pgy2s for staffing positions

[moxijab2016]

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I work in a large community hospital in a major city on the west coast.
I heard from my supervisor that they received a LOT of pgy2-trained applications for a general staff pharmacist position that was posted and this was the first year they've seen that.
this is scary, has anyone else seen this as well?

 

[rph3664]

Over the past few years, I've heard that a lot of new grads do a PGY or two just so they will have a job that pays more than minimum wage, so it shouldn't be too surprising.

 

[farmadiazepine]

Oh my God, I am so sick of PGY trained pharmacists working as staff pharmacists. They are so useless.

Sure, they are smart clinically, but they suck in every other aspect of staffing and running a pharmacy. They just want to make clinical interventions all day long on the phone and not do anything else in the pharmacy. That's why I can't stand them. It also shows me how stupid they really are for doing a PGY1 and/or PGY2 and spending all that time (and not making real pharmacist money), only to do a job that they didn't need the training for.

So far, the best hospital staff pharmacists I have seen all have come from retail. It's nice to have that one clinical person to teach everyone.

 

[John Detter]

Oh my God, I am so sick of PGY trained pharmacists working as staff pharmacists. They are so useless.

Sure, they are smart clinically, but they suck in every other aspect of staffing and running a pharmacy. They just want to make clinical interventions all day long on the phone and not do anything else in the pharmacy. That's why I can't stand them. It also shows me how stupid they really are for doing a PGY1 and/or PGY2 and spending all that time (and not making real pharmacist money), only to do a job that they didn't need the training for.

So far, the best hospital staff pharmacists I have seen all have come from retail. It's nice to have that one clinical person to teach everyone.

I would never fault someone for making an intervention to optimize therapy. I could argue the opposite and say that some staff pharmacists suck because they think they just have to mindlessly push meds along to earn their 6 figure salary. The best pharmacists are able to balance both clinical and operational responsibilities.

 

[PharmDBro2017]

I would never fault someone for making an intervention to optimize therapy. I could argue the opposite and say that some staff pharmacists suck because they think they just have to mindlessly push meds along to earn their 6 figure salary. The best pharmacists are able to balance both clinical and operational responsibilities.

But was it crucial to make that gabapentin dose change recommendation & i-vent because the patient's CrCl was 59mL/min?

 

[confettiflyer]

I'll probably chalk this up to the fact that it takes like 5mins to apply for a job online now and said PGY-2 graduate has nothing to lose by doing it.

As to the whole clinical vs operations...there's absolutely zero reason for a pharmacist to not be balanced. My program graduates residents that are proficient in both...we will not pass you if you cannot function in a traditionally staffing role. To me, that's a failure of program.

(we also function as a hybrid clinical department...even our ICU specs will do order verification, etc...)


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[awval999]

I'll probably chalk this up to the fact that it takes like 5mins to apply for a job online now and said PGY-2 graduate has nothing to lose by doing it.

As to the whole clinical vs operations...there's absolutely zero reason for a pharmacist to not be balanced. My program graduates residents that are proficient in both...we will not pass you if you cannot function in a traditionally staffing role. To me, that's a failure of program.

(we also function as a hybrid clinical department...even our ICU specs will do order verification, etc...)


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If you cannot validate orders. You are not a pharmacist.

Operations is the foundation of the pharmacy house. It's not always glamorous. But it is literally the only legal obligation of the pharmacist in an inpatient setting.

If someone doesn't realize how important operations is, just play the disaster scenario. If 3, 4, 5 of the operations staff pharmacist call off what happens? And no per diem answers their phone? The clinicals will get pulled to staff.

 

[confettiflyer]

If you cannot validate orders. You are not a pharmacist.

Operations is the foundation of the pharmacy house. It's not always glamorous. But it is literally the only legal obligation of the pharmacist in an inpatient setting.

If someone doesn't realize how important operations is, just play the disaster scenario. If 3, 4, 5 of the operations staff pharmacist call off what happens? And no per diem answers their phone? The clinicals will get pulled to staff.

QFT.

We have redundancies built into our staffing such that pretty much every pharmacist we have on staff has the ability sub into a clin spec role and function well. This goes for even the traditional spec realms of critical care and oncology.

