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Are there really any "Clinical" positions out there??

Discussion in 'Pharmacy' started by MuraRX, Mar 5, 2007.

  1. MuraRX

    MuraRX Member 5+ Year Member

    Jan 26, 2006
    I am going into pharmacy hoping and expecting to work as a clinical pharmacist when I am done. But, I did a few searches for work as a pharmacist and the only types of jobs that I see are in industry or in retail, regardless of the state in which I searched. Does anyone here actually work (or have you ever) as a clinical pharmacist? I can't believe that all the talk of pharmacy as such an evolving profession is all a lie. I guess I'm just feeling a little discouraged right now---someone please tell me I'm wrong! :oops:
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  3. sdn1977

    sdn1977 Senior Member 10+ Year Member

    Jul 28, 2005
    Where I live, there are no hospital positions - staff, "clinical" - gosh how I hate that term!!!!!, part-time, full-time, dop, supervisory, etc....NONE - are advertised in the common places - online or newspapers.

    The jobs are known through word of mouth or you apply with a good resume. Often you have to start with one thing and move to something else. In the really bad places to work, they use a head-hunter.

    A really good place to look for jobs is at local & state organization meetings.

    That's why you learn to network, network, network!!!

    Good luck!
  4. rxforlife2004

    rxforlife2004 Banned Banned 5+ Year Member

    Jan 13, 2004
    If 100/100 students want to be a clinical pharmacist, then who would do the distribution function? A nurse? a pharmacy tech? Who will check the prescription errors, verifying the dosage on an Rx? The clerk?

    I remember in my class....there was one time, a professor asked how many wanna be a clinical pharmacist? More than half of the class raised their hands. My class size was 120 students. So you're talking about more than 60 students would love to be "clinical Pharmacists". But now...we're about to far as i see, only about 30 people would do the residency. Out of 30 people, who would actually accept the residency offer? I would estimate to tbe around 20.

    To me, i rather do 50/50 in the sense of both clinical and staffing activities. It'll be handicapped if you know how to dose Vancomycin, TPN, but don't know how to enter the order into the computer system and the pharmacist in charge is out for lunch...or for whatever reason.....we're short one pharmacist. That's lame and embarrassing.

    So do both if you could...
  5. Super Glue

    Super Glue New Member

    Dec 23, 2004
    All pharmacy jobs are clinical. It all depends on how you view it, and how you work it. If you're not finding enough time for clinical checks, learn to dispense faster. I know retail pharmacists that put loads more thought into their work than clinical pharmacists.
  6. tussionex

    tussionex Pharmacist 2+ Year Member

    Jan 23, 2007
    po-town, NY
  7. sdn1977

    sdn1977 Senior Member 10+ Year Member

    Jul 28, 2005
    These replies reflect why you won't find a "clinical" positiion advertised - nor should it be!

    All pharmacist positions are clinical!

    I agree with tussiones - this apparent "divide" is just that - artificial, arbitrary, fractionates the profession & does nothing to improve the direction the profession is headed.
  8. howsoonisnow

    howsoonisnow 2+ Year Member

    Nov 21, 2006
    I see both sides of the coin on this one.
    I currently work as a technician on the "clinical team" in my hospital. (You think clinical pharmacist jobs are hard to come by, try clinical tech!)
    I am starting pharm school this year and all of my coworkers are trying to convince me that residency is the way to go.
    In some respects I understand and fully intend to do a residency, but at the same time I've worked in pharmacy for 16 years. I have been attending pharmacy sponsored lectures and journal clubs religiously. I am definitely at an advantage entering pharm school. And "clinical positions" certainly have advantages. But like others have mentioned on this post, EVERY pharmacist is a clinical pharmacist.
    Unfortunately, not all pharmacists adopt that mentality. I spend literally hours of my day scrambling to find and correct mistakes made by pharmacists more concerned with numbers of orders input than with the quality of their work. And when pharmacists don't put in effort, it can be extremely dangerous as we all know.
    I see a huge rift between the clinical and staff pharmacists at my hospital. Most of that dissention is a lack of understanding.
    The clinical pharmacists go on rounds with the medical teams, attend pharmacy & therapeutics meetings, form committees to deal with antibiotic usage & hospital acquired multi drug resistant infection, run our pharmacy practice residency program, and the list goes on.
    These are not functions that ever even cross the minds of our staff pharmacists.
    And yet the staff pharmacist role is crucial, and many of the staffers I work with take great pride in their work and do an amazing job, all the while keeping the needs and safety of the patient in the forefront.

