Chilling new message from a pharmacy podcast

[Argentium]

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.

I guess the argument could be made that this would be true across everything (not just pharmacy) - that you need hand holding right after graduating regardless of what profession you enter, but other industries give you a shot with some sort of entry level job.

Other more "attractive" options are discussed ad nausea on this forum, but what most people forget is that to get into those top tier XYZ jobs, most of the people who land those jobs have incredible prior work experience and can hit the ground running (multiple internships, co-ops, etc). I think this is true in pharmacy too - if you bust your ass - you will largely find a good position afterwards.

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[Hedgehog32]

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.

Ironically enough, I did work as an inpatient hospital intern during my time as a pharmacy student, but I (along with the rest of the interns) was fired during my P4 year, and the hospital system eliminated the intern position entirely. Around the same time, they also instated a strict new policy of only hiring residency-trained pharmacists for ANY positions, even PRN. It really sucks because if I had just graduated even a year earlier, I would've been eligible for at least a PRN or part time position. Ironically enough, when I was first hired as an intern by the hospital, I actually replaced a former intern who had just graduated from pharmacy school and who was being transitioned into a 7 on/7 off second shift position.

It's like the DOP told me a few weeks ago - when they take into consideration the fact that they can post a pharmacist job for any hospital facility in their network and for any shift and receive 50+ applications in a matter of hours, the relatively new policy of hiring only residency-trained pharmacists justifies itself on the basis of "the job market simply obligates us to be this selective."

Just out of curiosity, what advice would you give to a new pharmacy school graduate who has neither retail work experience nor residency training (they only have inpatient intern work experience, which "doesn't count" in the contemporary job market), doesn't qualify for hospital pharmacist positions or the vast majority of retail pharmacist positions, BUT they still want to somehow start a career as a pharmacist? Really, what options are left?

 

[Marzapan]

Ironically enough, I did work as an inpatient hospital intern during my time as a pharmacy student, but I (along with the rest of the interns) was fired during my P4 year, and the hospital system eliminated the intern position entirely. Around the same time, they also instated a strict new policy of only hiring residency-trained pharmacists for ANY positions, even PRN. It really sucks because if I had just graduated even a year earlier, I would've been eligible for at least a PRN or part time position. Ironically enough, when I was first hired as an intern by the hospital, I actually replaced a former intern who had just graduated from pharmacy school and who was being transitioned into a 7 on/7 off second shift position.

It's like the DOP told me a few weeks ago - when they take into consideration the fact that they can post a pharmacist job for any hospital facility in their network and for any shift and receive 50+ applications in a matter of hours, the relatively new policy of hiring only residency-trained pharmacists justifies itself on the basis of "the job market simply obligates us to be this selective."

Just out of curiosity, what advice would you give to a new pharmacy school graduate who has neither retail work experience nor residency training (they only have inpatient intern work experience, which "doesn't count" in the contemporary job market), doesn't qualify for hospital pharmacist positions or the vast majority of retail pharmacist positions, BUT they still want to somehow start a career as a pharmacist? Really, what options are left?

Have you tried looking for contract work?

 

[Hedgehog32]

Have you tried looking for contract work?

Some; the companies whose websites I've browsed usually specify a 1-2 year work experience requirement, although I definitely haven't researched every single contracting agency. Do you know of any companies that will hire new grads? Actually, more specifically, do you know of any contracting agencies that will consider new grads for inpatient staffing assignments? Would also be willing to consider industry-based contracting assignments as well.

 

[Marzapan]

Some; the companies whose websites I've browsed usually specify a 1-2 year work experience requirement, although I definitely haven't researched every single contracting agency. Do you know of any companies that will hire new grads? Actually, more specifically, do you know of any contracting agencies that will consider new grads for inpatient staffing assignments? Would also be willing to consider industry-based contracting assignments as well.

Never used one myself but the ones I see advertising a lot are RxRelief and RPhOnTheGo. One of my new grad friends landed a contract prior authorization position in a PBM with Rx Relief 2 years ago.. not sure if the requirements for contract roles have changed since, though from what you're telling me it seems like they do require experience now even for temp roles.

 

[quickpic007]

Ironically enough, I did work as an inpatient hospital intern during my time as a pharmacy student, but I (along with the rest of the interns) was fired during my P4 year, and the hospital system eliminated the intern position entirely. Around the same time, they also instated a strict new policy of only hiring residency-trained pharmacists for ANY positions, even PRN. It really sucks because if I had just graduated even a year earlier, I would've been eligible for at least a PRN or part time position. Ironically enough, when I was first hired as an intern by the hospital, I actually replaced a former intern who had just graduated from pharmacy school and who was being transitioned into a 7 on/7 off second shift position.

It's like the DOP told me a few weeks ago - when they take into consideration the fact that they can post a pharmacist job for any hospital facility in their network and for any shift and receive 50+ applications in a matter of hours, the relatively new policy of hiring only residency-trained pharmacists justifies itself on the basis of "the job market simply obligates us to be this selective."

Just out of curiosity, what advice would you give to a new pharmacy school graduate who has neither retail work experience nor residency training (they only have inpatient intern work experience, which "doesn't count" in the contemporary job market), doesn't qualify for hospital pharmacist positions or the vast majority of retail pharmacist positions, BUT they still want to somehow start a career as a pharmacist? Really, what options are left?

*Update on Comp Sci masters programs and programming bootcamp please!

 

[Timbo]

Slow, inefficient, but can't be corrected on anything because they "once ran a hospital dept and know what they're doing."

It's a totally different culture. One focuses on patient safety and the other focuses on how many people you can get to sign up for a rewards card

 

[Argentium]

Never used one myself but the ones I see advertising a lot are RxRelief and RPhOnTheGo. One of my new grad friends landed a contract prior authorization position in a PBM with Rx Relief 2 years ago.. not sure if the requirements for contract roles have changed since, though from what you're telling me it seems like they do require experience now even for temp roles.

We also hired a few contractors to help out in the last 6 months. The opportunities are out there at agencies, consultancies, etc. in a wide range of entry level roles (research associates, medical writers/content, scientific communications, med/drug info, etc.) -- COVID has thrown a wrench in things but even in January the market in these fields looked pretty solid, IMO.

