Any Transplant Pharmacists here?

[The Clyde]

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I find myself interested in the field, but the information is limited. I expect considering the field and the PGY2 requirement, but I thought this would be the best place to solicit some information for the benefit of my research and consideration.

Some questions I have include:
1. Is the training so specialized that you'd have a hard time transitioning/applying to other clinical jobs (asking this to be realistic about the possibility of no positions after PGY2)?

2. What's a work day like and does it include other non-transplant clinical duties? Or are you just that "guy/girl" focusing on that specialty all the time?

3. Any impressions about the job market from the inside looking out? Does it seem like a field that does/will have a growing need, or is it one of those "cool" fields that doesn't actually have demand?

4. Anything suggestions for/against it or general gems?

thanks

 

[GoldfishPharmD]

1) No. You need to know how to take care of any other patient out there and know your transplant stuff on top of that. If you aren't able to get a transplant position, you are more than qualified to work in say an internal medicine position.

2) Work day varies from hospital to hospital. Some transplant pharmacist work strictly inpatient and some work in ambulatory care clinics. Others may do a combination of both. As a resident, I do both in the same day. I'll see my patients in clinic and verify and take care of issues with patients that are admitted/newly transplanted.

3) Transplant pharmacist are required to be a part of the team by CMS. Right now, the job market is actually good. Pretty much all the PGY2s I've talked to have a position lined up for the fall. It seems like every week a new position is opening but who's to say how the market will be in the following years. You can't predict it.

4) If you love transplant/immunology. Go for it. I fell in love with this field early on and even had other transplant pharmacist tell me not to get my hopes too high about finding a job right after my training. I was fortunate enough to get a job at an awesome hospital so that's not an issue for me but it very well may be an issues for the residents in the years to come. You just have to decide if it's worth it to you to work in another area while trying to find a transplant job. Also, you have to be willing to travel. Not every hospital does transplants, so you may not be able to stay in whatever city you want. Good luck!

 

[The Clyde]

Incredible. Thank you for the response.

I have some time before I can truly start preparing, but can only hope that the market remains at least ok. It's great to know that the specialty isn't "wasted" if a specific position isn't available. Something about the heavy reliance on immune system knowledge and manipulation gets my interest.

 

[romaniangirl]

I'm also pretty curious about this field! How is the continuity of care? Obviously transplant patients need care for a long time after their transplant. so do you get to see the same patients year after year or is it a short-term thing? I'm assuming it probably depends if you do inpatient or clinic, right? Also, generally how much autonomy do transplant pharmacists usually have? Is it a specialty with a lot of autonomy or is it highly dictated by the physicians?

 

[The Clyde]

Found a few more sources of information for anyone else curious.

http://www.ajhp.org/content/65/24/2331.long
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2011.03601.x/full


and a forum post:

For us the day started with rounds at 7 or so. On rounds would be a fairly large team (the attending surgeon, a PA, pharmacy, PT/OT, nursing, nutrition, residents, fellows and students.) Sometimes there'd be 15 people and we did real rounds as a team. We started in the ICU where the patients were in the first part of post-op recovery. Here it's about establishing the pt. Then moved to the transplant floor where you'd see patients for just about everything. Most admissions were for acute rejection which is a surprisingly stable condition. We'd also have patients who were admitted for other ailments and conditions, but as I said they were always admitted to and treated by the transplant team. The attending would obviously lead rounds but every specialty gave updates at each pt. Pt discussion and game planning occurred on rounds. Rounds would take a few hours then it was on to pt work up, charting, pharmacy consults, etc. The transplant docs were in control of the transplant med dosing and are clearly the lead on this. Pharmacy played a support role in this and had a typical pharmacist role. However, for just about all other drug related issues the team relied heavily on the pharmacist. Infection? Ask the RPH what antibiotic. Pt is hypertensive and cholesterol bad? Pharmacist come up with a regimen. Diabetic pt renal transplant. Better take care of that new kidney, pharmacist what regimen should he be on? Also, of course any admitted pt provides an opportunity for med list review. I think you get my point. The attending is a surgeon and so specialized medically that they rely on you for the drug part.

We also attended the transplant mortality and morbidity conferences weekly, as well as grand rounds and other team related meetings.

You still do pharmacy consults and some of the typical clinical pharm stuff. I just felt it was the area where pharmacist most involved actual pt planning and execution. If you are looking at a specialty it's an interesting one for sure. It's a lot of work but it was cool. Our school did grand rounds as part of P4 year. I chose to do mine on a transplant topic and found that just from that 6 weeks I was more advanced on the topic than most of the faculty. It really is a whole different area and one that we didn't really see much in school.

 

[GoldfishPharmD]

My day's a bit different. I'll share when I have a minute.

