Clinical Pharmacy

[WJRX]

I am a P1 and am looking into the career of a clinical pharmacist. My main focus will be in direct patient care, making rounds on hospital floors rather than dispensing and sitting at a computer.

Will I need to complete a residency in clinical pharmacy or do you see the evolution of the pharmacy practice going toward pharmacists being completely active in direct patient care?

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[sdn1977]

I don't know where this job exists where you don't sit at a computer at all. Our jobs are very computer intensive.

Where I am, all pharmacists have some dispensing function, even those who are assigned to a nursing unit(s), unless, they are academic.

Yes, I feel you'll benefit from a residency.

Clinical....don't get me started......clinical refers to any practice setting!

 

[ZpackSux]

You want direct patient care? Why not nursing?

Define "Clinical" and "Direct Patient Care" then I'll give you my input.

 

[VCU07]

Speaking of residency and being on the floor, I have a quick question. I just did an acute care rotation and I find that pharmacists just don't have authority to make decisions. I definetly see the advantage of having a pharmacist teaching med students/residents, but in the end what we know should be done may not be done b/c the attending refuses. I like the idea of playing a clinical role, but it gets fustrating. What do you guys think? Will we ever get more autonomy?

 

[Crystal]

I understand what you mean... but the opp for more autonomy depends on where you practice and who you practice with. States like NM and WA have very progressive practices where pharmacists can prescribe. When I did transplant in NJ, even though there are no "laws" like that here, the surgeons would let the pharmacists order or whatever labs or drugs that thought were appropriate bc they really trusted the pharmacists and valued there opinions. So the moral I guess is, no matter where you live, building a good reputation and relations is key.

 

[WJRX]

I appologize, by clinical I meant hospital.

I guess what I was wanting to know is if completing a residency will enable me to work more on the floor.

 

[ZpackSux]

I appologize, by clinical I meant hospital.

I guess what I was wanting to know is if completing a residency will enable me to work more on the floor.

work on the floor doing what?

 

[WJRX]

Working along with the physicians and other health care professionals to assure the safe and effective prescribing and dispensing of medication per patient.

 

[alwaystired]

I am a P1 and am looking into the career of a clinical pharmacist. My main focus will be in direct patient care, making rounds on hospital floors rather than dispensing and sitting at a computer.

Will I need to complete a residency in clinical pharmacy or do you see the evolution of the pharmacy practice going toward pharmacists being completely active in direct patient care?

there seems to be a very helpful clinical pharmacist who posted a very imformative reply in the residency section. 👍 They even detailed their daily work....so I would recommend checking it out.

 

[WJRX]

Thank you very much, alwaystired. That was exactly what I was looking for.

 

[ZpackSux]

Working along with the physicians and other health care professionals to assure the safe and effective prescribing and dispensing of medication per patient.

My pharmacist stations are placed throughout the hospital. So pharmacist processes orders on the floor where they interact with physicians and nurses. These pharmacists are experts in pharmacotherapy but also fluent in technical knowledge of our pharmacy distribution system which is very automated. Most of these pharmacists do not have a residency but they are much more knowledgeable about pharmacotherapy and healthcare system pharmacy practice than a typical pharmacist who just finished residency.

Residency can help but it's not the answer. It depends on you and your abilities. So most of our pharmacists rotate and work on the floor. But I have 1 clinical pharmacy manager who is in charge of our clinical pharmacy program. Even then she participates in distribution of medications.

Medication Delivery System is very dynamic and complex. And it's a big part of pharmacy.

Do a residency... work at a hospital. And if you're keen enough for the administration to take notice of your talent, then I'm sure you can find 100 percent clinical job.

VA and/or HMO settings are ideal for what you're looking for... or in Academia.

 

[sdn1977]

Working along with the physicians and other health care professionals to assure the safe and effective prescribing and dispensing of medication per patient.

WJRX - being an acute care inpatient hospital pharmacist, depending on your location, will not necessarily require a residency - it didn't in my case, but I've got decades of experience.

