Hospital vs Retail Pharmacy

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Sinderella

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I would like to know the main differences between hospital and retail pharmacy. I used to work as a cashier in retail pharmacy and absolutely hated it( because of the cranky customers). However, I have been contemplating a career in hospital pharmacy. What is the job description of a hospital pharmacist? Do they have the same duties as retail pharmacists?

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I worked in a hospital pharmacy for 1.5 years. The majority of what they do is as follows:

1) Orders faxed from floors to pharmacy

2) Pharmacist types in orders into computer - calls doc if any questions, issues w/ the formulary etc.

3) Labels printed out immediately for PRN orders, which tech fills, then pharmacists signs off on (to ensure order filled properly). If the order was a change in daily meds, it will reflect on the next "cart fill," which a pharmacist will ultimately check

** just a quick aside as to what checking cart-fill entails: you have a huge cart with little drawers for each hospital room. In each drawer are the patient's meds which the pharm tech filled. A pharmacist has to go into each little drawer, dump the meds out, and check off that each single pill matches what's on the printout. This is a long, boring arduous process that all the pharmacists hated. They would usually split up the (hospital) floors between pharmacists.

4) IV orders are similarly filled by techs, and "checked off" by pharmacists.

5) TPN orders are taken by the pharmacist -- they punch in the ratio into the computer, and a machine automatically compounds it -- the tech checks the spec grav, and adds additional meds, vitamins, electrolytes, etc. A pharmacist usually 'loosely' supervises this, and signs off on it before it goes to the floor

So, as you can see, a majority of what hospital pharmacists do is enter orders in the computer, and sign off on orders once they're filled. Seriously, that's the gig, and the reason I never went into pharmacy.

In all fairness, there are some other niche jobs within hospital pharmacy, some of which are not as bad. The CCU pharmacist was really sharp, and worked out of a mini-pharmacy with one tech within the CCU, and really acted as sort of a pharmacy-advisor to CCU docs, PAs, nurses, etc. The CCU pharmacist was the most 'cerebral' role I saw of all the hospital pharmacists.

The pharmacist that worked in surgery was basically the anesthesiologist's servant. A tech could have easily done the job, but I'm sure it would be a legal nightmare, so a pharmacist has to do this.

Another pharmacist would usually have, as an ancillary responsibility, the role of "Coumadin Pharmacist." Fancy name for pharmacist that goes around and checks patients' INRs to ensure dosing is correct. If incorrect they call the doc. Again, not exactly a 'cerebral' job.

The only upside to being a hosptial pharmacist is that you usually don't have to deal with 'customers.' Instead, you gotta deal with doctors and nurses.

Another upside is that the hours are better than retail, and usually a little less hectic.

Oh yeah, I forgot to mention...about 50% of your time will be spent on the phone answering nurses' questions. I'm not even gonna go there.... ;)

Sorry, not a rosy picture of life as a hospital pharmacist...but that's the reality.
 
Baggywrinkle and GravyRPH are some of the best resources we have here (besides Teufelhunden)...they seem to be our resident pharmacy practitioners. Baggy used to work hospital (now retail) and Gravy currently works hospital.

In the meantime, you can check this out for job descriptions:
http://www.pfizercareerguide.com/pharmacy.html
 
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i heard that hospital pharmacy positions in general don't paid as much as the retail settings. is that true?
 
Originally posted by ucdbiochem
i heard that hospital pharmacy positions in general don't paid as much as the retail settings. is that true?

True, but they tend to make up for the difference with other bennies
 
Originally posted by Sinderella
I would like to know the main differences between hospital and retail pharmacy. I used to work as a cashier in retail pharmacy and absolutely hated it( because of the cranky customers). However, I have been contemplating a career in hospital pharmacy. What is the job description of a hospital pharmacist? Do they have the same duties as retail pharmacists?

The main difference between hospital and retail.

Both are customer oriented.

In retail your customer is the general public so you operate at a very basic level. This does not imply that your backround knowledge or the standard to which you are held is any less. But in the day-to-day operation it is easy to slack off and allow your knowledge base to erode. Allowing this to happen makes you miss opportunities to have a real impact on therapeutic outcomes.


In hospital your customer is still the general public, but you serve them by proxy through the health care team with nursing being your primary interface and medical staff being secondary. As the custodian of dangerous medications, your primary function is to protect the public by acting as a filter to prevent that five or so percent of errant orders from ever reaching the patient. This places you in the position of detective as you read and fill the orders faxed to determine just what is the physician's therapeutic intent vs what he has actually requested or overlooked. The casual observer might see this as a dispensing machine. The hospital pharmacist also operates in routine mode, and it is also possible to allow your knowledge base to deteriorate. But because you have access to a much larger picture of what is going on **just on the order sheet** and by accessing the patient chart if need be - the pharmacist has ample opportunity to impact outcomes.

For example, A colleague of mine was delivering routine meds to the floor and just happened to be there when that once-in-a-blue-moon code occurred on the pediatric floor. This was a small community hospital and the crash team was whatever ER physician happened to be on duty and whatever ICU nurses who could break away plus the general floor nurses at hand. Nobody attending had direct intimate knowledge of the ACLS doses appropriate for a nine month old and they were losing time looking things up. My colleague, having served several years in a peds dedicated intensive care as their satellite pharmacist had these doses on the tip of his tongue. He stood in the backround calculating and calling dosages as they were ordered.

