Clinical Pharmacist

[airtim00]

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Hi, I am going to major in pre pharm, and go on to become a Pharmacist.
I was just wondering what the different type of clinical pharmacists are and what they do...
Basically is anyone here a clinical pharmacist?
Can you guys share with me how you became a clinical pharmacist?

 

[Jeddevil]

Clinical pharmacists usually are expected to do residencies, then they get the cool opportunity to do renal dosing, IV to PO switches, and listen to irritating nurses ask stupid questions all day. I forgot another thing they do. They get to write up papers all the time for P&T committee, kind of like they are in an english class but get paid for it.

At least that is all I have seen clinical pharmacists do in the 4 different hospitals I have been on rotations at. It has to be better out there somewhere.

 

[gaba101]

Clinical pharmacists usually are expected to do residencies, then they get the cool opportunity to do renal dosing, IV to PO switches, and listen to irritating nurses ask stupid questions all day. I forgot another thing they do. They get to write up papers all the time for P&T committee, kind of like they are in an english class but get paid for it.

At least that is all I have seen clinical pharmacists do in the 4 different hospitals I have been on rotations at. It has to be better out there somewhere.

"Where's my bancomyciiiiin? i ordered iit a looong time agooo" (trying to imitate their accent and tone)

"How long ago?"

"i sent da orda down 5 miiiinutes agooo"

🙄

 

[Priapism321]

"Where's my bancomyciiiiin? i ordered iit a looong time agooo" (trying to imitate their accent and tone)

"How long ago?"

"i sent da orda down 5 miiiinutes agooo"

🙄

I don't know where this thread is coming from, or better yet, where it is going, but at the institution I work at, it would be the Pharmacists without a residency taking that call from the nursing staff. On the other hand, the Pharmacists who have completed a residency would be on rounds with the medical team dosing most antimicrobials, and instructing the nurse on why you cannot obtain vancomycin levels with the other morning labs at 0430.

Without a residency, you get the "cool" opportunity to listen to people bitch at you through a drive through microphone about why they can't buy their twelve pack of Keystone Light and carton of Marlboro smokes along with their carvedilol and why you can't go and grab these items for them. Oh, and you become very proficient in operating a cash register and ringing up coupons.

I'm being somewhat hyperbolic here, but the above two posts haven't been quite fair in my opinion.

 

[tussionex]

i did not complete a residency; however, i work in a hospital and i do ALL of the above mentioned tasks...i adjust dosages, talk to MD's and nurses, answer annoying phone calls, manage technicians, convert from IV to PO, make recommendations to P&T, and spend significant amounts of time maintaing the pharmacy computer system...
the only thing i don't do that "clinical" pharmacists do is go on rounds, but i work the evening shift, so rounds are over by the time i get there🙂

my point, yes, residency is nice....however, my best friend did a 1 year clinical residency, hated every minute of it, and now works in retail. you may need one for big, academic hospitals, but personally, it would have been a waste of my time and money. it's your chops, not your sheepskins that make a you good pharmacist.

 

[sdn1977]

There have been endless threads about "clinical" pharmacy on this forum - all due to this crazy misconception which was perpetuated from peoply who graduated in my era - the 1970's....

Unfortunately, folks don't see that "clinical" evolved into "pharmaceutical care" which is evolving yet again.....

Tussionex has it more right than any others - everyone who graduates these days is expected to address any clinical issues which come up. I could go on and on, but, sadly, I have to go to work🙄 .

What you kinds of issues you deal with is more dependent on the shift & location of your work that particular day than if you did a residency or not.

However, given that....there are some positions in which a residency is essential:

One of the oncology pharmacist specialist positions in a cancer center.

Pharmacist in a tertiary care children's hospital.

Nuclear pharmacy.

I may think of others...but those are some right off the top of my head which a regular inpt pharmacist cannot keep up with. However, it will be expected ANY pharmacist can adjust an aminoglycoside dose as easily as answer the question of when the lisinopril was sent or when the next time the tech is due to come fill pyxis.....We do the good with the bad - it comes with the territory!

pm me if you want more specifics......

 

[Priapism321]

However, given that....there are some positions in which a residency is essential:

One of the oncology pharmacist specialist positions in a cancer center.

Pharmacist in a tertiary care children's hospital.

Nuclear pharmacy.

I may think of others...but those are some right off the top of my head which a regular inpt pharmacist cannot keep up with. However, it will be expected ANY pharmacist can adjust an aminoglycoside dose as easily as answer the question of when the lisinopril was sent or when the next time the tech is due to come fill pyxis.....We do the good with the bad - it comes with the territory!

To name a few others, at least particular to my institution: Surgical Intensive Care, Medical Intensive Care, Cardiac Intensive Care, Neonatal Intensvie Care, General Pediatrics, Infectious Diseases, Solid Organ Transplant, Hyperalimentation, and Bone Marrow Transplant. These disciplines all have at least one Clinical, errrrrrrr........Hospital Pharmacist that only works in these areas, and quite often more than one. While all of these individuals do not hold Pharm.D. degrees, they are all residency trained, and this was most likely deemed essential to them being hired.

 

[airtim00]

Thx for feedback guys. I think I am beginning to understand, but
What about areas like Critical Care, and Ambulatory care?

What is usually the role of PharmD's who have clinical experience in these areas?

Also, what are rounds? Like visiting different patients and stuff?
Because I think i would be less interested in the retail side of pharmacy, and more attracted to the clinical side.

If so, should I apply for a residency after I graduate pharm schl?

 

[airtim00]

Also, do pharmacists with residencies get paid more or less than hospital pharmacists w/o residency ?

 

[Priapism321]

Thx for feedback guys. I think I am beginning to understand, but
What about areas like Critical Care, and Ambulatory care?

What is usually the role of PharmD's who have clinical experience in these areas?

Also, what are rounds? Like visiting different patients and stuff?
Because I think i would be less interested in the retail side of pharmacy, and more attracted to the clinical side.