 

[GoldfishPharmD]

Okay, here's my day. I get in about 6AM. I review my inpatients and see if there's anything that needs to be adjusted. I contact the appropriate person if it does. I then work up my clinic patients. I go through and just to find the most accurate list of their medications, I review old notes to see what their issues were on their last visit, I look at their previous labs, see if the current list of meds need adjustment or if anything can be optimize. I then meet with each patient 1 on 1. I update their medication list, ask them if they're having any side effects from their medications, any issues with compliance, any questions or concerns. I then meet up with the physician that's taking care of them in clinic and bring up any issues I found and make recommends. Examples: Can we cut back on immunosuppression, should we check an AUC on mycophenolate because I'm noticing toxicity from this medication, can we optimize their blood pressure medications, should we make changes to their lipid meds, etc. I then go round on my inpatients by myself. I ask them how their doing and get a feeling for how they're handling the medications. If I think they need adjustments, I'll bring it up with the providers. I then go back to my office where I get a sheet of all the cyclosporine or tacrolimus trough levels from our clinic patients. I then make recommendations on what to do with the value and send it to the appropriate provider. 99% of the time, my recommendation is carried out. Very rarely is something pushed back. I spend the rest of my afternoon righting SOAP notes on my clinic visits.

I'm pretty busy and tired at the end of the day, but it's worth it. Of course, every transplant program is different. You may end up with a job where you never see any clinic patients and just see brand new fresh transplants, etc.

 

[The Clyde]

Okay, here's my day.

...
I'm pretty busy and tired at the end of the day, but it's worth it. Of course, every transplant program is different. You may end up with a job where you never see any clinic patients and just see brand new fresh transplants, etc.

Quite a different description than the couple I've read, but still sounds great. The ability to 1on1 and round alone seems unique but probably great for making decision.

Can either of you speak to whether your workload is 100% transplant patient related, or if you get pulled away for non-transplant stuff regularly?

 

[GoldfishPharmD]

Quite a different description than the couple I've read, but still sounds great. The ability to 1on1 and round alone seems unique but probably great for making decision.

Can either of you speak to whether your workload is 100% transplant patient related, or if you get pulled away for non-transplant stuff regularly?

Nontransplant stuff like what?

 

[gwarm01]

Nontransplant stuff like what?

Probably regular staffing duties. It's hard to imagine many facilities having enough volume of transplant patients to necessitate someone working full-time, 100% of the time on that specific issue. I'm sure those positions do exist, but I wouldn't be surprised if many required other pharmacist duties.

 

[The Clyde]

Probably regular staffing duties. It's hard to imagine many facilities having enough volume of transplant patients to necessitate someone working full-time, 100% of the time on that specific issue. I'm sure those positions do exist, but I wouldn't be surprised if many required other pharmacist duties.

Yeah, that's what I was asking. I assumed as much, but never had a good feel for how high/low a volume implant hospitals deal with, and how often the people involved need to come back.

 

[GoldfishPharmD]

I've seen how things are ran at 3 different transplant centers and all the pharmacists there work strictly with the transplant patients. They very rarely worked with non transplant patient and if they did, it was those patients that were being considered for transplant. Is your job going to be just all about immunosuppression. No. You still need to know how to manage everything else (hypertension, diabetes, infections, etc.). You may be strictly clinical where you round with the team but don't do any order verification/putting in orders or you may be a hybrid like I am now. I verify all my orders for my transplant patients only, I do medication reconciliation on my patients, and still do the clinical stuff.

Even low volume centers still have a lot of responsibilities. You may be involved in ambulatory care setting in addition to your inpatients and you may be responsible for other things. Managing levels, writing policies, etc. You don't just sit there and twiddle your thumbs because you don't have a transplant patient in the hospital.

 

[futuredoctor246]

I've seen how things are ran at 3 different transplant centers and all the pharmacists there work strictly with the transplant patients. They very rarely worked with non transplant patient and if they did, it was those patients that were being considered for transplant. Is your job going to be just all about immunosuppression. No. You still need to know how to manage everything else (hypertension, diabetes, infections, etc.). You may be strictly clinical where you round with the team but don't do any order verification/putting in orders or you may be a hybrid like I am now. I verify all my orders for my transplant patients only, I do medication reconciliation on my patients, and still do the clinical stuff.

Even low volume centers still have a lot of responsibilities. You may be involved in ambulatory care setting in addition to your inpatients and you may be responsible for other things. Managing levels, writing policies, etc. You don't just sit there and twiddle your thumbs because you don't have a transplant patient in the hospital.

Hello. You're job seems so interesting. You answered all my questions, but I have one more? Is the salary higher than that of a regular pharmacist?

 

[GoldfishPharmD]

Hello. You're job seems so interesting. You answered all my questions, but I have one more? Is the salary higher than that of a regular pharmacist?

Not really. I get $55/hr. I got another job offer for $58/hr. I know people that make more and less than I do currently. It all depends on the area you live. If you live in bigger cities, you tend to get paid less. If you live in less desirable areas, you get paid more.