In my area of expertise, 1-2 years is considered entry level and is fair game for a new grad that shows interest, learning agility, good soft skills, etc. Both of our hires in the last 6 months were new grads that showed some of the above traits and did great in the interview.

 

[Marzapan]

It's a totally different culture. One focuses on patient safety and the other focuses on how many people you can get to sign up for a rewards card

One also has hard evidence to prove ROI (scripts filled etc.) while the other doesn't. Figuring out how to attribute hospitalizations avoided to pharmacy interventions is an art, not a science as the patient likely has 15 other touch points with other health care providers that in all likelihood prevented that readmission compared to a 5 minute counseling session on drugs that you provided for them.

 

[deleted562805]

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.

Well in the past, hospitals would train new grads for six months and the new grads would learn by experience. So how come in the past one did not need a residency to work in the hospital. But it was expensive because new grads were getting pharmacist pay. Promoting a residency is a cheaper alternative.

 

[Marzapan]

Well in the past, hospitals would train new grads for six months and the New grads would learn by experience. But it was expensive because new grads were getting pharmacist pay. Residency is used now to make it cheaper to train new grads. New grads wouldn’t be prepared even for retail without work experience.

But a resident is to an employee as a intern is to a tech.

The resident/intern is there to learn so they have more flexibility in what they actually do on a day-to-day basis than an employee or a technician who has a very specific, defined job they are being paid to do.

Is there overlap when you staff? Sure. But a tech/employee would never get access to special projects that an intern or resident would, so I wouldn't consider the experience that a "new grad who was trained for 6 months" has to be equivalent to a "resident who completed 6 months of residency." If you were a new grad hired into a hospital staffing role then your job is to verify orders - you will never get to go on rounds, do rotations, or interact with hospital personnel outside your immediate scope of practice. It's just not the same thing.

 

[deleted562805]

But a resident is to an employee as a intern is to a tech.

The resident/intern is there to learn so they have more flexibility in what they actually do on a day-to-day basis than an employee or a technician who has a very specific, defined job they are being paid to do.

Is there overlap when you staff? Sure. But a tech/employee would never get access to special projects that an intern or resident would, so I wouldn't consider the experience that a "new grad who was trained for 6 months" has to be equivalent to a "resident who completed 6 months of residency." If you were a new grad hired into a hospital staffing role then your job is to verify orders - you will never get to go on rounds, do rotations, or interact with hospital personnel outside your immediate scope of practice. It's just not the same thing.

Wrong, I know staff pharmacists that work satellite floors where they interact with other health care workers and do rounds. No residency at all. However, that is after years of experience working in central pharmacy. Residency is just a shorter path to those experiences and a cost alternative to hospitals.

In a pandemic, when dispensing and verifying actually matter. Do you think those projects are useful? I don’t think the medical model works for pharmacy. It does not make us versatile. Pharmacy is a broad field just like nursing where there needs to be a transition of skills. Where ones needs to be versatile.

 

[Argentium]

Wrong, I know staff pharmacists that work satellite floors where they interact with other health care workers and do rounds. No residency at all. However, that is after years of experience working in central pharmacy. Residency is just a shorter path to those experiences and a cost alternative to hospitals.

In a pandemic, when dispensing and verifying actually matter. Do you think those projects are useful? I don’t think the medical model works for pharmacy. It does not make us versatile. Pharmacy is a broad field just like nursing where there needs to be a transition of skills. Where ones needs to be versatile.

What is the argument here? Versatility is important in medicine (in general) though we've obviously seen an evolution in medicine towards more narrow training/specialization -- many medical professions have some sort of transition year

Terminal Degrees - PharmD vs NP vs MD

1. MD = 4 years undergrand + 4 years medical school (2 years didactic / 2 years rotations) + Residency (3 - 6+ years) + Fellowship (1 - 3 years) = $150k (FM/Peds/etc.) - $600k+ (surgery subspecialties)
2. PharmD = 2 - 4 years undergrad + 4 years pharmacy school (3 years didactic / 1 years rotations) = ~$100 - 150k (retail/hospital)
3. NP = 4 years BSN (3 years didactic / 1 years rotations) + 2 - 4 years DPN w/ 750+ hours of required RN experience (depends on state) = ~100 -$150k (in/outpatient)

 

[Marzapan]

Wrong, I know staff pharmacists that work satellite floors where they interact with other health care workers and do rounds. No residency at all. However, that is after years of experience working in central pharmacy. Residency is just a shorter path to those experiences and a cost alternative to hospitals.

In a pandemic, when dispensing and verifying actually matter. Do you think those projects are useful? I don’t think the medical model works for pharmacy. It does not make us versatile. Pharmacy is a broad field just like nursing where there needs to be a transition of skills. Where ones needs to be versatile.

In hospitals where staff pharmacists do a little bit of everything, there likely isn't even going to be "clinical specialists" at all since everyone is cross-trained and your core services are decentralized. In larger (especially academic) medical centers, there is a clear delineation between staff and "clinical" pharmacists. The only types of roles new grads would historically be able to get are the staffing only roles, not the roles where you are a jack of all trades. I do think that if you managed to get a "jack of all trades" type hospital role as a new grad then this will set you up well for the future, but more often than not the institutions with this kind of setup do not take a lot of students/residents so it's hard to get in.

As to your point about experience - I stand by what I say. You can make all the arguments you want about how a staff pharmacist can be exposed to other healthcare workers, go on rounds etc. but my point is that even if you are allowed to do this, the resident will get a better breadth (though not depth) of experience as the staff pharmacist because the staff pharmacist is paid to do a singular function. For example if you go on med/surg rounds as a staff pharmacist you are probably considered a med/surg pharmacist and you won't be going on ICU rounds, ER rounds, ID rounds etc. that a resident will go on as they do their rotations, and you sure as heck won't be doing any research or quality improvement projects in an area outside of your focus area. Why do you think hospitals hire fresh PGY-1/2 grads over long time staff pharmacists with relevant experience but no residency? Because they can see the big picture and will understand the institution better a staff pharmacist ever will. There is no substitute for the perspective that you get by doing a residency program. If I were to go back in time myself, I still would have done a residency due to the networking I got out of it.