If I were coming out of school now...I'd do a residency. I think as a P1, you are too "young" in your exposure to pharmacy to determine yet what area you want to pursue. There are soooo many options out there.

Personally, I'd recommend you pursue as many opportunities you have available. Try to get lots of exposure, take advantage of all sorts of clinics & volunteeer/shadow chances.

Why??? You may want to pursue intensive care/OR pharmacy or pedi/neonatal pharmacy or oncology or nuclear pharmacy. All have or are acute inpt areas of expertise....but, as a P1 with 3 months under your belt...its too soon to make a decision.

Do you have an advisor? Take every advantage you can to talk with him/her & find out what options your school has for students. Keep your eyes/ears open, go to local & nation meetings, read about what people are doing in the field you might have interest in....

Good luck & try to not fall into the "lingo" which some of us have tried to get you to clarify. That is artifical packaging - we want you to become the real package which Zpak would want to hire & I would want to work with.

Have fun!

 

[ZpackSux]

WJRX - being an acute care inpatient hospital pharmacist, depending on your location, will not necessarily require a residency - it didn't in my case, but I've got decades of experience.

If I were coming out of school now...I'd do a residency. I think as a P1, you are too "young" in your exposure to pharmacy to determine yet what area you want to pursue. There are soooo many options out there.

Personally, I'd recommend you pursue as many opportunities you have available. Try to get lots of exposure, take advantage of all sorts of clinics & volunteeer/shadow chances.

Why??? You may want to pursue intensive care/OR pharmacy or pedi/neonatal pharmacy or oncology or nuclear pharmacy. All have or are acute inpt areas of expertise....but, as a P1 with 3 months under your belt...its too soon to make a decision.

Do you have an advisor? Take every advantage you can to talk with him/her & find out what options your school has for students. Keep your eyes/ears open, go to local & nation meetings, read about what people are doing in the field you might have interest in....

Good luck & try to not fall into the "lingo" which some of us have tried to get you to clarify. That is artifical packaging - we want you to become the real package which Zpak would want to hire & I would want to work with.

Have fun!

I wonder what the schools are teaching and leading our students into. I hope schools are not leading them to think pharmacists will run the floors wearing a white coat with a clipboard telling docs what to prescribe...

At an academic setting, the healthcare team led by an attending with students, interns, residents, dietary, nursing etc.. where pharmacy input is appreciated isn't the real world of healthcare where busy practitioner storms into ICU and sees his patient for 5 minutes and leaves..

Many medical specialists are expert in their medications more so than most pharmacists. It bemuses me when a pharmacy student or a fresh grad wants a job not wanting to do distribution but feel like they should round with physicians and give them advices...

This I believe can make many pharmacy students very disappointed when they first start to practice.

Of course I found my niche in pharmacy management and pharmacoeconomics ....where I can contribute my expertise to a healthcare system.

I can't wait for Dallas to get a Pharmacy School.

 

[sdn1977]

I wonder what the schools are teaching and leading our students into. I hope schools are not leading them to think pharmacists will run the floors wearing a white coat with a clipboard telling docs what to prescribe...

At an academic setting, the healthcare team led by an attending with students, interns, residents, dietary, nursing etc.. where pharmacy input is appreciated isn't the real world of healthcare where busy practitioner storms into ICU and sees his patient for 5 minutes and leaves..

Many medical specialists are expert in their medications more so than most pharmacists. It bemuses me when a pharmacy student or a fresh grad wants a job not wanting to do distribution but feel like they should round with physicians and give them advices...

This I believe can make many pharmacy students very disappointed when they first start to practice.

Of course I found my niche in pharmacy management and pharmacoeconomics ....where I can contribute my expertise to a healthcare system.

I can't wait for Dallas to get a Pharmacy School.

Yep - Zpak....true - too very true!

The medical specialists are absolutely far more competent in their field than we ever will be. That, however, is not an issue for those of us who have developed our areas of expertise...yours is administration & mine is acute ICU/OR medicine.

