Chilling new message from a pharmacy podcast

[deleted562805]

I think a new grad would be better than a resident. Residents tend to have a high and mighty attitude. They think they're better than other pharmacists who "only" have a degree. Their hospital training is irrelevant for retail. In fact I would say it's a disadvantage.

From my rotation experience, it’s not just new grad pharmacists. Pharmacy residents I have come across look down on nursing students and even medical residents. Little do they realize that those professions generate revenue for the hospital.

---

Members don't see this ad.

 

[deleted562805]

In my experience , residency trained pharmacists are like people who have a masters degree in comparative lit: arrogant, entitled and mad at the world that does not recognize their "genius".

Most residencies are, yes, low wage programs and not very educational; basically one is the b&*^*-pharmacist oncall during the night and doing the stuff no one wants to do.

Most are damaged goods; give me a smart dedicated always-learning pharmacist without a residency any day

Yup. They definitely get mad at the world when a physician ignores their guideline based recommendation. When you tell them that physicians are good at diagnosing methods or mention anything positive about physicians, they go ballistic and hysterical

 

[Marzapan]

Yup. They definitely get mad at the world when a physician ignores their guideline based recommendation. When you tell them that physicians are good at diagnosing methods or mention anything positive about physicians, they go ballistic and hysterical

They have to continue selling the lie to justify their existence in the hospitals though...

 

[deleted562805]

They have to continue selling the lie to justify their existence in the hospitals though...

True and the justification comes from the lengthy SOAP notes they write.

 

[Marzapan]

True, and they have to justify why they exist based on the lengthy SOAP notes they write.

But I can see why "clinical" pharmacy is the way it is... as a new resident if you speak out then you'll hurt your reputation and likely not get a job. So if you want a job then the best way to play it is to keep your mouth shut and play the game.

 

[sfachine]

But I can see why "clinical" pharmacy is the way it is... as a new resident if you speak out then you'll hurt your reputation and likely not get a job. So if you want a job then the best way to play it is to keep your mouth shut and play the game.

That is true for almost any job.

 

[Marzapan]

That is true for almost any job.

The difference being that "pharmacy is a small world" and the gossip and toxic hospital culture transcends a single institution - that is, if you speak out then word about you is going to spread like wildfire across other institutions.

Contrast that to most other careers (engineering, the trades, etc.) which don't have the "gossipy" culture that pharmacy has and you have a situation where "what happens at your old job stays at your old job." Can't say that about pharmacy.

 

[deleted562805]

The difference being that "pharmacy is a small world" and the gossip and toxic hospital culture transcends a single institution - that is, if you speak out then word about you is going to spread like wildfire across other institutions.

Contrast that to most other careers (engineering, the trades, etc.) which don't have the "gossipy" culture that pharmacy has and you have a situation where "what happens at your old job stays at your old job." Can't say that about pharmacy.

I mean medicine and nursing are small worlds too. I would say their is less gossip talk in those professions because of the patient workload.

 

[TheBlaah]

Well, medicine is small world too. The difference is physicians don’t have time for gossip talk. Nursing is a small world too and they gossip too. The inferiority complex is less pervasive compared to pharmacy

Physicians gossip all the time. You're just not privy to it because they usually have a their own break room (or office).

The difference is physicians and nurses are always in demand so they don't have to worry about their reputation.

 

[deleted562805]

Physicians gossip all the time. You're just not privy to it because they usually have a their own break room (or office).

The difference is physicians and nurses are always in demand so they don't have to worry about their reputation.

And they don’t have to justify why they exist.

 

[owlegrad]

I love how the more you repeat something it just starts being accepted as truth. You think nurses aren’t destaffed when census is low? That they aren’t furloughed? They are a payroll expense the same as pharmacy but since they represent a larger percent of the Hospital payroll they are probably under even closer scrutiny than pharmacy. I totally reject that nurses are a profit center for the hospital. Give me a break. Nursing and pharmacy both exist as legal necessities and are expenses for the hospital.

 

[Argentium]

I love how the more you repeat something it just starts being accepted as truth. You think nurses aren’t destaffed when census is low? That they aren’t furloughed? They are a payroll expense the same as pharmacy but since they represent a larger percent of the Hospital payroll they are probably under even closer scrutiny than pharmacy. I totally reject that nurses are a profit center for the hospital. Give me a break. Nursing and pharmacy both exist as legal necessities and are expenses for the hospital.

