance and ER setting.

Imagine riding in an ambulance with a critical patient and being able to give him meds to treat him? sensational. Then, you get to go into the ER setting and follow-up treatment with ambulatory doctors & nurses.

To Poland, who mentioned he/she was learning about the topic on TLC/Discovery: excellent idea. Discovery does a great job at portraying ER Pharmacists (ambulatory care) in their medical shows, as does TLC. This is basically real life except for a few little details, the acting and precise day-to-day job routine is astonishing similar.

So, to those interested: seriously just check out discovery and tlc a lot. you'll learn so much about ambulance pharmacy/ er pharmacy (ambulatory).

Requiem is right...

I had my ambulatory care rotation in feb and it was so high paced and ultimately the most exciting thing i've ever done.

They even taught me how to properly use the defibrillator if necessary.

I highly HIGHLY recommend anyone who wants to go into this field to consider also being trained as an EMT

I love discovery and tlc and it always pumps me up to see what i will be doing in a few short months.

 

[Caverject]

I start my ambulatory care rotation on May 1st. I'm at a clinic in a rural area that serves a lot of migrant workers. I'll try to post some info about it once I get some experience with the setting.

I had the opportunity to do an amcare rotation not too long ago in a rural area. I was located in Vidalia Georgia where there is a lot of migrant workers as well. (onion farms) I must say the experience was eye opening. I never knew that in a rural area like this that cops ride along with the EMT's. They can't ride in cop cars because it would cause mass chaos in the fields. When the emt's and myself go to attend the patient in need, the cops check work visas and passports to make sure everyone is legal. Quite a few times, I have seen an unfortunate illegal worker get handcuffed to the stretcher, taken to the hospital and then deported. It's quite sad to watch, even sadder to watch the family as the patient gets cuffed but the law is the law. Like I said, eye opening!

 

[kwizard]

So, to those interested: seriously just check out discovery and tlc a lot. you'll learn so much about ambulance pharmacy/ er pharmacy (ambulatory).

Just a minor clarification. Ambulatory implies that the patient is not bedridden (i.e. capable of walking) and isn't necessarily exclusive to pharmacists working in the ER. However, funding for pharmacists in ER setting is becoming more popular due to JCAHO initiatives for med reconciliation and minimization of polyphmarmacy; however, if this is a path that interests you, obtaining some critical care training and/or BLS (Basic Life Support) and ACLS (Advanced Cardiac Life Support) certification may be quite advantageous given the potential acuity of the population (i.e. pts coding). Check out the American heart association for a list of classes (http://www.americanheart.org/). Most residencies train you in BLS/ACLS so you obtain certification during residency period.

Ambulatory care tend to be seeing pts in clinic settings (i.e. managing lipids, htn, diabetes, anticoag, etc); however depending on facility may also include some time in the ER as well but depending on the volume of the clinic, the pharmacy may be able to justify an entire separate pharmacist for the ER. It might be worthwhile to check out ASHP (www.ashp.org) and/or ACCP (www.accp.com) to look at potential am care and/or ER positions/residencies in various geographical areas. Off the top of my head Temple's hospital in Philly is currently looking for an ER pharmacist so it might be a good idea to look into to the position to compare/contrast w/ qualifications for the job w/ other listings.

Both settings are very impt and fast paced and really ideal for those who like pt contact and application of clinical skills.

 

[dgroulx]

I now have a week of ambulatory care under my belt. The clinic where I work has lots of poor patients. There is a sliding scale for paying the clinic for doctor and dentist visits.

We have a limited formulary. We do not stock any C-II meds at all. Most of the patients are on patient assistance programs sponsored by the drug company. We have certain shelves just for those meds. If they aren't on the program, we can sign them up. If a doctor writes for a med that is not in the patient assistance program or we have a lower cost alternative, we send a note next door with our recommendation.

We also counsel every patient. The pharmacist knows some Spanish, but one of the nurses comes over to act as an interpreter when we need it. For new diabetic patients, we have the time to show them how to use their glucose meter. We have demo inhalers to show asthma patients proper technique.

It's been a while since I've had pharmacology, so the pharmacist will quiz me while were filling a prescription. It's a good refresher course. We also have stools, so we can sit during down time which is nice.

It is very close to retail pharmacy, but at a much slower pace with lots of interaction with your patients.

 

[pharmforme]

I now have a week of ambulatory care under my belt. The clinic where I work has lots of poor patients. There is a sliding scale for paying the clinic for doctor and dentist visits.

We have a limited formulary. We do not stock any C-II meds at all. Most of the patients are on patient assistance programs sponsored by the drug company. We have certain shelves just for those meds. If they aren't on the program, we can sign them up. If a doctor writes for a med that is not in the patient assistance program or we have a lower cost alternative, we send a note next door with our recommendation.

We also counsel every patient. The pharmacist knows some Spanish, but one of the nurses comes over to act as an interpreter when we need it. For new diabetic patients, we have the time to show them how to use their glucose meter. We have demo inhalers to show asthma patients proper technique.

