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I just noticed, we made page 6...not too bad
Fellowships and Residencies delay the inevitable
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Yup. I have a lot to learn, and I'm thankful to be learning from great people that want to promote and advance the profession instead of someone that is obviously crotchety and bitter for whatever reason, so I'll leave you to it! 🙂
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Since you can figure out my "bitter" motivation so well from these posts, maybe you have a future as a psychologist?? Oh fishy, read the posts again...I actually feel bad for you guys...my career is about done...it was very good, but I approached it realistically...I started this post because you guys need to hear from the real world...I said it before and I'll say it one last time....you guys are the best of the best that ever was in the profession...you just got in at the wrong time....don't rationalize about my motivation...it is only to open your eyes to the truth....
Sans you're still dodging my question. Why didn't your generation accomplish anything but merely holding the profession together if you were all overeducated? Why has the profession not evolved into the direction it's been wanting to for the past 40 years? Why isn't there a national organization that can do something? Why was a nurse practitioner created before a pharmacy practitioner?
Why didn't your generation organize and not allow the profession to be destroyed 15-25 years before it's time?
Why didn't your generation organize and not allow the profession to be destroyed 15-25 years before it's time?
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Didn't do a residency (though not by choice). Got a job in a hospital in rural America and am having a hard time trying to decide where I want to go next with my career…
I have a hard time not thinking of myself as a lesser pharmacist now because I'm just a staff pharmacist and have no special training, though no one in in this hospital is PGY-anything.
Honestly I can see both sides of the debate here. Interesting thread.
I didnt do a residency (by choice). I have spent my days since graduation listening to educational podcasts, reading articles, making notes for myself and generally trying to learn as much as I can.
My plan for survival without a PGY is to pay off my student loans in < 10 years and to continue to keep up the learning to stay relevant. BCPS is on my radar as well.
My plan for survival without a PGY is to pay off my student loans in < 10 years and to continue to keep up the learning to stay relevant. BCPS is on my radar as well.
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We have not cut staff but what we have done is take on more responsibilities with the same staff. Will we add more pharmacists with the increased workload? Probably not. But we might expand our residency program...
We have had pharmacy schools contact us about placing their instructors at our hospital to provide "clinical services" but so far administration hasn't pursued this. Probably because the schools haven't managed to get above our director yet. I imagine that administration would be very excited about free clinical pharmacy services. What is crazy about this is that the closest pharmacy school is about 2 1/2 hours away. Obviously, none of us want someone to come in and take over our clinical responsibilities leaving us only with dispensing. Not that there is anything wrong with dispensing but most of us are rather happy having a position that allows for both.
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Funny, the jobs that were cut at our institution were all non-clinical roles.... I can do my clinical work and the dispensing roles as well. But I have a unicorn job and don't do much dispensing these days.
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As I wade into this discussion(now 6 pages in length), I am wary of individuals misconstruing the underlying points by quoting only select lines. It is an interesting time in healthcare, to say the least. I am fortunate to have witnessed a number of changes to the practice of pharmacy over the past 13 years (as a tech and now as a pharmacist). The original post questioned the need for residency as an integral part of the education process for a profession that has helped institutions and retail develop technology to review an ever increasing wealth of data related to ADEs (drug-drug, drug-lab, drug-food, and now, even drug-genome). The degree shifted from a BS to a BS or PharmD to a PharmD only profession, with both state and federal oversight equating all pharmacists as equal members of the healthcare team. Additional credentialing was developed, probably with a goal of creating a hierarchy, similar to medicine (Family Practice vs. Neurosurgeon) in order to suppress any questions related to relevancy of pharmacy at the table.
Fast forward to 2013, >105 schools of pharmacy exist and are on pace to graduate 16,000 pharmacists with Doctorate level degrees into a marketplace that has never fully recovered from an economic crisis that began in the mid 2000's. Last year, as noted earlier, ~64% of people who completed the application process actually matched to residency positions. The rest joined a large group of applicants searching for positions in various pharmacy practice venues. To be fair, I am a non-traditional example, I am married and have two children. I applied to the Match, but knowing the odds, I applied for jobs as well and had offer(s) written contingent on the Match results. Having worked in both community and institution (independent & chain, large and rural hospital), I can say that experience matters--regardless of how it is earned.