Teufelhunden paints an accurate superficial snapshot of what goes on. But he has not delved under the hood.

The perfect hospital pharmacy service is totally transparent to the end user. If the physician were a shuttle astronaut walking down the gantry smiling and waving at the media. The pharmacist would be in the mission control room making sure the smile wasn't wiped off his face.
 
I think you guys are missing the real question. This dude is asking about other options not just community: Clinical Pharmacy (In the CA legal code, pharmacists can write prescriptions and make modifications and are entitled to all pt med records. Administration, etc.

You don't have to work in a pharmacy to be a pharmacist. We have an ambulatory care pharmacist who never sets foot in a pharmacy. He meets with physicians and updates their tx plan. If you wanna work with pts that's highly accessible and highly demanded at this point.

Pharmaceutical care was created bc hospitals wanted to use their best resource, pharmacists to attack pt treatment. It's a a pretty simple equation, use the peeps with the most in depth knowledge of drugs to help design the plan for treating pts taking drugs. That's just a good business model.
 
Originally posted by Triangulation
I think you guys are missing the real question. This dude is asking about other options not just community: Clinical Pharmacy (In the CA legal code, pharmacists can write prescriptions and make modifications and are entitled to all pt med records. Administration, etc.

You don't have to work in a pharmacy to be a pharmacist. We have an ambulatory care pharmacist who never sets foot in a pharmacy. He meets with physicians and updates their tx plan. If you wanna work with pts that's highly accessible and highly demanded at this point.

Pharmaceutical care was created bc hospitals wanted to use their best resource, pharmacists to attack pt treatment. It's a a pretty simple equation, use the peeps with the most in depth knowledge of drugs to help design the plan for treating pts taking drugs. That's just a good business model.

Community and hospital comprise the lions share of positions available. Keep in mind that these two arenas cover a very wide range of practice settings from the scriptburger environment which may also be found in hospital to wonderfully intimate professional environments which involve an office or home review of the clients medication profile.

Other practice environments are home health care which is essentially all about administraion of sterile products in the client home, hospice is very similar to this, nursing home consultants who maintain compliance with accreditation and licensing bodies by doing chart reviews on a monthly basis (cerebral enough for you?), nuclear pharmacists - everything you wanted to know about radiopharmaceuticals - tends to be a very high stress job because there aren't very many of them. I worked with one and all he could say was never again.
What have I missed.

Many of the positions are not full time. I know a WAG pharmacist who moonlights with a consulting practice that has contracts with doc-in-the-box neighborhood clinics to keep them in compliance with state requirements.

Much of the pharmacists job is legal in nature. He is the guy that keeps the inspectors off your companies back because you are dumping toxic waste down the sink rather than having it incinerated as the law requires or keeping food in the medicinal refrigerator. Regulations and audit trails. If it isn't documented it didn't happen. So sayeth the inspector.

Law enforcement is also an option. Both federal and state hire pharmacists who can be your worst nightmare if they testify against you as an expert witness. One of the pharmacists I work with is retired from the DEA. A pharmacy degree plus a law degree is a killer combination. Malpractice anyone? Insurance companies love pharmacists to do audits for them.
 
Thank you all so much for your replies!! You guys have been a HUGE help. I believe I have decided to pursue hospital Pharmacy. I don't think the job sounds half bad, much better than PT which is what I was originally going to pursue.
 
Right on Sindy!! There's no position in health care with more flexibility as far as career options than pharmacy right now. Ask more questions as you think of them.:)
 
Baggywrinkle,

You said that a law degree with a pharmacy degree was killer. I would like to hear more on the subject. I am a third year law student who is considering pharmacy. Thanks.
 
Originally posted by Lance Turnbow
Baggywrinkle,

You said that a law degree with a pharmacy degree was killer. I would like to hear more on the subject. I am a third year law student who is considering pharmacy. Thanks.

If you specialize in medical malpractice the pharmacy degree gives you the medical backround to know when something stinks on ice. In your situation, since you already have eight years in, you might as well go to med school and get the whole ball of wax.
Just don't expect to be drinking gin & tonics with the boys down at the medical staff meetings - talk about the red haired step child! Pharmacy degree as your primary undergraduate degree is just more time efficient. Eight very well spent years.

Since the pharmacy degree specializes in chemical intervention, it obviously wouldn't help you much for cases involving surgery.

Keep in mind that pharmacists, as drug specialists, are very legally oriented anyway. Among health care workers, they tend to have a very good grasp of both the law and regulations by accrediting bodies. In pharmacy school they hype therapeutics and clinical participation. But this is like the rum in a rum cake. Much of it evaporates away. What is left, in your day-to-day, is the omnipresent shadow of the inspector looking over your shoulder. Indeed, it is law in every state I have practiced in that a pharmacy SHALL (note the wording) maintain "adequate references" and a current copy of state pharmacy practice law.

Most states have continuing education requirements. Much of it is a joke. But one seminar that I have ALWAYS been keen to attend was the law update. CYA
 
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