 

[APN-59 rph]

WHY...is ANYONE even considering getting a Pharm-D these days? Forget it...Fooooorget IT.......Jeeze.

 

[deleted562805]

In hospitals where staff pharmacists do a little bit of everything, there likely isn't even going to be "clinical specialists" at all since everyone is cross-trained and your core services are decentralized. In larger (especially academic) medical centers, there is a clear delineation between staff and "clinical" pharmacists. The only types of roles new grads would historically be able to get are the staffing only roles, not the roles where you are a jack of all trades. I do think that if you managed to get a "jack of all trades" type hospital role as a new grad then this will set you up well for the future, but more often than not the institutions with this kind of setup do not take a lot of students/residents so it's hard to get in.

As to your point about experience - I stand by what I say. You can make all the arguments you want about how a staff pharmacist can be exposed to other healthcare workers, go on rounds etc. but my point is that even if you are allowed to do this, the resident will get a better breadth (though not depth) of experience as the staff pharmacist because the staff pharmacist is paid to do a singular function. For example if you go on med/surg rounds as a staff pharmacist you are probably considered a med/surg pharmacist and you won't be going on ICU rounds, ER rounds, ID rounds etc. that a resident will go on as they do their rotations, and you sure as heck won't be doing any research or quality improvement projects in an area outside of your focus area. Why do you think hospitals hire fresh PGY-1/2 grads over long time staff pharmacists with relevant experience but no residency? Because they can see the big picture and will understand the institution better a staff pharmacist ever will. There is no substitute for the perspective that you get by doing a residency program. If I were to go back in time myself, I still would have done a residency due to the networking I got out of it.

This podcaster just told residents to go work for a bank and then come back to apply for a clinical job. Yeah, really shows how “valuable” residency is.

Unless, pharmacy residents are getting reimbursed for their services on top of their salary in hospital, a staff pharmacist with 1 or 2 years of experience with the right BCPS certification can perform equally to a fresh resident.

Residents having better breadth- not true. Most community hospitals allow staff pharmacists to do a variety of shifts. For example, one staff pharmacist might do OR for one week, ICU the next week etc. So staff pharmacists also can get a better breadth equivalent breadth. Residency path is again is cheaper path and more efficient path. That’s it. Also You think pharmacy managers and RPDs in average to mid tier hospitals have done a residency? Not many and they sure have better breadth of the hospital than a fresh new young resident.

Quality assurance projects- come on, lol. That is such a weak argument for residency over staff pharmacist with years of experience. A P4 can do those projects with the right mentorship. I mean P4s are presenting quality assurance projects during Mid year for peat sakes.
Also, Most of those projects were started by previous residents and are now completed by current residents. This begs the question, do they provide any value to the health care at large? Also, the quality of residents research projects have gone down compared to previous years. Read some of the research on ACCP. Residents are doing survey research on residency burn out and other academic bull ****. Is this what you call “quality” research? Lol.

 

[deleted562805]

What is the argument here? Versatility is important in medicine (in general) though we've obviously seen an evolution in medicine towards more narrow training/specialization -- many medical professions have some sort of transition year

Terminal Degrees - PharmD vs NP vs MD

1. MD = 4 years undergrand + 4 years medical school (2 years didactic / 2 years rotations) + Residency (3 - 6+ years) + Fellowship (1 - 3 years) = $150k (FM/Peds/etc.) - $600k+ (surgery subspecialties)
2. PharmD = 2 - 4 years undergrad + 4 years pharmacy school (3 years didactic / 1 years rotations) = ~$100 - 150k (retail/hospital)
3. NP = 4 years BSN (3 years didactic / 1 years rotations) + 2 - 4 years DPN w/ 750+ hours of required RN experience (depends on state) = ~100 -$150k (in/outpatient)

Medical residencies exist because of patient safety reasons. However, all of Internal medicine including the IM specialities are still versatile because the role of a doctor does not change, no matter what I specialize in. For example, if I am a pediatric oncologist, I can still treat cancer stricken children who have COVID. That’s what still makes medicine versatile.

NPs- Nursing is very much versatile. NPs who have prior nursing experience, can still go back and perform BSN roles. Again, nursing only has one role in a hospital, providing ancillary patient care.

Pharmacy- pharmacy has always been tied to dispensing medications and order verification. However, clinical pharmacy specialists are trying to escape from that essential role in order to round with doctors, provide recommendations etc. Many of those services, a staff pharmacist can do while maintaining the role of dispensing/order verification.

 

[Marzapan]

This podcaster just told residents to go work for a bank and then come back to apply for a clinical job. Yeah, really shows how “valuable” residency is.

Unless, pharmacy residents are getting reimbursed for their services on top of their salary in hospital, a staff pharmacist with 1 or 2 years of experience with the right BCPS certification can perform equally to a fresh resident.

Residents having better breadth- not true. Most community hospitals allow staff pharmacists to do a variety of shifts. For example, one staff pharmacist might do OR for one week, ICU the next week etc. So staff pharmacists also can get a better breadth equivalent breadth. Residency path is again is cheaper path and more efficient path. That’s it. Also You think pharmacy managers and RPDs in average to mid tier hospitals have done a residency? Not many and they sure have better breadth of the hospital than a fresh new young resident.

Quality assurance projects- come on, lol. That is such a weak argument for residency over staff pharmacist with years of experience. A P4 can do those projects with the right mentorship. I mean P4s are presenting quality assurance projects during Mid year for peat sakes.
Also, Most of those projects were started by previous residents and are now completed by current residents. This begs the question, do they provide any value to the health care at large? Also, the quality of residents research projects have gone down compared to previous years. Read some of the research on ACCP. Residents are doing survey research on residency burn out and other academic bull ****. Is this what you call “quality” research? Lol.

Why am I arguing with you? Aren't you an unemployed 2020 new grad? I think there are plenty of crappy residencies but several good ones - the fact that the explosion of residencies has led to lots of sub-par residencies like whatever you're describing to pop up is of course an issue, but if you train with an established residency program then you will definitely be years ahead of someone who just jumped into the workforce. And as to the "managers and directors don't have residency" argument - that is because all these people are grandfathered in, in an era where residencies were not even needed because there was a shortage of pharmacists. You have to dig deeper and not just analyze things at the surface level...