    Yes, clinical positions are harder to come by, but clinical pharmacist is a redundant title.
  9. sleazye

    sleazye 10+ Year Member

    Dec 20, 2006
    I understand that no one likes the term "clinical pharmacist" but doesn't there need to be a differentiation between the pharmacists that do rounds in teams with physicians and visit patients and the pharmacists that are in the basement mixing IVs or in the satellite pharmacies entering and filling the prescriptions ordered by the teams? Seems like the jobs are different.
  10. konkan

    konkan coup de grace 10+ Year Member

    Sep 11, 2005
    What r u talking about? There is a clear division between clinical pharmacists and staff pharmacists. Maybe it shouldn't be that way, but it is. Go to any website and you'll find ads for staff and clinical pharmacist positions separately.
  11. sdn1977

    sdn1977 Senior Member 10+ Year Member

    Jul 28, 2005
    Sorry! I've been (and am!) both - there is absoutely no difference in what is expected and if a hospital advertised that difference, I'd run fast because they've already put up an arbitrary & misguided difference which just shouldn't exist in 2007. In fact, if any of you are members of ASHP (which if you're students you should be!) - you should be aware of the process of trying to bridge this awful divide which has developed in the course of taking ourselves from a dispensing to a consultative in addition to dispensing role.

    If my job for a particular day is to be in the ICU & I call in sick - there must be someone else who does it - it goes to the staff to fill in. Likewise, the reverse holds true. The same as when I work in the OR or have to cover the mental health unit or the snf.

    Our pay is the same, our jobs are the same....but - as someone pointed out earlier - the mentality is not the same.

    I was at the very begininning of "clinical" pharmacy - I was a new grad in its infancy. I cannot NOT believe this inane argument is still going on! And - who is promoting it? The schools who have you believe you are going to be doing something tremendously different than those who graduated 5, 10 or even 30 years ago like me....AND those individuals who choose to hold a "superior" attitude toward their coworkers - which is where the destructive & divisive nature of our profession is at its worst.

    There are some absolute differences in certain areas. One is oncology. There is no one who can stay up with oncology unless you have done a residency & you'd be fooling yourself if you think you can. Likewise, neonatal & pedi are areas that are not interchangable with just any pharmacist. But, at least in N CA - no general hospital has pedi depts anymore & level III neonates are transferred to level III hospitals within hours of birth. Thus - these pharmacists work in children's hospitals & are likewise trained within that work setting to be able to shift between the NICU & the adolescent cystic fibrosis patients.

    But, for general acute surgery & medicine, the standard is we are all "clinical" - that means everyone can & should intervene in each and every order which crosses your hands, no matter your shift or setting.

    For the individual who asked about differentiating between different jobs - rounding with physicians for example. If you don't work in a teaching hospital with house staff - there are no rounds. The physicians see each of their patients on their own time & at different times of the day - surgeons in the afternoon & IM/FP in the AM or at lunch. I don't work in a teaching hospital unless I relieve a friend - so there are absolutely no rounds where I work primarily. How do I communicate with the physicians? I know when they come, they find me, or ..... I work with the hospitalist or their PA's.

    For that pharmacist in the basement (haven't seen one in a basement in forever & rarely do I see my colleagues mixing IV's....) but - that individual is supervising a tech to make sure they mix that CA & PO4 correctly in the tpn because it is at the upper limit of solubility & sometimes techs just don't "get" that they can't squirt everything in one right after the other. That pharmacist is also ready & able to mix a streptokinase in less than 3 min if the cath lab calls for one stat - so tell me - is that not clinical????

    The satellite pharmacists are entering orders in the computer & making sure they are correct - not only for drug choice, but for dosing, interactions, correlate with labs. You just see them entering orders, but the thought process is all "clinical" - otherwise, we'd just be clerks - is that what you think they are doing????