Lol a significant portion of what this guys says at any given time is completely false.

 

[deleted562805]

Lol a significant portion of what this guys says at any given time is completely false.

Significant portion of what I say is not false. Most of my opinions are from posters who have pharmacy work experience. Mainly ones who got banned on this site or who are non existent on this forum.

 

[deleted562805]

I love how the more you repeat something it just starts being accepted as truth. You think nurses aren’t destaffed when census is low? That they aren’t furloughed? They are a payroll expense the same as pharmacy but since they represent a larger percent of the Hospital payroll they are probably under even closer scrutiny than pharmacy. I totally reject that nurses are a profit center for the hospital. Give me a break. Nursing and pharmacy both exist as legal necessities and are expenses for the hospital.

Nurses Drive Hospital Revenue Too | AMN Healthcare

Patient satisfaction is critical to the bottom line, and so is the importance of nurse satisfaction. download the whitepaper to see the Influence of nursing on hospital revenue.

www.amnhealthcare.com

 

[owlegrad]

Nurses Drive Hospital Revenue Too | AMN Healthcare

Patient satisfaction is critical to the bottom line, and so is the importance of nurse satisfaction. download the whitepaper to see the Influence of nursing on hospital revenue.

www.amnhealthcare.com

Did you even read the article? Pharmacy can also claim to be a profit generator by reducing Med errors and other cost containment strategies.

 

[deleted562805]

Did you even read the article? Pharmacy can also claim to be a profit generator by reducing Med errors and other cost containment strategies.

I did read the article. Is reducing med errors equal to reducing surgical events?

Is reducing med errors solely attributed to just pharmacy? NPs can also reduce med errors. They do them all the time in Family medicine clinics.

I forgot to mention that even nursing can bill for their services. Another reason why nursing don’t have to justify why they exist.

https://www.nursingworld.org/~498582/globalassets/practiceandpolicy/health-policy/final_carecoordination.pdf

Keep in mind we are talking about clinical pharmacists the ones who want to round with physicians etc, not staff pharmacists with or without a residency, who order and verify medications. Staffing pharmacists are a legal necessity in a hospital. Truth is clinical pharmacists are really not needed. You can have some staff pharmacists do some of their jobs with the required certification and without a PGY-1 or PGY-2 residency

 

[DagS132]

I thought nurses gossiped all the time. I also hear that the CLS's and nurses often have conflicts

 

[steveysmith54]

Anyone else notice the amount of MD/MD students on youtube who vlogging claiming to be busy? Haven't seen a pharmacist vlog in a pharmacy yet...

 

[grumpyRph]

what are all the calls i'm making at work doing? at least half the refill reminder calls the patient accepts. and usually when anyone asks for a refill i scan their whole profile and remind them of others. you can be a car salesman as much as you want to get script count up. and vaccines. we can write for plan b's, narcan. a pharmacist has a lot of power and influence to generate script count, but a lot of posts here seem to disregard that like all we do is monitor the c2 cabinet or something.

 

[El-Rami]

You need to file a class action lawsuit against pharmacy schools for lying about their programs and what they had to offer.

 

[BidingMyTime]

I forget now what the original OP was even talking about.....but to add on to the current conversation 1) hospitals are one of the most gossipy workplaces ever 2) nurses are a huge source of that gossip (not because they are more prone to gossiping than anyone else, but because of the greater numbers of them) 3) all humans are prone to gossip--it is just some workplaces, because of their setup, are more prone to gossip than others.

 

[Marzapan]

I forget now what the original OP was even talking about.....but to add on to the current conversation 1) hospitals are one of the most gossipy workplaces ever 2) nurses are a huge source of that gossip (not because they are more prone to gossiping than anyone else, but because of the greater numbers of them) 3) all humans are prone to gossip--it is just some workplaces, because of their setup, are more prone to gossip than others.

The hospital pharmacy gossip culture is definitely a uniquely toxic thing to hospital.

If you worked in retail then you have nobody to gossip to at work besides techs (since there is minimal overlap these days), and the pharmacist-tech interaction is obviously very different from a pharmacist-pharmacist interaction.

Conversely, when you have several pharmacists staffing a hospital pharmacy at any given time and order verifying in the same workspace, what do you think happens when things are slow? You gossip. Plus, chances are your insitution will be precepting a lot of tryhard students (since everyone wants to do "clinical" instead of retail) so there's more content to gossip about.