But when you have a staff that is > 90% residency trained and/or board certified, you can do stuff like that.

I really can't understand why more pharmacies don't go this route...to me, you're sowing internal divisions between staff and have much reduced flexibility in times of need.

Have an old bear of a pharmacist that only wants to "slum it in central?" (I stole that phrase from someone here, I can't remember who)....that's crap, you CAN teach an old dog new tricks. I have no sympathy for pharmacists who claim age as a learning disability.


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[gwarm01]

I work in a large community hospital in a major city on the west coast.
I heard from my supervisor that they received a LOT of pgy2-trained applications for a general staff pharmacist position that was posted and this was the first year they've seen that.
this is scary, has anyone else seen this as well?

I knew a pharmacist with a PGY2 who was working a "hybrid" position that was honestly 90% staffing. They were eventually given more clinical shifts, but so were the new grads who started in the same position. Seems like a waste of two years if you aren't willing to go out there and find that specialized position afterwards. Then again, this was pediatrics. It can be a little weird.

Oh my God, I am so sick of PGY trained pharmacists working as staff pharmacists. They are so useless.

Sure, they are smart clinically, but they suck in every other aspect of staffing and running a pharmacy. They just want to make clinical interventions all day long on the phone and not do anything else in the pharmacy. That's why I can't stand them. It also shows me how stupid they really are for doing a PGY1 and/or PGY2 and spending all that time (and not making real pharmacist money), only to do a job that they didn't need the training for.

So far, the best hospital staff pharmacists I have seen all have come from retail. It's nice to have that one clinical person to teach everyone.

No kidding. It doesn't apply to everyone, obviously, because there was plenty of very well rounded pharmacists. It's just the people who nitpick over things that aren't really significant, or if they lack a certain sense of urgency that can be needed in a busy central pharmacy. You definitely need to pick your battles in that kind of situation.

The worst is if they page a doctor about something ridiculous, then leave for their lunch break. I've been forced to find the most polite and professional way to explain to the doc that I know this is a stupid question, I would never bother you with this, but nevertheless here is the issue.

(we also function as a hybrid clinical department...even our ICU specs will do order verification, etc...)

I really think this is the smartest way to run a successful pharmacy department. You will have well-rounded employees, can cover any shift for call outs/vacation, and tend to have happier pharmacists.

 

[TheBlaah]

Ever have a clinical pharmacist from another hospital fill in PRN as staff?

Absolutely. Worthless.

 

[pharmasaurusRex17]

The last sentence. The best RPhs are able to balance both clinical, staffing, and operational. If you want to know how to do pharmacy, you better start from the bottom up. You have to know how to do the tech's jobs, and you have to know how to do the interns and the staff and the clinical and blah blah blah.

There's stories from both sides. Don't bash because both types of pharmacists are still pharmacists at the end of the day.

 

[confettiflyer]

I'm reading all of these posts and this is absolutely 100% a management and training issue.

Why the hell did the pharmacy director hire a PRN staffer who can't even function in that role?

Anyway, all these issues are valid but solvable from a programmatic perspective.


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[Dred Pirate]

We have 2 PGY2's working at hour hospital in staffing position (we have a blended model) - they do the same job as 2 new grads

 

[nasacort24hr]

What actually separates a staff pharmacist vs a clinical pharmacist any way? I mean, when you are verifying order, aren't you required to have clinical knowledge to analyze whether a medication order, it's dose, rate, and drug-interaction, or if a combination of therapy make sense (multiple antibiotic treatments, for example)? This requires one to know what the current treatment guidelines are, and understand how to monitor a drug therapy---ordering labs, analyzing lab results, etc. This requires one to have certain level of clinical knowledge in order to verify orders in a timely manner. When you see a strange order (odd dose, rate of infusion/ route of administration), you need to know how to look up things fast, analyzing if this is appropriate, and if this warrant a call to md, and if md say ok, when would you decide it is actually ok (risk vs benefit), and when it is definitely no ok to approve an order. I think this is very clinical oriented. So I don't really know what really separates a staff pharmacist vs a clinical pharmacist in the knowledge aspect. Can someone educate me?

