Hospital Staff Pharmacist or PGY1?

[Lost Pharm]

I know times have changed. Hospital positions are getting harder to find. If you were offered a hospital staff position, would you take it over a residency? Most hospitals in my area are requiring a residency just to apply and if you don't have one, they require 5+ experience. What would you do if you were given this choice straight out of school?

(And you have 240k debt)

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[awval999]

Of course I would take the job over residency.

But it would have to be in writing.

 

[confettiflyer]

Take the job, but ensure the place at least pays some lip service to internal training/cross training and promotion.


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[Litha]

Don't pass up a job offer over the chance to apply for a residency (which is not guaranteed you will match!).

 

[mentos]

The job obviously. Doing a residency does not guarantee you a job so what's the point?

 

[sakigt]

Take the job. Self study. Listen to podcasts. Take the BCPS. Take the extra clinical work. Go to codes. Be a badass.

 

[radio frequency]

Job for sure. A job is paid and will give you experience. Parlay that experience into something greater through self study. You can likely go back and do a residency in the future if you take the job, but a residency won't always lead to a job. One of my very best preceptors was turned down for residency programs...after years of self study they are BCPS certified, just like many of those who did a residency.

 

[gwarm01]

People are doing residencies to qualify for staffing jobs, so if you get the opportunity why not take it?

Take the job, but ensure the place at least pays some lip service to internal training/cross training and promotion.


Sent from my iPhone using SDN mobile app

Yeah that's an important thing to consider. When we got a new director the unwritten rules on promotion changed. The new guy had more credentials than sense and would overlook internal candidates with years of experience in order to hire someone fresh from residency. Nothing worse than having five years of experience in a specialty, then being told you can't be promoted because you don't have a residency or board certification. Then they have you train the new hire for six months until they start to get it.

 

[confettiflyer]

So....I will say I did turn down an inpatient, clinic/staff hybrid position on the east coast in order to pursue a residency in California.

But the calculus behind my decision was 3-5 years on the east coast, take BCPS, THEN move, or move first, gamble on getting a job post-PGY1. Ultimate final goal was to return to the west coast (lots of overriding personal reasons which I won't detail here, that and I like the beach, PM if interested).

Financially, I'm unable to quickly model exactly what it cost me to do this, because I had/have a) a relatively high paying residency, b) a +$58,240 salary difference over what I would be making on the east coast at 3 years post-PGY1 (estimate only, I can't know with certainty what I would be making now had I stayed), c) wildly different costs of living & tax structures (I have a car and drive to work vs. I'd probably have taken a cab/Uber to work every day back east).

I'm lucky in that I found dream job type employment immediately after PGY1, not everyone can say that.

Even with my situation, I would still reaffirm taking an inpatient job at a supporting & clinically advanced facility* over the gamble of PGY-1.


*clinically advanced does not mean tertiary institution, it means a place where pharmacists get to challenge physicians, mingle w/ nurses, be involved in decision-making, do kinetic dosing under protocol, etc... (not just be yes sir/yes ma'ams and fill as ordered). This can be a 25 bed critical access hospital in the middle of nowhere, or it can be UCSF Medical Center.

 

[Dred Pirate]

People are doing residencies to qualify for staffing jobs, so if you get the opportunity why not take it?



Yeah that's an important thing to consider. When we got a new director the unwritten rules on promotion changed. The new guy had more credentials than sense and would overlook internal candidates with years of experience in order to hire someone fresh from residency. Nothing worse than having five years of experience in a specialty, then being told you can't be promoted because you don't have a residency or board certification. Then they have you train the new hire for six months until they start to get it.

We must work at the same place...

 

[gwarm01]

We must work at the same place...

Either that or every hospital in Florida has that attitude! I worked at large healthcare system in South Florida until recently.

It's kind of sad because our ground level supervisors would rather hire a new grad and train them in our practices, then as you get experience you can be promoted. Plus we had a lot of bad experiences hiring people that brought some bad habits from residency. A few acted like they were still in an academic setting, leaving the pharmacy to drink coffee at grandrounds while everyone else handouts your orders.

I think it was more of an unofficial mandate from above to only hire residency trained people. So we would hire residency trained people for evening staffing who were unhappy that they weren't specialists, OR PGY1 pharmacists for specialty positions they weren't really qualified for. Good times.