If so, should I apply for a residency after I graduate pharm schl?

The roles of pharmacists in these areas are actually very dynamic. If you read my above post, there are pharmacists that specialize in several areas of Critical Care, and it is also highly dependent on the type of institution, whether it be a community hospital or an academic medical center. Ambulatory Care also encompasses a very broad variety of opportunities for the pharmacist, whether it be anticoagulation management, diabetes management, heart failure management, etc. Speaking of what a pharmacist can do for a heart failure population, if anyone is interested, an article was published just today in the Annals of Internal Medicine under the "Improving Patient Care" heading. Pharmacists from a lot of different areas participated in this study, perhaps most importantly the dispensing pharmacist who actually was the "interventionalist."

Rounds can mean several different things as well. At my institution, rounds in the surgical intensive care unit usually consists of up to ten people: an attending physician, a clinical, errrrrrr.....hospital pharmacist, 3+ medical residents, a physician assistant student, and a pharmacy student. This makeup can also vary. But yeah, you walk around, discuss the patient's progress, figure out the goals of the day, and make them happen. For Oncology, they consist of an attending oncologist, a fellow, and the oncology pharmacist. They sat around a table and discussed patients rather than walking bed to bed. Similarly, they would establish goals for the day, then go to them.

Pay also is something that varies. Clinical, errrrrr.....Hospital Pharmacists with residency training that specialize are generally salaried employees, whereas the Staff, errrrr....Hospital Pharmacists without specialized training are paid on an hourly basis. I can only speak for the type of hospital I work in, which is an academic medical center associated with a very large university. I think Staff Pharmacists end up making more when it is all said and done. There is a lot more that goes into this, but given where you are at, this should offer some sort of foundation.

 

[sdn1977]

The roles of pharmacists in these areas are actually very dynamic. If you read my above post, there are pharmacists that specialize in several areas of Critical Care, and it is also highly dependent on the type of institution, whether it be a community hospital or an academic medical center. Ambulatory Care also encompasses a very broad variety of opportunities for the pharmacist, whether it be anticoagulation management, diabetes management, heart failure management, etc. Speaking of what a pharmacist can do for a heart failure population, if anyone is interested, an article was published just today in the Annals of Internal Medicine under the "Improving Patient Care" heading. Pharmacists from a lot of different areas participated in this study, perhaps most importantly the dispensing pharmacist who actually was the "interventionalist."

Rounds can mean several different things as well. At my institution, rounds in the surgical intensive care unit usually consists of up to ten people: an attending physician, a clinical, errrrrrr.....hospital pharmacist, 3+ medical residents, a physician assistant student, and a pharmacy student. This makeup can also vary. But yeah, you walk around, discuss the patient's progress, figure out the goals of the day, and make them happen. For Oncology, they consist of an attending oncologist, a fellow, and the oncology pharmacist. They sat around a table and discussed patients rather than walking bed to bed. Similarly, they would establish goals for the day, then go to them.

Pay also is something that varies. Clinical, errrrrr.....Hospital Pharmacists with residency training that specialize are generally salaried employees, whereas the Staff, errrrr....Hospital Pharmacists without specialized training are paid on an hourly basis. I can only speak for the type of hospital I work in, which is an academic medical center associated with a very large university. I think Staff Pharmacists end up making more when it is all said and done. There is a lot more that goes into this, but given where you are at, this should offer some sort of foundation.

I'd have to agree with Priaprism that this gives a fairly good & consistent description with an academic environment in which the "clinical" (gosh I hate that term...) is separate from "staff". This does not exist in my environment - N CA...altho most of my work is in a community, moderate scale bed capacity hospital, I do work for friends in the local (well-known) medical university setting.

In my area, all the pharmacists are paid hourly - none, other than administrative (dop, asst dop) are salaried - primarily due to the labor laws of CA.

In my setting, I'm an intensive care/OR pharmacist...who has to occasionally take my turn in mhu & snf when needed. We do have an oncologist pharmacist, but among the whole staff, only two are residents & they are recent graduates - trained in the last 10 years.

After a certain number of years, residency is not as significant as experience. However, I will adamantly state, a general pharamcist cannot adequately shift between peds/NICU or oncology & adult medicine & be safe.

Since my institution is non-academic, there are no "rounds" as all you folks know them. The private practice physicians come when they have time - surgeons very early & very late.....IMs come at lunch, hospitalists are there all day & into the night. All our pharmacists (including those who work at the academic university setting) are required to dose antibiotics, start anticoagulation, start tpn - altho...that is totally unnecessary at night & provide input on pain management & blood pressure control options.

However, this is very location dependent. I have a colleague I speak with in NC who tells me hospitals won't even hire non-PharmD's, let alone residency trained PharmD's. In my view, this is short sighted. Fortunately, that is not the case in CA. Our jobs tend to be more globally responsibile for all the aspects which a generally trained resident should know.

However....the real question, I think here, is - should you do a residency or not????

My answer is - get the best education you can at the time you get it. If you want to pursue a specialty.....network with those in your area who are in that specialty. If I had to advise anyone....yes, consider a residency. I'm not sure a general residency is the best option, particularly if the site is not going to offer you something you don't already have.

No - I don't think you'll necessarily get paid more. However, many studies & many years in the business...at some point, your pay is not the primary reason why you go to work. I know thats hard to believe, but at a certain level of income....the reason you go is to keep your interest & desire to contribute.

For myself - I'm not a residency trained PharmD (for many reasons), but I've been a Pharm D for 30 years. The degree itself opened many doors - my experience opened the rest......

Good luck - keep an open mind, take advantage of every opportunity & think, think, think independently & with leadership!

 

[ZpackSux]

man...you can really type...

 

[sdn1977]

man...you can really type...

I've told you more than once you missed a good hire when you didn't hire me😉 !