 

[confettiflyer]

I would feel so bad about my residency if that was my situation. Granted I have no residency and have the same job as an entirely residency trained team.

It's the millennial way of life....more education for the same damn job anyone could have right out of high school in the old days.

As for you, you're a different kind of unicorn. Backdoor unicorn! Hahah


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[gwarm01]

We have 2 PGY2's working at hour hospital in staffing position (we have a blended model) - they do the same job as 2 new grads

Are those two the type who absolutely must live in one specific city and refused to look elsewhere for work? I would hope anyone willing to sacrifice that kind of time, money, and sanity would then stop at nothing to find a job in their specialty. The sad thing is many people just float from point A to point B because that's what they were told to do.

What actually separates a staff pharmacist vs a clinical pharmacist any way? I mean, when you are verifying order, aren't you required to have clinical knowledge to analyze whether a medication order, it's dose, rate, and drug-interaction, or if a combination of therapy make sense (multiple antibiotic treatments, for example)? This requires one to know what the current treatment guidelines are, and understand how to monitor a drug therapy---ordering labs, analyzing lab results, etc. This requires one to have certain level of clinical knowledge in order to verify orders in a timely manner. When you see a strange order (odd dose, rate of infusion/ route of administration), you need to know how to look up things fast, analyzing if this is appropriate, and if this warrant a call to md, and if md say ok, when would you decide it is actually ok (risk vs benefit), and when it is definitely no ok to approve an order. I think this is very clinical oriented. So I don't really know what really separates a staff pharmacist vs a clinical pharmacist in the knowledge aspect. Can someone educate me?

It's not a clear cut distinction and answers will vary across institutions. Like many things in pharmacy, it isn't exactly well defined. Generally speaking, staff pharmacists will be located in a central pharmacy while clinical pharmacists are decentralized / based in a unit. Staff focus on production and distribution, while clinical focuses more on rounding with the medical team and taking consults, doing chart reviews, patient education etc. Expectations differ based on area of focus. Clinical pharmacy is the job every student thinks they want. Staff pharmacist is the job they are more likely to get, although retail is still the most common position by far.

The line between the types of jobs has blurred in many institutions. Hybrid models are very common these days. Look for a job title of "clinical staff pharmacist" or often just "clinical pharmacist" without any specific specialty listed in job postings. These positions typically train you in different areas and allow you to rotate through them while still working central pharmacy shifts. It's how I got my start and was a great way to get a solid baseline of experience. I'm out of the clinical game for now, but if I were to go back that would be my starting point.

 

[rxdawg21]

I would feel so bad about my residency if that was my situation. Granted I have no residency and have the same job as an entirely residency trained team.

I'm in an almost identical situation. Right place at the right time is the only way I can explain it

 

[gwarm01]

I'm in an almost identical situation. Right place at the right time is the only way I can explain it

A little bit of luck and a whole lot of personality if you ask me. Jumped from peds onc to clinical informatics back in 2015 with no residency, just some solid internship experience and a little bit of enthusiasm. Also my charming good looks.

 

[rxdawg21]

Right time/place for sure. I will admit the residency trained specialist are more well rounded and have more overall knowledge than I do.

Ours are hit and miss. A few are duds, but vast majority are good. Some efficiency problems for sure. One of our best is non residency trained. I do overall agree with that statement as far as overall knowledge. The very few non residency trained ones do not have efficiency problems like some of the residency trained ones. But that could be due to sample size

 

[confettiflyer]

Right time/place for sure. I will admit the residency trained specialist are more well rounded and have more overall knowledge than I do.

But that knowledge gap should narrow over time, assuming a site is training continuously and not creating silos.


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[zelman]

I'll probably chalk this up to the fact that it takes like 5mins to apply for a job online now and said PGY-2 graduate has nothing to lose by doing it.

It takes longer than 5 minutes. You have to type every scrap of data that you already put in your resume into individual form fields. Also, the data they want is crazy (real example: "EXPERIENCE. Please begin with your present or last employment and work backward showing all of your employment for the past 20 years. In addition, describe all training, including military service and volunteer work, which you have received." Going back 20 years is crazy. For new grads, they've basically got to include potty training.) I've grown to hate it with a passion.

