Is PGY3 the Future of Clinical Pharmacy Training?

[Pharmibippy]

One thing that I still cannot figure out... why do residents have to work under a pharmacist if they have their own active license? Is this a legal thing or a matter of hospital policy? They obviously don't have to be under direct supervision 24/7 like an intern (though nobody pays attention to me when I'm talking to patients anyways) but I'm told that a resident cannot be the only pharmacist on duty/only pharmacist in the pharmacy.

Also, whats the point of spending 45 hours a week at rotation all of P4 if the rational for residency is that you need practical experience? Wouldn't anyone with common sense who wants to work in a hospital schedule hospital rotations? I feel like I'm surrounded by pharmacists who did 2 years of residency in order to calculate a vanco dose and look at a CrCl that the computer automatically calculates for them anyways. Maybe I'm missing something.

I'll be honest I never thought I'd consider hospital, and I hated my current rotation at first, but there are some aspects of the job that I actually found interesting/enjoyable. The problem is the load of bullcrap you have to do to get a residency, the residency itself, you get screwed in terms of pay, and quite honestly it didn't take me long to realize that nurses and doctors are miserable people to work with. I'm a chill person who doesn't stress out... I couldn't imagine doing some of the passive aggressive crap that these nurses pull. One of them goes out of her way to intentionally mess things up for me it's just stupid.

In my program I can be the only pharmacist in say the ICU if my preceptor is on PTO or something. I can't speak for all programs though.

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[Pharmd = Phake Doctor]

What on earth has happened to the pharmacy curriculum that P4s are now unprepared for pharmacy practice? Either these schools are feeding lies to students or the accrediting board is somehow lowering standards across the country.

It's that communist propaganda they spew at the pharmacy schools (especially the newer ones). Seems like some students lack the critical thinking skills to discern Phantasy (MTM, Provider Status, Residency) from reality (the drudgery of working in one of the most regulated professions).

The hardest part of the pharmacy curriculum isn't the subject matter. It's having to listen to a bunch of pinkos, aka the "pharmacy practice" faculty, tell you what the practice of pharmacy should be even if it has no basis in reality. Question the unrealistic ideas these unemployable pharmacists put forth only if you've got the desire to be branded a traitor to the Revolution and be sent to the re-education/labor camp.

I've seen too many students do a residency only to end up working in retail or in a position they could've gotten straight out of school.

It looks like comrade @pharmrx33 was successfully brainwashed by the thought police. His childish diatribe clearly shows his dedication to the Revolution.

 

[beautifulrobot]

What on earth has happened to the pharmacy curriculum that P4s are now unprepared for pharmacy practice? Either these schools are feeding lies to students or the accrediting board is somehow lowering standards across the country.

My guess is it's hard to find good quality rotations/preceptors for all of the new students - there's only so many rotation sites and only so far students are willing/able to travel for their APPEs.

 

[beautifulrobot]

One thing that I still cannot figure out... why do residents have to work under a pharmacist if they have their own active license? Is this a legal thing or a matter of hospital policy? They obviously don't have to be under direct supervision 24/7 like an intern (though nobody pays attention to me when I'm talking to patients anyways) but I'm told that a resident cannot be the only pharmacist on duty/only pharmacist in the pharmacy.

Hospital policies may vary, but at minimum, ASHP accreditation requires pharmacy residents to not occupy a position that otherwise would not exist if the pharmacy resident didn't exist, i.e. any job a pharmacy resident does supplements or adds additional coverage to that job, but the pharmacy resident cannot be "essential" for the job. This ensures that residents are receiving some sort of guidance and feedback, and are not just being used as cheap labor instead of hiring a full-time pharmacist that's dedicated to that particular service/job. There are also exhaustive evaluation requirements by ASHP (ugh, awful ResiTrak flashbacks...), and in order to fulfill those evaluation requirements there needs to be some contact with a preceptor on a fairly regular basis. From my recollection this doesn't apply when residents are fulfilling staffing requirements (unless hospital policy dictates otherwise) - there were definitely times when I staffed as a resident and I was the only pharmacist in the pharmacy/only pharmacist covering certain floors. Also I definitely covered for my preceptors on occasion when they were on leave, and would spend the whole day by myself without any supervision (and managed to not kill any one / set the whole hospital on fire).

 

[lord999]

You hit this one out of the ballpark. @pharmrx33 is kidding himself if he thinks the PharmD or PGY-1,2,3 residency is gonna make him close to being as useful as a PhD or an MD when it comes to cutting edge research.

I had the unfortunate experience of going to a research symposium at the school of pharmacy a few months ago. The PhD students had some really interesting research topics and it was a joy to talk with them during the poster presentation. However, when I went the section cordoned off for the pharmacy residents, I was unprepared for how infantile their projects were.

• One dude had a project in which he found that putting a pamphlet at the Rx register made people more aware of vaccines. (You guessed it. This was a community pharmacy resident!)
  
• Another dude found that medical staff at a hospital were ordering a certain medication at a lower-than-recommended dosage because the hospital carried two volumes of this med and they were too lazy to waste the leftover amount of the larger dosageform. This resident called his research "eye-opening".

They actually had dude #2 present his "research" at the auditorium. I don't know which part was more cringe-worthy: when the emcee introduced him as Dr. ABC or when no one had any questions to ask him at the end. This was in stark contrast to the excitement that attendees had when they barraged the previous presenter about his project.

Mind you, this is at a world class research institution at a public state university where professors and their graduate students were working on million dollar projects funded by chemical companies and various government agencies. Representatives from various drug companies and professors from the various departments were talking with the PhD students while crickets could be heard from the PharmD section.

Although straight MD's are no longer funded at anywhere near their counterparts 20 years ago for research. At minimum, it's MD/MS, but the currency is still the MSTP MD/PhD or the PharmD/PhD for our routes. And your observation is pretty straightforward too, I do make it a point to attend other university's research days specifically to:

1. Figure out if the PhD candidates communicate in English and what their salary ranges are. The hardcore schools that I consider competitors I have on a different thread, but it's a night and day difference.

