Fellowships and Residencies delay the inevitable

[Sans Crainte]

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Haha. My services are recognized in the marketplace (i.e, I currently have a job and am respected by the medical team).

I've never referred to myself as doctor. Never have and never will. I despise pharmacists that call themselves doctor. I also do not wear a lab coat.

I'm not knocking the guy in the satellite. In fact, I sometimes work in a satellite when I'm not working on a unit.

As a matter of fact, I'm sitting in a satellite right now, putting my career on the line with every order.

God help those patients that are depending on you tonight.

 

[GoldfishPharmD]

I'm happy you have had so many accomplishments, San Crainte. Good pharmacists pave the way, but I feel like you have nothing but negative things to say about those that are trying to change the career and make others see the value of our profession outside of staffing and retail.

 

[GoldfishPharmD]

I'm not saying how "crappy" residents are. I'm saying that all of you are chasing 5% of the jobs. Your residencies and fellowships prepare you for these esoteric roles of playing junior doctor somewhere. I have seen maybe 10% of new grads who are capable of performing staff functions. The rest are suited for academia. Staff functions scare you to death.

Why shouldn't it be scary for someone coming out of school? That's a lot of responsibility, and I want to make sure the things I do aren't harming patients. I rather have someone that is super careful at first then someone that doesn't know anything jump right into it without a care in the world.

 

[Sans Crainte]

I'm happy you have had so many accomplishments, San Crainte. Good pharmacists pave the way, but I feel like you have nothing but negative things to say about those that are trying to change the career and make others see the value of our profession outside of staffing and retail.

You miss the point. I think that you guys are the best of the best that ever were in pharmacy, talent-wise. Times have changed. Roles have changed. Even physicians are fighting for their lives. I'm telling you, from the perspective of age, which is the ONLY advantage I have over you guys, is that you should diversify. Don't put all of your eggs in one basket. Pharmacy is a redundant, dying profession that is going to morph into something less, not more.

 

[Sans Crainte]

Why shouldn't it be scary for someone coming out of school? That's a lot of responsibility, and I want to make sure the things I do aren't harming patients. I rather have someone that is super careful at first then someone that doesn't know anything jump right into it without a care in the world.

You now how to overcome the fear? Think about the PATIENT and not yourself.

 

[GoldfishPharmD]

You miss the point. I think that you guys are the best of the best that ever were in pharmacy, talent-wise. Times have changed. Roles have changed. Even physicians are fighting for their lives. I'm telling you, from the perspective of age, which is the ONLY advantage I have over you guys, is that you should diversify. Don't put all of your eggs in one basket. Pharmacy is a redundant, dying profession that is going to morph into something less, not more.

Well, that's why many of us are doing a residency. We're trying to make ourselves stand out from the herd. Yeah, maybe getting an MBA or another degree may help as well, but this is another option that some of us are choosing to take. Plus, getting extra degrees = extra money and loans for some people. I, for one, don't have that option at this time.

 

[GoldfishPharmD]

You now how to overcome the fear? Think about the PATIENT and not yourself.

How is that not thinking about the patient? I don't want to make a mistake that can harm someone. That's not for my sake, it's for theirs.

 

[DrWrong]

God help those patients that are depending on you tonight.

This is just an extra shift that I picked up. Not planning to add too much value tonight. Just make sure the physicians don't kills anyone's kidneys.

Also, an MD just called me for dosing recommendations on a trauma patient's digoxin since her level was 0.5. I explained to him that following levels for digoxin are pointless (just some evidence based medicine I know a little about). Patient was still irregular irregular with a HR of 120. Her diltiazem was maxed out and her BP couldn't stand going up on the metoprolol anymore. Given that she was 224 kg, I just recommend that he double her dose of 200 mcg daily. I didn't recommend that he load her since she was hemodynamically stable.

I couldn't find a computer prompt to help me, so I had to do that all on my own =-(. I was scared.

See: Inefficacy of therapeutic serum levels of digoxin in controlling the ventricular rate in atrial fibrillation in the American Journal of Cardiology.


While I was typing this, another MD called to ask about starting Mycamine on a patient because he was concerned about candida glabrata. I explained that 90% of our candida glabrata was still dose-dependent sensitive to fluconazole and that it would be a better alternative since it is cheaper (saving the patient and hospital money). Hope I was right =-/

 

[Sans Crainte]

This. He uses an example of how crappy residents are at staffing, but yet he fails to realize that we just barely graduated. It hasn't even been a full year for the majority of residents. How is a new grad with no residency going to be any different from one that is in a residency?