It takes years & years to develop the rappaport sufficient for the prescribers to seek us out...it doesn't come just because we graduate. Unfortunately, on another thread...students don't want to do any dispensing functions, but a significant amount of what we do is make sure we get the medication to the place its needed when its needed. They also don't seem to want to learn interpersonal skills which is absolutely required to be effective in the inpt setting.

Can't you offer a remote intern site? We did in ICU & OR for the summer. It gave students an ability to get elective credit & work at a community hospital without a house staff - eye opening for sure. When is the school in Dallas due to open?

 

[ZpackSux]

It is our goal to start a clinical rotation for University of Texas and Texas Tech RX schools. We want a medicine rotation with critical care and infectious disease.

There was a talk of University of North Texas opening a pharmacy school in FT Worth.. not sure if it will ever happen. I want to lecture an elective and institutional pharmacy management where I could teach Group Purchasing Contract, JCAHO accredidation Process, Pharmacy cost per Adjusted patient Days and interpersonal skills dealing with other professionals.

Of course..I don't think anyone would be interested in that stuff... so I'll have a small class...

Are you a preceptor?

 

[BonniePharmD]

I like my job. I don't set foot in the pharmacy. I am strictly clinical, so I round with the inpatient team, write chemo, adjust electrolyes, write TPN's, write ABX, etc.

My typical day: get to work between 6:30-7:00 am; get labs, look at charts, go on rounds (these can last from 2-5 hours depending on our census, etc). After rounds, I go back and write orders on the stuff that I didn't have time to do during rounds. I also reconcile the medications for the patients who are being discharged; give them a copy, and go over their meds (unless they are frequent fliers). I then send their scripts via computer down to the outpatient pharmacy (or call them in to Walgreens, CVS, etc). At my institution, the clinical pharmacist have delegated prescriptive authority, meaning I can write orders and sign them without having to "verbal order". The only drugs I have to get signed by the MD's are C 2's and chemo. It's a lot of responsibility, but it is rewarding.

 

[sdn1977]

It is our goal to start a clinical rotation for University of Texas and Texas Tech RX schools. We want a medicine rotation with critical care and infectious disease.

There was a talk of University of North Texas opening a pharmacy school in FT Worth.. not sure if it will ever happen. I want to lecture an elective and institutional pharmacy management where I could teach Group Purchasing Contract, JCAHO accredidation Process, Pharmacy cost per Adjusted patient Days and interpersonal skills dealing with other professionals.

Of course..I don't think anyone would be interested in that stuff... so I'll have a small class...

Are you a preceptor?

Not a preceptor anymore since I'm only part-time, but I was & I do take on the teaching responsibilities when I'm working. I was a preceptor when I was full time - lots of work, but great to do.

I've lectured as well....not as much fun...they take you waaaay too seriously & get hung up on every word you say rather than the signifcance of what you're saying...if you get my meaning...

Bonnie - I'm thinking you must be in a teaching institution. No private practice physician can afford to make rounds for 2-5 hours. Altho this is a fun spot, its unique in its isolation. We have weekly interdisciplenary rounds on ICU pts who have been on vents > 3 days. These rounds, which include the family at the end, last no more than 45 min. Every hospital pharmacist in CA has authority to write orders for inpts....each hospital chooses how much independence they have in what orders are written.

Good for the OP to learn lots of different practice settings & exposures!!!

 

[BonniePharmD]

Not a preceptor anymore since I'm only part-time, but I was & I do take on the teaching responsibilities when I'm working. I was a preceptor when I was full time - lots of work, but great to do.

I've lectured as well....not as much fun...they take you waaaay too seriously & get hung up on every word you say rather than the signifcance of what you're saying...if you get my meaning...

Bonnie - I'm thinking you must be in a teaching institution. No private practice physician can afford to make rounds for 2-5 hours. Altho this is a fun spot, its unique in its isolation. We have weekly interdisciplenary rounds on ICU pts who have been on vents > 3 days. These rounds, which include the family at the end, last no more than 45 min. Every hospital pharmacist in CA has authority to write orders for inpts....each hospital chooses how much independence they have in what orders are written.