 

[LazyPharmacist2.0]

You need to file a class action lawsuit against pharmacy schools for lying about their programs and what they had to offer.

The demise of the pharmacy profession was decades in the making. A "shortage" of pharmacists was perceived to be an issue in the early 2000s. This was used as an excuse to create all these pharmacy schools. Present day you have thousands of pharmacists scrambling for jobs and now makes it easier for companies to get rid off pharmacists.

In addition, pharmacy programs mandated the PharmD degree and changed the curriculum so that pharmacists went from a dispensing role to a "clinical" one. This was done to make our profession's skill sets similar to other medical professions; thus making our roles less significant. The main thing that made us unique compared to others was our dispensing role. Dispensing was vilified and clinical diagnosis was touted as the future for our profession.

Now you have even competition among residency trained pharmacists for jobs that don't even cater to their "residency skills." There is now a movement started by an individual that I won't name. He and others in the medical community are blaming retail chains for exploiting pharmacy staff and the undue hardships they face everyday. This movement will be used as a catalyst to get rid of retail pharmacy. Expect the death of retail very soon.

 

[steveysmith54]

The demise of the pharmacy profession was decades in the making. A "shortage" of pharmacists was perceived to be an issue in the early 2000s. This was used as an excuse to create all these pharmacy schools. Present day you have thousands of pharmacists scrambling for jobs and now makes it easier for companies to get rid off pharmacists.

In addition, pharmacy programs mandated the PharmD degree and changed the curriculum so that pharmacists went from a dispensing role to a "clinical" one. This was done to make our profession's skill sets similar to other medical professions; thus making our roles less significant. The main thing that made us unique compared to others was our dispensing role. Dispensing was vilified and clinical diagnosis was touted as the future for our profession.

Now you have even competition among residency trained pharmacists for jobs that don't even cater to their "residency skills." There is now a movement started by an individual that I won't name. He and others in the medical community are blaming retail chains for exploiting pharmacy staff and the undue hardships they face everyday. This movement will be used as a catalyst to get rid of retail pharmacy. Expect the death of retail very soon.

Good post, but can you elaborate on how the retail job death is imminent? I know many pharmacist who say their souls died, but are you're saying that their jobs will, as well?

 

[LazyPharmacist2.0]

Good post, but can you elaborate on how the retail job death is imminent? I know many pharmacist who say their souls died, but are you're saying that their jobs will, as well?

Yes, I mean the actual elimination of retail jobs. There was a NYT article that said about 86% of people with chronic illness fared well even during the lockdown. So the conclusion was that people don't need to seek healthcare as much as once thought.

So there will be a complete overhaul of the US healthcare system. Many MDs, NP, nurses and whatnot will be jobless. They were already furloughed during the pandemic so their further existence is not warranted.

Automation will also accelerate the elimination of many healthcare jobs. If Amazon can deliver your 90 day supply of meds by a drone and you can ask questions online with a healthcare professional from Calcutta, do you really need your local CVS pharmacist named Dan, ?

 

[steveysmith54]

Yes, I mean the actual elimination of retail jobs. There was a NYT article that said about 86% of people with chronic illness fared well even during the lockdown. So the conclusion was that people don't need to seek healthcare as much as once thought.

So there will be a complete overhaul of the US healthcare system. Many MDs, NP, nurses and whatnot will be jobless. They were already furloughed during the pandemic so their further existence is not warranted.

Automation will also accelerate the elimination of many healthcare jobs. If Amazon can deliver your 90 day supply of meds by a drone and you can ask questions online with a healthcare professional from Calcutta, do you really need your local CVS pharmacist named Dan, ?

I get the automation. Seems like if anything, telemedicine is picking up and increasing people's access to health care. I could be wrong.

 

[LazyPharmacist2.0]

I get the automation. Seems like if anything, telemedicine is picking up and increasing people's access to health care. I could be wrong.

Telemedicine was created to overhaul the current healthcare system. It's not meant to increase access, it is actually the opposite. More healthcare practitioners will be let go as a result.

AI technology is advanced to the point that it can even diagnose disease, let alone determine if the correct pill has been dispensed.