What kind of a pharmacist can't type????? I'm of the school who rolled the label in the platen then rolled it down to type it - do you even remember that???

Say - hows OC? Its cold up here!!!!

 

[ucsd2011]

are there pharmacists that have worked in a hospital setting for a long time (say over 20 years)? does the job ever get tedious? I've read stories about how bad it can be...any inputs? Thanks!

 

[airtim00]

I'm an intensive care/OR pharmacist...who has to occasionally take my turn in mhu & snf when needed.

You say you are not a residency trained PharmD, but have been working for 30 years so I'm guessing that experience alone can lead to specialization? How much experience?
BTW, I'm interested, what exactly does an Intensive Care/OR pharmacist do?
I mean I'm pretty much a noobie, so I won't understand a lot of pharm terminology, but generally speaking do you interact w/ patients, doctors, etc/// how would you describe it?

Clinical, errrrrr.....Hospital Pharmacists

Hehe, I'm guessing that the term "clinical" is just ridiculous?

No - I don't think you'll necessarily get paid more. However, many studies & many years in the business...at some point, your pay is not the primary reason why you go to work. I know thats hard to believe, but at a certain level of income....the reason you go is to keep your interest & desire to contribute.

That's definitely my position on this issue. The reason I'm so curious about the clinical/residency side of pharmacy, is because that is where my interest and desire to contribute lies. I don't have anything against retail or staff pharmacists, I just feel more interest in interacting more with other ppl... and having more direct impact on patient care...
But than again, i just thought/assumed that the specialization obtained from completing residency might result in a higher paycheck?? hehe...
Anyways since avg. earnings of a retail pharm is around 80,000 - 90,000 (correct me if im wrong...) I would be pretty happy with 75,000 + ?

Once again, Im a noobie so i'm sure I have a lot more to learn...
Im a HS senior, and I'll be starting a 3 + 3 accelerated pharm program, with 3 yr undergrad, and 3yr pharm schl.. and so I just wanted to keep my options open.. and so right now i guess im planning to do a PGY1 and PGY2 ?
Are these residencies really competitive?
Any tips guys??

THnx for all the feed back!

 

[ZpackSux]

I've told you more than once you missed a good hire when you didn't hire me😉 !

What kind of a pharmacist can't type????? I'm of the school who rolled the label in the platen then rolled it down to type it - do you even remember that???

Say - hows OC? Its cold up here!!!!

ehhh...type on the label?? way before my time!!!

OC is aight... I don't know why people think it's so great here...

But working in OC with my SC buddies is awesome ! 👍

 

[sdn1977]

are there pharmacists that have worked in a hospital setting for a long time (say over 20 years)? does the job ever get tedious? I've read stories about how bad it can be...any inputs? Thanks!

Yes - I've worked in the same hosital for for 20 years, now part-time. Worked 3 in a group of 2 different hospitals (long ago) & occassionally will fill in for friends when they need coverage (in the referenced teaching hospital).

Yes - it can be tedious.

All jobs can be tedious - talk to my dr sdn - he has tedious days. I was friends with a group of CV surgeons who found their work tedious. Everything makes its way that way if you do it long enough - you get good at what you do.

Actually, it is the uniqueness of the pts who make each day different from the next.

Are you wondering how you'll stay interested for a lifetime???

 

[sdn1977]

You say you are not a residency trained PharmD, but have been working for 30 years so I'm guessing that experience alone can lead to specialization? How much experience?
BTW, I'm interested, what exactly does an Intensive Care/OR pharmacist do?
I mean I'm pretty much a noobie, so I won't understand a lot of pharm terminology, but generally speaking do you interact w/ patients, doctors, etc/// how would you describe it?


Hehe, I'm guessing that the term "clinical" is just ridiculous?



That's definitely my position on this issue. The reason I'm so curious about the clinical/residency side of pharmacy, is because that is where my interest and desire to contribute lies. I don't have anything against retail or staff pharmacists, I just feel more interest in interacting more with other ppl... and having more direct impact on patient care...
But than again, i just thought/assumed that the specialization obtained from completing residency might result in a higher paycheck?? hehe...
Anyways since avg. earnings of a retail pharm is around 80,000 - 90,000 (correct me if im wrong...) I would be pretty happy with 75,000 + ?

Once again, Im a noobie so i'm sure I have a lot more to learn...
Im a HS senior, and I'll be starting a 3 + 3 accelerated pharm program, with 3 yr undergrad, and 3yr pharm schl.. and so I just wanted to keep my options open.. and so right now i guess im planning to do a PGY1 and PGY2 ?
Are these residencies really competitive?
Any tips guys??

THnx for all the feed back!

Too much info for me to answer right now - I have to go to work.....

The tedious use of the word "clinical" is from a long time back - the 1960's & 70's when those of us in pharmacy were trying to turn the practice of pharmacy around from dispensing to a more interactive approach between medicine, nursing and the patient. The use of "clinical" was coined & this experiement actually began on the 7th floof of the UCSF Moffitt Hospital which had one of the first decentralized pharmacies in the country. The pharmacist there was devoted just to proper use of medications, drug information, made rounds with the medicine "teams" which included nursing & pharmacy students as well as medical students, residents & attendings.

This pharmacist had no dispensing function, which was sometimes odd becasue he/she would generate a drug order which was completely inapropriate.....So...over time (decades actually) the concept of "clinical" pharmacy incorporated the idea that we not just dispense what is sent to us - either as an rx or a hospital order. We are part of this whole complicated & difficult mess called healthcare.

In the OR that may mean trying to sort out a drug reaction fast, in the ER, getting tpa made quickly so it can get started just as soon as the pt is out of imaging, in the ICU, it may mean suggesting pain/sedatin regimens which are easy for nursing, but still allow physicians to follow mentation.

In the outp setting, it means providing the means & way of many of these elderly to get their medication & understand what they take & why.....and to keep taking it - a sometimes difficult task. For others, it requires monitoring of their antipsychotic & intervening rapidly with the physician to keep that person out of the ER.