Good for the OP to learn lots of different practice settings & exposures!!!

Oh yes, I am in a very large teaching institution (part of the University of Texas). I precept students as well as residents (very rewarding)...

 

[sdn1977]

So OP...you've got 3 practicing pharmacists....one a dop who also works in a staff position regularly enough to know what goes on, an academic pharmacist who is specialized (heme/onc - right?) & me, a community staff ICU/OR pharmacist......

There are lots of variations in practice settings.....all of us are clinical & interactive on the behalf of pts...we just do it differently day in & day out.

Hang in....you'll find your niche!

 

[ZpackSux]

So OP...you've got 3 practicing pharmacists....one a dop who also works in a staff position regularly enough to know what goes on, an academic pharmacist who is specialized (heme/onc - right?) & me, a community staff ICU/OR pharmacist......

There are lots of variations in practice settings.....all of us are clinical & interactive on the behalf of pts...we just do it differently day in & day out.

Hang in....you'll find your niche!

so she sums it up for us..👍

 

[rxforlife2004]

I am a P1 and am looking into the career of a clinical pharmacist. My main focus will be in direct patient care, making rounds on hospital floors rather than dispensing and sitting at a computer.

Will I need to complete a residency in clinical pharmacy or do you see the evolution of the pharmacy practice going toward pharmacists being completely active in direct patient care?

You are not being realistic here. You won't be able to control what to prescribe. Chances are you would recommend an MD to switch/discontinue a medication (to reduce cost, safe money, better efficacy...whatever...). And sometimes they listen to you, sometimes they don't even care what you wrote in the chart. Probably you should wait until you hit your clinical rotations and you'll see the reality.

Like Zpack said, "direct patient care" = nurses, MDs.

 

[MdBrndPhrmcst]

I like my job. I don't set foot in the pharmacy. I am strictly clinical, so I round with the inpatient team, write chemo, adjust electrolyes, write TPN's, write ABX, etc.

My typical day: get to work between 6:30-7:00 am; get labs, look at charts, go on rounds (these can last from 2-5 hours depending on our census, etc). After rounds, I go back and write orders on the stuff that I didn't have time to do during rounds. I also reconcile the medications for the patients who are being discharged; give them a copy, and go over their meds (unless they are frequent fliers). I then send their scripts via computer down to the outpatient pharmacy (or call them in to Walgreens, CVS, etc). At my institution, the clinical pharmacist have delegated prescriptive authority, meaning I can write orders and sign them without having to "verbal order". The only drugs I have to get signed by the MD's are C 2's and chemo. It's a lot of responsibility, but it is rewarding.

I'm a 4th year pharmacy student and have taken a majority clinical hospital rotations.. they've been hard.. but none of them have really concentrated on teaching us how to do TPN's.. adjust electrolytes...and dose antibiotics.. I'm afraid next year when i'm doing a residency I'm going to get slammed.. and my supervisors are going to ridicule me.. when did you learn how to do all this?

 

[ZpackSux]

I'm a 4th year pharmacy student and have taken a majority clinical hospital rotations.. they've been hard.. but none of them have really concentrated on teaching us how to do TPN's.. adjust electrolytes...and dose antibiotics.. I'm afraid next year when i'm doing a residency I'm going to get slammed.. and my supervisors are going to ridicule me.. when did you learn how to do all this?

I can learn you that stuff...

 

[BonniePharmD]

I'm a 4th year pharmacy student and have taken a majority clinical hospital rotations.. they've been hard.. but none of them have really concentrated on teaching us how to do TPN's.. adjust electrolytes...and dose antibiotics.. I'm afraid next year when i'm doing a residency I'm going to get slammed.. and my supervisors are going to ridicule me.. when did you learn how to do all this?

I learned most of it during my residencies. My practice residency was basically 50% staffing; order entry, etc. You would be suprised how much you learn by entering orders over and over...all the post-op stuff, admission orders, etc. It's during that residency that I learned the most about electrolytes, ABX, etc.