 

[Twentytwelve2]

Automation isnt perfect. Technology isnt perfect. Evidence: scriptpro machines break down frequently

 

[LazyPharmacist2.0]

Automation isnt perfect. Technology isnt perfect. Evidence: scriptpro machines break down frequently

At the present moment, no it isn't. That doesn't mean that it can't be close to perfection. Human beings are not, so why should techonology?

 

[deleted562805]

At the present moment, no it isn't. That doesn't mean that it can't be close to perfection. Human beings are not, so why should techonology?

Well if automation is not perfect. Then it still needs human beings to program it and assist it. It’s not going to be perfect because AI technology is created by men. Automation will more than likely reduce the number of the healthcare workers, but not really replace all of them 100%

 

[LazyPharmacist2.0]

Well if automation is not perfect. Then it still needs human beings to program it and assist it. It’s not going to be perfect because AI technology is created by men. Automation will more than likely reduce the number of the healthcare workers, but not really replace all of them 100%

That is true, it will largely replace humans but not completely

 

[KARM12]

"Chilling" indeed...

 

[Marzapan]

pharmacy programs mandated the PharmD degree and changed the curriculum so that pharmacists went from a dispensing role to a "clinical" one. This was done to make our profession's skill sets similar to other medical professions; thus making our roles less significant. The main thing that made us unique compared to others was our dispensing role. Dispensing was vilified and clinical diagnosis was touted as the future for our profession.

Imagine if pharmacy schools focused on dispensing. Then when retail dies due to automation, pharmacists would be REALLY screwed since "clinical" jobs aren't even in the vernacular. All "clinical pharmacy" is is playing make-pretend doctor and people are wising up to how it is completely unnecessary - but it has served its purpose which is to extend the timeline until extinction of pharmacists.

 

[ValeRx]

Not sure why this is 'chilling' or 'new'... considering anyone coming into this profession now is never going to get a job.

 

[steveysmith54]

Not sure why this is 'chilling' or 'new'... considering anyone coming into this profession now is never going to get a job.

Did you read the original post? I don't know where you went to school or when, but my pharmacy school professors never told our class that they might need to start their careers working for a bank or a fast food chain. This is an all time low, in my opinion. You may agree or disagree with me. that fine.

 

[Hedgehog32]

Not sure why this is 'chilling' or 'new'... considering anyone coming into this profession now is never going to get a job.

This pretty much sums up the reality that the vast majority of new pharmacy graduates have to look forward to. I'm a c/o 2020 graduate myself, and one of my former preceptors at a local facility actually reached out to me to gauge my interest in a possible position, and when I thanked them profusely for contacting me and told them I was interested (of course), they said they'd forward my details to the facility's HR dep't. to see about getting the hiring process underway. However, the preceptor told them that the HR rep responded to them immediately and told them that they were only considering applications from either residency-trained pharmacists or those with at least 1-2 years of experience (this is not a clinical position).

The job market has become so saturated that even the old fall-back of "as long as you did what you should have done to impress preceptors as a student during rotations, you'll still get a job offer, because there will always be a shortage of quality candidates!"

... Yeah, no. The saturation has granted HR dep'ts. with the authority to be so selective that either having residency training or extensive work experience is now a bare-minimum technical criteria on the level of "must be a US citizen," "must hold a pharmacy license in the state the pharmacist will be practicing in," "must be able to pass a background check, etc."

 

[mentos]

Good post, but can you elaborate on how the retail job death is imminent? I know many pharmacist who say their souls died, but are you're saying that their jobs will, as well?

It's pretty simple. CVS just cut hours across the nation. They will keep cutting until there is zero overlap. Profits are razor thin. Stores will continue to close and more jobs will be lost.

 

[Sine Cura]

as long as you did what you should have done to impress preceptors as a student during rotations, you'll still get a job offer, because there will always be a shortage of quality candidates!"

I know you already mentioned this, but shortage of quality candidates with work experience. No one really wants to roll the dice with new grads esp these days

Also Walmart keeping pharmacy hours 9-7 weekdays is a prelude to laying off more pharmacists and techs (if there is slack to cut, which there is for techs at least)

 

[deleted562805]

This pretty much sums up the reality that the vast majority of new pharmacy graduates have to look forward to. I'm a c/o 2020 graduate myself, and one of my former preceptors at a local facility actually reached out to me to gauge my interest in a possible position, and when I thanked them profusely for contacting me and told them I was interested (of course), they said they'd forward my details to the facility's HR dep't. to see about getting the hiring process underway. However, the preceptor told them that the HR rep responded to them immediately and told them that they were only considering applications from either residency-trained pharmacists or those with at least 1-2 years of experience (this is not a clinical position).