I will admit, I was super nervous for staffing because there are still things that I need to learn (which is why I'm doing a residency). I'm not comfortable with IVs and drips because we don't really learn that stuff in pharmacy school. It takes experience. I would hope you with your 37 years of experience would outshine a new grad, residency or not...

A person training as a tech, who has never been in a pharmacy, can come in and in 90 days be extremely proficient in making IV's and drips. You have been in school for what, 6 to 8 years and you aren't comfortable making IV's??? It all goes to my point, the schools are preparing you guys for some other profession that doesn't exist. You don't need a residency. You just need to go out and get a job.

 

[Sans Crainte]

This is just an extra shift that I picked up. Not planning to add too much value tonight. Just make sure the physicians don't kills anyone's kidneys.

Also, an MD just called me for dosing recommendations on a trauma patient's digoxin since her level was 0.5. I explained to him that following levels for digoxin are pointless (just some evidence based medicine I know a little about). Patient was still irregular irregular with a HR of 120. Her diltiazem was maxed out and her BP couldn't stand going up on the metoprolol anymore. Given that she was 224 kg, I just recommend that he double her dose of 200 mcg daily. I didn't recommend that he load her since she was hemodynamically stable.

I couldn't find a computer prompt to help me, so I had to do that all on my own =-(. I was scared.

See: Inefficacy of therapeutic serum levels of digoxin in controlling the ventricular rate in atrial fibrillation in the American Journal of Cardiology.


While I was typing this, another MD called to ask about starting Mycamine on a patient because he was concerned about candida glabrata. I explained that 90% of our candida glabrata was still dose-dependent sensitive to fluconazole and that it would be a better alternative since it is cheaper (saving the patient and hospital money). Hope I was right =-/

Admirable. Pat yourself on the back. But all of that will be handled by software programs and apps in no time at all. Not some $60/hr prima donna. And while you were giving all of that advice, who was manning the work-que???

 

[GoldfishPharmD]

Yes, I had 4 years of pharmacy school training. I didn't spend every single day of those 4 years working with IV's. We had one compounding and one parenteral lab. This was over 2 years. If you make something day in and day out, I would hope you're proficient in it. Additionally, not every single pharmacists makes IVs. Sigh, it's kind of pointless to have a discussion with you. You have only this one image of a pharmacist and if a person doesn't fit that image then they are horrible.

 

[Sans Crainte]

How is that not thinking about the patient? I don't want to make a mistake that can harm someone. That's not for my sake, it's for theirs.

You are approaching it DEFENSIVELY. "I don't want to harm a patient". What you are saying, really, is "I don't want to lose my license" and "I don't want to get sued". And when you start your career that way, that is how you practice throughout. So by obsessing on not making a mistake and allowing the work-que to get bigger and bigger and further behind, you neglect many patients and put therapy behind. You don't have the luxury of examining each and every order to your comfort level. The patient needs care NOW. You get paid to be a professional and accept the risk of being a professional. Most of you kids today want to avoid that responsibility. That's a shame because you have so much talent, but so little courage.

 

[Sans Crainte]

Yes, I had 4 years of pharmacy school training. I didn't spend every single day of those 4 years working with IV's. We had one compounding and one parenteral lab. This was over 2 years. If you make something day in and day out, I would hope you're proficient in it. Additionally, not every single pharmacists makes IVs. Sigh, it's kind of pointless to have a discussion with you. You have only this one image of a pharmacist and if a person doesn't fit that image then they are horrible.

No, it is not pointless. My point is that the schools have let you kids down. You should be polished and confident when you graduate.

 

[Sans Crainte]

Yes, I had 4 years of pharmacy school training. I didn't spend every single day of those 4 years working with IV's. We had one compounding and one parenteral lab. This was over 2 years. If you make something day in and day out, I would hope you're proficient in it. Additionally, not every single pharmacists makes IVs. Sigh, it's kind of pointless to have a discussion with you. You have only this one image of a pharmacist and if a person doesn't fit that image then they are horrible.

Goldfish...you are going to be fine...this is a scary time for you...I understand that...

 

[GoldfishPharmD]

What student in any profession is confident and polished? Teachers, medical students, physician's assistants, nurses, etc. The majority of each of those professions come out with some hesitation. That's life.

 

[DrWrong]

Admirable. Pat yourself on the back. But all of that will be handled by software programs and apps in no time at all. Not some $60/hr prima donna. And while you were giving all of that advice, who was manning the work-que???

Would you believe I had to man the work-que also!?!? It was difficult.

To be completely honest with you, I do feel like pharmacy may be a dying profession--we are undervalued. There are a lot of times I get frustrated because I have to call an MD or PA or ARNP to get an order changed. I am a pharmacotherapy specialist. The only hope I have is that one day I have some limited prescriptive authority (other than that given by my P and T committee).