 

[Dred Pirate]

Are those two the type who absolutely must live in one specific city and refused to look elsewhere for work? I would hope anyone willing to sacrifice that kind of time, money, and sanity would then stop at nothing to find a job in their specialty. The sad thing is many people just float from point A to point B because that's what they were told to do.



It's not a clear cut distinction and answers will vary across institutions. Like many things in pharmacy, it isn't exactly well defined. Generally speaking, staff pharmacists will be located in a central pharmacy while clinical pharmacists are decentralized / based in a unit. Staff focus on production and distribution, while clinical focuses more on rounding with the medical team and taking consults, doing chart reviews, patient education etc. Expectations differ based on area of focus. Clinical pharmacy is the job every student thinks they want. Staff pharmacist is the job they are more likely to get, although retail is still the most common position by far.

The line between the types of jobs has blurred in many institutions. Hybrid models are very common these days. Look for a job title of "clinical staff pharmacist" or often just "clinical pharmacist" without any specific specialty listed in job postings. These positions typically train you in different areas and allow you to rotate through them while still working central pharmacy shifts. It's how I got my start and was a great way to get a solid baseline of experience. I'm out of the clinical game for now, but if I were to go back that would be my starting point.

yes they are the type that were geographically limited

But at our place we have the hybr - everybody does everything except for about 8 clinical service managers (and a few traditional managers)

 

[gwarm01]

It takes longer than 5 minutes. You have to type every scrap of data that you already put in your resume into individual form fields. Also, the data they want is crazy (real example: "EXPERIENCE. Please begin with your present or last employment and work backward showing all of your employment for the past 20 years. In addition, describe all training, including military service and volunteer work, which you have received." Going back 20 years is crazy. For new grads, they've basically got to include potty training.) I've grown to hate it with a passion.

Yikes, that's thorough. I would give them my work history as far back as my hospital internship. If I happen to remember that I did it that day, I may also include my summer internship with Cardinal. I didn't keep records of all of the volunteer work I did in pharmacy school, so that's out. They certainly don't need to hear about the data entry job I had in college, or that month in high school where I worked in fast food and ate a lot of free chicken tenders.

 

[rl123]

speaking from a residency-trained standpoint working in a centralized distribution model- residents staff as part of their training, sure we say it's to teach them pharmacy operations, but at the end of the day its cost justification to run the residency program (# of residents * # of required hours * pharmacist hourly base rate= cost avoidance in staff pharmacy pay). Our residents often feel bad because they feel like more seasoned pharmacists have to carry a heavier burden when working the same shift as them especially when they first start out, but in actuality- a PGY1 resident goes thru an orientation on steroids in the July for all operational areas, whereas a new staff hire gets 3 months of full time training- and so I think it's unfair to expect them to perform to the same level

Now take this concept a step further to compare staff pharmacists vs clinical pharmacists/specialists- when I landed a specialist job after residency- I was oriented to the hospital's policies/procedures, but I didn't spend any real time in the various areas of distribution/production. In this hospital's model, I think it's unrealistic to expect a clinical pharmacist to be up to par with a staff pharmacist if they were to be thrown into a staff shift due to call outs/sick calls. Likewise, I think it's unrealistic to expect a staff pharmacist to perform to the same level as a clinical/ residency-trained pharmacist due to the gap in training, but even more than that- the huge time constraints and expectations for verification/ production productivity.

having worked as a full time staff rph before residency, productivity and getting the drugs out the door is obviously paramount. but depending on the model (fully centralized vs even decentralized with a large patient volume), traditional staff pharmacists just aren't positionally able to make the same type of interventions that a residency-trained pharmacist can make. I find that our staff pharmacists interpret medication orders in a vacuum (ie is the new order appropriately dosed, renally adjusted, interaction screen etc), and don't see the whole picture (ie is this even the right therapy for this patient's comorbidities)- and this is exactly where I see the difference between residency trained vs non residency trained.

Example: daptomycin 6mg/kg daily for a HD patient- I would expect our staff to catch that- they check the dose, they check the renal function, they intervene and frequency is changed to Q48; that same order already profiled when I come to rounds the next day for MRSA pneumonia- I recommend an alternative agent because I don't have the same staffing responsibilities and therefore I have more time to assess the order along with micro data and what's discussed during rounds.