That said, the marketplace has shifted and adopted the additional skills when looking for new labor to replace the occasional retiring pharmacist who has worked with the company for 30+ years. Most applications now utilize the ominous "technology" that utilizes key phrases in order to disqualify as many applicants as possible. Relationships can overcome some of that, so networking continues to be important. But the truth of the matter is, to stay competitive as a young graduate, hospitals have adopted the ASHP 2015 initiative and the PPMI models that stress completion of a post graduate indentured service for any institution-based position. Can someone earn BCPS without it? Yes. But that window is closing, as clearly demonstrated by the change regarding Amb Care certification. Can someone find examples where people are hired without a year of residency? Yes. But those examples often exist in rural or outlying areas of the country where market forces aren't as strong.
Technology will continue to enhance everything that is done in healthcare. CPOE is a great example--formulary mgmt, drug-drug interactions and auto-adj can be executed through data strings. A cautionary tale of total reliance on those algorithms, someone must constantly be watching/verifying that the equation executed properly, or that the correct drug was selected initially. No physician can keep up with 5000+ drugs and all of their caveats, nor can any pharmacist. But a pharmacist, by owning that unique portion of care that is bestowed on 80% of patients in the United States can be the double check to prevent the ADE, ensure that the institution follows the evidence based medication and gets the proper reimbursement from the payor. I can tell you that NO company/hospital/etc is immune to the effects of the changes in healthcare. My current employer, a four hospital health system, experienced a size-able reduction in force, including EIGHT FTE at a single facility, many of whom were highly qualified practitioners.
Techs can make or break a department as easily as a patient who crashes and needs a pharmacist to work up a TPN, aminoglycoside and perform a home med rec, all while triaging an aging Pyxis machine. But techs cannot should the burden of the liability that is associated with decisions surrounding healthcare. A pharmacist who oversees tech work should be able to perform all aspects of their job if they are going to sign their name (and License) verifying the accuracy. Consider the pharmacist who sits in jail after verifying and dispensing the wrong dose of chemo, ordered by a physician, inputted through a computer decision system and then mixed incorrectly by a technician. Just as you would not have a legal aid represent you in a court case, a technician should be held responsible for counseling, and reviewing drug interactions of medications.
As far as billing is concerned, most states do not yet recognize pharmacists (regardless of degree earned) as providers who can bill for cognitive services. This is changing, as evidenced by California, New Mexico, North Carolina and in limited scopes, several Western states with limited access to physicians. As a profession, we must recognize that not everyone has the same goals for the practice of pharmacy and that the skills of our colleagues are just as important as our own. The studies that have been performed regarding pharmacist interventions show that patient care offered by a team (ie physician, pharmacist, nurse, etc) afford the patient the best outcome. Often, the pharmacist is highlighted because intensive, repeat disease and medication education is needed in order to improve the outcome (ie achieve goal BP/A1C/Cholesterol/INR). These additional rights are not afforded to everyone, just as a fresh MD is not afforded a prescription pad immediately upon graduation. Each state has rules and regulations regarding advanced practice pharmacy, but in each case the pharmacist, if the regulations are met, is allowed to bill for cognitive services (not just MTM or anticoag) to private third parties, as well as Medicaid patients. As an aside, nothing prohibits any pharmacist(or pharmacist group) from approaching a private third party payor (like Blue Cross/Blue Shield) and developing a contract for services provided in a clinic setting. Many states include pharmacists in the definition of healthcare provider.
Finally, education (as an industry) has taken advantage of anyone deemed to have high earning potential and has siphoned off capital in the form of tuition in order to create beautiful buildings, update infrastructure, fund executive salaries at the expense of the student who wishes to pursue an advanced degree. Tuition dollars are easily captured and considered revenue because of an extraordinary low default rate and fairly reasonable repayment terms. New England Journal of Medicine recently published an article that reviewed ROI for students entering into health-related fields comparing salaries vs. tuition spend. But we have chosen this as a profession, one that I am proud to represent each day as a go and perform a variety of tasks-- both staff and clinical in nature.
