Clinical Pharmacy

[Ante cibum]

Advertisement - Members don't see this ad

So I've been looking at careers in health care. I think I'd like to something where I interact with patients, like a clinical pharmacist. According to the Bureau of Labor Statistics, in 2010 there were 275k jobs for pharmacist, 23% of which were at hospitals, which is something like 63,000 hospital jobs. I don't know how many of these would be clinical roles, hybrid or purely clinical. Anybody have any numbers for the number of clinical pharmacist positions available?

I'd definitely like to do something clinically related. Basically I'm curious how hard it is to get a job as a clinical pharmacist? I know you need a residency, how many are these available? How many students apply for these? I enjoy chemistry and learning about how pharmaceuticals work in the body, and think I'd enjoy being a clinical pharmacist, although I really want to do something clinical and would like to know realistically what it takes.

For instance, does anyone know how many pharmacy graduates obtain purely clinical or hybrid positions? I'd really like to help people and use my knowledge of pharmacy to improve their health.

Thanks

 

[lisinopril]

So I've been looking at careers in health care. I think I'd like to something where I interact with patients, like a clinical pharmacist. According to the Bureau of Labor Statistics, in 2010 there were 275k jobs for pharmacist, 23% of which were at hospitals, which is something like 63,000 hospital jobs. I don't know how many of these would be clinical roles, hybrid or purely clinical. Anybody have any numbers for the number of clinical pharmacist positions available?

I'd definitely like to do something clinically related. Basically I'm curious how hard it is to get a job as a clinical pharmacist? I know you need a residency, how many are these available? How many students apply for these? I enjoy chemistry and learning about how pharmaceuticals work in the body, and think I'd enjoy being a clinical pharmacist, although I really want to do something clinical and would like to know realistically what it takes.

For instance, does anyone know how many pharmacy graduates obtain purely clinical or hybrid positions? I'd really like to help people and use my knowledge of pharmacy to improve their health.

Thanks

My hospital has 40 pharmacists...and we only have 3 clinical pharmacists. You get the idea. Most of us have had residency training, too. So residency doesn't mean you will be a clinical pharmacist. But I've done both clinical and staff (my tittle now is a clinical pharmacist) and to be honest, being clinical pharmacist is more boring than staff...in my opinion. Very same routine things to do. But no stress...is a trade off.

 

[pharmasaur]

I just wanted to throw out there that the most "clinical" of all pharmacists is no where near the "clinical"-ness of not only physicians, but NPs/PAs/RNs and a lot of other healthcare professions (respiratory therapists, psychologists,etc...). if you reaaally want something more hands on with patients I would consider something else because honestly pharmacy is not really there yet.

 

[BenJammin]

I just wanted to throw out there that the most "clinical" of all pharmacists is no where near the "clinical"-ness of not only physicians, but NPs/PAs/RNs and a lot of other healthcare professions (respiratory therapists, psychologists,etc...). if you reaaally want something more hands on with patients I would consider something else because honestly pharmacy is not really there yet.

Ding ding ding. This is why I'm becoming more and more distant from my role as a clinical pharmacist. Still thinking about PA school so I can really have an impact on my patients.

 

[PriorAuth]

Just remember that it is difficult and frustrating to be "clinical" without having the prescriptive authority.
I mean you can be clinical all you want but at the end of the day, your clinical judgments/decisions/recommendations need to be approved by the people with prescriptive authority.

 

[pharmasaur]

Just remember that it is difficult and frustrating to be "clinical" without having the prescriptive authority.
I mean you can be clinical all you want but at the end of the day, your clinical judgments/decisions/recommendations need to be approved by the people with prescriptive authority.

True, but RNs do not have prescriptive authority and yet they are more clinical then we are - they see patients and treat them and manage their case.

It just comes down to how much of a direct impact you want to have on patients and how close you want to be to managing their case. Pharmacists are still on the periphery. Kind of like where the hospital dietitians are.

 

[xiphoid2010]

Remember, as pgy-1 trained pharmacist becomes increasingly available, the expectation for even normal staff pharmacist positions will go up. I'm not foreseeing the hold non-clinical hospital staffing position to last another generation. It make sense to have a team of hybrids clinical/staff pharmacists rotating though staff/non-specialist positions, so to have the operational flexibility of cross-covering most positions as needed. The cost of pgy1 trained will come within line of current pharmacists soon or already, while specialist pgy2 will take significantly longer. The only major shortage in specialized pharmacists that I can think of is the IT kind and those will last for as far as I can see since people who are good with both biological sciences and computer technology just don't naturally mix.

 

[Digsbe]

Just remember that it is difficult and frustrating to be "clinical" without having the prescriptive authority.
I mean you can be clinical all you want but at the end of the day, your clinical judgments/decisions/recommendations need to be approved by the people with prescriptive authority.

In some cases you do, like if you are with the VA or have a CPA with a physician. Although, you won't have independent prescriptive authority. To my knowledge not even PA's or NP's have independent prescriptive authority and need to have a supervising physician. That being said though it's not commonplace for even a clinical pharmacist to be prescribing in private institutions.