2. PharmD presentations aren't completely worthless, I keep an eye out for the unhappy PharmD that makes a presentation that takes stupid risks as that's the type I and everyone else wants to recruit for their PhD programs.

3. And if the PharmD is particularly attractive in either gender (at least an 8), industry snaps them up for marketing positions. Wisc, UMN, Ole Miss, and Iowa get a bunch of the East Coast PhRMA show up to grab some skin in their terms during student presentations. I nonsarcastically tell the classes that if you want to work for them, then you have to sell yourself (and to the implication's extent is their own concern). But good looking guys rejoice, you're much harder to recruit these days and command higher (+30k) salaries and probably longer career trajectories if you can do a good Jon Hamm/George Clooney mature man impression.

 

[lord999]

Does #3 apply to 30+ old males that are still an 8?

Yes, actually. GSK and Amgen are specifically looking for those kind of people right now (just got out of RTP six hours ago with them asking for recommendations from the students). Job placement is a happy burden on me (and helps with those alumni contributions too!).

Less kindly, it takes a certain kind of person to do that work well. The better you are at compartmentalizing your work from your other lives, the better industry works out for them. I make it a point to refer good looking, shallow (and this is a positive), and competitive people to them as they have the chance to thrive there in a way where retail and institutional waste their innate talent. I'm not that kind of person at all, and I do envy the easy ability of those people to make associations and socialize. There's a better place for good partiers than the standard practice.

And yes, this is probably the only reason why I tolerate frats (I think they are a net negative for most) and have a preference for recruiting certain students who came from boarding school situations. Boarding schools and frats help you change your socialization patterns and understand the necessity of power relations.

You need to be a solid 8, be able to socialize with everyone especially awkward people like pharmacists and physicians, and be able to be your own brand and market yourself. If you're up to that, drop GSK Provider Relations your resume.

 

[ldiot]

Yes, actually. GSK and Amgen are specifically looking for those kind of people right now (just got out of RTP six hours ago with them asking for recommendations from the students). Job placement is a happy burden on me (and helps with those alumni contributions too!).

Less kindly, it takes a certain kind of person to do that work well. The better you are at compartmentalizing your work from your other lives, the better industry works out for them. I make it a point to refer good looking, shallow (and this is a positive), and competitive people to them as they have the chance to thrive there in a way where retail and institutional waste their innate talent. I'm not that kind of person at all, and I do envy the easy ability of those people to make associations and socialize. There's a better place for good partiers than the standard practice.

And yes, this is probably the only reason why I tolerate frats (I think they are a net negative for most) and have a preference for recruiting certain students who came from boarding school situations. Boarding schools and frats help you change your socialization patterns and understand the necessity of power relations.

You need to be a solid 8, be able to socialize with everyone especially awkward people like pharmacists and physicians, and be able to be your own brand and market yourself. If you're up to that, drop GSK Provider Relations your resume.

This is good info... I wish I wasn't socially ******ed

 

[gwarm01]

Although straight MD's are no longer funded at anywhere near their counterparts 20 years ago for research. At minimum, it's MD/MS, but the currency is still the MSTP MD/PhD or the PharmD/PhD for our routes. And your observation is pretty straightforward too, I do make it a point to attend other university's research days specifically to:

1. Figure out if the PhD candidates communicate in English and what their salary ranges are. The hardcore schools that I consider competitors I have on a different thread, but it's a night and day difference.

2. PharmD presentations aren't completely worthless, I keep an eye out for the unhappy PharmD that makes a presentation that takes stupid risks as that's the type I and everyone else wants to recruit for their PhD programs.

3. And if the PharmD is particularly attractive in either gender (at least an 8), industry snaps them up for marketing positions. Wisc, UMN, Ole Miss, and Iowa get a bunch of the East Coast PhRMA show up to grab some skin in their terms during student presentations. I nonsarcastically tell the classes that if you want to work for them, then you have to sell yourself (and to the implication's extent is their own concern). But good looking guys rejoice, you're much harder to recruit these days and command higher (+30k) salaries and probably longer career trajectories if you can do a good Jon Hamm/George Clooney mature man impression.

Buddy, now you're speaking my language. Give me a year in the gym and my natural good looks will kick in.

Edit: can we get a good example of a solid 8 for a 30+ year old? I know I qualified in my early twenties, but... Time.

 

[PAtoPharm]

My biggest beef with my last year clinicals it is technically a mini residency (had several great sites but not all at the same place so initial learning process). Yet even tho you have experience doing anticoagulation, vancomycin and aminoglycoside dosing, rounds, etc. you still have to jump through the hoops of residency for most hospital jobs.


I get that it is a direct result of supply/demand but man it's getting crazy as salaries stagnate and cost of attendance/loans continue to climb. From the employer prospective it makes sense to continue with current system. Just so many other routes that are better financially. It's clear pharmacy isn't a golden goose and I hope people stop going 150-200K + in debt for a job that 40 hours isn't guaranteed off the bat now and most likely will just get worse in future. When the trend is to hire new grads or grads out for 1 year as managers you know there is a problem.

This is what I don't get... people post stuff like this, and then still tell students that they must be committed to completing pharmacy school, or else! The schooling is more expensive than it has ever been, a 40%+ future unemployment rate is almost guaranteed to occur in the future, and new grads are being offered part-time hours (and the worst hasn't even yet to come). Like you said in your post, there are so many other routes that are better financially. To any pre-pharmacy students reading this, do anything else you can get accepted to -- PA/NP school, nursing school, medical school, radiation therapist school, nuclear medicine technologist school, the list goes on and on. Literally ANY of those careers is a better (and in many cases, cheaper) bet than pharmacy school.

 

[lord999]

One thing that I still cannot figure out... why do residents have to work under a pharmacist if they have their own active license? Is this a legal thing or a matter of hospital policy? They obviously don't have to be under direct supervision 24/7 like an intern (though nobody pays attention to me when I'm talking to patients anyways) but I'm told that a resident cannot be the only pharmacist on duty/only pharmacist in the pharmacy.