As much as others may be pragmatists, I am optimistic that pharmacy is both needed and necessary in order to provide appropriate care. Looking outside of the United States, pharmacists are integral in their provision medical services and perhaps we as an industry are just a little slow to evolve. The challenge is to be creative in how you practice moving forward into the next decade. Healthcare represents a HUGE spend as a part of our nation's economic drivers, and so it has a big bullseye since the population continues to age and require additional services. Get additional credentials that you can utilize to bill. Learn how to perform as a staffer and gain insight from practitioners who have been in that seat longer than many of us have been alive. It is over a lifetime that one develops wisdom and experience. Some experiences are less likely to be experienced outside of an educational environment, like a residency, but are not precluded from ever happening. YouTube is one of my greatest allies in terms of unique procedures or knowledge gaps with regard to medicine. 🙂 It is time for us to stand up and set aside our emotion, be proud of our profession and offer the knowledge (and the experience) that each of us possess in order to treat the real problem--the illness.
Fast forward to 2013, >105 schools of pharmacy exist and are on pace to graduate 16,000 pharmacists with Doctorate level degrees into a marketplace that has never fully recovered from an economic crisis that began in the mid 2000's. Last year, as noted earlier, ~64% of people who completed the application process actually matched to residency positions. The rest joined a large group of applicants searching for positions in various pharmacy practice venues. To be fair, I am a non-traditional example, I am married and have two children. I applied to the Match, but knowing the odds, I applied for jobs as well and had offer(s) written contingent on the Match results. Having worked in both community and institution (independent & chain, large and rural hospital), I can say that experience matters--regardless of how it is earned.
That said, the marketplace has shifted and adopted the additional skills when looking for new labor to replace the occasional retiring pharmacist who has worked with the company for 30+ years. Most applications now utilize the ominous "technology" that utilizes key phrases in order to disqualify as many applicants as possible. Relationships can overcome some of that, so networking continues to be important. But the truth of the matter is, to stay competitive as a young graduate, hospitals have adopted the ASHP 2015 initiative and the PPMI models that stress completion of a post graduate indentured service for any institution-based position. Can someone earn BCPS without it? Yes. But that window is closing, as clearly demonstrated by the change regarding Amb Care certification. Can someone find examples where people are hired without a year of residency? Yes. But those examples often exist in rural or outlying areas of the country where market forces aren't as strong.
Technology will continue to enhance everything that is done in healthcare. CPOE is a great example--formulary mgmt, drug-drug interactions and auto-adj can be executed through data strings. A cautionary tale of total reliance on those algorithms, someone must constantly be watching/verifying that the equation executed properly, or that the correct drug was selected initially. No physician can keep up with 5000+ drugs and all of their caveats, nor can any pharmacist. But a pharmacist, by owning that unique portion of care that is bestowed on 80% of patients in the United States can be the double check to prevent the ADE, ensure that the institution follows the evidence based medication and gets the proper reimbursement from the payor. I can tell you that NO company/hospital/etc is immune to the effects of the changes in healthcare. My current employer, a four hospital health system, experienced a size-able reduction in force, including EIGHT FTE at a single facility, many of whom were highly qualified practitioners.
Techs can make or break a department as easily as a patient who crashes and needs a pharmacist to work up a TPN, aminoglycoside and perform a home med rec, all while triaging an aging Pyxis machine. But techs cannot should the burden of the liability that is associated with decisions surrounding healthcare. A pharmacist who oversees tech work should be able to perform all aspects of their job if they are going to sign their name (and License) verifying the accuracy. Consider the pharmacist who sits in jail after verifying and dispensing the wrong dose of chemo, ordered by a physician, inputted through a computer decision system and then mixed incorrectly by a technician. Just as you would not have a legal aid represent you in a court case, a technician should be held responsible for counseling, and reviewing drug interactions of medications.
As far as billing is concerned, most states do not yet recognize pharmacists (regardless of degree earned) as providers who can bill for cognitive services. This is changing, as evidenced by California, New Mexico, North Carolina and in limited scopes, several Western states with limited access to physicians. As a profession, we must recognize that not everyone has the same goals for the practice of pharmacy and that the skills of our colleagues are just as important as our own. The studies that have been performed regarding pharmacist interventions show that patient care offered by a team (ie physician, pharmacist, nurse, etc) afford the patient the best outcome. Often, the pharmacist is highlighted because intensive, repeat disease and medication education is needed in order to improve the outcome (ie achieve goal BP/A1C/Cholesterol/INR). These additional rights are not afforded to everyone, just as a fresh MD is not afforded a prescription pad immediately upon graduation. Each state has rules and regulations regarding advanced practice pharmacy, but in each case the pharmacist, if the regulations are met, is allowed to bill for cognitive services (not just MTM or anticoag) to private third parties, as well as Medicaid patients. As an aside, nothing prohibits any pharmacist(or pharmacist group) from approaching a private third party payor (like Blue Cross/Blue Shield) and developing a contract for services provided in a clinic setting. Many states include pharmacists in the definition of healthcare provider.