 

[Sans Crainte]

Would you believe I had to man the work-que also!?!? It was difficult.

To be completely honest with you, I do feel like pharmacy may be a dying profession--we are undervalued. There are a lot of times I get frustrated because I have to call an MD or PA or ARNP to get an order changed. I am a pharmacotherapy specialist. The only hope I have is that one day I have some limited prescriptive authority (other than that given by my P and T committee).

Bingo!!! The elephant in the room!!! The role of the pharmacist...WE should be the ones with prescriptive authority. The docs make the diagnosis and hand it off to the pharmacist. We are the medication experts who are not allowed to perform that job. Why? Because the docs are frightened to give it up and they have a much more powerful lobby than pharmacists. That is why we traipse along at their sides on rounds, hoping for a bone here and there.

 

[Sans Crainte]

What student in any profession is confident and polished? Teachers, medical students, physician's assistants, nurses, etc. The majority of each of those professions come out with some hesitation. That's life.

You are wise. Yes, I agree with you. But I know that the educational process was flawed back in 1976. It has really never changed.

 

[DrWrong]

Bingo!!! The elephant in the room!!! The role of the pharmacist...WE should be the ones with prescriptive authority. The docs make the diagnosis and hand it off to the pharmacist. We are the medication experts who are not allowed to perform that job. Why? Because the docs are frightened to give it up and they have a much more powerful lobby than pharmacists. That is why we traipse along at their sides on rounds, hoping for a bone here and there.

Hopefully, by doing residencies that train on a more clinical basis, we will someday be able to do that.

 

[Sans Crainte]

Hopefully, by doing residencies that train on a more clinical basis, we will someday be able to do that.

Who knows? The problem for you young people today, in any profession, is that technology can make any career obsolete overnight. And pharmacy looks to be more vulnerable than most. That is why I would spend the effort and time in a complimentary field, than in a residency or fellowship.

 

[DrWrong]

Who knows? The problem for you young people today, in any profession, is that technology can make any career obsolete overnight. And pharmacy looks to be more vulnerable than most. That is why I would spend the effort and time in a complimentary field, than in a residency or fellowship.

Well, I've already done a residency. If I could do it again I would have gone to PA school after Rx school. Now I can only push for and hope for more prescriptive authority by showing what I am able to do. We need people to advance the practice, and that means completing residency training.

I agree with your point whole-heartedly, but for some people it may not be an option and they may want to do Rx school/residency because it's what they truly want to do.

 

[Sans Crainte]

Well, I don' know you, but good luck. You have a lot of talent and a good idea of where you want to go. Individuals, like yourself, may be able to carve out a niche. But that still leaves the 99% scrambling when the doors cave in. Don't be blind to other opportunities.

 

[rxlea]

There is always grad school 😀

 

[Sans Crainte]

There is always grad school 😀

For sure...you can build on your pharmacy degree in a complimentary field...use your imagination

 

[OSU2017]

For sure...you can build on your pharmacy degree in a complimentary field...use your imagination

Which is best? Going into industry and doing marketing? Or managed care and doing something like that?

 

[rxlea]

For sure...you can build on your pharmacy degree in a complimentary field...use your imagination

Already on my way.

 

[rxlea]

Which is best? Going into industry and doing marketing? Or managed care and doing something like that?

Industry is certainly an option, even with a PharmD.

Managed care is another option..

Then there is health administration, government, consulting, academia, clinical research, and much more.

You have to be strategic with what degree you pursue though. It seems like many pharmacy students are starting to jump onto the dual degree band wagon but I've seen mostly MPH or MBA.

I'd say you would be somewhat more competitive. If you wanted to eventually be a DOP at a hospital, a graduate degree is pretty much essential.

 

[Sans Crainte]

Which is best? Going into industry and doing marketing? Or managed care and doing something like that?

Data mining is the newest craze and it looks like it has saying power. With your pharmacy background you can go into marketing, website develpoment, govenment agencies, insurance...you're only limited by your imagination. Go on Coursera and sign up for a free course related to data mining to get your feet wet...network on the forums for career ideas...its free and its great

 

[OSU2017]

Data mining is the newest craze and it looks like it has saying power. With your pharmacy background you can go into marketing, website develpoment, govenment agencies, insurance...you're only limited by your imagination. Go on Coursera and sign up for a free course related to data mining to get your feet wet...network on the forums for career ideas...its free and its great

Thanks. What kind of work can a pharmacist with data mining abilities do with website development?

What do you think of careers in the pharmaceutical industry or managed care?