The job market has become so saturated that even the old fall-back of "as long as you did what you should have done to impress preceptors as a student during rotations, you'll still get a job offer, because there will always be a shortage of quality candidates!"

... Yeah, no. The saturation has granted HR dep'ts. with the authority to be so selective that either having residency training or extensive work experience is now a bare-minimum technical criteria on the level of "must be a US citizen," "must hold a pharmacy license in the state the pharmacist will be practicing in," "must be able to pass a background check, etc."

Not just new grads. The podcasts even mentioned PGY-1/2 residents need to look for a non pharmacy job. That is a new low to this profession. When I was in school, I was taught that residency with some networking guaranteed you a job in a hospital.

 

[deleted562805]

Yes, I mean the actual elimination of retail jobs. There was a NYT article that said about 86% of people with chronic illness fared well even during the lockdown. So the conclusion was that people don't need to seek healthcare as much as once thought.

So there will be a complete overhaul of the US healthcare system. Many MDs, NP, nurses and whatnot will be jobless. They were already furloughed during the pandemic so their further existence is not warranted.

Automation will also accelerate the elimination of many healthcare jobs. If Amazon can deliver your 90 day supply of meds by a drone and you can ask questions online with a healthcare professional from Calcutta, do you really need your local CVS pharmacist named Dan, ?

Not just Amazon. CVS and Walgreens are also experimenting with driverless vehicles and drone delivery

 

[ValeRx]

Did you read the original post? I don't where you went to school or when, but my pharmacy school professors never told our class that they might need to start their careers working for a bank or a fast food chain. This is an all time low, in my opinion. You may agree or disagree with me. that fine.

I did, and my comment refers to the absurdity of the profession at this point that someone would start off their career at a bank or a fast food manager just to get some experience. Hence my comment... no jobs... and the whole 'chilling' or 'new'... is neither chilling nor new. It's been like this for the last couple years and only getting worse.

 

[DagS132]

lmao, i wonder how long until pharmacy forums get taken down on SDN and show up on CS forums on how to further improve the automation tech

 

[Hedgehog32]

I know you already mentioned this, but shortage of quality candidates with work experience. No one really wants to roll the dice with new grads esp these days

Also Walmart keeping pharmacy hours 9-7 weekdays is a prelude to laying off more pharmacists and techs (if there is slack to cut, which there is for techs at least)

Your point is correct, but what's unusual (IMO at least) about my situation is the fact that the DOP of the hospital wanted to hire me, and they were actually overridden by corporate HR on the basis of the fact that hiring me would be failing to take advantage of job market dynamics that put them in the position of being able to insist on hiring only experienced and/or residency-trained pharmacists.

Usually, I've heard that when an employee as high up as the DOP wants to hire someone, they basically just tell HR to process the hiring/onboarding and that's it. So that's why my specific scenario seems unusual, because it demonstrates that the pharmacist job market is so saturated that even the highest-ranking employees in a hospital's pharmacy department no longer have the authority or autonomy to hire their own chosen candidates. Like someone else who works in the pharmacy at the same hospital told me, it's gotten to the point where they can basically compare pharmacist job applicants side by side as if they were "pieces of paper."

 

[Marzapan]

Your point is correct, but what's unusual (IMO at least) about my situation is the fact that the DOP of the hospital wanted to hire me, and they were actually overridden by corporate HR on the basis of the fact that hiring me would be failing to take advantage of job market dynamics that put them in the position of being able to insist on hiring only experienced and/or residency-trained pharmacists.

Usually, I've heard that when an employee as high up as the DOP wants to hire someone, they basically just tell HR to process the hiring/onboarding and that's it. So that's why my specific scenario seems unusual, because it demonstrates that the pharmacist job market is so saturated that even the highest-ranking employees in a hospital's pharmacy department no longer have the authority or autonomy to hire their own chosen candidates. Like someone else who works in the pharmacy at the same hospital told me, it's gotten to the point where they can basically compare pharmacist job applicants side by side as if they were "pieces of paper."

I don't think it's the saturation that's causing the DOP to "lose power," I think it's the fact that the DOP never had power to begin with (compared to medical directors or nursing directors, anyways, since hospital pharmacy budgets come out of the medical side).