 

[Argentium]

Why am I arguing with you? Aren't you an unemployed 2020 new grad? I think there are plenty of crappy residencies but several good ones - the fact that the explosion of residencies has led to lots of sub-par residencies like whatever you're describing to pop up is of course an issue, but if you train with an established residency program then you will definitely be years ahead of someone who just jumped into the workforce. And as to the "managers and directors don't have residency" argument - that is because all these people are grandfathered in, in an era where residencies were not even needed because there was a shortage of pharmacists. You have to dig deeper and not just analyze things at the surface level...

delete

 

[deleted562805]

Why am I arguing with you? Aren't you an unemployed 2020 new grad? I think there are plenty of crappy residencies but several good ones - the fact that the explosion of residencies has led to lots of sub-par residencies like whatever you're describing to pop up is of course an issue, but if you train with an established residency program then you will definitely be years ahead of someone who just jumped into the workforce. And as to the "managers and directors don't have residency" argument - that is because all these people are grandfathered in, in an era where residencies were not even needed because there was a shortage of pharmacists. You have to dig deeper and not just analyze things at the surface level...

Years ahead in what exactly? If it is academic projects, then I agree with you. Look, resident trained pharmacist may have the advantage initially, but the new grad working as a staff pharmacist caring for patients on all floors will be able to catch up.

Residency is only needed due to the economics of the situation.

Do you think PGY-3 in medication safety is needed? Do you think community retail residencies are needed? After all, by your logic a community resident is lightyears ahead of a floater or staff retail pharmacists without a community residency.

Residency has become a complete scam for pharmacy, unless a resident trained pharmacist can actually bill for their service. That’s what brings value to a hospital.

 

[Argentium]

Wow, what a creep. You deflect and obfuscate and have resulted to as hominem attacks lol. GPA is just a number.

Fair enough, I deleted and I'll bite on this one.

MD's are versatile in the beginning but even with a pediatric oncologist treating some ID disease, they'll always ask for a consult. After specialization, it rarely makes sense to go in another direction -- how many multiple board certified physicians do you know? At the end of the day, if you're already in one specialization, you need to do xx hours and xx procedures, etc. to be qualified to sit the board for another specialty and be licensed -- how do you do that when you're already working your day job? Hospitals do not allow a cardiologist to "rotate" into a neurosurgery

NP's going back to RN-type gigs. Same thing as a PharmD going back to a tech -- why?

Pharmacists in clinical roles that can be done in staff/hybrid models -- sure these exist, but most top tier hospitals have dedicated clinical roles and if you look at the trends in the last 2 decades, its moving more towards clinical roles in pharmacy in general. Ask staff/DoP whether they think a residency trained pharmacist or a staff pharmacist with 1-5 years experience is more qualified, you will get a wide range of answers which speaks to the fact that it isn't clear cut at all. There's no doubt the future of hospital pharmacy is moving towards more residency-trained if you just look at the new hires.

 

[deleted562805]

Fair enough, I deleted and I'll bite on this one.

MD's are versatile in the beginning but even with a pediatric oncologist treating some ID disease, they'll always ask for a consult. After specialization, it rarely makes sense to go in another direction -- how many multiple board certified physicians do you know? At the end of the day, if you're already in one specialization, you need to do xx hours and xx procedures, etc. to be qualified to sit the board for another specialty and be licensed -- how do you do that when you're already working your day job? Hospitals do not allow a cardiologist to "rotate" into a neurosurgery

NP's going back to RN-type gigs. Same thing as a PharmD going back to a tech -- why?

Pharmacists in clinical roles that can be done in staff/hybrid models -- sure these exist, but most top tier hospitals have dedicated clinical roles and if you look at the trends in the last 2 decades, its moving more towards clinical roles in pharmacy in general. Ask staff/DoP whether they think a residency trained pharmacist or a staff pharmacist with 1-5 years experience is more qualified, you will get a wide range of answers which speaks to the fact that it isn't clear cut at all. There's no doubt the future of hospital pharmacy is moving towards more residency-trained if you just look at the new hires.

I have deleted my comment as well.

Everything what you said about MD is true. A Cardiologist taking Neurosurgery consults is dangerous. I never mentioned anything about surgery, surgery as a whole is narrow and specialized. I agree there is zero overlap between IM specialities. True, if A pediatric oncologist had a COVID problem, an ID consult would be needed. But medicine is still versatile. What I am saying is that a pediatric oncologist working with different types of patients with different pediatric cancers, prescribing and even certain cases dispensing medications is what makes medicine versatile. Also, a pediatric oncologist can prescribe homeopathy or nutrition with respect to a cancer patient. Medicine is versatile in that aspect even though there is specialization. Plus, an IM specialist can treat patients in various settings, ICU, General floor, etc., based on their scope of practice.


NPs- I was just saying that NPs can go back and perform BSN roles. There is no law preventing them from doing so. Hence, Nursing is versatile. Also, the same NP can also work in various settings in the ER, ICU, Med Surg etc. Making NPs in and of itself versatile too. NPs are versatile when they work in various settings, plus they can switch back to bed side BSN roles if need be.

Pharmacy- pharmacy profession has created two separate roles, unlike the other two professions, which is not needed not required. Staff pharmacist is tied to order and verification, but is capable of performing clinical roles equivalent to a clinical specialist. A clinical specialist is tied to rounding, recommendations, didactic work, and feather bedding activities. That is a major problem with pharmacy. Due to specialization and following the medical model, clinical pharmacist have forgotten the order/verification and dispensing role of a staff pharmacist.

Hospital pharmacy is moving towards residency trained hires due to economics and job saturation of new graduates. Not due to resident trained pharmacists being “superior” to staff pharmacists with 1-5 years experience, which was what the argument I started with @Marzapan. It is the job market reality. You would be really lucky to get a hospital job without a residency in this current market.