Try and do some ICU/nutrition as an elective and you will get the exposure to TPN's...

 

[sdn1977]

Mdbrnd - you have to be willing to follow the same pt day after day after day.....watch what happens to the electrolytes, but think of the physiology!!! You have to know how the extracellular Ca is influenced by the Cr, follow the renal function, keep track of all the fluids being administered.

Yeah - its hard, but during your rotations, ask your preceptor you'd like to follow one pt COMPLETELY! Which means - you can't just look at one aspect of drug therapy - you have to integrate all drugs, fluids, physiology of the disease or process going on.

I'd recommend not starting on an ICU pt - these pts change hourly. They are hard to learn first. Start with a stable pt - 2 wk post op GI resection for example or post trauma....get used to following labs, which perhaps are drawn just once daily rather than every 4-6 hours like an ICU pt.

Then...get your preceptor & talk, talk, talk!!! You learn by looking & doing - look at the labs, think - what would I do? If your choice is the same as the prescriber, you're on the right track. If not - ask your preceptor why the choice was made differently......get to know your house staff....

 

[nikkai]

Mdbrnd - you have to be willing to follow the same pt day after day after day.....watch what happens to the electrolytes, but think of the physiology!!! You have to know how the extracellular Ca is influenced by the Cr, follow the renal function, keep track of all the fluids being administered.

Yeah - its hard, but during your rotations, ask your preceptor you'd like to follow one pt COMPLETELY! Which means - you can't just look at one aspect of drug therapy - you have to integrate all drugs, fluids, physiology of the disease or process going on.

I'd recommend not starting on an ICU pt - these pts change hourly. They are hard to learn first. Start with a stable pt - 2 wk post op GI resection for example or post trauma....get used to following labs, which perhaps are drawn just once daily rather than every 4-6 hours like an ICU pt.

Then...get your preceptor & talk, talk, talk!!! You learn by looking & doing - look at the labs, think - what would I do? If your choice is the same as the prescriber, you're on the right track. If not - ask your preceptor why the choice was made differently......get to know your house staff....

Hmm. So with all this talk, how about we interject w/ a question regarding non community and non hospital?

Any opinions regarding Big Pharma and PBM work (ie: The managed care side, not the R & D side)

I love what I'm learning via AMCP, and I'm really getting swayed away from dreams of grandeur that I had entering school (being a super clinical guy who doesn't deal w/ the financial side of things). Now, it's straight up, if I want something done, I gotta know how the money's gonna be procured and how it'll impact the system and pt financially. Fun stuff, seriously.

 

[sdn1977]

Hmm. So with all this talk, how about we interject w/ a question regarding non community and non hospital?

Any opinions regarding Big Pharma and PBM work (ie: The managed care side, not the R & D side)

I love what I'm learning via AMCP, and I'm really getting swayed away from dreams of grandeur that I had entering school (being a super clinical guy who doesn't deal w/ the financial side of things). Now, it's straight up, if I want something done, I gotta know how the money's gonna be procured and how it'll impact the system and pt financially. Fun stuff, seriously.

Big Pharma??? Are you talking about pharmaceutical companies? I don't know how much you're going to get with this on rotations...certainly not from my school. However, some may have rotations thru large drug companies. There are lots of intern possibilities in this area though. That said....I've got 2 classmates I know of who are vice presidents of large drug companies...so its definitely out there.

As for PBMs....again...I don't know anyone in the business & I'd imagine you'd have to do an internship to really get involved in it.

But...you've got me wondering about your statement "if I want something done, I gotta know how the money gonna be procured & how it will impact the system & the pt"....that actually sounds like administration residencies to me. These residents learn budgets & working contracts advantageously in addition to personnel & labor models. Zpak would be your guy here....I think his general perspective will work for a hospital pharmacy department & a retail establishment as well (since he does both...)