Finally, education (as an industry) has taken advantage of anyone deemed to have high earning potential and has siphoned off capital in the form of tuition in order to create beautiful buildings, update infrastructure, fund executive salaries at the expense of the student who wishes to pursue an advanced degree. Tuition dollars are easily captured and considered revenue because of an extraordinary low default rate and fairly reasonable repayment terms. New England Journal of Medicine recently published an article that reviewed ROI for students entering into health-related fields comparing salaries vs. tuition spend. But we have chosen this as a profession, one that I am proud to represent each day as a go and perform a variety of tasks-- both staff and clinical in nature.
As much as others may be pragmatists, I am optimistic that pharmacy is both needed and necessary in order to provide appropriate care. Looking outside of the United States, pharmacists are integral in their provision medical services and perhaps we as an industry are just a little slow to evolve. The challenge is to be creative in how you practice moving forward into the next decade. Healthcare represents a HUGE spend as a part of our nation's economic drivers, and so it has a big bullseye since the population continues to age and require additional services. Get additional credentials that you can utilize to bill. Learn how to perform as a staffer and gain insight from practitioners who have been in that seat longer than many of us have been alive. It is over a lifetime that one develops wisdom and experience. Some experiences are less likely to be experienced outside of an educational environment, like a residency, but are not precluded from ever happening. YouTube is one of my greatest allies in terms of unique procedures or knowledge gaps with regard to medicine. 🙂 It is time for us to stand up and set aside our emotion, be proud of our profession and offer the knowledge (and the experience) that each of us possess in order to treat the real problem--the illness.
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After just coming across this forum filled with the complete spectrum of hopelessly optimistic and vengeful pessimism, I would like to chime in with a few thoughts of my own...
I am all for people going into specialty residencies for extreme niche fields if they truly want to do that. No harm to me. Not spending (postponing) my paycheck, if you get enjoyment out of it, do you. Along with that there are limited jobs in which I would want a specialist handling the medications. Pediatric oncology is the first example I can think of that I would want a highly educated (and experienced) pharmacist verifying that order because I know even PGY1's with a year of general medicine that I wouldn't trust checking something like that. That being said....
My mind is still trying to wrap my head around our industry trying to carve out some new service to bill for on the interventions they provide. I am assuming (I could be wrong, and I'm sure the exception case will say that I am) most of you residents are all about ACO's and PCMH's in which we are seeing reimbursement trends shift from fee for service to outcome based payments. Having said that we the brave pharmacists are trying to stick our hand out in the marketplace and ask for a fee for service in providing interventions for the same system we support being outcomes based. While I don't want the masses to assume that I am against providing these interventions, I must say the economics around this are quite intriguing. So we want our field to transition away from dispensing where there will always be a supply and demand, to a more clinical based focus where the existing providers are only going to get stronger from technological advances thus narrowing the gap for error and need for interventions? Or do we want to open up eligibility and create more interventions that we can bill for to grab our slice of the pie and run up more costs? I urge you all to think about the concept and economics of preventative care. I am all for preventative care because of the morality of service but to say preventative care on chronic conditions saves money is preposterous. You're intervention leads to less heart attacks in a 1 year period, I'm happy you prolonged that person's life. Especially happy if it is my family member. Now what is going to happen to my family member in a year? Have a heart attack? Now you've added on the cost of your intervention, the cost of treatment for the year, cost for a nursing home (jeez talk about serious dough) and the cost of the heart attack (maybe at a marginally cheaper cost). If I could have provided this same intervention with the clinical knowledge that exists (you must have learned it somewhere) and cut the cost of your billed intervention, I'd say that is the best case scenario from an ethical and cost-saving approach.