    Instead of thinking about being "clinical" - try thinking about what it takes to be a "good" pharmacist?

    That tech who posted who is going to pharmacy school - his/her experience reflects working with "good" pharmacists & ones who are just going through the motions. Each & every task you do as a pharmacist is "clinical" & we are gettin rid (slowly) of those which are not (pyxis checks for example). If only we could get rid of this notion of finding that "clinical" job which makes all other pharmacist jobs less - we'd become a better & more cohesive profession which ultimately will do a better job at patient care.
  12. sleazye

    sleazye 10+ Year Member

    Dec 20, 2006
    Thank you for the different perspective, I always like reading your posts because they are so informative. I volunteered in a hospital that was just as I described: some pharmacists got to do rounds with physicians, one in the satellite pharmacy and the rest were in "the dungeon" as they called it. The pharmacist in the satellite pharmacy said his "clinical" skills weren't good enough yet to work on a team so he was put in the satellite until he could relearn some things (his excuse was that he had done reatil too long and forgot a lot). He was not allowed to fill in for one of the pharmacists on the team if they were sick because he wasn't good enough. That's why I got the impression that there is a divide and it doesn't seem made up. It seems like that is the hospitals policy: certain pharmacists do different things. So I guess CA is where I wanna be if all the pharmacists out there are "clinical" because it's clearly not that way here in Michigan. Wondering if CA and MI are two extremes?
  13. sdn1977

    sdn1977 Senior Member 10+ Year Member

    Jul 28, 2005
    No - I don't think they're two extremes. I think NC & CA are two extremes though - just as one example.

    I have a colleague I talk to in NC & she says most hospitals won't hire a BS pharmacist at all - no matter how much experience they have.

    Now...since you're in MI - I work with a pharmacist who got her BS in Pharmacy from UM in 1978 & she's as skilled clinically as me or anyonne else I've ever worked with.

    To just shut out a whole era of pharmacists is embarrassing since some were still giving BS degrees in 1999 - but they were teaching the same things.

    The experience you relate - that pharmacist was put in the satellite because his clinical skills are not up to par reflects his own desires & motivations. At the time he worked retail, he let his acute surgical or medical skills with regard to pharmaceutical care lapse - that was a choice he made. Now that he wants to do hospital work, his choice is to relearn them or not be allowed to do them. BUT - the point is - he learned them once & let them lapse. Since you were a volunteer, I'm not sure how much you actually learned about the dept politics, but each of us has our own areas of strength. I love & do mostly critical care - but if I have to do mhu &/or snf, I'll do if, of course. No one is allowed to be a prima donna, altho some do indeed try. It is admirable this hospital in MI was willing to take on this pharmacist & mentor him so he can pursue this aspect of his career. That's a remarkable thing actually.

    In retail - in the years ahead - pharmacists will not be allowed to have their clinical skills lapse & be able to practice some of the newer retail practice models which are being discussed. So....hopefully, there will be less & less of this distinction between hospital & retail. Hospital pharmacists, in a very practical sense, have very little input into the long-term outcome of a patient. The retail pharmacist has much more influence in this, but only if we choose to retain & use those clinical skills we were taught.

    So......think about what area is of interest to you, experience all sorts of areas before you decide, hone your clinical & pharmaceutical skills well since you'll never know what you might need...then - seek out those in the field of interest to you. Talk to them, network with them, share information, go to conferences, be willing to start at the bottom & learn from everyone. Finally - NEVER denigrate anyone, no matter their degree, their experience, their choice of position or shift. They have worked as hard as you to obtain their degree. It is their choice to do with it what they want. hold yourself in "higher" esteem or to demean those who choose to get involved in P&T committees, outreach programs, or any other activity that doesn't appeal to you - only diminishes yourself & reflects poorly on our profession. All of us can do a great job - but we're not all cut out for all jobs.