 

[Marzapan]

Not just new grads. The podcasts even mentioned PGY-1/2 residents need to look for a non pharmacy job. That is a new low to this profession. When I was in school, I was taught that residency with some networking guaranteed you a job in a hospital.

Just curious, what do you do now?

 

[Hedgehog32]

I don't think it's the saturation that's causing the DOP to "lose power," I think it's the fact that the DOP never had power to begin with (compared to medical directors or nursing directors, anyways, since hospital pharmacy budgets come out of the medical side).

So do you think it's basically the case - since you mentioned budget - that HR simply wants to get "the most bang for their buck," so to speak, and take advantage of the fact that for the same amount of money (I.e., salary), they can get a desperate PGY-1/PGY-2 grad who would be happy to get the same basic staffing position the DOP wanted to offer me? In other words, are they looking at it from the perspective that the $90k (or whatever the starting salary is) would be better spent on a residency-trained/experienced pharmacist, since they can obviously afford to be picky enough to get one?

 

[Marzapan]

So do you think it's basically the case - since you mentioned budget - that HR simply wants to get "the most bang for their buck," so to speak, and take advantage of the fact that for the same amount of money (I.e., salary), they can get a desperate PGY-1/PGY-2 grad who would be happy to get the same basic staffing position the DOP wanted to offer me? In other words, are they looking at it from the perspective that the $90k (or whatever the starting salary is) would be better spent on a residency-trained/experienced pharmacist, since they can obviously afford to be picky enough to get one?

I think so. In any profession, if you're objective about hiring then you will always take the most qualified candidate for a job if you could pay them the same as the least qualified candidate who applied, so nepotistic or cronyistic pharmacy hires are going to happen much less in the future (unless the person in question happened to be the most qualified candidate). Since pharmacy does not generate revenue, they do not have their own budget (i.e. medical gives them the budget), and because funding is coming from elsewhere they will need to play by their funders' rules rather than making up their own rules.

 

[Hedgehog32]

I think so. In any profession, if you're objective about hiring then you will always take the most qualified candidate for a job if you could pay them the same as the least qualified candidate who applied, so nepotistic or cronyistic pharmacy hires are going to happen much less in the future (unless the person in question happened to be the most qualified candidate). Since pharmacy does not generate revenue, they do not have their own budget (i.e. medical gives them the budget), and because funding is coming from elsewhere they will need to play by their funders' rules rather than making up their own rules.

This makes sense. Of course, it also hearkens back to the critical issue new pharmacy grads are faced with: how to actually get a job in the first place as an inexperienced pharmacist who has never worked as a pharmacist before when there aren't even enough jobs to accommodate all the experienced and/or residency-trained pharmacists who are looking for jobs. Even retail chains are now mandating that applicants have either paid intern work experience or (preferably) chain retail pharmacist work experience, even for retail pharmacist jobs posted in small towns throughout the southeast. For many of us, it's more feasible to just say "the he** with it" and simply transition into another career altogether.

 

[Argentium]

This makes sense. Of course, it also hearkens back to the critical issue new pharmacy grads are faced with: how to actually get a job in the first place as an inexperienced pharmacist who has never worked as a pharmacist before when there aren't even enough jobs to accommodate all the experienced and/or residency-trained pharmacists who are looking for jobs. Even retail chains are now mandating that applicants have either paid intern work experience or (preferably) chain retail pharmacist work experience, even for retail pharmacist jobs posted in small towns throughout the southeast. For many of us, it's more feasible to just say "the he** with it" and simply transition into another career altogether.

I've said this before but the reality is that this has been true in the northeast for a while - if you didn't have at least paid intern experience, even when I graduated 5-10 years ago, you were going to be in a pretty tough spot because 80%+ did have work experience and you would be the bottom tier without it.

 

[Marzapan]

I've said this before but the reality is that this has been true in the northeast for a while - if you didn't have at least paid intern experience, even when I graduated a 5-10 years ago, you were going to be in a pretty tough spot because 80%+ did have work experience and you would be the bottom tier without it.

Which is why I never understood the animosity towards doing a residency/fellowship since it is the perfect bridge between expectations (what you learn in academia) and reality (what pharmacy is like in the real world). How many P4's can truly say that they feel comfortable practicing with no hand-holding immediately after graduation? Very few, and those who didn't have work experience during school would definitely not be prepared no matter what they think.