I do not doubt any of the clinical knowledge all of the residents (and even those that are seeking residency) have. Pharmacy school puts us through hell and I know residency programs that prolong that hell. What I think the OP is referring to is that there is an area of opportunity for someone without a PharmD to wipe out the necessity for an immeasurable amount of the "services" you think are needed. How do you think big chains and even newer organizations (ie OutcomesMTM) target these services for their population. If you think they hire 200 pharmacists to sit behind the curtain and say these people could take omeprazole instead of Aciphex, or this person hasn't filled their lisinopril and their MPR is below X we should call them, or this person filled metformin and wait a second they don't have an ace or an arb we should get on that, than you are INSANE. Big data is here. High powered analytics is here. Compressing what you think to be highly complex clinical decision making into a logistical data mining and SQL query is already going on.
80 20 rule folks, 20% of you are in/looking for/completed residencies and are making 80% of the noise in our profession. Be careful where you lead us.
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Ok, well being a Pharm.D., M.S., fellowship, I wouldn't do crap because I don't have to do the mundane work you do. I don't even work in pharmacy because it is a joke and I make a boat load more money working in industry. So it is simple. I am going to get up in the morning, drink some coffee, log into my company's VPN, work from home and thank my lucky stars that I had the foresight to not work in the crap profession. I do agree with you that the opening of schools destroyed the "profession." Just don't be a punk to make a point.
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I don't even bother paging the physicians for most of my "clinical interventions". I enter the changes myself and document it on the EMR. Haven't got in trouble yet.
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I don't have a residency or fellowship, but I'm not making that drip unless I see a order from the doctor without a diluent, concentration, or dose rate.
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I'm the opposite.
I'll make it myself in the ED or tube it down and wait for an order.
This is a life saving medication: we can do paperwork later.
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I don't have a residency or fellowship, but I'm not making that drip unless I see a order from the doctor without a diluent, concentration, or dose
Meaning you go to the ED to make it or you already work in the ED? We keep Levophed vials, syringes, D5W/NS bags in the crash cart anyway so they shouldn't be calling over for a STAT drip.
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Well, I'm the ED clinical specialist, so if I hear it from a credible source it's a legal order as far as I'm concerned. So if we need it now, I'll make it now. If we have time, I prefer it comes from the IV room, but bag #2 can come from the hood.
But if I'm in a meeting, or staffing, or in the main pharmacy for any reason, I'll send them a norepinephrine bag without a patient label and bill later.
There's a reason why the vials are available on override in the Pyxis. And if they opened the crash cart just for norepinephrine, well they know they would have to deal with my wrath. So that doesn't happen.
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But why is opening a crash cart an issue? Isn't that the reason why it's there? We have Levophed vials in the Pyxis too so that's generally the first step.
Perhaps I should recommend making a stock of 4-5 bags of Levophed and keeping them ready to go in the Pyxis and replacing them as they expire or are used up. What grinds my gears is when the nurse sends over some volunteer who has no clue what's going on or a nursing aide and just tells them to get a Levophed drip, no patient name, no information, nothing.
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I did hear something very similar about millennials too. (how each one of us thinks we are special, etc). Something that I have always gotten in trouble with no matter where I go is wanting to do things my own way (since I believe my way is more efficient).
That's one thing. I hate being stuck in the pharmacy department. What I prefer is to go up to the floor, set up shop at a nursing station and verify from up there (albeit, I have no ability to dispense when I do this. The label prints downstairs and it's up to someone else to fill it and verify it).
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Maybe I'm in a bubble...but isn't this the norm? I've been to...one hospital that was like this (all pharmacists in the pharmacy). We've always maintained the minimal legal/operational staffing required in the central pharmacy and put pharmacists on the floor.
I guess I just view truly centralized pharmacists the way I view paper orders...a quaint throwback to a time that will never return (for good reason!)
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I think progression is pretty variable.
We have paper orders, clinical specialists on specific floors, order entry pharmacists who stay central, and clinical pharmacists who do paperwork in the main pharmacy and then go to the floor to do chart review/write orders.
It's a hybrid.
We've proposed a decentralized staffing model, but frankly there just isn't room on the floors to have a dedicated pharmacist computer on most floors.
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I guess I've just been lucky. We solved some of the "room" issues with laptops and/or rolling computer carts. By virtue of running a lean operation, clinical staff covers dispensing duties while simultaneously completing clinical protocols for several hours usually at the beginning or end of shift.
Guess you're right, it's a hybrid...not pure/demarcated decentralization, but much more advanced than an all central/all paper operation that sparda is talking about.
I've learned that IT will make or break your operations...the poorer the IT support, the more the department has to make up for it with manual/traditional/centralized tasks and duties. I'm spoiled from other places and my current battle is for more IT support/time.