Pharmacy has an identity crisis much like a adolescent. This pandemic has shown the lack of versatility in the pharmacy profession as a whole and has shown that clinical pharmacists are not valuable to a hospital.

Instead of having clinical specialists and making the profession less valuable to a hospital, have some staff pharmacists perform those same clinical roles with the right BCPS certification. Then, when a pandemic happens and clinical roles are not needed, those BCPS certified staff pharmacists can go right back to order verification and dispensing in central pharmacy. That’s how pharmacists as a profession should bring value to the hospital to solve this current resident problem. Not with creating more residency programs or adding a third and/or fourth year of residency.

Overall, the medical model does not work for pharmacy and has failed in providing value to a hospital in terms of reimbursement of services, increase in pay, generating revenue for a hospital and failed in recognizing pharmacists as providers.

 

[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.

My bad. I take back my words on nursing providing revenue. General BSN are legal expenses; however, certain hospitals do allow nurses to bill for their services. So indirectly, they generate revenue. But, overall, they are legal expense.

 

[Hedgehog32]

Never used one myself but the ones I see advertising a lot are RxRelief and RPhOnTheGo. One of my new grad friends landed a contract prior authorization position in a PBM with Rx Relief 2 years ago.. not sure if the requirements for contract roles have changed since, though from what you're telling me it seems like they do require experience now even for temp roles.

I actually in touch with the owners of one of those agencies back in the winter and was told that for any hospital positions (whether pure staffing or clinical), most of the hospitals they work with are now requiring two years of hospital pharmacist work experience to qualify for placement into staff pharmacist assignments.

Believe it or not, around the same time I had actually gotten in touch with the DOP of the only hospital in one of the extremely small, desolate Alaska towns (think Barrow, Bethel, Sitka, Utqiagvik, etc.) that had an opening for a staff pharmacist posted on their website and was told that they'd actually received several applications from experienced and/or residency-trained pharmacists for the job and were therefore not considering applications from new graduates or from pharmacists who don't have retail experience. I haven't gotten back in touch with the DOP to inquire as to whether "no new grads" had become a new permanent criteria for hiring consideration.

 

[Hedgehog32]

*Update on Comp Sci masters programs and programming bootcamp please!

Application has been submitted to one MS program and am preparing to send off another one within the next week or so. Also looking into whether it might be a better idea to save a substantial amount of time and complete one of the few well-reputed bootcamps instead (would be finished by early December).

My hometown has two corporations headquartered here that hire CS professionals. One is what most would consider to be a "tech company," while the other one is an F500 company that isn't a classical tech corp but which hires for a handful of CS positions.

A family member is friends with some of the longtime CS/IT staff at the tech company and was able to put me in touch with them. They told me that for the time being (I.e., as long as market remains unsaturated), they have no issues with hiring competent bootcamp graduates and that if I was finishing a bootcamp program today I would be eligible to be considered for a software engineer job that involves working second shift, 10 hrs/shift, Mon-Thurs. The job would require me to come in and work at the corporate facility for the first 6 months, and then I'd be eligible to request a transition to work-from-home status.

I'm going to have to to make some tough decisions real soon here, as the well-reputed bootcamps require candidates to complete ~5 wks of prep coursework followed by a technical interview prior to being officially admitted into their programs. So I'll have to decide within the next couple of weeks if I'm going to begin the prep course or study for and take the NAPLEX/MPJE, as I won't be able to do both at the same time.

AFAIK and based on what I've been told, the main risk of doing a bootcamp program vs. a formal MS degree is whether employers outside of my hometown (which I hope to leave after 6-12 months of working here) will consider the combination of bootcamp prep + CS work experience to make me qualified for CS jobs offered by their companies.

 

[deleted562805]

Application has been submitted to one MS program and am preparing to send off another one within the next week or so. Also looking into whether it might be a better idea to save a substantial amount of time and complete one of the few well-reputed bootcamps instead (would be finished by early December).

My hometown has two corporations headquartered here that hire CS professionals. One is what most would consider to be a "tech company," while the other one is an F500 company that isn't a classical tech corp but which hires for a handful of CS positions.

A family member is friends with some of the longtime CS/IT staff at the tech company and was able to put me in touch with them. They told me that for the time being (I.e., as long as market remains unsaturated), they have no issues with hiring competent bootcamp graduates and that if I was finishing a bootcamp program today I would be eligible to be considered for a software engineer job that involves working second shift, 10 hrs/shift, Mon-Thurs. The job would require me to come in and work at the corporate facility for the first 6 months, and then I'd be eligible to request a transition to work-from-home status.

I'm going to have to to make some tough decisions real soon here, as the well-reputed bootcamps require candidates to complete ~5 wks of prep coursework followed by a technical interview prior to being officially admitted into their programs. So I'll have to decide within the next couple of weeks if I'm going to begin the prep course or study for and take the NAPLEX/MPJE, as I won't be able to do both at the same time.

AFAIK and based on what I've been told, the main risk of doing a bootcamp program vs. a formal MS degree is whether employers outside of my hometown (which I hope to leave after 6-12 months of working here) will consider the combination of bootcamp prep + CS work experience to make me qualified for CS jobs offered by their companies.

Is it possible to work in your home town after boot camp to get some experience and pay off those loans? Then maybe do a Masters later on if need be?

 

[Hedgehog32]

Is it possible to work in your home town after boot camp to get some experience and pay off those loans? Then maybe do a Masters later on if need be?

Yes, definitely. At least one local company has said that if I was graduating from the bootcamp program today, I'd be eligible for a second shift software engineer position. Just going to have to weigh the pros and cons of not having a formal degree, at least at first.

 

[DagS132]

Is it possible to work in your home town after boot camp to get some experience and pay off those loans? Then maybe do a Masters later on if need be?

I suggest you look for what the company is specifically looking for. Bootcamps go over 1 or 2 languages and focus hard on them. You also actually need to have experience or have extensively studied the basic concepts of CS to be accepted into one. It wouldn't be very wise of you to apply to any random company as a software engineer. You would have to go for a CS degree to cover everything an actual entry level software engineer knows.