The insurance side doesn't have the system & pts best interests first...so you'd get a bit of a skewed picture there. That doesn't mean its not valid - its just skewed to their interest.

 

[nikkai]

UIC offers a few rotations at companies such as Abbot and Takeda. Also have a pretty strong link to WHI and Caremark (which I guess now is CVS/Caremark). Then of course there's the other route of the FDA rotation.

So many options... But that admin description sounds interesting too.

 

[ZpackSux]

UIC offers a few rotations at companies such as Abbot and Takeda. Also have a pretty strong link to WHI and Caremark (which I guess now is CVS/Caremark). Then of course there's the other route of the FDA rotation.

So many options... But that admin description sounds interesting too.

I know very little about the PBM. and I only deal with big Pharma as a customer.

But I understand Pharmacy Administration. Pharmacy Administration is an art not taught in school. It involves HR, Clinical-therapeutics, purchase contracts, Group Purchasing Organizations, Automation, Regulation and accredidation, Risk Managment, guest relations, inventory management, and day to day operation in a clinical setting. It's dynamic, difficult, and worthwhile.

Pharmacy Management industry is very small and is a tight knit society. We all know each other... The key players were the old Owen Pharmacy management who sold to Cardinal. Now McKesson Med Management is up and running. There is Comprehensive Pharmacy Services who I used to work for. And we're all trying to accomplish the same thing. At an inpatient setting, pharmacy is not a revenue generating department, rather a huge cost. It is our goal to reduce cost. And no one does it better than the Pharmacy Management Division of Health Management Associates..a hospital corporation our of Naples FL..who operate 65 hospitals.

No healthcare system has achieved what HMA did..which has the lowest pharmacy cost per hospital admission for profit hospital sector. In fact, most hospital systems have very little clue how to effectively run a pharmacy.

Pharmacy Administration truly is an art. And it's a niche no automation can take away.

If your goals is to get into management, do an administration residency, then get a job with a pharmacy management company...who will train and place you in a hospital.

 

[nikkai]

If your goals is to get into management, do an administration residency, then get a job with a pharmacy management company...who will train and place you in a hospital.

The above statement inspired another question: Do many hospital contract out their pharmacy (including the management?) I know, in a private hospital I volunteered at, they were all contracted through McKesson

 

[ZpackSux]

The above statement inspired another question: Do many hospital contract out their pharmacy (including the management?) I know, in a private hospital I volunteered at, they were all contracted through McKesson

I will say less hospitals use management company. McKesson Med Management Sux... j/k

Gotta love all those AcuDose cabinets..right?

 

[nikkai]

We were actually using Pyxis. Not too bad of a machine, except the finger print recognition sucks.

So did lazy nurses. Sometimes I wanted to grab the security film and show them that I actually did put meds in the drawer, one by one. =/

To continue on w/ questions, if you don't mind:

1. What should I expect if I were to pursue a Pharm Admin Residency?
2. Where would I find myself after the residency (Zpak stated some sort of Pharmacy Management Company), and what would I be doing there starting out?
3. Should I concentrate more on pharmacoeconomic/marketting/managed care courses to help me?

 

[sdn1977]

The Ohio State University used to be the big gun in hospital administratin residencies....not sure if that is still the case though.

You need to post your question on the residency forum for more specifics.

However....the very best pharmacy administrators who I've ever worked for have had a good clinical foundation. They may not be completely up to date, but they did not sacrifice their clinical knowledge for the administrative/economic requirements....thus the residency.

So...pay good attention to your years in pharmacy school. Be able to do EVERYTHING...from filling an amoxicillin rx for a 1 yo to calculating a gentamicin dose for a renal failure ICU pt.

Your residency will expose you to contracts, budgets, personnel issues, P&T committee & other interdisciplinary involvement.

During that time....you need to go to national & state meetings so you can see what others are doing & become "exposed"....as Zpak said...its a very small group - like pharmacy in general!

Start with your school student ASHP organization. They may have an administration subdivision.

Good luck!

 

[nikkai]

Thanks! 👍