See - "clinical" is used here as a term interchangeable with "hospital", when its not. It is a descriptive term of pharmacists. Somewhat the opposite of the "lick & stick" variety of pharmacist.

"Clinical" morphed into "pharmaceutical care" which was a term which fell flat on its face about 5 years ago.

The reality is....the practic of pharmacy goes on in many locations - all of them clinical. They are just differrent. Take Zpak - he's now a consultant - a suit with a laptop & a rental car & a key to a hotel room.....about as far from clinical as one might guess - right? I mean, he doesn't review charts, dispenses no medications, is not on any hospital committees......But....his job, in reality (I think), is about as clinical as they come. He is right there with dops who either can't or don't know how to implement difficult or costs saving policies which can change therapy for that one hospital or region.

So....clinical is ad adjective - not a noun....and it is what we've all become, no matter the practice setting. Unfortunately, some areas & specific sites choose to make it restrictive (my NC example of hospitals who won't hire anyone who doesn't have a PharmD - ridiculous!).

OK - rant over......I've got to go to work (yes, clinical!).

pm me if you want more info.

 

[ucsd2011]

I really don't know if pharmacy is the thing for me. I really enjoy learning about what medicine can do but I really dislike science it may be because of boring teachers or just my interests. I became interested in the pharmacy career especially in the hospital setting because I enjoy the patient interactions and talking with other doctors.

 

[Dustbunny]

I really don't know if pharmacy is the thing for me. I really enjoy learning about what medicine can do but I really dislike science it may be because of boring teachers or just my interests. I became interested in the pharmacy career especially in the hospital setting because I enjoy the patient interactions and talking with other doctors.

Then major in something you enjoy, do your pre-med pre-reqs, and go to medical school. Yeah, there's a lot of science, but it's a lot more "hands-on" than pharmacy school. Gross anatomy lab, small group discussions, etc. Then the last two years of med school is all rotations in the various specialties to get a feel for what you might be interested in.

PS- You can't talk with "other doctors" if you're not a doctor. 😉

 

[sdn1977]

I really don't know if pharmacy is the thing for me. I really enjoy learning about what medicine can do but I really dislike science it may be because of boring teachers or just my interests. I became interested in the pharmacy career especially in the hospital setting because I enjoy the patient interactions and talking with other doctors.

So....are you an undergrad at UCSD? If so, there are pre-pharm & pre-med clubs....join one of them. They also give you great things to put on your application when the time comes (my daughter graduated from UCSD).

Have you really taken science classes at UCSD???? My daughter was a Molecular Biochem major.....from what she told me - the classes were fascinating. You have some of the brightest & best professors (even TA's who are graduate students) there.

It may be a problem of this just not being "your thing" - which is not a bad thing. You just need to find what "your thing" is.

If you want patient interaction....it doesn't happen so much at the inpatient setting, except in very rare circumstances (specialties). Why? Because insurance requires such short stays for inpt. There are many other places for pharmacists with lots of pt interaction that don't involve the routine "lick & stick" mills....but you have to be very qualified & mostly, you have to know - this is what you want - not medicine.

My advice??? (You didn't ask for it, I know 😀 ) Join both those groups at your school. There are lots of opportunities for volunteer experiences. Shadow as many folks in a variety of settings as you can - you can find them in hospitals, pharmacies & even dentists in the area...

Good luck - you don't have to decide right away - take your time & be thoughtful.

 

[ucsd2011]

thanks everyone!

sdn1977, i'll definitely give the classes a shot before making an actual decision because I wouldn't want any regrets in the future. what percentage of the hospital pharmacists tasks involve patient interaction? I tried and am trying to shadow, but currently UCSF will not allow any shadows becasue of liability issues or something like that.

 

[sdn1977]

thanks everyone!

sdn1977, i'll definitely give the classes a shot before making an actual decision because I wouldn't want any regrets in the future. what percentage of the hospital pharmacists tasks involve patient interaction? I tried and am trying to shadow, but currently UCSF will not allow any shadows becasue of liability issues or something like that.

hospital pharmacists & patient interaction with shawdowing - almost none! Privacy violations among so many other issues.

With volunteering...go into it just asking the volunetter coordinator that you are very, very interested in healthcare. That's what my daughter did.

She was assigned to ER first, then, ICU. Her assignments ranged from getting charts from medical records to taking samples to the lab (she got lost😉 )

If you're interested in pharmacy....do whatever the volunteer coordinator wants you do to - deliver flowers, take pts mail, take a pt to radiology,, etc..

But...on your way, stop by the pharmacy (they are usually on every floor)....ask to talk to a pharmacist. Ask about their job - what they like (don't ask at this point what they don't like - they could have had a bad interaction & you really don't want to know this!). Ask who the director's name is.

Ok.....now you have a name, you can get a phone #. Call the guy - ask to see him....tell his secretary you're interested in becoming a pharmacist. Don't at this point tell her/him you're volunteering. If he/she will see you, now you can say your a volunteer (after asking all the preliminary questions, etc..) - ask if there are any opportunities for volunteers within the pharmacy.

You can give it a shot. It has worked for some, but pharmacy is not one actually that asks for volunteer help. You can always ask if you can shawdow a pharmacist who is assigned to a specific unit - ICU or mhu or snf for example to just see/watch. Be sure to get the name (his/her card would be best!) and Always! ask if it would be possible to obtain a reference at some point in the future......if for nothing more than expressing your interest.

Good luck!

 

[ucsd2011]

wait, i'm a bit confused..are you saying that hospital pharmacists do not have any contact with patient at all or is it just that there's no opportunity for interested students like me to shadow a hospital pharmacist? thanks!

by the way, how does your daughter like pharmacy so far? is it stressful?