It's been a while since I've had pharmacology, so the pharmacist will quiz me while were filling a prescription. It's a good refresher course. We also have stools, so we can sit during down time which is nice.

It is very close to retail pharmacy, but at a much slower pace with lots of interaction with your patients.

As a newbie here I have to say this is a great thread!! Makes me wonder if we should put threads like this in the FAQ portion- one for each type of pharm job.
Thanks to all of you for taking the time to detail your experiences.

 

[pinkyrx]

I now have a week of ambulatory care under my belt. The clinic where I work has lots of poor patients. There is a sliding scale for paying the clinic for doctor and dentist visits.

We have a limited formulary. We do not stock any C-II meds at all. Most of the patients are on patient assistance programs sponsored by the drug company. We have certain shelves just for those meds. If they aren't on the program, we can sign them up. If a doctor writes for a med that is not in the patient assistance program or we have a lower cost alternative, we send a note next door with our recommendation.

We also counsel every patient. The pharmacist knows some Spanish, but one of the nurses comes over to act as an interpreter when we need it. For new diabetic patients, we have the time to show them how to use their glucose meter. We have demo inhalers to show asthma patients proper technique.

It's been a while since I've had pharmacology, so the pharmacist will quiz me while were filling a prescription. It's a good refresher course. We also have stools, so we can sit during down time which is nice.

It is very close to retail pharmacy, but at a much slower pace with lots of interaction with your patients.

Dana, thanks for describing your experience! I went into pharmacy school thinking that I would be a community/retail pharmacist when I graduated but I'm looking more and more toward ambulatory care. This is probably a dumb question, but do you think there are any job opportunities for this type of work without doing a residency after school? I'm an "older" student and I'd really like to just get out of school and start working rather than continuing on with my education after my PharmD.

 

[dgroulx]

Dana, thanks for describing your experience! I went into pharmacy school thinking that I would be a community/retail pharmacist when I graduated but I'm looking more and more toward ambulatory care. This is probably a dumb question, but do you think there are any job opportunities for this type of work without doing a residency after school? I'm an "older" student and I'd really like to just get out of school and start working rather than continuing on with my education after my PharmD.

My preceptor graduated from UF in 1999, did one year of retail then took the ambulatory care position. I think a general residency would help more with getting a hospital job. This is disease state management and the meds that the patients take are the ones you find in a retail setting, not hospital. It all depends on who is doing the hiring, I guess.

I'm not sure how many jobs are available in this setting. But, I think any slower pharmacy would give you the same opportunity for patient contact.

 

[pinkyrx]

I'm not sure how many jobs are available in this setting. But, I think any slower pharmacy would give you the same opportunity for patient contact.

Thanks Dana! Many moons ago when I was in undergrad I worked at a "slow" pharmacy for several years and it is there that I decided that I was meant to be a pharmacist. Now, I work at a pharmacy that is VERY busy and it just doesn't even have the same feeling. I've been telling myself that when I graduate (if I do go the community/retail route) that I need to ensure that I work for a store that is slow enough to actually allow this kind of patient interaction.

Of course, the only problem with that is that we live really close to a big city so pretty much all of the pharmacies around are really busy. I think the extra drive to the outskirts of town will be worth it though if it's a better environment to work in.

Anyway, thanks for the description of your rotation thus far. Please keep us updated on how its going.

 

[rx4beauty]

I now have a week of ambulatory care under my belt. The clinic where I work has lots of poor patients. There is a sliding scale for paying the clinic for doctor and dentist visits.

We have a limited formulary. We do not stock any C-II meds at all. Most of the patients are on patient assistance programs sponsored by the drug company. We have certain shelves just for those meds. If they aren't on the program, we can sign them up. If a doctor writes for a med that is not in the patient assistance program or we have a lower cost alternative, we send a note next door with our recommendation.

We also counsel every patient. The pharmacist knows some Spanish, but one of the nurses comes over to act as an interpreter when we need it. For new diabetic patients, we have the time to show them how to use their glucose meter. We have demo inhalers to show asthma patients proper technique.

It's been a while since I've had pharmacology, so the pharmacist will quiz me while were filling a prescription. It's a good refresher course. We also have stools, so we can sit during down time which is nice.

It is very close to retail pharmacy, but at a much slower pace with lots of interaction with your patients.

Thanks for all the information. Please keep us informed on any updates and interesting events that occur during your rotation.

 

[dgroulx]

Thanks for all the information. Please keep us informed on any updates and interesting events that occur during your rotation.

I've just about finished my 3rd week. I'm relearning a lot of the details that I had forgotten. My 3rd year at UF was very hospital clinically oriented. Now I'm back to managing the normal diabetes, hypertension, etc.

My preceptor asks me every day about patient medications - how do they work, how is it different from another similar medication, what should we counsel on.

