Hi, so I have been recently accepted into 2 fantastic pharmacy schools and I need some advice on the career path of inpatient pharmacy. It seems the more research I do on it, the more I'm left confused by what inpatient / clinical pharmacy is. Some people have told me it requires residency. Some people told me it doesn't. Some people have said I'll get to see it during my 4th year during rotations.
In other words, I'm pretty confused at this point and would like some insight into what it actually is, how much patient interaction you get, what a typical day looks like for an inpatient pharmacist, and what needs to be done to get there. Any help in this?
the term "inpatient" pharmacist isnt usually used .. it's typically known as a "hospital pharmacist". And their days can vary a lot. The idea of "clinical" pharmacy means that the pharmacist serves as a more extensive resource to the dr to help directly manage the patient's drug therapy decisions.
Pharmacists that work in an inpatient environment (hospital or Ltac) will spend part of their day preparing or (most likely) supervising the preparation of all the custom prepped IV bags for patients (dissolving powders and mixing drug solutions), part of their day entering orders into the system for each new med, supervising technicians as they fill the various med cabinets in the hospital, and helping run the pharmacy as a business, like inventory, ordering, looking at ways to reduce costs, etc. Also, at least in the small hospital where i worked, they will work on some calculations for patients to change their therapy, such as for warfarin, vancomycin, pain control, and nutrition. They also spend some time responding to drug information requests from doctors about ways to use drugs or how to switch therapies. For example, when a patient is going to need a taper off of a drug that their body has become physically dependent on, like a blood pressure med or a narcotic, pharmacist will be called to make up a step down / taper off plan. Also they may round with doctors and meet with committees to decide the best plan of care for individual patients and for the hospital pharmacy's bottom line. Where i worked, the biggest source of patient/pharmacist communication (i worked in a high acuity facility, so patients wouldnt often be able to talk until they were good enough to get sent home) was in discharge counseling. When the patient left the hospital, a pharmacist would spend 20 minutes or so talking to the patient about how to use their meds, what each one is doing, why they are important, etc.
That pretty much sums up what happens at a small size hospital for a "staff or inpatient" pharmacist. At larger hospitals you could expect to be able to specialize in one or more areas, or rotate through different roles on different days. With a designation of "clinical pharmacist" which is employed at larger or academic centers, you would spend more time doing projects to start, stop, or modify drug therapy for specific patients given their medical history and background, whether it be on rounds, in an office, or in committees.
Even though i'm not planning on going into hospital pharmacy, i was very happy with my small hospital experience, and would encourage any pre pharm or new pharmacy student to attempt to find work in the small hospital environment. While there are advantages to working or interning in both large and small facilities, at a small hospital pharmacy you will be able to pick up on and practice more skills than if you remained specialized in a larger department. On the flipside, larger hospitals will sometimes have programs to put their pharmacists into clinical niches where you can become a true expert in a specialty. Also large hospitals will no doubt leave you with better job connections. (But a workplace where you can really get to know your boss could lead to a better reference)
Residencies are required to work as a clinical specialist in a large hospital, urban center, or academic hospital. They are not typically required for "staff" positions in most hospitals, or as a generalist in a small hospital or rural market. Some people are predicting that even staff jobs will more or less require residencies, either now or in the future, in many cities where there are a lot of pharmacists seeking jobs. Some academic centers only hire pharmacists with residencies, simply due to the prestige level of the hospital and the advanced responsibilities pharmacists can pick up there.
Hope this helps!
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