 

[airtim00]

i volunteered at a hospital...
and i did all those.. lab runs, paper work, stamping, patient escorts etc... hehe
it was quite fun.

Anyway i'm planning on getting some experience at the pharmacy, so Im probably gonna talk to my volunteer coordinator soon...

 

[sdn1977]

wait, i'm a bit confused..are you saying that hospital pharmacists do not have any contact with patient at all or is it just that there's no opportunity for interested students like me to shadow a hospital pharmacist? thanks!

by the way, how does your daughter like pharmacy so far? is it stressful?

My daughter is not in pharmacy - she is in medicine. She did not follow her parents at all (see how little influence we have????😉 )

She's an MSIII, tired much of the time, but feels she's in paradise - knows she made the right choice for her (which, knowing her like I do & the field like I do....I'd have to agree). Right now, she's not stressed, but she's finished her Step I so the stress will begin again later.

I might have mislead you - yes, hospital pharmacists have SOME patient interaction, but it varies. I'm in the ICU/OR, so my patients often are sedated or don't remember I was ever there. Their families remember me morre than they do.

One of the sad issues of medicine is currently in the US is pts stay a very short time in the hospital. Often, pharmacists never interact with the pt since the stay is so short. I had that unique observation with my own mom who had bilateral pulmonary emboli, was admitted & stayed for 3 days, started on Lovenox & warfarin & discharged....was never seen by a pharmacist (& this is in one of the USC teaching hospitals, of which some of my classmates are staff!).

To try to shawdow a hospital pharmacist in observing pt interaction, you probably won't see the interaction you're looking for - you might want to pursue more a long term care facility or snf (skilled nursing facility). Those employ consultant pharmacists who do monthly medication reviews & may or may not give eduational information.

Really - most of the pt education goes on nowdays in the outpt setting, sadly!

 

[ucsd2011]

so what do hospital pharmacists usually do? some say that they are in a room all day writing prescriptions (not very appealing) some on this board say they work with a team of physicians. I really like the 'team of physicians' idea..maybe because i'd rather do teamwork than independent work 🙄

 

[OrganicPharmer1]

so what do hospital pharmacists usually do? some say that they are in a room all day writing prescriptions (not very appealing) some on this board say they work with a team of physicians. I really like the 'team of physicians' idea..maybe because i'd rather do teamwork than independent work 🙄

From what I've seen in the hospital inpatient pharmacy (in California), they do everything you mentioned. Inpatient pharmacists check and enter prescriptions, prepare IVs, go on rounds with physicians, etc. They rotate through all these things, so an inpatient pharmacist usually wouldn't do just one thing. By the way, if you are looking to become a volunteer, try UCSD Medical Center. They let volunteers work in both outpatient and inpatient pharmacies. I would definitely recommend inpatient but you could try both. It's one of very few hospitals in SD that take volunteers into their pharmacies.

 

[Hpower12]

I am currently on my adult med rotation at a hospital. None of the clinical pharmacists have residencies, I kinda feel like the schools to promote this to promote themselves, since they are the ones teaching.

The pharmacists basically dose abx and do coumadin consults. So basically in the morning I get a list of all the patients that are on pharmacist consult and I go through my floor and check every thing and basically dose abx and coumadin. They later one of the clinical pharmacists will check off on it. The pharmacy gets questions about random things also, like the best treatment for a lady with endocarditis, a valve replacement, and on dialysis. Another thing I had to research was whether ondansetron is ok to give to kids in the tablet form.

There is really no patient contact since you are mostly dealing with lab values, occationally I will do a coumadin teaching, which is for someone who is new to it and going to be on it long term,

 

[Priapism321]

I am currently on my adult med rotation at a hospital. None of the clinical pharmacists have residencies, I kinda feel like the schools to promote this to promote themselves, since they are the ones teaching.

The pharmacists basically dose abx and do coumadin consults. So basically in the morning I get a list of all the patients that are on pharmacist consult and I go through my floor and check every thing and basically dose abx and coumadin. They later one of the clinical pharmacists will check off on it. The pharmacy gets questions about random things also, like the best treatment for a lady with endocarditis, a valve replacement, and on dialysis. Another thing I had to research was whether ondansetron is ok to give to kids in the tablet form.

There is really no patient contact since you are mostly dealing with lab values, occationally I will do a coumadin teaching, which is for someone who is new to it and going to be on it long term,

This sounds like you are rotating through a Community Hospital. At an Academic Medical Center, the roles of the Clinical (I am beginning to feel the same way as SDN does when it comes to this term, at least on this board) Pharmacists are completely different. The Pharmacists that have specialized training rarely set foot in the actual pharmacy, have offices on the floors where their patients reside, and have as much patient contact as some of the physicians.

Example: Solid Organ Transplant Pharmacist, office in the Transplant Center, rounds with one Pulmonary Transplant Specialist on pre-op and post-op patients daily, and has no order entry/staffing responsibilities whatsoever. I cannot elaborate on many other details that go into her day because I do not do what she does, but it is not something that you could generalize to any other pharmacist in the entire institution.

 

[airtim00]

The Pharmacists that have specialized training rarely set foot in the actual pharmacy, have offices on the floors where their patients reside, and have as much patient contact as some of the physicians.

Example: Solid Organ Transplant Pharmacist, office in the Transplant Center, rounds with one Pulmonary Transplant Specialist on pre-op and post-op patients daily, and has no order entry/staffing responsibilities whatsoever.

Thats what Im interested in 🙂

 

[Jeddevil]

This sounds like you are rotating through a Community Hospital. At an Academic Medical Center, the roles of the Clinical (I am beginning to feel the same way as SDN does when it comes to this term, at least on this board) Pharmacists are completely different. The Pharmacists that have specialized training rarely set foot in the actual pharmacy, have offices on the floors where their patients reside, and have as much patient contact as some of the physicians.