 

[Sans Crainte]

Well, that would be as wide as your imagination. Look at a sight like WebMD and try to imagine who visits the site, their demographic profile and how to mine the data that might help to bring in ad revenue...or help you sell the data to other industries...once again, data mining coupled with your pharmacy background would make you gold for both pharmaceuticals and managed care...this is the "information age" after all...

 

[desklamp]

I'm not "bashing" anyone for doing a residency. I'm telling you that your time would be better spent specializing in statistics and data mining. A residency doesn't make you any more competitive. You'll likely get a job from "who you know", rather than "what you know". But only the wisdom of age can tell you that. Right now you are gulping the kool-aid and don't want to hear the truth. If all of you new grads are doing residencies then how are any of you different? So that is where the fellowship comes in, I guess? And you know what else, the residency and the fellowship only makes you a worse staff pharmacist because you analyze everything instead of developing the skills needed to get the job done. You need to develop problem-solving skills to be a good staff pharmacist. Of course, none of you want to be staff. You want to head up the "drug-information" program somewhere. Here's a cold dip in the pool; as the pressure mounts for hospitals to cut costs, a pharmacist's salary sticks out like a sore thumb. We've over-priced ourselves. There is no cost-effective role for us, even as a lowly staff pharmacist, let alone in some made-up role the schools will have you believe is waiting for you. I could run a 200 bed hospital with one pharmacist on each shift. Technicians, armed with technology, can do just about everything that needs done. And out side of the department, where all of you clinical folks hope to make a differenc, it is even worse. There are so many others who can do our job for much less. Technology can replace the physician these days. What hope is there for a Pharm D even with a fellowship? I'm telling you guys the truth. There is no role for you. So trudge down to Walgreens and get a job before someone writes an app and 20,00o pharmacists lose their jobs. And forget that dream "role" they told you about in school. It doesn't exist. Hell, they told us the same stuff back in 1976.

See the thing is, none of us who do residencies actually want to be the pharmacist sitting there verifying orders. Staffing is boring and 80 different kinds of mindless. Furthermore, were you all sorts of prepared and stellar staff pharmacist when YOU first came out of school? Cut these residents some slack.

The push is to try and become a part of the health care team, rounding with physicians, answering drug information questions, dosing questions, etc. Being more involved with patient care and not sitting at a computer clicking 100 times a minute. I just don't really know how to respond to you because you make some good points about cost effectiveness of pharmacists and then you go on to say something completely biased and extreme. Like "technology can replace physicians these days." What? Because some computers can diagnose some diseases? Still not going to happen anytime soon.

 

[rxstudent204]

Okay, I have to chime in now. Sans, you actually make a lot of good points. I don't like that pharmacy schools continue to push people towards residency and then there's the laughable notion that some day all pharmacists will have to do a residency (nice try, ASHP!). It bothers me that people sign up to do residency because they think they "should". I think it's ridiculous that entry level pharmacist positions are starting to require PGY1 and yet here I am doing a PGY1. The difference is I'm doing it because I truly want the experience.

I think new graduates are scared of hospital pharmacy and part of that is the fault of the schools. I worked 24-32 hours a week in an inpatient hospital pharmacy from the year before I started all the way through pharm school and I would say that MOST of my learning came from my experiences there and taking initiative to practice at the top of my intern license (from a state that allows interns to do a lot). You're not wrong, most of my classmates would be scared to check an IV product but you gotta give them some time.


I really didn't pick up from your comments that you are against residencies, I think people on this thread who are being defensive about doing residencies probably have a little insecurity about their decision to get so defensive. I do take issue with your claims that everything we do could be done by a doctor, NP, PA, RN and a computer. Yeah, sure an RN, a DR, etc could see a patient is taking PO meds and probably doesn't need IV cipro anymore etc but the main difference between pharmacists and those practitioners is they don't CARE about med issues. I'm not saying they don't care about the patient, of course they care about the patient, but they are focusing on a lot of other things that have nothing to do with meds. We are the ones who are looking at those meds and comparing them to what is supposed to be ordered, their labs, etc. My hospital is now using electronic progress notes and the practitioners basically cut and copy every day and there are frequently discrepancies between what is in the note and what the patient is actually receiving. Yeah maybe this is an issue at my hospital but it's just an example that a lot of times the docs just don't look (same with NPs and PAs) because it's not the focus of their assessment. I guess I haven't encountered a computer system that is able to replace human judgment and or is able to compare discrepancies between what is written and what is ordered so maybe you have worked with more advanced systems than I have. And yeah, docs should notice a lot of the stuff we do but guess what, they DON'T!

Anyway, just my two cents. This thread has been entertaining.