Also, whats the point of spending 45 hours a week at rotation all of P4 if the rational for residency is that you need practical experience? Wouldn't anyone with common sense who wants to work in a hospital schedule hospital rotations? I feel like I'm surrounded by pharmacists who did 2 years of residency in order to calculate a vanco dose and look at a CrCl that the computer automatically calculates for them anyways. Maybe I'm missing something.

I'll be honest I never thought I'd consider hospital, and I hated my current rotation at first, but there are some aspects of the job that I actually found interesting/enjoyable. The problem is the load of bullcrap you have to do to get a residency, the residency itself, you get screwed in terms of pay, and quite honestly it didn't take me long to realize that nurses and doctors are miserable people to work with. I'm a chill person who doesn't stress out... I couldn't imagine doing some of the passive aggressive crap that these nurses pull. One of them goes out of her way to intentionally mess things up for me it's just stupid.

No legal reason currently in pharmacy unless you started before you licensed UNLESS you're nuclear where Title 42 has additional licensure requirements for unrestricted practice. For medical, there are legal reasons as the internship year typically does not have the USMLE/COMLEX Step 3 passed at the start (kind of like during the initial part of pharmacy residency, it is unusual to have your license until August).

And that's always been my take on residencies for general practice as most pharmacists should have been properly exposed (but not necessarily comfortable) with those aspects that you brought up. There are a couple of personal exceptions from the practical standpoint:

1. Nutrition Support (IV hood pharmacist), Critical Care, and Oncology (Chemo pharmacist) which have BPS credentialing are a pretty specialized group as those pharmacists see things on a regular basis and become good in a way that the central pharmacy staff are not efficient at handling (even if the director does not formally designate a pharmacist for those roles, they organically become roles for certain pharmacists if the order load is sufficient). I group ID and neonatology (almost always children's hospital specific) in that even though they are not BPS specialties. It's not that the central staff can't handle it, it's just a timesink as you'd have to do major lookups (and in neonatology, have to call the manufacturer and rely on house lore which makes for a high risk practice).
2. Nuclear HAS to be an apprenticeship mainly because NRC forces certifications for unrestricted practice (RSO, BCNP).

 

[Rockinacoustic]

What on earth has happened to the pharmacy curriculum that P4s are now unprepared for pharmacy practice? Either these schools are feeding lies to students or the accrediting board is somehow lowering standards across the country.

Just go read the student musing in the ACEI-ARB combo therapy thread...

 

[ABCPharmD]

Yes, actually. GSK and Amgen are specifically looking for those kind of people right now (just got out of RTP six hours ago with them asking for recommendations from the students). Job placement is a happy burden on me (and helps with those alumni contributions too!).

Less kindly, it takes a certain kind of person to do that work well. The better you are at compartmentalizing your work from your other lives, the better industry works out for them. I make it a point to refer good looking, shallow (and this is a positive), and competitive people to them as they have the chance to thrive there in a way where retail and institutional waste their innate talent. I'm not that kind of person at all, and I do envy the easy ability of those people to make associations and socialize. There's a better place for good partiers than the standard practice.

And yes, this is probably the only reason why I tolerate frats (I think they are a net negative for most) and have a preference for recruiting certain students who came from boarding school situations. Boarding schools and frats help you change your socialization patterns and understand the necessity of power relations.

You need to be a solid 8, be able to socialize with everyone especially awkward people like pharmacists and physicians, and be able to be your own brand and market yourself. If you're up to that, drop GSK Provider Relations your resume.

I was ready to apply after you said 8+ and competitive. I've got those covered. Then you started talking about socializing. Although I would say I excel at socializing with other awkward people so maybe that's close enough lol. I'm easy to get along with and most people like me, but I'm pretty reserved at first. In small groups and with friends I can be outgoing; I'm pretty much a classic introvert.

I'm just curious what this even means "Boarding schools and frats help you change your socialization patterns and understand the necessity of power relations." Please explain.

 

[pharmdit]

I think he means you will get used to being abused by someone in power and will not complain about it.

Kinda like a business-oriented dom/sub relationship? I can dig it.


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[lord999]

I was ready to apply after you said 8+ and competitive. I've got those covered. Then you started talking about socializing. Although I would say I excel at socializing with other awkward people so maybe that's close enough lol. I'm easy to get along with and most people like me, but I'm pretty reserved at first. In small groups and with friends I can be outgoing; I'm pretty much a classic introvert.

I'm just curious what this even means "Boarding schools and frats help you change your socialization patterns and understand the necessity of power relations." Please explain.

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.937.185&rep=rep1&type=pdf

When I talk to people who want to work for our Foreign Service in the Department of State, I explain to them that besides the day job in the longer career conditional phase, that their night job is to be a professional partier. Most people scoff at this, but it really is not an easy job, and it isn't one that adult training can really overcome.

If you are going to move in those circles, you have to have etiquette training, power relations knowledge, and a gift for conversation and observation in a way that feels natural. Boarding schools and frats teach those concepts through humiliation, shared experience in bad behavior, and forced socialization. In a boarding school environment, how the good old boys network develops is from sending a bunch of normal people involuntarily into an institutionalized environment and forcing them to cope. In true Lord of the Flies style, the same old stuff in terms of cliques, secrets, jealousies create those informal social hierarchies between supposedly "equal" classmates as well as the overt social order that the headmaster, teachers, and docents hand down. When you send your child to a boarding school, it is not for the normal classroom education alone. It is to be around people that your child will develop that good old boy network, break ties based on blood relations (meaning you the parents as well) forcing them to create their own intimate relations, and to give them a head start in learning to use power networks (both the formal school and the informal peer networks) to get what they want.

Frats can sometimes make someone this way, but it's something that learning young makes it more natural. Usually, you can tell the difference between the two by noting how they work at seduction. If you see the person coming off as sleazy or slutty, there are not doing it right. If they always seem to get what they want, but they always seem to be able to do it without disrupting the social order, you have a winner.