 

[NYCGuy86]

In some cases you do, like if you are with the VA or have a CPA with a physician. Although, you won't have independent prescriptive authority. To my knowledge not even PA's or NP's have independent prescriptive authority and need to have a supervising physician. That being said though it's not commonplace for even a clinical pharmacist to be prescribing in private institutions.

For NPs and PAs, it's really state dependent, and specifically for NPs, a number of states allow them independent practice, with no collaborating physician agreement necessary. Elsewhere, while a PA or NP might need a supervising or collaborating physician, they may still be able to prescribe (and diagnose, treat, etc) in a highly autonomous fashion, where the SP reviews the charts after the fact.

 

[ChemoSabe]

Just remember that it is difficult and frustrating to be "clinical" without having the prescriptive authority.
I mean you can be clinical all you want but at the end of the day, your clinical judgments/decisions/recommendations need to be approved by the people with prescriptive authority.

Totally agree!

 

[joetrisman]

Just remember that it is difficult and frustrating to be "clinical" without having the prescriptive authority.
I mean you can be clinical all you want but at the end of the day, your clinical judgments/decisions/recommendations need to be approved by the people with prescriptive authority.

How is this different from being on a team other than the primary for a patient?

 

[PumpkinSmasher]

How is this different from being on a team other than the primary for a patient?

I was thinking the same thing but also understand what the poster was trying to say...

I receive pharmacy consult requests, I review the information and submit my recommendations to the attendings. Personally I like the arrangement but that is just me🙂

 

[Sparda29]

Just remember that it is difficult and frustrating to be "clinical" without having the prescriptive authority.
I mean you can be clinical all you want but at the end of the day, your clinical judgments/decisions/recommendations need to be approved by the people with prescriptive authority.

Just had this situation today at my per diem hospital job. Resident wants to order Vanco 500mg IV q12h. I run my calculations, PK and all, and estimated trough is like 3. The diagnosis here is bacteremia so the goal is 15-20 for trough. I recommend Vanco 1500 mg q12h. He tells me he's not comfortable with that. A couple of hours later I check the notes. ID consult comes back and recommends the exact same thing that I recommended. 😡😡

 

[confettiflyer]

Just had this situation today at my per diem hospital job. Resident wants to order Vanco 500mg IV q12h. I run my calculations, PK and all, and estimated trough is like 3. The diagnosis here is bacteremia so the goal is 15-20 for trough. I recommend Vanco 1500 mg q12h. He tells me he's not comfortable with that. A couple of hours later I check the notes. ID consult comes back and recommends the exact same thing that I recommended. 😡😡

Happens to me all the time. I found that, if you don't bring it up, that physician will be more apt to say yes to whatever you suggest next time (provided that you sell it right).

I like my position as a consultant, I get as close to my patients as I'm comfortable with...that's through the chart/labs, chatting with the RD's, RN's, and RT's (as well as the physicians), occasional drop-ins during their stay, and on admission/discharge depending on what I'm doing.

If the physician doesn't want to take my recommendation, short of it actually killing the patient (rarely happens), I'll challenge but it's no sweat off my back if it's still declined. I'll document to cover my ass and it's now your show to run.

If I wanted to get "closer" to my patients, I'd have gone to medical school.

It's also nice getting scheduled to "hide in the pharmacy" for the day and work on distributive duties every so often. Clock in, clock out, goodnight... no after hours paging, nada.

Though I might be singing a different tune if this advanced pharmacist practitioner law passes in CA (SB493), especially if that's how we'll be getting paid. Ah well, times are a changing.

 

[xiphoid2010]

Its about building rapport with physicians and confidence in the pharmacy staff. It takes a while to gain but quick to lose. But once you gained full faith of the main docs, you basically can practice medicine, eg, implement protocol/policies that make vanc/AG automatically pharmacy to dose, autosubs, extended infusions, sedation protocols...

 

[knight on horse]

Few spots.

If you're
1. Smart

2. Popular with, or can handle, a. Doctors b. Nurses c. Pharmacists

3. And can present, both yourself well for the interview and in the future healthcare/managerial topics to hospital/corporate staff

4. And/or have wicked connections,

Then you will make it

 

[confettiflyer]

But once you gained full faith of the main docs, you basically can practice medicine, eg, implement protocol/policies that make vanc/AG automatically pharmacy to dose, autosubs, extended infusions, sedation protocols...

Yup, I have my handful of docs I'm cool with and I am pretty much their right arm in the hospital with (almost) carte blanche to do what needs to be done. Obviously, a big part of this is knowing your limits (legally, knowledge-wise, knowledge of the patient) and giving him or her a call when you reach this limit and/or grey area.

I think the least appreciated function we have is interpreting physician intent and operating within a varying latitude depending on our comfort with a particular prescriber.

It's a win-win - physician gets a trusted medical professional operating within their scope of expertise to grease the wheels of his or her shift with minimal calls/pages and thus giving them more time to do things they actually want to do.

Given what we as a healthcare system are doing to physicians, the workload hospitalists have, and the demands of the job....if, as a pharmacist, you are encountering difficulty selling your services, either a) you're doing something wrong or b) your hospital isn't providing a conducive environment for that type of relationship, or c) both.