    If I were in your shoes, I'd look at that hospital & be proud that this individual is being given an opportunity to change his career direction. MI is a great state for pharmaceutical care & lots of excellent work comes from there (NC too for that matter - I just don't agree with their current philosophy!).
  14. Futurejayhawk

    Futurejayhawk 2+ Year Member

    Nov 29, 2006
  15. BiOGoly

    BiOGoly 10+ Year Member

    Jun 12, 2003
    Portland Oregon
    Interesting conversations... The pharmacy director for OHSU (Oregon's university hospital) addressed our class yesterday and stated in no uncertain terms that she thought the idea of a "clinical" pharmacist (completely removed from the dispensing role) has been an ongoing mistake thirty years in the running. There are currently 5 purely clinical pharmacists (a very innovative program) at OHSU and when they vacate those positions, the positions will be terminated. Future positions she explained will be 60/40 clinical and dispensing. Her reasoning is that we are pricing ourselves out of the market clinically...why pay so much for a "clinical" pharmacist to do things that could be accomplished by less expensive members of the healthcare team? I think she made some very valid points, but I found her assessment a bit depressing...I can't help but feel that pharmacy is taking one step forward and two steps back.
  16. sdn1977

    sdn1977 Senior Member 10+ Year Member

    Jul 28, 2005
    Are you an ASHP member? If so...did you read the January issue?

    If not - why not?
  17. psychoandy

    psychoandy Junior Member 7+ Year Member

    Aug 30, 2005
    Hey! My hospital is fun and awesome! But we're using headhunters, or so rumor has it...

    Anyways, my hospital is a central pharmacy, so my idea of "clinical" and "staff" is that "staff" ONLY checks meds/IVs all day and is more of a logistical job, whereas "clinical" deals with actual pt care issues and med orders and whatnot. It's weird though, because the staff pharmacists are totally outnumbered by "clinical" pharmacists 6:1, so I can't think of why people think there are a shortage of clinical positions and a glut of staff positions. And I'd like to think that most hospitals are decentralized, so they just have RPhs rotate on who gets to sit around and check and who gets to enter/approve orders and etc.

    I think people just need to differentiate between different parts of the hospital that one would be covering, i.e. ICU pharmacist, onc team, peds, cards, etc. Or people just need to say that they have a hard-on for wanting to round and make all kinds of interventions (ha) instead of doing the normal scutwork that's part of pharmacy...and in that case, lots of "clinical" pharmacists still have to do it. Even the cushy ICU pharmacists doing a M-F day shifts all the time who don't have to work holidays occasionally have to cover in data entry and other misc scut.
  18. MuraRX

    MuraRX Member 5+ Year Member

    Jan 26, 2006
    Wow--I can't believe my question started such a debate, albeit a good one! Thank you all for all the information (especially sdn1977). I have a better idea of what a pharmacist's career/life entails and what I need to do to be happy where I end up :D
  19. onepharmer

    onepharmer 2+ Year Member

    Dec 20, 2006
    The American College of Clinical Pharmacy website has a great search function for pharmacist positions of all kinds.

    My advice to students--look at postings for positions that you want in the future and look at the desired qualifications...this will help you to understand when residency/fellowship training is required, how many years, if credentialing is a requirement, years in practice, etc. I did this as a P1 and it helped me to create a career plan throughout school with certain goals I wanted to meet along the way. I am now a resident and will be starting a 2-yr fellowship in July. I am also working part-time on an MPH and intend to sit for my CDE and BCPS within the next 5 years or so. Understanding the position I ultimately wanted really helped me to plan for these experiences.

    good luck!
  20. davidgayz

    davidgayz 5+ Year Member

    Nov 10, 2006
    Im on my last rotation, ambulatory at the VA, and although I would never think of doing it (the pay sucks), it is as close to living the dream as most pharmacists are gonna get. The pharmacist has an office, sees patients by appointment, prescribes medication, orders labs and does low key physical exams. I don't know what they have worked out in this system to be able to do this but it is definately in existance.
  21. davidgayz

    davidgayz 5+ Year Member

    Nov 10, 2006
    oh wait, is this a job availablity question? nevermind, i should have read more carefully.
  22. pharmboy30

    pharmboy30 order entry monkey 2+ Year Member

    Aug 13, 2006
    I had a couple VA rotations and loved them. I'm going to look into working there in the near future.

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