Example: Solid Organ Transplant Pharmacist, office in the Transplant Center, rounds with one Pulmonary Transplant Specialist on pre-op and post-op patients daily, and has no order entry/staffing responsibilities whatsoever. I cannot elaborate on many other details that go into her day because I do not do what she does, but it is not something that you could generalize to any other pharmacist in the entire institution.

You left out an important part. There are not very many jobs like this available nationwide. Sure, if you can find a teaching hospital, you will actually work in the 'clinical' role that schools teach you about. Numbers wise, there are just not many of these positions available. So, the vast majority of 'clinical' pharmacists do renal dosing, various medication consults, and other stuff that anyone with a pharmacy degree can do.

 

[Priapism321]

You left out an important part. There are not very many jobs like this available nationwide. Sure, if you can find a teaching hospital, you will actually work in the 'clinical' role that schools teach you about. Numbers wise, there are just not many of these positions available. So, the vast majority of 'clinical' pharmacists do renal dosing, various medication consults, and other stuff that anyone with a pharmacy degree can do.

Well, this is part of my point. This is why I am a big proponent of post-graduate residency training. If you desire to do something like my post above describes, you have to go above and beyond what the average pharmacist does. And it honestly is not that much to ask. And, while it is not like Walgreens, where you can tell them to build you a store and make you a manager, it is not as rare as you make it seem to get a specialized position:

http://www.accp.com/rec_searchpos.php (scroll down and click search to view positions currently available).

Do the necessary prerequisites, and take your pick if it is what you want. I personally think most of these positions require additional training if you are a newer graduate (someone who graduated in the era where the Pharm.D was the entry level degree in pharmacy). If one obtained a Doctor of Pharmacy degree prior to this, these individuals can rely heavily on experience, and the fact is that when they graduated, they were doing what was considered going well above and beyond what was required to be a Pharmacist at that time. 20 years ago (I am young, my time frame may be off), a Pharm.D. required a Bachelor's degree, as well as research (for some institutions) before they were granted the doctoral degree.

 

[sdn1977]

OK - lets clarify a few things in inpt, acute medicine (aka - hospitals).

There are a number of different "models" -
1) The true "academic" insititution (UCSF, Ohio State, among others - many others) - the "clinical" staff often is separate & apart from the actual functioning pharmacy staff. The reason is simple - the hospital must function & the pharmacy is but one of the many functions. However, these are also teaching institutions - they teach not only pharmacy students, they also teach medical, nursing & a variety of other health professions. So, much of the "clinical" work - the drug level monitoring, the reconcilliation, the compliance with chemical restraint policies, tpn adjustments, anticoag monitoring (it could go on & on....) will occur within this set of "clinical" positions. Now - since these pharmacists are also usually adjunct staff with teaching responsibilities, they often don't have dispensing responsibilities. (I can also say they are sometimes clueless as to the "practical" matters of drug administration - but we won't go there right now). So - they don't "dispense" - they don't do pyxis checks, they don't get first doses, they may not even enter orders. They round with the whole "team" from the medical attending on down to the P1 student. There is a whole separate staff which makes sure the medications get entered correctly into the computer, get delivered to the right place & at the right time - hopefully, with follow up!

2) The community hospital which has a rotation for pharmacy students. These pharmacists act dually - as preceptors for the students, but they also function as a pharmacist for the hospital. In other words - their whole purpose is not to teach. Teaching is in addition to functioning as a pharmacist. Now - there may or may not be "rounds" in this setting. "Rounds" as you use the term - meeting with physicians every AM, only occur within a MEDICAL teaching hospital - not a hospital which teaches pharmacy students (altho it can....I'll try to elaborate later). When there is no MEDICAL student teaching, all the physician staff is private - there is NO housestaff - which is an intern, resident, etc..... Each physician has their own call situation - either within a group, or with a "hospitalist" or they take their own call. In this circumstance, there are no "rounds" because each physician does their hospital visits on their own schedule. This is more my setting. I did say I would elaborate - I did work with a group of physicians who treated HIV/AIDS pts & they wanted a pharmacist with them every weekday AM because we did the tpns for them. This was a very unstructured arrangement & each one assigned to that particular unit did the "rounds" with them.

3) Finally, there is the hospital that is like a "community" hospital above, but may have some medical teaching, but not totally academic. This is like the VA or Kaiser. Some take medical residents within certain programs - ER, trauma, transplant (altho Kaiser has taken a real hit here - poorly run!), OB....Depending on the particular institution....they may take more pharmacy students, residents than they do medical residents - so your exposure will be different.

However - the reason I get so bent out of shape about the whole "clincal" title is that even in the most academic setting - lets take my alma mater - UCSF......very academic with extensive "clinical" (aka teaching staff), rounds with physicians, medical students, medical residents, pharmacy students, pharmacy residents, etc....there is always that pt who is admitted at 1:45AM with orders to start heparin per protocol, start aminoglycoside dosing per protocol, start tpn in AM based on 6AM labs & pharmacist - please convert the pts MS Contin + MS IR dosing to an MS pca. Well....the 11-7:30 pharmacist is expected to do all of it & none of the teaching (aka "clincal") staff is on until 9AM. This is all "clinical" - which is the basic expectation for a hospital pharmacist!

This scenario goes on in community hospitals & many other practice settings all over the country.

The bottom line is - you have to be "clincal" - which actually means, you have to be competent to be an inpt hospital pharmacist. The "title" doesn't mean a thing - its what you do & how you do it. That's why you don't learn for a job - you learn for a "career" which is a different concept completely.

Your patient contact will change based on the economics of healthcare more than what you learn or what your residency is. I've seen the economics change many times, but no matter what.....if you're good at what you do & have a good base in your education, you'll adapt to the economics and practice settings.

As for the history of the PharmD - its an interesting one, but too long for this post. However, the degree is actually more than 100 years old, was stopped in the 1930's, resurrected in the 1950's in CA in 2 out of the 3 schools available at that time & became the entry level degree in 2000.