 

[Sans Crainte]

Okay, I have to chime in now. Sans, you actually make a lot of good points. I don't like that pharmacy schools continue to push people towards residency and then there's the laughable notion that some day all pharmacists will have to do a residency (nice try, ASHP!). It bothers me that people sign up to do residency because they think they "should". I think it's ridiculous that entry level pharmacist positions are starting to require PGY1 and yet here I am doing a PGY1. The difference is I'm doing it because I truly want the experience.

I think new graduates are scared of hospital pharmacy and part of that is the fault of the schools. I worked 24-32 hours a week in an inpatient hospital pharmacy from the year before I started all the way through pharm school and I would say that MOST of my learning came from my experiences there and taking initiative to practice at the top of my intern license (from a state that allows interns to do a lot). You're not wrong, most of my classmates would be scared to check an IV product but you gotta give them some time.


I really didn't pick up from your comments that you are against residencies, I think people on this thread who are being defensive about doing residencies probably have a little insecurity about their decision to get so defensive. I do take issue with your claims that everything we do could be done by a doctor, NP, PA, RN and a computer. Yeah, sure an RN, a DR, etc could see a patient is taking PO meds and probably doesn't need IV cipro anymore etc but the main difference between pharmacists and those practitioners is they don't CARE about med issues. I'm not saying they don't care about the patient, of course they care about the patient, but they are focusing on a lot of other things that have nothing to do with meds. We are the ones who are looking at those meds and comparing them to what is supposed to be ordered, their labs, etc. My hospital is now using electronic progress notes and the practitioners basically cut and copy every day and there are frequently discrepancies between what is in the note and what the patient is actually receiving. Yeah maybe this is an issue at my hospital but it's just an example that a lot of times the docs just don't look (same with NPs and PAs) because it's not the focus of their assessment. I guess I haven't encountered a computer system that is able to replace human judgment and or is able to compare discrepancies between what is written and what is ordered so maybe you have worked with more advanced systems than I have. And yeah, docs should notice a lot of the stuff we do but guess what, they DON'T!

Anyway, just my two cents. This thread has been entertaining.

Wonderful comment. You get "it". To clarify, I think that our profession has really never had a place to call its own. We are neither fish nor fowl, doctor nor nurse. We try to 'encroach' on the territory inhabited by other professionals. My opinion is that pharmacy is very, very vulnerable to overnight extinction. Someone writes an app and 80% of pharmacists can be obsolete. Plus there is an incentive for that to happen; cost containment. Our salary limits our effectiveness. I will say it again; the current class of students is the best of the best that this profession has ever seen. There is a role that matches your training and expertise for maybe 5% of you, at most. The other 95% are chasing their tails. Diversify and pursue a complimentary area of study; don't double-down with and residency or fellowship.

 

[StellargalS]

Bingo!!! The elephant in the room!!! The role of the pharmacist...WE should be the ones with prescriptive authority. The docs make the diagnosis and hand it off to the pharmacist. We are the medication experts who are not allowed to perform that job. Why? Because the docs are frightened to give it up and they have a much more powerful lobby than pharmacists. That is why we traipse along at their sides on rounds, hoping for a bone here and there.

You guys the OP shoots from the hip i.e. tells it like it is largely due to her chronology. I believe her motive is to get your attention. Consider the following snip it from the AMA publication How to make your voice heard in congress.

Be a “Very Influential Physician”
​

The AMA has developed a program to help physicians take on a
leadership role in grassroots activities on behalf of organized medicine.
Our Very Influential Physicians (VIP) program helps physicians learn how
to create, maintain, and effectively leverage relationships with members
of Congress and their staff in order to advance our shared agenda on
Capitol Hill.


Look at this attached historical PDF from 1974. It is less than 3 pages. It is a forty year old echo. Our leadership and representation is the problem.

 

[Sans Crainte]

Hub

See the thing is, none of us who do residencies actually want to be the pharmacist sitting there verifying orders. Staffing is boring and 80 different kinds of mindless. Furthermore, were you all sorts of prepared and stellar staff pharmacist when YOU first came out of school? Cut these residents some slack.

The push is to try and become a part of the health care team, rounding with physicians, answering drug information questions, dosing questions, etc. Being more involved with patient care and not sitting at a computer clicking 100 times a minute. I just don't really know how to respond to you because you make some good points about cost effectiveness of pharmacists and then you go on to say something completely biased and extreme. Like "technology can replace physicians these days." What? Because some computers can diagnose some diseases? Still not going to happen anytime soon.