#2: Nimbex order hits the verification queue; pharmacist looks at the mg/kg bolus and the continuous infusion rate, checks all the titration parameters are included in the order as per protocol, it all checks out, verified. I see the same patient, and see that the patient is sedated on fentanyl and precedex, ask for a deeper level of sedation with another agent, take the opportunity to educate the ICU team, and hope it never happens again.

just my 2 cents

 

[confettiflyer]

It takes longer than 5 minutes. You have to type every scrap of data that you already put in your resume into individual form fields. Also, the data they want is crazy (real example: "EXPERIENCE. Please begin with your present or last employment and work backward showing all of your employment for the past 20 years. In addition, describe all training, including military service and volunteer work, which you have received." Going back 20 years is crazy. For new grads, they've basically got to include potty training.) I've grown to hate it with a passion.

I used to ignore that prompt, I figured the site wasn't interested in my high school volunteer work and me tutoring the kids next door when I was 15.

I just started at undergrad and beyond.

 

[confettiflyer]

Example: daptomycin 6mg/kg daily for a HD patient- I would expect our staff to catch that- they check the dose, they check the renal function, they intervene and frequency is changed to Q48; that same order already profiled when I come to rounds the next day for MRSA pneumonia- I recommend an alternative agent because I don't have the same staffing responsibilities and therefore I have more time to assess the order along with micro data and what's discussed during rounds.

#2: Nimbex order hits the verification queue; pharmacist looks at the mg/kg bolus and the continuous infusion rate, checks all the titration parameters are included in the order as per protocol, it all checks out, verified. I see the same patient, and see that the patient is sedated on fentanyl and precedex, ask for a deeper level of sedation with another agent, take the opportunity to educate the ICU team, and hope it never happens again.

just my 2 cents

See... I disagree. I absolutely think every pharmacist should catch the indication on the dapto and make that intervention. It's literally 3 clicks to get into the chart & 30 seconds worth of scanning to figure out what's going on. There's no need to subdivide clin vs. staff this way and if it's a knowledge gap, that can be addressed.

As for the Nimbex example... funny because our most bad ass night pharmacists made a similar intervention one morning before I came in on rounds (level of sedation on new start paralytic).

Though I see your point if a particular institution is geared up this way and "staff" is expected to just pump out the order and offload clinical review to a specialized group of people. It's a change in culture and a huge operational shift, but I think not doing so is a disservice to patients, the more-than-capable pharmacists handling these orders, and to the institution as a whole.

Again and again, this all circles back to the management of a pharmacy. Change and culture start at the top.

 

[rl123]

Don't get me wrong, I am all for elevating the level of practice across the board.
At my current place, they hire pretty much anyone who they don't think would give them trouble from a union point of view. That, and new grads and retail crossovers with 0 hospital experience

 

[nasacort24hr]

See... I disagree. I absolutely think every pharmacist should catch the indication on the dapto and make that intervention. It's literally 3 clicks to get into the chart & 30 seconds worth of scanning to figure out what's going on. There's no need to subdivide clin vs. staff this way and if it's a knowledge gap, that can be addressed.

As for the Nimbex example... funny because our most bad ass night pharmacists made a similar intervention one morning before I came in on rounds (level of sedation on new start paralytic).

Though I see your point if a particular institution is geared up this way and "staff" is expected to just pump out the order and offload clinical review to a specialized group of people. It's a change in culture and a huge operational shift, but I think not doing so is a disservice to patients, the more-than-capable pharmacists handling these orders, and to the institution as a whole.

Again and again, this all circles back to the management of a pharmacy. Change and culture start at the top.

This is exactly what I thought. As a staff pharmacist, don't you need to verify the order for renal dose adjustment, check drug-drug interaction to see what the patient is being treated, if duplicated order are presented, and if the combination of medication makes sense. Those are pretty clinical oriented.

 

[confettiflyer]

Don't get me wrong, I am all for elevating the level of practice across the board.
At my current place, they hire pretty much anyone who they don't think would give them trouble from a union point of view. That, and new grads and retail crossovers with 0 hospital experience

Then yes I see specialization as a necessary evil in that case.