Good luck!

 

[ucsd2011]

wow, thanks for the long post!!..i'm kind of confused...so do pharmacists at UCSF meet with other doctors or are they seperated? Also, my grandma was occasionally admitted to UCSF and there were times when different people would come in sayin ghtey were a pharmacist or social worker or nutrionist, etc..are they students? thanks!

 

[sdn1977]

wow, thanks for the long post!!..i'm kind of confused...so do pharmacists at UCSF meet with other doctors or are they seperated? Also, my grandma was occasionally admitted to UCSF and there were times when different people would come in sayin ghtey were a pharmacist or social worker or nutrionist, etc..are they students? thanks!

I'm not sure what you mean exactly - pm me if you want to be more specific.

Pharmacists "meet" with doctors all the time - face-to-face, telephone, fax, etc....Are you referring to going on "rounds" with them? Yes, some do - that would be the teaching staff.

There is a whole separate pharmacy staff in any teaching hospital which is taking care of the actual distribution of drugs all over the hospital. They are also taking care of what some consider the "clinical" aspects of those patients who are not admitted to a teaching serivce (most hospital will allow pts to be admitted as private pts - not seen by students). Someone has to monitor these pts as well.

At UCSF, there is no graduate program in social work or nutrition, but your grandmother may very well have been visited by the staff social worker or dietician. These are people who exist in every hospital on the staff.

The difference between a teaching hospital & a non-teaching hospital is you have either more staff whose sole responsibility is teaching (in the case of UCSF they are paid by the University rather than the hospital - separate entitites) or staff whose time is divided between teaching & staff functions.

It really is not as difficult as it sounds once you're in it.

 

[pion]

OK - lets clarify a few things in inpt, acute medicine (aka - hospitals).

Thank you for posting this, very informative. 👍

 

[tussionex]

OK - lets clarify a few things in inpt, acute medicine (aka - hospitals).

However - the reason I get so bent out of shape about the whole "clincal" title is that even in the most academic setting - lets take my alma mater - UCSF......very academic with extensive "clinical" (aka teaching staff), rounds with physicians, medical students, medical residents, pharmacy students, pharmacy residents, etc....there is always that pt who is admitted at 1:45AM with orders to start heparin per protocol, start aminoglycoside dosing per protocol, start tpn in AM based on 6AM labs & pharmacist - please convert the pts MS Contin + MS IR dosing to an MS pca. Well....the 11-7:30 pharmacist is expected to do all of it & none of the teaching (aka "clincal") staff is on until 9AM. This is all "clinical" - which is the basic expectation for a hospital pharmacist!
!

sdn, you are my new best friend! your posts are always informative, but thanks for giving props to the "off-shifts"....there sometimes is the misconception that we are just the flunkies who do nothing all night. the reality is, sometime we are the ONLY pharmacists in house...so we have to be "staff", "clinical" "residency-trained" all rolled into one

your post made me smile!👍

 

[airtim00]

so how do you become a pharmacist who goes on rounds and stuff ?

Do you mean that only teaching pharmacists go on rounds?

 

[airtim00]

i mean, is it all just experience, or are residencies important?

 

[ucsd2011]

i'm not sure if other people in my position think or feel this way..but are you ever afraid of prescribing the wrong medicine? or too much dosage? etc. are there other pharmacists who you can consult with and won't think you're asking a silly question?

 

[Priapism321]

i'm not sure if other people in my position think or feel this way..but are you ever afraid of prescribing the wrong medicine? or too much dosage? etc. are there other pharmacists who you can consult with and won't think you're asking a silly question?

Generally speaking, what Pharmacist is prescribing any medicine? I understand that if you work at a VAMC, pharmacists have prescriptive authority within their scope of practice, but this is certainly the exception to the norm. Also, there are protocols that are developed by pharmacists, but this is indirect prescribing, and in accordance with the medical staff, I suppose. However, to answer your question, anyone who is responsible for prescribing anything I would imagine is worried about getting it wrong. This is the responsibility they take, and most of them are suited for the role. Maybe I am misinterpreting your query.

 

[sdn1977]

sdn, you are my new best friend! your posts are always informative, but thanks for giving props to the "off-shifts"....there sometimes is the misconception that we are just the flunkies who do nothing all night. the reality is, sometime we are the ONLY pharmacists in house...so we have to be "staff", "clinical" "residency-trained" all rolled into one

your post made me smile!👍

No problem!!! Thats why I keep harping - ALL pharmacists are clinical!!! We are just in different practice settings, shifts, etc.....

The night shift can often be the most difficult one - most people are born & die at night - so can get lots of urgent/emergent issues with little staff & few resources to call upon.....been there/done that!

Good pharmacists know the night shift pharmacist is worth their weight in gold!!!

 

[sdn1977]

so how do you become a pharmacist who goes on rounds and stuff ?

Do you mean that only teaching pharmacists go on rounds?

Why do you want to go on "rounds and stuff"????

If its to teach - you have to become a good instructor. That means, you not only have to know your material well, you also have to really LIKE students and know how to communicate well.

 

[sdn1977]

i mean, is it all just experience, or are residencies important?

Sorry....gotta quote one by one - I'm not completely computer illiterate - just a little bit (altho my son would dispute that!)

You can use the search function to see what it takes to become a professor or adjunct, assistant, associate, etc.... professor.

Generally - yes, you'll need to specialize & do a residency. You have to be "someone" to be able to teach someone.

 

[sdn1977]

i'm not sure if other people in my position think or feel this way..but are you ever afraid of prescribing the wrong medicine? or too much dosage? etc. are there other pharmacists who you can consult with and won't think you're asking a silly question?

I think you mean "calculating" the wrong dose when using a protocol - am I right?