 

[297point1]

Baseball analogy: when you get called up to the major leagues, do you:
A. Report to the team and say "Put me in coach, I'm ready", OR
B. Say "No, I'll spend another year in AAA riding on buses, staying at the Comfort Inn, and getting paid less, because I really need to work on hitting the curveball"

Take. The. Job.

If you wait a year, the parent club might opt for that young hotshot with the perceived higher upside, and the call up to the majors you were expecting never materializes.

Take. The. Job.

Just make sure you aren't going to work for the Montreal Expos of hospitals.

 

[Dred Pirate]

Baseball analogy: when you get called up to the major leagues, do you:
A. Report to the team and say "Put me in coach, I'm ready", OR
B. Say "No, I'll spend another year in AAA riding on buses, staying at the Comfort Inn, and getting paid less, because I really need to work on hitting the curveball"

Take. The. Job.

If you wait a year, the parent club might opt for that young hotshot with the perceived higher upside, and the call up to the majors you were expecting never materializes.

Take. The. Job.

Just make sure you aren't going to work for the Montreal Expos of hospitals.

to continue your analogy - generally a position on the worst major league team is better than being on the best minor league team. I worked at the Montreal expos of hospitals - a small 15 bed critical access hospital in the middle of no wear right out of school (I was the only rph) - and turned it into a position at a well respected hospital on the east coast

 

[sakigt]

I used a football drafting analogy: Took the best position available, regardless of need

 

[Dalteparin]

I did do a PGY-1 and now I'm a staff pharmacist. Take. The. Job.

 

[Lost Pharm]

Thanks for the advices. I was worried that not having a residency would come back and haunt me some time in the future. Hospitals in my area are starting to hire pharmacists with one year residency over pharmacists with many years of experience. I thought it would affect my job prospects in the future if I didn't take the residency. The hospital that offered me a position has about 100 beds, so I believe it's one of the smaller hospitals in the area.

 

[farmadiazepine]

Job. No brainer.

 

[gwarm01]

PA school

 

[radio frequency]

PA school

Only if it's free does this maybe potentially make much sense.

 

[gwarm01]

Only if it's free does this maybe potentially make much sense.

How about pharmacy technician school?

 

[KatleyS]

Thanks for the advices. I was worried that not having a residency would come back and haunt me some time in the future. Hospitals in my area are starting to hire pharmacists with one year residency over pharmacists with many years of experience. I thought it would affect my job prospects in the future if I didn't take the residency. The hospital that offered me a position has about 100 beds, so I believe it's one of the smaller hospitals in the area.

It'll only come back to haunt you if you don't challenge yourself learning some job skills while you're performing your on the job duties as a staff pharmacist. I would learn what interests you whether: antibiotic stewardship, troubleshooting Epic/Cerner programs, customer-service oriented people person at the beside for transitions of care counseling, etc. I usually also try to learn tasks that make me uncomfortable, because I believe in being versatile as possible if the situation calls for it. I don't have to be an expert, but I can familiarize (i.e. college speak- 'minor' in it) myself with it. That way, I would think one could argue what skills and successes you have done to contribute to your current working environment that might be also valuable to your future employer.

 

[radio frequency]

How about pharmacy technician school?

PA school after pharmacy school doesn't make sense. It makes sense if you aren't already a pharmacist though. Basically in this situation, Job > Residency >>> PA school.

Pharmacy technician school is a whole different subject. It never makes sense so far as I can tell. At least the serious techs I've met who learned on the job seem to be of far higher caliber than anyone I've met who attended tech school.

 

[Dred Pirate]

PA school after pharmacy school doesn't make sense. It makes sense if you aren't already a pharmacist though. Basically in this situation, Job > Residency >>> PA school.

Pharmacy technician school is a whole different subject. It never makes sense so far as I can tell. At least the serious techs I've met who learned on the job seem to be of far higher caliber than anyone I've met who attended tech school.

put up your sarcasm meter

 

[owlegrad]

Pharmacy technician school is a whole different subject. It never makes sense so far as I can tell. At least the serious techs I've met who learned on the job seem to be of far higher caliber than anyone I've met who attended tech school.

Two of the really good techs I have worked with went to tech school. Several really bad techs I have worked with also went to tech school. Which is pretty much the same as techs that haven't gone to tech school (a few really good, most not). I agree that it never makes sense (financially) to go to tech school but I wouldn't go so far as to suggest that the people who go to tech schools are inferior to those who did not.