Oh, you are just the audience my post was intended to ferret-out! Exactly. You find working the que, boring!!! You want to play doctor, just like the schools are mapping out for you. You don't realize that working the que is not boring if you apply your skills to helping the patient. You don't want to work the que because that is where the risk is. Make a mistake and there goes your career. Working the que means you have to make a decision and quickly or someone may die. No, working the que is not boring, just scary. You are deluding yourself to think that pharmacy's role is going to expand. Everyone out there is trying to protect their territory, from doctors to nurses to respiratory therapists. Pharmacy has been trying to expand our role since I graduated in 1976. It hasn't happened up to now and it for sure won't happen now. Technology and the marketplace have made pharmacy vulnerable to overnight extinction. Add to that the glut of pharmacists and you'll be begging for a job verifying orders. Or else you'll end up seating people at the Cheesecake Factory!

 

[Sans Crainte]

You guys the OP shoots from the hip i.e. tells it like it is largely due to her chronology. I believe her motive is to get your attention. Consider the following snip it from the AMA publication How to make your voice heard in congress.

Be a “Very Influential Physician”
​

The AMA has developed a program to help physicians take on a
leadership role in grassroots activities on behalf of organized medicine.
Our Very Influential Physicians (VIP) program helps physicians learn how
to create, maintain, and effectively leverage relationships with members
of Congress and their staff in order to advance our shared agenda on
Capitol Hill.


Look at this attached historical PDF from 1974. It is less than 3 pages. It is a forty year old echo. Our leadership and representation is the problem.

Does pharmacy have anything even approaching the power of the AMA? Not even close. Which makes my advice on canning the fellowship and the residency in favor of grad school or a complementary degree more valid. The AMA limits the scope of pharmacy practice. And very effectively. The promises from the colleges of an expanded role have been that since 1976. Calling the new base degree a "Doctor" of pharmacy further enrages the MD's and does nothing to help. It was a very, very poor choice for the new base degree. You guys are chasing a dream that for 99% of you isn't gong to happen. Get back to school or get a job. It is already too late. I tell you this as if you were my own kids.

 

[fauxden]

I think this guy seems cool.

 

[OSU2017]

Would jobs such as a "PHARMACY BENEFITS CONSULTANT" be a viable option to retail?

Here is a job I found: https://mmc.taleo.net/careersection/2/jobdetail.ftl?job=754920

 

[Sans Crainte]

I think this guy seems cool.

I don't know if a 60 year old can be "cool", but thanks. I've done and seen quite a lot in pharmacy. Been closely associated with the colleges and been a preceptor to many, many of you. I'm just alarmed at where things seem to be going and you kids getting sold a bill of goods. Nothing wrong with a residency or fellowship if you have the money and the time. Just be very realistic about where you will end up and in how much debt. With the current glut that is only going to get worse, and maybe quickly, people who are selective now in their preferences of their dream job might have to settle on anything with a paycheck. And with the glut, that paycheck is going to get smaller, quickly. Go to grad school or go get a job and make some money so you will be in position for a new career, should the worst happen.

 

[Sans Crainte]

Would jobs such as a "PHARMACY BENEFITS CONSULTANT" be a viable option to retail?

Here is a job I found: https://mmc.taleo.net/careersection/2/jobdetail.ftl?job=754920

Now you're talking! Great choice. And if you can perform data analysis, you're gold.

 

[Sans Crainte]

Here's a suggestion that might seem radical, but in light of modest projections of 20% of you not having jobs after graduation for the foreseeable future,is not radical at all. The colleges want you guys to extend your "training" period with residencies and fellowships because they don't want you to find out that there are no jobs. Especially the "clinical" dream jobs or jobs in academia. You guys need to organize on every campus (easy with Twitter, Facebook and social media) and form "Occupy Schools of Pharmacy" and have your own version of an "Arab Spring". You should demand that the schools of pharmacy reduce their next freshman classes by 20%, from 2013 levels, and maintain that level for at least 10 years. You should also demand that schools of pharmacy should all contribute to a fund that will contribute 50% to lower each student's loan obligation after graduation. The schools caused this glut by overbuilding; charged outrageous tuition; and over-promised on the role of pharmacy in the current health care environment. You kids need to be your own advocates or you're going to be out in the cold. Use "Occupy" to bring attention to this fiasco; demand government hearings on the subject. It may spur others in other fields, such as law, to do the same.