Say, if Tussionex received an order to start aminoglycosde per pharmacy protocol at 3AM. She will need appropriate labs & in the absence of labs, she'll need weight, height (or the very best guess), diagnosis, renal function &/or history/physical to determine possible renal issues &/or fluid status (is the pt dehydrated, in heart failure, etc....what things can influence the possible numbers she might be looking at). Then - she will calculate the loading dose.

This could be of an aminoglycoside, heparin, warfarin, any number of drugs. Then....the next shift evaluates based upon defined parameters which have been set & agreed upon by the P&T committee.

In pharmacy & medicine - there is an "art" to treatment as well as a science. Fortunately, within our field, we have defined parameters by which we function - the parameters are set & agreed upon by people in the medical depts who have significant input. Also...whenever there is a concern.....we can run the numbers by the prescriber because we don't know the diagnostic factors - we only know what was written in the chart. But, protocols are in place so the prescriber doesn't have to do the number crunching.

Have I ever been afraid? No - I'm pretty sure of what I do. But....I have been dismayed when I've had to tell a physician the acute renal failure they are seeing is due to a bad pharmacy calculation (fortunately not by me!!!!) I've seen this happen 3 times

 

[Farmercyst]

I think you mean "calculating" the wrong dose when using a protocol - am I right?

Say, if Tussionex received an order to start aminoglycosde per pharmacy protocol at 3AM. She will need appropriate labs & in the absence of labs, she'll need weight, height (or the very best guess), diagnosis, renal function &/or history/physical to determine possible renal issues &/or fluid status (is the pt dehydrated, in heart failure, etc....what things can influence the possible numbers she might be looking at). Then - she will calculate the loading dose.

This could be of an aminoglycoside, heparin, warfarin, any number of drugs. Then....the next shift evaluates based upon defined parameters which have been set & agreed upon by the P&T committee.

In pharmacy & medicine - there is an "art" to treatment as well as a science. Fortunately, within our field, we have defined parameters by which we function - the parameters are set & agreed upon by people in the medical depts who have significant input. Also...whenever there is a concern.....we can run the numbers by the prescriber because we don't know the diagnostic factors - we only know what was written in the chart. But, protocols are in place so the prescriber doesn't have to do the number crunching.

Have I ever been afraid? No - I'm pretty sure of what I do. But....I have been dismayed when I've had to tell a physician the acute renal failure they are seeing is due to a bad pharmacy calculation (fortunately not by me!!!!) I've seen this happen 3 times

Not that acute renal failure is a good thing but 3 times in 30 years isn't that bad given then number of scripts you must've either seen/followed up on.

 

[ZpackSux]

Not that acute renal failure is a good thing but 3 times in 30 years isn't that bad given then number of scripts you must've either seen/followed up on.

And I have never come across a renal failure due to a bad pharmacy calculation. But I have seen many many renal toxicities due to a lack of pharmacy involvement in dosing of renally toxic medications.

 

[sdn1977]

And I have never come across a renal failure due to a bad pharmacy calculation. But I have seen many many renal toxicities due to a lack of pharmacy involvement in dosing of renally toxic medications.

I've given some thought as to how to respond to this comment. First, you're very fortunate - not so much that you haven't seen it, but more that you haven't had to deal with the personnel issues it brings up.

These incidents touches on your current thread - management, but also on some of the threads that appear occasionally - what school to go to, why, will I be a candidate for a particular job, what about a residency, why so much memorization, what's the point of calculus........

These 3 ARFs due to gent toxicity were the result on one person's calculations. Unfortunately, I followed her on each occasion the next day. She did everything "right" by the formulas & doing the math, but she didn't understand the source of the formula or why she couldn't use a particular number (lab value).

Although many of us tried to explain the kinetics of aminoglycoside dosing & the physiology of various disease states & why some of the lab values don't accurately reflect the actual body compartment the drug will be in, she never seemed to "get" it.

This is the difference between "learning" and "memorizing". This is why the pharmacist can't sit in the pharmacy with a link to the lab computer & crunch numbers. This is why the pharmacist actually has to go to the unit & read the chart, know what he/she is reading, know that a CABG pt will come back from the OR with a lot of fluid within the tissues, but that fluid will come off within a few hours. Thats why the pharmacist has to learn that when a pt gets an arteriogram with contrast, the renal function will bump.

This pharmacist never got that & somehow never could learn it from others. She was one who really never learned physiology, so when it came to trying to teach abnormal physiology to her, it was difficult & she didn't want to spend the time trying to learn it.

So....it resulted in her no longer being allowed to do kinetic dosing.

But, what does that teach us who are currently working & those of you still in school? For me - I've got to learn about each new procedure & process as well as the new drugs - not because I need to do a medical procedure (I don't!), I need to know what to expect physiologically after. Learning about each new drug will either reinforce my concepts of metabolism, excretion, handling, absorption & why & when any of those things can become distorted - or, it will open up a whole new area I've never learned about - like the biologicals - Enbrel & Humira.

For you students....you really need to "learn" the material. Learn why you can't rely on the serum creatinine which was drawn the day after your pt had an angiogram, what do you look for to evaluate hemodilution or hemoconcentration?

If you're in a school which teaches you & gives you exposure to these things - great - take advantage of them. If you're not, you must expect to learn them on your own, so be open minded and try to take every opportunity to be exposed to seeing pts in all sorts of settings. And...don't be frustrated because some dop won't hire you to do ICU staffing right off the bat. It costs the hospital a lot of money & time when the pharmacist screws up.

So....Zpak was fortunate to have always been with & hired great staff. But, we all have a responsibility to continue to educate ourselves & if we have the ability, to help educate those who need some extra assistance in the nicest & most respectful way we can....

Just more thoughts .........

 

[ZpackSux]

I lied. There was one incident of pediatric patient receiving 50mg of amphotericin-B. The baby died. The physician said he wrote 5.0mg... I didn't remember this because I was an intern and this happened to the pharmacist who was a per diem I worked with. This happened at her full time job which was down the road from where I worked.

I never found out what happened to her...