PHRMA's generally satisfied with seduction, but what happens is that with that alone, once you lose that charismatic edge, you get pushed out. Higher order areas like corporate headquarters need people who can seduce with enough emotional intelligence to avoid slutty or sleazy impressions, and the very best outfits (Department of State) require those skills to be as natural as possible. The sort of person that you always want to confess to without intending to and that person being able to note the relevant conversation and non-verbal stimuli, and always being able to detect the overall flow of the gathering and react accordingly, is what is really wanted.

Sex sells, but that's not all. If you're going to do that sort of work, there has to be more to it than animal spirits. Unfortunately, companies hire cheerleaders intentionally knowing that they'll be used up in their 40s (now 50s with proper diet, exercise, and cosmetic surgery). But the people who end up making it a career either consciously or unconsciously have the ability to manipulate everyone, including their employers to give them what they want.

Far above my level to do, but comes naturally to most boarding school alumni/ae and possibly learned if in a particularly transgressive frat (the more alpha, the better). The difference is that I can only make a living by working not by being. But when you see those Department of State professional partiers at work, being who they are IS the job, and most people never understand just how hard it is to always be that interesting person to their current target.

 

[Its Z]

I didn't read the entire thread.

How about we rephrase the question. How many are willing to complete a PGY3 to become an Advanced Pharmacy Practitioner/Provider?

I personally think it's a bit over the top and a well structured PGY2- Ambulatory Care should prepare a pharmacist to become a mid-level.

And we are very close.

Then again, it's not my cup of tea. I have no desire to see patients, diagnose, and prescribe all day long.

 

[deleted820760]

I didn't read the entire thread.

How about we rephrase the question. How many are willing to complete a PGY3 to become an Advanced Pharmacy Practitioner/Provider?

I personally think it's a bit over the top and a well structured PGY2- Ambulatory Care should prepare a pharmacist to become a mid-level.

And we are very close.

Then again, it's not my cup of tea. I have no desire to see patients, diagnose, and prescribe all day long.

Right, because if you did, you would have gone to medical school from the beginning.

 

[Dred Pirate]

I didn't read the entire thread.

How about we rephrase the question. How many are willing to complete a PGY3 to become an Advanced Pharmacy Practitioner/Provider?

I personally think it's a bit over the top and a well structured PGY2- Ambulatory Care should prepare a pharmacist to become a mid-level.

And we are very close.

Then again, it's not my cup of tea. I have no desire to see patients, diagnose, and prescribe all day long.

we have the equivalent of a mid-level (CPP in NC) that have pgy-0 - it is not necessary with the proper training that you can do over a couple of months

 

[Its Z]

we have the equivalent of a mid-level (CPP in NC) that have pgy-0 - it is not necessary with the proper training that you can do over a couple of months

Right, because one outlier should define the industry and a couple of months should be enough for primary care provider education.

/sarcasm

 

[gwarm01]

we have the equivalent of a mid-level (CPP in NC) that have pgy-0 - it is not necessary with the proper training that you can do over a couple of months

What sort of authority do they have and what are they expected to do? If I had to give any sort of physical examination I'd be pretty worthless, but if it was drug therapy initiation/modification.. hell, any pharmacist with a little bit of experience working in a unit could handle that.

 

[Dred Pirate]

Right, because one outlier should define the industry and a couple of months should be enough for primary care provider education.

/sarcasm

I never said primary care - this is one one very specific role (lipid/coagulation management) - plus RPh's will never diagnosis - only manage drug therapy after diagnosis - that part will always be MD,PA,NP

 

[Rockinacoustic]

I didn't read the entire thread.

How about we rephrase the question. How many are willing to complete a PGY3 to become an Advanced Pharmacy Practitioner/Provider?

I personally think it's a bit over the top and a well structured PGY2- Ambulatory Care should prepare a pharmacist to become a mid-level.

And we are very close.

Then again, it's not my cup of tea. I have no desire to see patients, diagnose, and prescribe all day long.

Spot on- if people have the drive to obtain extremely niche clinical training, good for them. Their n will be smaller than the number of posters in this thread, and by no means a paradigm shift to suggest they are the new standard of clinical training.

Serious question for those who like to google: What percentage of hospital pharmacists nationwide are even residency trained?

 

[Dred Pirate]

Spot on- if people have the drive to obtain extremely niche clinical training, good for them. Their n will be smaller than the number of posters in this thread, and by no means a paradigm shift to suggest they are the new standard of clinical training.

Serious question for those who like to google: What percentage of hospital pharmacists nationwide are even residency trained?

My hospital is about 35%

 

[y0ssarian87]

You hit this one out of the ballpark. @pharmrx33 is kidding himself if he thinks the PharmD or PGY-1,2,3 residency is gonna make him close to being as useful as a PhD or an MD when it comes to cutting edge research.

I had the unfortunate experience of going to a research symposium at the school of pharmacy a few months ago. The PhD students had some really interesting research topics and it was a joy to talk with them during the poster presentation. However, when I went the section cordoned off for the pharmacy residents, I was unprepared for how infantile their projects were.

• One dude had a project in which he found that putting a pamphlet at the Rx register made people more aware of vaccines. (You guessed it. This was a community pharmacy resident!)
  
• Another dude found that medical staff at a hospital were ordering a certain medication at a lower-than-recommended dosage because the hospital carried two volumes of this med and they were too lazy to waste the leftover amount of the larger dosageform. This resident called his research "eye-opening".

They actually had dude #2 present his "research" at the auditorium. I don't know which part was more cringe-worthy: when the emcee introduced him as Dr. ABC or when no one had any questions to ask him at the end. This was in stark contrast to the excitement that attendees had when they barraged the previous presenter about his project.

Mind you, this is at a world class research institution at a public state university where professors and their graduate students were working on million dollar projects funded by chemical companies and various government agencies. Representatives from various drug companies and professors from the various departments were talking with the PhD students while crickets could be heard from the PharmD section.