 

[Sans Crainte]

You sign up on Friday, make one thread that merely bashes the profession you have spent such a "valiant, dedicated, and clinically based" career practicing in, and then throw out a bunch of words such as "hubris," and each time tell everyone to look it up, automatically insulting the intelligence of every person in this generation that you supposedly "have so much respect for their knowledge. The fact that anyone gives you the time of day is utterly shocking. In a day and age where pharmacy is evolving and people need to find new niche corners of practice to establish themselves in to keep the profession alive, someone like you who insults every deviation from the typical staff pharmacist is exactly what has been holding pharmacy back for so many years. When my medical team asks for a dose of a medication used off label in a rare disease and the clinical pharmacist knows off the top of their head the ONE case report that exists, that is knowledge. The typical staff pharmacist would have smoke coming out of their ears or have their managers on speed dial for a question of that nature. Live and let live. Do your dream job and let others chase theirs. Don't **** on others to make yourself feel good. You're an embarrassment to the profession, and I hope you realize that before you become an embarrassment to yourself.

This statement speaks volumes about ignoring the reality of today's information age and the abundant technology, changing daily; "When my medical team asks for a dose of a medication used off label in a rare disease and the clinical pharmacist knows off the top of their head the ONE case report that exists, that is knowledge." No doubt that is knowledge, but Google could bring up thousands of cases, in an instant. In most of my career, in the stone age of books and periodicals, a clinician was valuable. he researched all of this stuff. Today, the doc with an IPad has everything and more at his fingertips. Quit being a "techo-denier". You know better than that.

 

[Sans Crainte]

Here's a question for those of you who like to perform research: Liability insurance rates. You know how the rates are based on occupation and the scope of practice of that occupation? For example, the scope of practice of a Medical Doctor has more liability than that of a Nurse Practitioner. That being said; are liability insurance rates different for a pharmacist with a 4-year BS, a 5-year BS, a Pharm D, a PharmD with a residency or a Pharm D with a residency AND a fellowship? Do the insurers view the scope of practice differently for each group or do they base their rates on being a Registered Pharmacist only? For everyone. Because, if the residency and fellowship increase the scope of practice, as many of you seem to feel, you would think the cost of your liability insurance would be much higher than those without them. I think this would make an interesting research assignment.

 

[confettiflyer]

I just worked with a resident who had to work today as staff. he tiptoed around everything, as if the keyboard had manure on the keys. He was not equipped to enter the most simple order. He could round with docs, but he can't proved patient care.

That's a trainable deficiency, though. I'll take the aptitude over sheer order entry ability any day.

 

[Sans Crainte]

That's a trainable deficiency, though. I'll take the aptitude over sheer order entry ability any day.

No, you miss the point. That is not a "trainable deficiency". It is a common character trait of the current group of grads. Neither the residency, nor the fellowship, instills a sense of what the actual job entails. It is also a character trait of millenials, in general. It is not about the job or the patient; it is about THEM. I'm not going to push "verify" until I am absolutely sure I've studied all of the angles. After all, I may lose my license over this. They don't realize that no one has the luxury of "analyzing" everything to their comfort level. Many patients depend on them being able to perform tasks in a timely fashion. That requires not only self-confidence, which you think after all of this schooling they would have in abundance, but also putting the patient before self. It isn't a trait that goes away with time and training. It is maintained throughout the career. The residency and fellowship just delays the inevitable of having to actually perform the job. Not the job of drug info specialist, or rounding, not the actual job of being a pharmacist. No, the schools of pharmacy have prepared the new grads for a role that is nowhere in site for 95% of them. They are not prepared to get down and dirty, saving lives with split-second decisions. It is not their make-up. They don't want that risk.

 

[rxlea]

No, you miss the point. That is not a "trainable deficiency". It is a common character trait of the current group of grads. Neither the residency, nor the fellowship, instills a sense of what the actual job entails. It is also a character trait of millenials, in general. It is not about the job or the patient; it is about THEM. I'm not going to push "verify" until I am absolutely sure I've studied all of the angles. After all, I may lose my license over this. They don't realize that no one has the luxury of "analyzing" everything to their comfort level. Many patients depend on them being able to perform tasks in a timely fashion. That requires not only self-confidence, which you think after all of this schooling they would have in abundance, but also putting the patient before self. It isn't a trait that goes away with time and training. It is maintained throughout the career. The residency and fellowship just delays the inevitable of having to actually perform the job. Not the job of drug info specialist, or rounding, not the actual job of being a pharmacist. No, the schools of pharmacy have prepared the new grads for a role that is nowhere in site for 95% of them. They are not prepared to get down and dirty, saving lives with split-second decisions. It is not their make-up. They don't want that risk.

I'm genuinely curious what your evidence is to make such sweeping statements aside from your experience at your site.

I'm also assuming you are referring to only hospital pharmacy???

I think rotations and internships do a decent job of preparing students for community practice for sure.

The difficulty with hospitals is that there is so much variation in terms of protocols, "how things are done here", the EMR, workflow, what's kept in pyxis, what's prepared in batches, the formulary, and many other things. It's a lot to adjust to and residents who staff a couple times a month are going to take a while to acclimate.