 

[Hedgehog32]

I suggest you look for what the company is specifically looking for. Bootcamps go over 1 or 2 languages and focus hard on them. You also actually need to have experience or have extensively studied the basic concepts of CS to be accepted into one. It wouldn't be very wise of you to apply to any random company as a software engineer. You would have to go for a CS degree to cover everything an actual entry level software engineer knows.

What you said in your post is why I made sure that bootcamp training would make me eligible for hire by local companies. Also, the ones I'm looking at require applicants to take a 5-wk prep course (free) to become proficient with Javascript at the beginner level.

Doing a bootcamp isn't an ideal solution, but you have to keep in mind that my options are either complete a CS bootcamp program and have a decent shot at getting a job *somewhere*, or stick with pharmacy and qualify for practically zero "entry-level" jobs whatsoever, save for maybe a handful of jobs here and there working at one of CVS' or Walgreens' "problem stores" in some rural area.

 

[DagS132]

What you said in your post is why I made sure that bootcamp training would make me eligible for hire by local companies. Also, the ones I'm looking at require applicants to take a 5-wk prep course (free) to become proficient with Javascript at the beginner level.

Doing a bootcamp isn't an ideal solution, but you have to keep in mind that my options are either complete a CS bootcamp program and have a decent shot at getting a job *somewhere*, or stick with pharmacy and qualify for practically zero "entry-level" jobs whatsoever, save for maybe a handful of jobs here and there working at one of CVS' or Walgreens' "problem stores" in some rural area.

Yeah, you actually are doing everything right when it comes to bootcamp. There are many stories of people in your same situation and come out very happy at the end.

 

[Hedgehog32]

Yeah, you actually are doing everything right when it comes to bootcamp. There are many stories of people in your same situation and come out very happy at the end.

Do you think it's a good idea to attend one that focuses on teaching Javascript?

Also still considering an MS program instead, although I'd rather not spend an additional 2 yrs in school if I can help it.

 

[deleted562805]

Do you think it's a good idea to attend one that focuses on teaching Javascript?

Also still considering an MS program instead, although I'd rather not spend an additional 2 yrs in school if I can help it.

JavaScript, C++, and they definitely should be teaching Python

 

[Argentium]

Do you think it's a good idea to attend one that focuses on teaching Javascript?

Also still considering an MS program instead, although I'd rather not spend an additional 2 yrs in school if I can help it.

If you're able to land a job at a F500, every F500 that I have worked at or have received an offer from has offered a relatively generous tuition reimbursement policy for relevant degrees, providing you are performing well at your job. Glassdoor will tell you whether the company offers tuition reimbursement

 

[DagS132]

Do you think it's a good idea to attend one that focuses on teaching Javascript?

Also still considering an MS program instead, although I'd rather not spend an additional 2 yrs in school if I can help it.

If you for sure got word from that tech company that they would hire you if you were able to complete the bootcamp course, I would say yes go for it. If you are asking if Javascript is a good general language to know, the general answer is you should be able to learn other languages very quickly based on the concepts you learn from Javascript. The only difference between languages is the syntax and the advantages each language has over another based on what you are doing. You will still definitely need to keep learning the other parts of CS to be more well rounded for employers but there are still companies out there that hire programmers.

 

[KidPharmD]

Pharmacy- pharmacy profession has created two separate roles, unlike the other two professions, which is not needed not required. Staff pharmacist is tied to order and verification, but is capable of performing clinical roles equivalent to a clinical specialist. A clinical specialist is tied to rounding, recommendations, didactic work, and feather bedding activities. That is a major problem with pharmacy. Due to specialization and following the medical model, clinical pharmacist have forgotten the order/verification and dispensing role of a staff pharmacist.

I am going to disagree here. I have worked with many staff pharmacists who could definitely not do what a clinical specialist does. I have also worked in several places where the clinical specialists are the decentralized pharmacists verifying their own orders.

At the last hospital I worked at, we tried moving some of the staff pharmacists into more decentralized roles. Almost everyone of them threw a fit at having to do the small amount of clinical work we were asking them to do. Make sure you understand, we were not asking them to do more while staffing the pharmacy. We were asking them to come out of the pharmacy and do some decentralized verification along with a small amount of clinical work (vanc notes and such). A couple threatened to quit.

I prefer the hybrid model of clinical pharmacy, but many staff pharmacists do not want to put in the work to provide clinical services.

 

[deleted562805]

I am going to disagree here. I have worked with many staff pharmacists who could definitely not do what a clinical specialist does. I have also worked in several places where the clinical specialists are the decentralized pharmacists verifying their own orders.

At the last hospital I worked at, we tried moving some of the staff pharmacists into more decentralized roles. Almost everyone of them threw a fit at having to do the small amount of clinical work we were asking them to do. Make sure you understand, we were not asking them to do more while staffing the pharmacy. We were asking them to come out of the pharmacy and do some decentralized verification along with a small amount of clinical work (vanc notes and such). A couple threatened to quit.

I prefer the hybrid model of clinical pharmacy, but many staff pharmacists do not want to put in the work to provide clinical services.

I can agree with what you said. I guess each system is different. The place where I rotated, staff pharmacists can do both order and verification of a staff pharmacists, fix TPNs, and go over kinetics and were involved in clinical projects.They would work in the OR, ICU, CCU, ER, CVICU, Orthopedics, and Oncology. ER staff pharmacists were the most versatile in the hospital I rotated. And I will admit the clinical specialist employed by the hospital was versatile in that this person managed antibiotic therapy on all the floors- order/verification of ABXs and Vanc kinetics

However, the clinical pharmacists who are employed by the school of pharmacy but offer their services to the hospital were mainly focused on didactic work and rounding

 

[steveysmith54]

What is the argument here? Versatility is important in medicine (in general) though we've obviously seen an evolution in medicine towards more narrow training/specialization -- many medical professions have some sort of transition year

Terminal Degrees - PharmD vs NP vs MD

1. MD = 4 years undergrand + 4 years medical school (2 years didactic / 2 years rotations) + Residency (3 - 6+ years) + Fellowship (1 - 3 years) = $150k (FM/Peds/etc.) - $600k+ (surgery subspecialties)
2. PharmD = 2 - 4 years undergrad + 4 years pharmacy school (3 years didactic / 1 years rotations) = ~$100 - 150k (retail/hospital)
3. NP = 4 years BSN (3 years didactic / 1 years rotations) + 2 - 4 years DPN w/ 750+ hours of required RN experience (depends on state) = ~100 -$150k (in/outpatient)

In Los Angeles, Family Medicine/Internal Medicine docs make 200K-2500K.
Retail Pharmacist 125K.
I'd say a retail pharmacist can make 60% of a Family Medicine/Internal Medicine docs' salarry.