There's an article in this month's AJHP regarding the development and improvement of residency research training. They note a general consensus that resident graduates do not have adequate practice-based research skills. Worth a read for OP (edit: not OP, pharmrx33) if he's interested in practice-based research to understand the state of research in pharmacy residency programs. It's kind of funny to see all the ways the author sh*ts on the profession's research capabilities.


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[Dred Pirate]

Seems like collaborative practice which is legal pretty much everywhere, right?

I can't comment on other states. But this is kind of a step above just following protocols va being completely independent. The can use judgement and don't have to have the provider in house.

 

[lord999]

There's an article in this month's AJHP regarding the development and improvement of residency research training. They note a general consensus that resident graduates do not have adequate practice-based research skills. Worth a read for OP (edit: not OP, pharmrx33) if he's interested in practice-based research to understand the state of research in pharmacy residency programs. It's kind of funny to see all the ways the author sh*ts on the profession's research capabilities.


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That's well-known among the postgraduate degree faculty that pharmacists in general are terrible researchers as well as practicing physicians except interventional radiology, pathology, and sometimes oncology (because the difference between them having an MD/PhD and an MD is simply writing a dissertation in modern cases as the classwork and lab work is at standard). That's not a competency issue, it's a focus and time issue. Sure, anyone who can do a residency has the potential to do at least competent research. However, that's certainly not the priority (again, above exceptions apply since it's fairly impossible not to deal with some accessory research or lab work in those medical specialties). So, they get half-baked training, what do you expect their research quality to be.

This does not mean that you want to spend that kind of time. Not to hit the mudphuds (MD/PhD's) harder, but there is a widespread perception among the NIH (and some poor, inconclusive research) that the MD/PhD MSTP program usually produces below average physicians and researchers when compared with single degrees where the candidates were better off with either one of the two but not both degrees, because their attention is divided and they inevitably choose between the two rather than integrate the practices. The reason why the MSTP program still gets funded is that for all of those below average products, once in a while you get a Goodman Gilman style Nobel Prize winner out of that. The superstar exception potential has always been a compelling case for the MSTP, but the likelihood that you are the exception is low.

And, it's really not funny to me mainly because the idea of research is akin to mental mas....you can fill in the word. The entire point of what became research was the idea that a resident would have to found a clinic, get the resources together, than carry it out with outcomes because it was unlikely they would go into a clinical pharmacy situation, kind of like a supervised independent practice. Unforutnately, research has been the way it's worked as of late, because actually getting a clinic to work requires real work, and do RPD's really want any real work?

 

[Xarelto-10]

Our professions obesession for extra letters after Our names never stop to amaze me.

I am not opposed to expert level knowledge but I am very doubtful how much of this is really moving our profession in demand.
For the most part it is an investment with little to no return.

Is PGY3 the Future of Clinical Pharmacy Training?

He cannot seriously believe a PGY-3 is useful..... ?

 

[sozetone]

Is PGY3 the Future of Clinical Pharmacy Training?

He cannot seriously believe a PGY-3 is useful..... ?

I have the solution! they can send pharmacists through about 30 years of schooling in all sorts of cool stuff, then we can get out and immediately RETIRE! job problem solved! lol.

 

[projektreverb]

Did we just necrobump a thread from last year? But honestly, I think that PGY3 is the future. Why? Because who wouldn’t take a pharmacist at a third the cost? I think residency is a labor scam for the most part.

 

[BenJammin]

Did we just necrobump a thread from last year? But honestly, I think that PGY3 is the future. Why? Because who wouldn’t take a pharmacist at a third the cost? I think residency is a labor scam for the most part.

It's 100% a scam. I feel sorry for these people who say "residency is not a scam because I couldn't have gotten my clinical position if it wasn't for my residency". Those people are so invested in the scam they can't turn back. It's like those old women who sell Mary Kay and refuse to call it a pyramid scheme because that would mean that their early 401k cash out was for nothing.

 

[projektreverb]

It's 100% a scam. I feel sorry for these people who say "residency is not a scam because I couldn't have gotten my clinical position if it wasn't for my residency". Those people are so invested in the scam they can't turn back. It's like those old women who sell Mary Kay and refuse to call it a pyramid scheme because that would mean that their early 401k cash out was for nothing.

The funny part is, I am a resident and I still say it’s a scam.

 

[Secret_Informant]

What on earth has happened to the pharmacy curriculum that P4s are now unprepared for pharmacy practice? Either these schools are feeding lies to students or the accrediting board is somehow lowering standards across the country.

I think neither are accurate.

I believe the schools are using behavioral strategies against the student who speaks out about the decreasing job prospects to preserve the lie and recruit unsuspecting students. The peers within pharmacy school also isolate that individual making them feel less competent and skilled in their own work. Since team projects like the PLRP are required for graduation, that person cannot graduate if they cannot "work within their team." If that does not happen, then they will not attain the degree. This traps the student with peers they may not like or appreciate for at least 2 years (at most 4-6 years). Students that catch on to everything we are talking about on SDN, Reddit, and even Pharmacy Times are considered "behaviorally challenged" or "not worth talking to," which is a true injustice. That is what happened with me and why I do not associate with the Pharmacy College anymore. I conducted my PLRP project alone without a team because I considered my peers incompetent people. Because students are in a vulnerable position, they are easy to take advantage of. There are more dynamics at work than just the Board and the educational standards, dynamics we were not allowed as students to discuss. If pharmacy destroys itself, that is not the school's problem. If hope is instilled in the majority of the student body, then the school did their job. The politics are left for the pharmacy students to navigate.

The concepts of hope and trust are instilled in students to make them "think" and "believe" these job opportunities exist when they actually do not fit every pharmacist. Not every pharmacist WANTS to be a clinical pharmacist and not every pharmacist wants to (or is able to) move halfway throughout the country to find a job in their field. It's kind of like an over-extended video game plot on YouTube. It is a crafty ploy. Those trained in psychological manipulation are very good at what they do and that is why they have that job as a Student Affairs Professional.