On my current rotation, I can see that the pharmacists are greatly appreciated. Just today during case conference, a surgeon told the entire room how great the pharmacists are and that he trusts their judgment (we were discussing some mishaps with a case). Granted, we are a teaching hospital.

I certainly see your point that schools prepare students for the 5-10% of pharmacists' roles. On the other hand, don't you think that the culture of health care has changed such that pharmacists are moving into more integral roles (ie more utilized)? Overall, we're moving toward a more interdisciplinary approach. I don't think that preparing students for this change, and future changes, is a bad thing.

Not all students are arrogant millenials either.

 

[Sans Crainte]

Well, I understand your skepticism about my experience in the profession and "generalizing" about characteristics. Millenials, in my opinion, are the best group we have produced in my 60 years existing in this country. You are much less biased and more open-minded and very, very talented. That, in turn, will lead to a better society. But, in my opinion, generally speaking, millenials have certain traits that makes them view their role as an employee different than maybe their employer has in mind. I heard a recruiter speak about how we, as parents, tried to make every one of you, winners...everybody got a trophy in soccer, in baseball, etc. We thought you were special and we achieved the goal of making you think you were special and should be treated as such, in every endeavor. You were rarely held accountable. We, your parents, excused failure.
As for the topic at hand. Yes pharmacy is appreciated. But we have ALWAYS been a part of the interdisciplinary team; and we never had to leave the pharmacy to be a part of that team. Rounding is fine. Going on codes is fine. Discussing best practices is fine. But actually working a shift, in the department, is no insult to your considerable skills. You can actually help the most patients and staff that way. But, in general again, you avoid that role. I don't think it is because you find it boring. I think it frightens you to be held accountable; to have to make a decision and attach your name to it. In essence, to be a professional. I may be generalizing, but in the perch I occupy, there is truth in what I say.
Lastly, no, I do not see our role expanding. They told me in 1976 to expect our role to increase. That is the point of this thread. Even with the residencies and fellowships, our profession has reached a tipping point.

 

[Sans Crainte]

Why aren't any of you addressing post # 94?

 

[Sans Crainte]

What about post # 92?

 

[Sans Crainte]

I'm genuinely curious what your evidence is to make such sweeping statements aside from your experience at your site.

I'm also assuming you are referring to only hospital pharmacy???

I think rotations and internships do a decent job of preparing students for community practice for sure.

The difficulty with hospitals is that there is so much variation in terms of protocols, "how things are done here", the EMR, workflow, what's kept in pyxis, what's prepared in batches, the formulary, and many other things. It's a lot to adjust to and residents who staff a couple times a month are going to take a while to acclimate.

On my current rotation, I can see that the pharmacists are greatly appreciated. Just today during case conference, a surgeon told the entire room how great the pharmacists are and that he trusts their judgment (we were discussing some mishaps with a case). Granted, we are a teaching hospital.

I certainly see your point that schools prepare students for the 5-10% of pharmacists' roles. On the other hand, don't you think that the culture of health care has changed such that pharmacists are moving into more integral roles (ie more utilized)? Overall, we're moving toward a more interdisciplinary approach. I don't think that preparing students for this change, and future changes, is a bad thing.

Not all students are arrogant millenials either.

Well, I understand your skepticism about my experience in the profession and "generalizing" about characteristics. Millenials, in my opinion, are the best group we have produced in my 60 years existing in this country. You are much less biased and more open-minded and very, very talented. That, in turn, will lead to a better society. But, in my opinion, generally speaking, millenials have certain traits that makes them view their role as an employee different than maybe their employer has in mind. I heard a recruiter speak about how we, as parents, tried to make every one of you, winners...everybody got a trophy in soccer, in baseball, etc. We thought you were special and we achieved the goal of making you think you were special and should be treated as such, in every endeavor. You were rarely held accountable. We, your parents, excused failure.
As for the topic at hand. Yes pharmacy is appreciated. But we have ALWAYS been a part of the interdisciplinary team; and we never had to leave the pharmacy to be a part of that team. Rounding is fine. Going on codes is fine. Discussing best practices is fine. But actually working a shift, in the department, is no insult to your considerable skills. You can actually help the most patients and staff that way. But, in general again, you avoid that role. I don't think it is because you find it boring. I think it frightens you to be held accountable; to have to make a decision and attach your name to it. In essence, to be a professional. I may be generalizing, but in the perch I occupy, there is truth in what I say.
Lastly, no, I do not see our role expanding. They told me in 1976 to expect our role to increase. That is the point of this thread. Even with the residencies and fellowships, our profession has reached a tipping point.