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In my short career I've seen places that run the full gamut.
It makes me laugh that as a student I thought my home institution was Podunk, compared to the hospitals my mother had been an icu RN in.
Now I long to work somewhere that advanced again...
It makes me laugh that as a student I thought my home institution was Podunk, compared to the hospitals my mother had been an icu RN in.
Now I long to work somewhere that advanced again...
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I'm trying to figure out how will a decentralized system work at my hospital. We have 2 pharmacists who work 7am-3pm, 2 pharmacists who are 9am-5pm, one pharmacist from 10am-6pm, and 2 pharmacists who are 3pm-11pm and 2 pharmacists 11pm-7am (3 days a week, otherwise its only 1 pharmacist) on a given normal weekday.
We have one technician from 7am-3pm, 2 from 9am-5pm, one from 3pm-11pm, and no techs overnight.
If I'm decentralized past 6pm, it's gonna be just a pharmacist and a tech downstairs.
We are full CPOE and EMR now. The only paper orders that come in are orders for patient at the nursing home next door. They don't like when I try to escape the pharmacy to the floors. Even when I go on my required monthly floor inspections, once they find out I'm upstairs doing stuff other than inspecting, I get the call to return to the pharmacy.
IT is pretty good at my hospital. I think we have plenty of space for a pharmacist to work on a nursing station upstairs. There's no dedicated pharmacist computer, but I can easily log in to one and start cranking out orders. Only thing is I don't have the apps/charts/excel files that I've saved to my home computer in the pharmacy.
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When do you do your batch fills and TPNs?
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What do you mean by batch fills? Cart fills or like IVs and stuff like that. Those are done in the morning.
The TPN is done in the morning too. Doctor calls the pharmacy (from his office), asks the pharmacist to read the labs for him, recommends what ingredients to put in there and the order is entered. Then that order is transcribed to an external service, I believe we use CAPS and they make the TPN and deliver it to us. We usually do like max of 2-3 TPNs a day.
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Make some of your dayshift pharmacists decentralized based on the needs of the wards (when does each ward order the most meds) while leaving 1 in the IV room and 1 in the central pharmacy to check meds at any given time. Evening and overnight would be centralized. This is what the hospital that I currently work at does.
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I don't think that happens much, except maybe in very large institutions.
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Even at my 1000+ bed hospital where i did my rotations, i don't recall having any decentralized services after 4pm. There were signs up and down all the different ICU's that said for pharmacy assistance, call XXXX.
Or if there was one, it would be like a single pharmacist covering everyone...or a hapless resident with a pager.
What kind of traits are needed to work in industry?
Can someone from managed care get into that field?
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"Pharmacists in managed care divisions of pharmaceutical manufacturers work as account managers, medical science liaisons, pharmacoeconomics, market researchers and drug information specialists. Their expertise also used in areas such as marketing, economics modeling, managed care organization contracting and legislative affairs."
http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=14955
Thank you! Have you seen anyone make the transition from managed care into pharma, or is it on the rarer side?
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Personally, I haven't met anyone that has made that transition from managed care to pharma, but I can't imagine it being rare. Pharma/biotech/medDev companies are very data driven in order to break into markets nowadays, and if you have a strong pharmacecon background and understanding of reimbursement policies, you will be a valuable asset.
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I did my residency in the school of the real world - was great - took a job at a small hospital - became director in a year - got paid 6 figures to learn the inns and outs - unlike a real residency where you do the same thing I did but make 1/3 of the salary.
Now I am in a working supervisor role at a large community hospital, I interview and precept residents and kinda laugh that I got the same place (and very likely a better position in less time) while making more money than the poor saps coming out of school now. I went from new grad to director in a year, then moved to staff pharmacist and the superivsor role 5 years out of school.
Now I am in a working supervisor role at a large community hospital, I interview and precept residents and kinda laugh that I got the same place (and very likely a better position in less time) while making more money than the poor saps coming out of school now. I went from new grad to director in a year, then moved to staff pharmacist and the superivsor role 5 years out of school.
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my point being times have changed and I am thankfull I didn't have to deal with the issues new grads have to deal with today - and I have only been out of school 10 years
and sorry - there are no unicorns! unless it is running a beach bar in the carribbean
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I met lots of unicorns over the last few weeks.