The one at USF College of Pharmacy used to work for LECOM (Pharmacy). That is how I know her strategy. The ASDAA told me I was being abusive when I mentioned the lack of jobs out there, as an alumnus. Very childish indeed, coming from a professional with a PhD. She may send a complaint to the Board of Pharmacy to take my license away once I achieve it to preserve her ideal world too. I would not be surprised as she may be looking online at my posts at this very moment.

I cannot speak for other schools, but for USF: Accountability is preserved only if the institutional policy and philosophy is preserved and naysayers are not allowed to talk (or post). Most of us come here to discuss the job market as no one else will hear us. This discussion is perceived as "whiny" speech by peers AND viewed as excuses by "competent" educators.

Pharmacy education revolves around the concept of perception rather than reality and hope rather than evidence of job placement. That is why the emphasis is on credentialing in education rather than patient care outcomes. That conflict between education and patient care will always be a constant battle in pharmacy.

The profession does not want negativity in its midst, which is why the facts are neglected and the positive thought is preserved. People just want to be around positive people, even if the facts are staring them in the face. So the truth is neglected until the student cannot find the job themselves.

 

[Secret_Informant]

The funny part is, I am a resident and I still say it’s a scam.

The term "Clinical Pharmacist" does not have a clear-cut definition. This means you may not have a residency and still be considered a Clinical Pharmacist. The definition depends on where you work.

The position is always relative to the person considering them and the duties of the position itself. For example, one pharmacist can be designated as a "Clinical Pharmacist" for a PBM and only worked in retail for 2 years (no residency). Another pharmacist can be designated as a "Clinical Pharmacist" for a hospital and all of a sudden a residency is "preferred" or "required" depending upon the place of employment. Some positions require residency, others do not, and some require both a residency and experience. The training and experience must be equivalent to a residency, but even equivalency of training is a subject for debate.

 

[Digsbe]

PGY3 is a silly ploy for health systems to have a pharmacist work for 1/3 the salary. 4 years of grad school and 3 years of residency puts training time on par with physicians yet you make half the money and still cant write a prescription or do anything clinical with any autonomy. Just get an NP or PA degree, takes 2 years.

 

[projektreverb]

PGY3 is a silly ploy for health systems to have a pharmacist work for 1/3 the salary. 4 years of grad school and 3 years of residency puts training time on par with physicians yet you make half the money and still cant write a prescription or do anything clinical with any autonomy. Just get an NP or PA degree, takes 2 years.

This. I said in another thread that a PGY1 will become the norm to dispense in nowhere North Dakota. Want to do a major city? PGY2 for you sir! Want a staff hospital job in a rural setting? PGY3 for you! Want a clinical job in a major city? PGY4 for you!

Why? Because who wouldn’t want a pharmacist at a third the cost for 4 years? On the plus side, with the match rate for residency, at least this model will address the saturation problem the field has.

 

[Secret_Informant]

I really don’t get why people hate on residency so much. Do residents work hard yes, do they get paid a crummy salary yes; however, for those who desire to hone their clinical skills beyond that of baseline competence, a residency is a sure shot way in that direction.I’m on rotations now as a final year pharmacy student and I’m realizing how much there is for me to learn and grow. To have the ability to do that in an environment, solely dedicated to the purpose of molding me into a grounded clinician is a privilege. Are there grounded clinicians who did not complete residency ...a duh, but for the students and recent grads who live in any non-rural area, if you don’t want to work retail and you want to work in a clinical setting... 99% of places will not hire us and residency will be a stepping stone. To call residency a scam and liken it to a pyramid scheme is absurd.


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Most of the points presented here are salient and pyramid schemes are considered illegal and detrimental to business. However, obtaining a residency or fellowship (from my research) is not the only way to gain the job you want let alone a clinical pharmacist position; it is just a shorter path with the level of help and support dependent upon the program you apply to. I have seen Physician Assistants, PhDs, and PharmDs without PharmD residencies and PharmD fellowships become MSLs because they were able to translate their clinical skills and research and clinical experiences to meet the client's needs and were able to influence KOLs in their decision-making capabilities. Other pharmacists worked retail for 2-5 years, then transitioned into managed care because they were able to translate their skills into formulary management and clinical decision making: again without a residency (ASHP accredited or not).

If residency is treated as the only way to get a really good job in pharmacy and to have autonomy in one's career, why put oneself through the hassle for "a chance" at something else without calculating the financial and personal risk? The phrase "jumping out of an airplane without a parachute" comes to mind. I decided not to continue with ASHP MidYear 2018 this year for FINANCIAL REASONS. For those with a mortgage, a house, and a family, is it fiscally responsible to try for a residency when under such constraints, especially when the cost of MidYear and PPS is well-over $2,000 not including MidYear Registration and ASHP National Membership? You can't defer your loans for long as the interest incrementally increases while you are training. Programs also have their own stipulations about working while under their thumb (check the residency contracts), which makes earning $70K-$110K very difficult: the academic institutions affiliated with these colleges also have policies against working a second job if your performance is subpar. Some pharmacists work another job during residency as a per-diem retail for some extra money and a change-of-pace, but it is not common. Pharmacists that promote risk-taking behavior are the ones that can handle the risk. Some of us just want to work and pay our bills without being mandated to pursue a residency and some of us are fulfilled without a residency. Seasoned pharmacists should not be restricted from residency matriculation just because they decided to get their life in order first.

I agree that the clinical training for residency is a privilege. However, not everybody gains that privilege (20% get in) or wants the added responsibility and liability. Furthermore, some of us with a mountain of student loan debt ($200,000+) cannot afford to start at the bottom again at $35K-$45K per year after 5-10 years of practice. It is not because it is beneath them, but because they cannot afford to do so or because they just don't want to.

For those that are restricted financially, have "adult" obligations, or just want to retire on-time, there must be an alternative to pursuing post-graduate training for a clinical position, not an invitation for a higher debt-to-income ratio just to advance one's prospects. You also forgot to address non-traditional PGY-1 residencies that allow you to staff while you train for 2-3 years, which is also not a new thing. Applications for these programs were posted in Phase II last year. The benefits and risks must be weighed carefully when you are 5-20 years in practice, which is a completely different perspective with different challenges than that of a PY4 student nearing the "supposed" end of their didactic academic training. At 5-20 years, directors will ask: why a residency and why now. Getting ones finances in order, may not be considered "compelling" enough by residents because they are "privileged."