Again, I'll say it...lazy an uninspired management.


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[Abby Atwood]

Job opportunities are out there if you look for them. As a new grad who was passed over for residency positions, I was lucky enough to get the exact type of job I was hoping to obtain after completing a PGY2 residency. Granted, part of the reason I was not chosen by some residency programs was that they were aggressively not impressed by my aspirations; however, it is a clinical ambulatory care job in a specialty area.

I think it's really more about willingness to pursue the opportunities that exist. I was willing to move to a small town, so I got a really cool job. A PGY2 trained resident has endless opportunities if they are willing to move for them, and they can maybe get an okay job even if their job search radius is about 30 miles.

 

[pharmasaurusRex17]

Exactly my thoughts Abby! I moved to a random area for PGY-1 and I can say that I've fallen in love with the area. I can go hiking anywhere I want, I can go up to Rainier, Mt Hood, the Cascades, etc. I can go wine tasting (I love my wines). I can go eat anywhere. I can drive for a bit and be in Seattle, Spokane, or Portland OR. This place is definitely somewhere I can settle down haha, and start a family although it's a bit conservative but that's ok. I'm happy with where I'm at 🙂

 

[farmadiazepine]

See... I disagree. I absolutely think every pharmacist should catch the indication on the dapto and make that intervention. It's literally 3 clicks to get into the chart & 30 seconds worth of scanning to figure out what's going on. There's no need to subdivide clin vs. staff this way and if it's a knowledge gap, that can be addressed.

As for the Nimbex example... funny because our most bad ass night pharmacists made a similar intervention one morning before I came in on rounds (level of sedation on new start paralytic).

Though I see your point if a particular institution is geared up this way and "staff" is expected to just pump out the order and offload clinical review to a specialized group of people. It's a change in culture and a huge operational shift, but I think not doing so is a disservice to patients, the more-than-capable pharmacists handling these orders, and to the institution as a whole.

Again and again, this all circles back to the management of a pharmacy. Change and culture start at the top.

+1

Now that's what I'm talking about!

 

[sakigt]

Have an old bear of a pharmacist that only wants to "slum it in central?" (I stole that phrase from someone here, I can't remember who)....that's crap, you CAN teach an old dog new tricks. I have no sympathy for pharmacists who claim age as a learning disability.
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Pretty sure that was me.

Ive got as much problem with the old timers wanting to slum it in central and never respond to a code as with the new grads who cant keep central running at a brisk pace.

 

[confettiflyer]

Pretty sure that was me.

Ive got as much problem with the old timers wanting to slum it in central and never respond to a code as with the new grads who cant keep central running at a brisk pace.

That phrase is awesome, btw.

I have sympathy for you, I have none for them.

Change or die, I live by that rule (or try to, I'm only human).

They're 100% capable, but complacency is a bitch.


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[Mao Mao]

I read all the stuff about lack of jobs for Pgy1/ Pgy2 residents but then my hospital in South CA has so much trouble hiring. If you know of some good pgy1 or 2 grads looking for jobs and willing to move to south Cali, about 1 hr away from LA, please send them my way.

 

[confettiflyer]

I read all the stuff about lack of jobs for Pgy1/ Pgy2 residents but then my hospital in South CA has so much trouble hiring. If you know of some good pgy1 or 2 grads looking for jobs and willing to move to south Cali, about 1 hr away from LA, please send them my way.

Please don't call it south cali :::shudder:::


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[pharmasaurusRex17]

I read all the stuff about lack of jobs for Pgy1/ Pgy2 residents but then my hospital in South CA has so much trouble hiring. If you know of some good pgy1 or 2 grads looking for jobs and willing to move to south Cali, about 1 hr away from LA, please send them my way.

@pharmasaur Here's your chance to go back to CA if you see this haha!

 

[samven582]

I read all the stuff about lack of jobs for Pgy1/ Pgy2 residents but then my hospital in South CA has so much trouble hiring. If you know of some good pgy1 or 2 grads looking for jobs and willing to move to south Cali, about 1 hr away from LA, please send them my way.

Thats because they're failing the CPJE lol