 

[Reirrac]

It is clear that taking the job is better than taking a gamble with a residency, but how does one put it to practice? Most residency programs start matching early in the year before students graduate and become licensed.

I can live with the repercussions of dropping a residency match and taking a open position, but is there a better or more efficient way?

 

[radio frequency]

Two of the really good techs I have worked with went to tech school. Several really bad techs I have worked with also went to tech school. Which is pretty much the same as techs that haven't gone to tech school (a few really good, most not). I agree that it never makes sense (financially) to go to tech school but I wouldn't go so far as to suggest that the people who go to tech schools are inferior to those who did not.

My n is admittedly small! Glad to hear others have had ok experiences with techs from tech schools.

 

[knight on horse]

Consider the benefits of the residency vs the job if you think you may change jobs in the future. If the residency is particularly good, it merits consideration. That being said the job market will only get worse

 

[Its Z]

So....I will say I did turn down an inpatient, clinic/staff hybrid position on the east coast in order to pursue a residency in California.

But the calculus behind my decision was 3-5 years on the east coast, take BCPS, THEN move, or move first, gamble on getting a job post-PGY1. Ultimate final goal was to return to the west coast (lots of overriding personal reasons which I won't detail here, that and I like the beach, PM if interested).

Financially, I'm unable to quickly model exactly what it cost me to do this, because I had/have a) a relatively high paying residency, b) a +$58,240 salary difference over what I would be making on the east coast at 3 years post-PGY1 (estimate only, I can't know with certainty what I would be making now had I stayed), c) wildly different costs of living & tax structures (I have a car and drive to work vs. I'd probably have taken a cab/Uber to work every day back east).

I'm lucky in that I found dream job type employment immediately after PGY1, not everyone can say that.

Even with my situation, I would still reaffirm taking an inpatient job at a supporting & clinically advanced facility* over the gamble of PGY-1.


*clinically advanced does not mean tertiary institution, it means a place where pharmacists get to challenge physicians, mingle w/ nurses, be involved in decision-making, do kinetic dosing under protocol, etc... (not just be yes sir/yes ma'ams and fill as ordered). This can be a 25 bed critical access hospital in the middle of nowhere, or it can be UCSF Medical Center.

So...... when you were making this decision, you actually ran a triple integration function calculation to decide what to do?

That's interesting.

 

[spacecowgirl]

So...... when you were making this decision, you actually ran a triple integration function calculation to decide what to do?

That's interesting.

Well it would be a shame not to put those years of undergrad calculus to use. I personally like to do quotients and functions to unwind.

Seriously, WTF was up with all of those pre-reqs? Physics? Bite me.

 

[confettiflyer]

So...... when you were making this decision, you actually ran a triple integration function calculation to decide what to do?

That's interesting.

Not a triple integration function...okay fine, I probably ran decision tree analysis with expected values assigned to each branch. I guess the more appropriate line isn't "the calculus behind my decision" it's more like "the statistical analysis and amalgamation of personal preferences vs. economic gain behind my decision."

Happy now?

 

[confettiflyer]

Well it would be a shame not to put those years of undergrad calculus to use. I personally like to do quotients and functions to unwind.

Seriously, WTF was up with all of those pre-reqs? Physics? Bite me.

Physics was awesome, what're you talking about? My university separated out all the annoying pre-health/pre-medical people into a separate dumbed down physics course (3 quarter series, vs. like double for physics majors). I think I showed up for day 1, midterm, and final and squeezed out a B.

 

[Its Z]

Well it would be a shame not to put those years of undergrad calculus to use. I personally like to do quotients and functions to unwind.

Seriously, WTF was up with all of those pre-reqs? Physics? Bite me.

Physics allows you to calculate how fast and wide antibiotic suspension can hit the ceiling if you shake the bottle without the lid.

 

[Its Z]

Not a triple integration function...okay fine, I probably ran decision tree analysis with expected values assigned to each branch. I guess the more appropriate line isn't "the calculus behind my decision" it's more like "the statistical analysis and amalgamation of personal preferences vs. economic gain behind my decision."

Happy now?

Rest in peace Jaime Escalente

Minute mark 1:06