Different strokes for different folks, but the option must still be there for older practitioners if they want to move into something else. The majority of residency slots are only granted to recent high-performing PharmD graduates (leadership, academics, or both) and not the seasoned pharmacists who have much to offer, which is very restrictive and very political. Look on LinkedIn and you will see that most pharmacy residents are new graduates. It is not surprising why residency is treated like an exclusive club where only the best get in and the "negative" attitudes permeate on social media about lack of jobs. If people feel they cannot advance their career or are not appreciated for the value they bring to the organization, they will leave (the profession or the job) and they won't tell you why to your face.

The reason why people hate on residency is because they were not "privileged" enough and their accomplishments are not taken as seriously as compared to those that are not residency trained. Working retail and following true authority is like being in Kohlberg's Preconventional Stage of Moral Development for a very long time. The lack of flexibility of options takes a toll on you psychologically, especially if you cannot use the bathroom when you are the only pharmacist and no one else wants to help you. If residents made us feel better during the initial stages of our training (including preceptors that were residency-trained themselves), then maybe the "hate" would not be there in the first place. I am not practicing yet and I still saw a PGY2 pharmacist working retail for 3 years before earning a Specialty Pharmacy job and BPharms that became BOARD members that evaluate your competence when you make a mistake as a pharmacist. Pharmacy has a wider mixture of people than what you have been taught or seen in school. Keep in mind that there is much more for YOU to learn about us as well.

Just because a person does not have a residency does not mean that they are worthless. If that thought of worthlessness without residency permeates, the residency-trained pharmacists might as well handle ALL of the patients while the rest of us that do not have residency or fellowship training look for other jobs where we feel appreciated.

 

[BenJammin]

The day retail requires a residency for a job (and believe me, that day is coming within the next 20 years maybe even 10) is the day the pharmacy profession becomes a total scam. 4 years of undergrad, 4 years of pharmacy school, and 3 years of "residency training" so Mrs Jones can tell you that she doesn't have a deductible while you make $80-100k. Who in the hell would go to pharmacy school for that?

 

[projektreverb]

The day retail requires a residency for a job (and believe me, that day is coming within the next 20 years maybe even 10) is the day the pharmacy profession becomes a total scam. 4 years of undergrad, 4 years of pharmacy school, and 3 years of "residency training" so Mrs Jones can tell you that she doesn't have a deductible while you make $80-100k. Who in the hell would go to pharmacy school for that?

Glad I’m not the only one who sees the profession going that direction.

Retail would salivate at being able to pay pharmacists 40-50k for one year.

 

[projektreverb]

There are actually retail residencies. Kroger has them. I'm sure WAG does as well ..... I don't think it will be to that point ever. Eventually ppl will stop going to school for the PharmD

Sent from my Pixel 3 XL using Tapatalk

Wags does have one. I think they take on like 25 residents a year? Albertsons and most retails have at least one residency

 

[Secret_Informant]

Wags does have one. I think they take on like 25 residents a year? Albertsons and most retails have at least one residency

Don't forget about health systems and pharmacy college clinics. They have their own too, but may not teach practical skills. Not every program trains you for the workforce.

The demand is increasing for residencies, but growth of these programs is not fast enough to absorb the new graduates. If practice is evolving to eventually require a PGY1 or above to practice pharmacy in the next 5-10 years, what can we do about those that lack that training to practice?

Hence the argument for alternative careers due to a paucity of residency spots. There simply are not enough to accommodate everyone.

 

[projektreverb]

Don't forget about health systems and pharmacy college clinics. They have their own too, but may not teach practical skills. Not every program trains you for the workforce.

The demand is increasing for residencies, but growth of these programs is not fast enough to absorb the new graduates. If practice is evolving to eventually require a PGY1 or above to practice pharmacy in the next 5-10 years, what can we do about those that lack that training to practice?

Hence the argument for alternative careers due to a paucity of residency spots. There simply are not enough to accommodate everyone.

100% agree but how many residency programs were there 10 years ago vs today? My guess is people will be grandfathered in.

 

[Secret_Informant]

100% agree but how many residency programs were there 10 years ago vs today? My guess is people will be grandfathered in.

A job requirement for many non-traditional residencies is to be working at their facility for at least 1-3 years. How do I know?

I applied to ASHP MidYear in 2017 and read the job descriptions for the ASHP Phase II applications. It does not take much time to do this.

Also, the number of residency program growth does not mention the past. Residencies were not necessary for most positions 10-20 years ago due to less student demand and (arguably) better people. Pharmacists were also competent without one, so there was no need for the additional boost unless you wanted to specialize in a specific area. Keep in mind: you could work anywhere back then with little resistance and the numbers of PharmD graduates were not what they are today. Now, because of the educational explosion (more pharmacy schools and consequently more PharmD graduates) and less students passing the MPJE, many PharmD graduates are stuck where they are not out of fear, but out of financial reasons. "Why pursue a license when there is no guarantee you will even be employed, much less practicing pharmacy." Other practitioners are doing less and getting more out of the system but our progress is at a snail pace if not slower.

The ASHP 2020 initiative failed miserably. We need more jobs, not more "risk taking" students and cowardly employers not willing to take enough risk to absorb these graduates.

PM me if you want to know more.

 

[Modest_anteater]

Hey, I have worked with a PGY2 trained pharmacist that I thought wasn't adequate to staff and verify routine orders. There's a certain level of competency that you just don't get until you are in the trenches handling the routine and complex cases day after day.

I've always been a supporter of on the job training for pharmacists. For one, I look out for my profession and hate to see the days of being trained at full salary go away just so you can get a few extra letters on your e-mail signature. Also, I feel like the focused nature of our job is such that multi-year post-graduate training is really necessary to become proficient in any one area.