 

[KidPharmD]

I can agree with what you said. I guess each system is different. The place where I rotated, staff pharmacists can do both order and verification of a staff pharmacists, fix TPNs, and go over kinetics and were involved in clinical projects.They would work in the OR, ICU, CCU, ER, CVICU, Orthopedics, and Oncology. ER staff pharmacists were the most versatile in the hospital I rotated. And I will admit the clinical specialist employed by the hospital was versatile in that this person managed antibiotic therapy on all the floors- order/verification of ABXs and Vanc kinetics

However, the clinical pharmacists who are employed by the school of pharmacy but offer their services to the hospital were mainly focused on didactic work and rounding

I would say you didn't have "staff pharmacists" at that place. This is mostly the hybrid model with a couple of specialists added in. I have been at hospitals that are very effective at this. Places that still have a divided model often have pharmacists in the staffing role who don't want to, for one reason or another, practice their clinical skills. It doesn't take long for those pharmacists to loose those skills entirely.

As for university-paid specialists, you have to realize that these pharmacists are mostly professors who spend something like 0.3-0.4 FTE in a practice site in order to develop a clinical experience. They are mostly teaching and don't really count as full-time specialists.

The hybrid model really does work. It can even work in big AMC's. The problem is how to get there. Very few institutions started that way long enough ago. Most still have a divided model. You can spend years only hiring hybrid pharmacists every time either a staff or specialist quits, or you can immediately give all staff clinical responsibilities and all specialists staffing responsibilities (and then fire anyone who can't or won't do it). The former can take forever to do. I have seen the second one work but it also causes a couple of years of hell (and probably only works if you are an AMC who won't loose a bunch of specialists to somewhere else).

 

[deleted562805]

I would say you didn't have "staff pharmacists" at that place. This is mostly the hybrid model with a couple of specialists added in. I have been at hospitals that are very effective at this. Places that still have a divided model often have pharmacists in the staffing role who don't want to, for one reason or another, practice their clinical skills. It doesn't take long for those pharmacists to loose those skills entirely.

As for university-paid specialists, you have to realize that these pharmacists are mostly professors who spend something like 0.3-0.4 FTE in a practice site in order to develop a clinical experience. They are mostly teaching and don't really count as full-time specialists.

The hybrid model really does work. It can even work in big AMC's. The problem is how to get there. Very few institutions started that way long enough ago. Most still have a divided model. You can spend years only hiring hybrid pharmacists every time either a staff or specialist quits, or you can immediately give all staff clinical responsibilities and all specialists staffing responsibilities (and then fire anyone who can't or won't do it). The former can take forever to do. I have seen the second one work but it also causes a couple of years of hell (and probably only works if you are an AMC who won't loose a bunch of specialists to somewhere else).

1. I disagree. They were not really specialists because they didn’t have a residency in a particular area. They just had 5 to 30 years of hospital experience. Their first hospital pharmacy experience was working night shift staff pharmacy before working the satellite floors.

2. They are not loosing the skills of verifying medications. Even when you work the floors, you still have to verify orders specific to the floors and performing clinical tasks- Heparin protocols, TOC consults, and counseling etc and TPNs.

3. I know a ER pharmacist who can work night shift staff, ER, CCU, CVICU, OR, and MICU. No residency and started out as a staff pharmacist and just had a interest in the ER.
In the past, a pharmacist could tell the manager what area he or she had a particular area of interest without the need of residency or certification.

4. I know another pharmacist in this hospital, who started his career at CVS, then switched to LTC, and then started as night shift staff pharmacist in this hospital. Now, this pharmacist can work staff, OR, CCU, MICU, CVICU, and help the ID clinical specialist with kinetics. No residency at all.

The only specialist is the ID pharmacist and this pharmacist did a residency, a general PGY-1 residency back when residency was rare or not even needed to work in a hospital. Back in 2000- 2008.

Three other pharmacists did the general PGy-1 residency during the 2010-2014 era, when residency started to make one competitive. One pharmacist is specific to ER and only does ER, the other does staff and CCU, and the third just does night shift staff.

The rest of the 12 pharmacists are staff pharmacists who can also perform clinical roles as well. So as you can see, very few have done a residency in this hospital I am describing. And not to mention the RPD and the Pharmacy Manager are not residency trained either.
I have no doubt a staff pharmacist with years of hospital experience can also work the satellite floors and perform clinical tasks in addition to staff duties.

I think all hospital pharmacy should implement this clinical hybrid model. it would make hospital pharmacy much more versatile.

Fair enough the clinical pharmacists from the school don’t count.

Now hiring is different story. We both can agree that hospitals including this hospital now are only hiring residency trained grads due to the the surplus of new grads.

However, I still think the medical model does not work and this COVID-19 has shown that it does not work for pharmacy. And Now we see a saturation of resident trained pharmacists as well as new grads. We hear resident trained pharmacist working at a community college telling future residents to go work for a bank. How many medical residents are working for a bank or credit union?

Guess what ASHP’s solution is after this mess: creating PGY-3s to be implemented in hospitals. Do you really think your average hospital has enough money to fund for a PGY-3. I think the pharmacy residency program needs a huge change drastic change before hospital pharmacy becomes extinct.

Retail is in the process of becoming extinct. Clinical pharmacy/ staff pharmacy will soon follow.

If a clinical hybrid model existed in all hospitals, big and small, there would not be as many furloughs. The staff pharmacists with clinical skills and no residency can go right back to verifying orders.

 

[BidingMyTime]

If a clinical hybrid model existed in all hospitals, big and small, there would not be as many furloughs. The staff pharmacists with clinical skills and no residency can go right back to verifying orders.