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probably all about perspective - I like my job, but don't love it. I work 40 hours a week - get 7 weeks vacation, get paid well- but would never say it is a unicorn. Everybody is different, I do not live to work, I work to live. Once the door shuts and my time is up, my brain is turned off from all things pharmacy (thats why I am not a director any more). There are people I know who spend their vacation going to conferences, naw, I will spend it on the beach. I find it nearly impossible that there is a job out there (at least in pharmacy in my eyes) that is a unicorn. But other people have different expectations, different loves, different perspectives. And good for them. Just not me and I hate how the vast majority of our profession (don't have the stats) probably falls into retail and traditional hospital positions, yet we sell it as we have all these choices - which a low percentage of us pharmacist will ever end up in a non-traditional role.
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Yes, it's all about your perspective. The unicorns I met are unicorns because they have a different perspective than you do. Again, n=1. Just because you don't believe in unicorns (based on your personal experience and opinions) doesn't mean they don't exist.
But thank you for sharing your perspective.
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I feel my n=1 has more people agree than your n of 1 that we all are searching for a possibility of a unicorn job that most people will never realize. In my conversations with students that pass through our facility I ask them what their career plans are most answer they are going to do a residency "because they have to" not because they want to - obviously in the interview they say a different thing. But this shows that most people don't want to do them.
I am searching for my narwal job.
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I never said we are all searching for unicorn jobs. I'm not sure where I stated that. I don't recall doing so.
What I'm telling you is just because you got to where you are (your "non-unicorn" job) without a residency doesn't mean 1) that other people don't need a residency for a unicorn job (or non-unicorn job for that matter), and 2) that unicorn jobs don't exist.
Further, just because some students say "they have to" do a residency doesn't mean all/most students don't want to. The advantages of residency have been discussed in other threads. You might find interest in those.
What constitutes a unicorn or non-unicorn job has been discussed in other threads as well.
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Also, I always wondered why narwhals have such long horns since they are so tiny compared to other whales. They're pretty ferocious looking!!!
I like the timid Humpbacks.
I like the timid Humpbacks.
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I am more of a manatee guy - they are more my pace. But hey, I am just a n of 1
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Manatees are awesome.
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There are two very extreme sides of the spectrum here:
1. Residencies are useless and most of the "clinical interventions" that a clinical pharmacist makes are 'worthless' (e.g. changing enteric coated aspirin to chewable aspirin)
2. Residency trained clinical pharmacists are the next best thing after sliced bread. Clinical pharmacists will greatly enhanced patient care and save the hospital millions.
The truth likely lies somewhere in the middle of the spectrum between these two extremes. Have I been on rotations at big academic medical centers where residency trained clinical pharmacists don't seem to be doing much and just 'tag along' on rounds? Absolutely. Have I seen residency trained ambulatory care pharmacists make huge improvements in a patient's A1C? You betcha. It all depends on the culture of the institution and the relationships that are formed.
I think we should all agree that we have to be realistic in our assessment, but optimistic enough to move the profession forward. Nevertheless, very interesting thread and a good debate.
1. Residencies are useless and most of the "clinical interventions" that a clinical pharmacist makes are 'worthless' (e.g. changing enteric coated aspirin to chewable aspirin)
2. Residency trained clinical pharmacists are the next best thing after sliced bread. Clinical pharmacists will greatly enhanced patient care and save the hospital millions.
The truth likely lies somewhere in the middle of the spectrum between these two extremes. Have I been on rotations at big academic medical centers where residency trained clinical pharmacists don't seem to be doing much and just 'tag along' on rounds? Absolutely. Have I seen residency trained ambulatory care pharmacists make huge improvements in a patient's A1C? You betcha. It all depends on the culture of the institution and the relationships that are formed.
I think we should all agree that we have to be realistic in our assessment, but optimistic enough to move the profession forward. Nevertheless, very interesting thread and a good debate.
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this hits it spot on - never said they were useless - I love having a resident who can make my job easier, and I enjoy the opportunity to educate them because I think of the most dangerous things out there is a newly licensed health care practioner set loose to wreck havock on the world. I was one of those probably - when you don't know what you don't know - you can kill someone pretty easy.
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Yep. +1
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On one on my interviews, a resident told me how humbling it was during the first few weeks of residency where they just learned staffing.
I think sometimes you can learn the most from staffing. I personally look forward to it.
I agree- you don't know what you don't know until you get there.