Not nearly as pissed as I will be when they come out with PGY4 in 10 years and my 28 year old director decides I'm no longer qualified for my job! Of course, I will be even more pissed when I have to train my replacement for six months because they can't do my job.

Damn, I'm still bitter about what happened to my friend a couple years ago.




This is why it's so frustrating. All it does is created a hierarchy in pharmacy that no one else recognizes or cares about. A motivated and intelligent new pharmacist could get a job at a hospital, staff for year one, move into more clinical duties for year two (ICU coverage, evening clincal position etc), then begin working in a CVICU in year three. If they care anything at all about their job, I guarantee you they will be just as competent as anyone completing a PGY3 if not more so. The only pharmacist I know who would not agree with this are those that act like their residency has somehow elevated them to a status that no one else can ever achieve.

I understand why hospitals would advocate for residency, as it allows them pharmacist labor at a discounted price. I would say it takes the burden of training off of them, but that hasn't been my experience for many new hires. Workflow and policy can be so different between institutions, and that is always a consideration for pharmacists.

I understand why the academy would advocate for residency, because it is an attractive story to sell students and further the fevered dream of new and emerging jobs, pharmacists with prescriptive authority, provider status, running your own clinic etc.

I just don't understand why any pharmacist would get behind the idea of a PGY3. PGY1 and 2 are here to stay, but why would you want to put more burden on the individual? It wasn't that long ago that a PharmD was enough to get your foot in anywhere, and it was expected that your employer would provide training and you would learn as you go along. I understand market pressures, and I understand why a new grad would want to pursue a residency since a PGY1 is basically a requirement to staff these days, but I'll never understand people who are happy about it. We are basically getting the same jobs for more personal sacrifice. It's a poor deal. It would make much more sense if we did expand our scope of practice.

I understand why the academy would advocate for residency, because it is an attractive story to sell students and further the fevered dream of new and emerging jobs, pharmacists with prescriptive authority, provider status, running your own clinic etc.



DING DING DING. It also makes it an easier sell for the Dean to sell the degree to the Fed. Keep that gravy train running uncle sam!

 

[deleted562805]

You cannot be serious. Is that important to be a Physician. Why cannot this person be happy as a pharmacist? And PGY-3 is not the solution. Clinical pharmacy needs to figure out how to create a demand or need for more spots for PGY-1. and then make standardized test exam to make it fair, especially to good candidates who did not get matched because some PC crap like not likable etc.

 

[sozetone]

YES, PGY3 will save everything thats wrong with pharmacy. More schooling, education...etc is all we need. Perhaps they should extend the degree and make it a 6 year PHD?

 

[projektreverb]

YES, PGY3 will save everything thats wrong with pharmacy. More schooling, education...etc is all we need. Perhaps they should extend the degree and make it a 6 year PHD?

The amount of self validation that’s happening in pharmacy nowadays is sad.

 

[deleted562805]

One thing that I still cannot figure out... why do residents have to work under a pharmacist if they have their own active license? Is this a legal thing or a matter of hospital policy? They obviously don't have to be under direct supervision 24/7 like an intern (though nobody pays attention to me when I'm talking to patients anyways) but I'm told that a resident cannot be the only pharmacist on duty/only pharmacist in the pharmacy.

Also, whats the point of spending 45 hours a week at rotation all of P4 if the rational for residency is that you need practical experience? Wouldn't anyone with common sense who wants to work in a hospital schedule hospital rotations? I feel like I'm surrounded by pharmacists who did 2 years of residency in order to calculate a vanco dose and look at a CrCl that the computer automatically calculates for them anyways. Maybe I'm missing something.

I'll be honest I never thought I'd consider hospital, and I hated my current rotation at first, but there are some aspects of the job that I actually found interesting/enjoyable. The problem is the load of bullcrap you have to do to get a residency, the residency itself, you get screwed in terms of pay, and quite honestly it didn't take me long to realize that nurses and doctors are miserable people to work with. I'm a chill person who doesn't stress out... I couldn't imagine doing some of the passive aggressive crap that these nurses pull. One of them goes out of her way to intentionally mess things up for me it's just stupid.

Same way as a Medical resident has to work under an attending Physician. The Only difference is every time I see a pharmacy resident it is with a pharmacy preceptor. where as medical resident, they are allowed spread their wings, just that their notes are reviewed by an attending fostering independence. There needs to be some independence instilled in pharmacy residents if they want the profession to have confidence.

 

[deleted562805]

Stuff like this makes me shake my head... Who are they marketing too? The pharmacy world or the outside? Many practitioners and physicians don't even know that pharmacists can do a residency, heck many don't even know it's a 4 year doctorate.

With a PGY3 you've literally done the years and training a physician does with none of the pay and none of the privileges in a practice act. At that point you've done undergrad, 4 years of a doctoral program and 3 years in residency. Unless it pays better, expands a pharmacists scope, or somehow meaningfully advances the profession I see it as overkill and a way to super-specialize for jobs that might not even exist. If you get that much education and still can't change tablets to capsules or practice beyond dispensing then it's not worth it.

Pharmacists and pharmacy organizations should be less focused on pushing residency and PGY3 and focusing more on actual issues like pharmacist reimbursement (provider status in all areas, not just undeserved), expanding scopes of practice, and dealing with market saturation and wage stagnation. If you do 3 years of residency post PharmD and still have less area to practice than a mid-level then just go to PA school, it would be faster and when you're done you can actually modify medications and have a legal scope to practice more meaningfully.

and none the Job security compared to a Medical Residency.

 

[projektreverb]

and none the Job security compared to a Medical Residency.

Except medical residents need the residency to practice medicine.... Since it’s an optional exercise for us... Well you see where I’m going with that, right?

 

[deleted562805]

Except medical residents need the residency to practice medicine.... Since it’s an optional exercise for us... Well you see where I’m going with that, right?

Yeah, because of saturation of retail. you might as well say required for pharmacy students.

 

[projektreverb]

Yeah, because of saturation of retail. you might as well say required for pharmacy students.

“Might as well be required” and “required” are not the same. You can still get a job in BFE with no residency.