I also review charts when new prescriptions are written. This week I had a question about an increase in Lipitor from 40mg to 80mg. I looked at current labs and the patient had an LDL of only 42, but low HDL & high triglycerides. I recommended to add Niacin or a fibrate instead. The pharmacist and I talked to the doctor in the clinic and he said that he didn't feel that she would be compliant if we added another med. So, the Lipitor increase stayed. I would have liked to at least try her on another med and then see how compliant she was, but I just don't have the autonomy to do that.

 

[mph2pharm]

Dana, thanks for describing your experience! I went into pharmacy school thinking that I would be a community/retail pharmacist when I graduated but I'm looking more and more toward ambulatory care. This is probably a dumb question, but do you think there are any job opportunities for this type of work without doing a residency after school? I'm an "older" student and I'd really like to just get out of school and start working rather than continuing on with my education after my PharmD.

I agree...I too had the idea that I would go into community/retail pharmacy but I am realizing more and more that there are so many other exciting opportunities out there. Ambulatory care pharmacy sounds really exciting. But like you pharmagirl, I am also an "older" student and will not be looking forward to having to do possibly a 2+ year residency after pharm school in order to do anything besides retail. I am going to need to start working....I may have a kid to support by then!

 

[kwizard]

I agree...I too had the idea that I would go into community/retail pharmacy but I am realizing more and more that there are so many other exciting opportunities out there. Ambulatory care pharmacy sounds really exciting. But like you pharmagirl, I am also an "older" student and will not be looking forward to having to do possibly a 2+ year residency after pharm school in order to do anything besides retail. I am going to need to start working....I may have a kid to support by then!

Everybody please don't get locked into the idea that you have to do 2yrs of residency training to fulfill your interest in ambulatory care. Even with the new residency standards many am care residencies may/will still be available as 1yr programs (PGY1) either as straight am care residencies or by general pharmacy practice residency programs w/ an emphasis in am care (http://www.ashp.org/rtp/PDF/FAQ_newSTD.pdf or http://www.ashp.org/). Either types of these programs can be found most commonly in the VA or in Kaiser. Therefore the option for just doing 1yr is is certainly possible. If that still seems like too much remember that nothing is "in stone" regarding pharmacy training so a possible alternative you may try to shoot for jobs at Kaiser or the VA straight out of school (you never know what might happen).

Ohter option check out the community care residencies (http://www.aphanet.org/ResidencyLocator/ResidencyLocator.asp) as their goals are typically to integrate the am care dz management programs in community pharmacy (independent or chains) as it seems that everyone on the list seems to enjoy. The residency option is available but if you come off as a "go-getter" w/ potential than the option of getting hired straight out of school is likely to also be available. Remember their is always more than one way to get from point A-->point B. Hope this helps.

 

[sdn1977]

Also....if you are still in school, don't discount the possibility of volunteering even as a pharmacy student. Often intern positions are based on availability of money in the dept. Budget constraints may not allow an intern position to be available. Many sites though will allow volunteers and with volunteer exposure, they get to know you - just another way to get your foot in the door. You may not be allowed all the functions of an intern, but it gives you exposure & the ability to network. Volunteering is much easier once you're a pharmacy student because they know are aware of all the legal issues.

 

[dgroulx]

I'm about to start my last week. It's been a good 8 week rotation. The clinic I work for has an opening for a pharmacist in Orlando. It's hard to fill because it is in a rough neighborhood. But, most of the indigent care clinics are in bad areas of town.

I have put this down as a job I would like to do when I graduate, if I can find an open position. Several clinics in Florida require you to also know Spanish.

All "community health" clinics get funded by the government. The salaries aren't as high as retail, but they have other benefits. For instance, they forgive $25,000 per year of student loans for the 1st two years. If you sign on for another 2 years, they will forgive another $25,000 per year. Other benefits include 401k matching, paid holidays (they are closed for all federal holidays), payment for completing you CE's including travel & hotels, and probably some others that I'm forgetting right now.

 

[MdBrndPhrmcst]

I'm about to start my last week. It's been a good 8 week rotation. The clinic I work for has an opening for a pharmacist in Orlando. It's hard to fill because it is in a rough neighborhood. But, most of the indigent care clinics are in bad areas of town.

I have put this down as a job I would like to do when I graduate, if I can find an open position. Several clinics in Florida require you to also know Spanish.

All "community health" clinics get funded by the government. The salaries aren't as high as retail, but they have other benefits. For instance, they forgive $25,000 per year of student loans for the 1st two years. If you sign on for another 2 years, they will forgive another $25,000 per year. Other benefits include 401k matching, paid holidays (they are closed for all federal holidays), payment for completing you CE's including travel & hotels, and probably some others that I'm forgetting right now.

by aren't as high are you talking like 80,000? or like 60,000?

 

[dgroulx]

by aren't as high are you talking like 80,000? or like 60,000?

They haven't given me the salary figure. Sorry.