There would still be furloughs, because no matter how you look at it, the amount of work decreased during COVID. Hospitals work with the minimum amount of pharmacists necessary.....whether those pharmacists are clinical, staff, or hybrid, once the census goes down, the workload for everyone is effected, so furloughs happen. It's not like when the amount of clinical work goes down, there will be suddenly more order entry verification needed that will compensate for the lack of clinical work.

 

[Hedgehog32]

If you're able to land a job at a F500, every F500 that I have worked at or have received an offer from has offered a relatively generous tuition reimbursement policy for relevant degrees, providing you are performing well at your job. Glassdoor will tell you whether the company offers tuition reimbursement

For me, the primary reason why I would rather not spend the 2 yrs it would take to earn an MS is because of the amount of time itself. I would really rather not put everything on hold for another 2 yrs if I can help it.

 

[Argentium]

For me, the primary reason why I would rather not spend the 2 yrs it would take to earn an MS is because of the amount of time itself. I would really rather not put everything on hold for another 2 yrs if I can help it.

you would do it part-time if you're getting tuition reimbursement, of course ..

 

[deleted562805]

There would still be furloughs, because no matter how you look at it, the amount of work decreased during COVID. Hospitals work with the minimum amount of pharmacists necessary.....whether those pharmacists are clinical, staff, or hybrid, once the census goes down, the workload for everyone is effected, so furloughs happen. It's not like when the amount of clinical work goes down, there will be suddenly more order entry verification needed that will compensate for the lack of clinical work.

So what you are saying is that there would be less work for every one system wide then. By that logic, less orders to verify. Fine, I agree with you on that.

But this pandemic did reveal that order verification/dispensing role of a pharmacist is more essential than clinical work

 

[Hedgehog32]

you would do it part-time if you're getting tuition reimbursement, of course ..

That's a good point, but the issue for me is that my reason for pursuing additional education (whether via a bootcamp or a formal masters program) is so that I can actually gain education and skills that will make me eligible for well-paying, in-demand careers. In other words, until I either go back to school/bootcamp to learn something like computer science or randomly get lucky with getting a pharmacy job, I won't qualify for anything other than dead-end retail, restaurant, and other low-wage "blue collar" jobs. My situation presents kind of a catch-22, simply because of the fact that I won't qualify for good jobs like those you're describing *until* I go back to school/bootcamp to gain a new skillset.

 

[Argentium]

That's a good point, but the issue for me is that my reason for pursuing additional education (whether via a bootcamp or a formal masters program) is so that I can actually gain education and skills that will make me eligible for well-paying, in-demand careers. In other words, until I either go back to school/bootcamp to learn something like computer science or randomly get lucky with getting a pharmacy job, I won't qualify for anything other than dead-end retail, restaurant, and other low-wage "blue collar" jobs. My situation presents kind of a catch-22, simply because of the fact that I won't qualify for good jobs like those you're describing *until* I go back to school/bootcamp to gain a new skillset.

I was getting at the following:
Bootcamp --> F500 --> Tuition Reimbursement --> MS program part time = future proof your boot camp background

 

[deleted562805]

It's a totally different culture. One focuses on patient safety and the other focuses on how many people you can get to sign up for a rewards card

Both focus on patient safety. Have you read the NYTs article about a pharmacist in Publix giving methotrexate instead of metformin.

 

[steveysmith54]

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."

Sorry to hear that this happened to you. Unfortunately, at of lot hospitals that I've worked at, this has been the standard over the last decade. A lot of them focus on residency status and Board Certifications; the actual Pharm.D. degree has lost value.

 

[quickpic007]

Application has been submitted to one MS program and am preparing to send off another one within the next week or so. Also looking into whether it might be a better idea to save a substantial amount of time and complete one of the few well-reputed bootcamps instead (would be finished by early December).

My hometown has two corporations headquartered here that hire CS professionals. One is what most would consider to be a "tech company," while the other one is an F500 company that isn't a classical tech corp but which hires for a handful of CS positions.

A family member is friends with some of the longtime CS/IT staff at the tech company and was able to put me in touch with them. They told me that for the time being (I.e., as long as market remains unsaturated), they have no issues with hiring competent bootcamp graduates and that if I was finishing a bootcamp program today I would be eligible to be considered for a software engineer job that involves working second shift, 10 hrs/shift, Mon-Thurs. The job would require me to come in and work at the corporate facility for the first 6 months, and then I'd be eligible to request a transition to work-from-home status.

I'm going to have to to make some tough decisions real soon here, as the well-reputed bootcamps require candidates to complete ~5 wks of prep coursework followed by a technical interview prior to being officially admitted into their programs. So I'll have to decide within the next couple of weeks if I'm going to begin the prep course or study for and take the NAPLEX/MPJE, as I won't be able to do both at the same time.

AFAIK and based on what I've been told, the main risk of doing a bootcamp program vs. a formal MS degree is whether employers outside of my hometown (which I hope to leave after 6-12 months of working here) will consider the combination of bootcamp prep + CS work experience to make me qualified for CS jobs offered by their companies.

An important career intersection here. I'd say just don't get soaked for tuition at either.

 

[Hedgehog32]

An important career intersection here. I'd say just don't get soaked for tuition at either.

The reality that I have most likely every ounce of the time, money, and effort I put into pharmacy school is still sinking in. Back when I was a student, I had always assumed that I'd have a hard time finding a job, but I didn't think it would literally be IMPOSSIBLE to find one. What a waste. Oh well, time to push forward and not make the same mistake twice. TGFIBRP (Thank God For IBR Plans).

 

[Hedgehog32]

Sorry to hear that this happened to you. Unfortunately, at of lot hospitals that I've worked at, this has been the standard over the last decade. A lot of them focus on residency status and Board Certifications; the actual Pharm.D. degree has lost value.

I guess it basically comes down to the fact that hospitals (and even LTC facilities) can afford to be as picky as they want, especially since there is now even an oversaturation of residency-trained pharmacists. The hospital I used to work as an intern at accepts & graduates 10-12 pharmacists per year in its residency program. At this point I think it would honestly be less stressful to just try to force myself to forget I ever went to pharmacy school in the first place and just transition into a totally new career.