Pharmacy Hierarchy

[Amicable Angora]

Can anyone go over the positions that pharmacists occupy from lowest to highest?

So for example for retail I know there are floaters and staffers (about same level of authority), then comes the pharmacist-in-charge and then I'm not sure?

And what about in hospital? Staff pharmacist then?

I don't understand the difference between a "director of pharmacy" for example, compared to a PIC.

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[gwarm01]

Hospital hierarchies vary from institution to institution. Here's an example from a hospital I used to work at:

Clinical pharmacist (staff) reports to director of pharmacy, who reports to some higher hospital administrator.

Clinical specialist reports to clinical coordinator who reports to director of pharmacy.

Technicians report to pharmacy supervisor who reports to operations manager who reports to director of pharmacy.

Of course, there is a lot of cross communication. A clinical staff person can discuss clinical issues with the clinical coordinator for insurance l insurance. As a pharmacist, while there is a definite chain of command, you also have a lot of leeway in professional judgement.

 

[Lnsean]

Can anyone go over the positions that pharmacists occupy from lowest to highest?

So for example for retail I know there are floaters and staffers (about same level of authority), then comes the pharmacist-in-charge and then I'm not sure?

And what about in hospital? Staff pharmacist then?

I don't understand the difference between a "director of pharmacy" for example, compared to a PIC.

The DOP for a large hospital is like the DM/RXsupervisor in retail. Generally, there are only these levels:

The ants: these are your per diem/ PT staff---I call them leechers because they probably have another job somewhere or a side gig and just want to keep their foot in the door

Workerbees: Staff pharmacists (retail, clinical, specialists...no one cares). People in this range are very sensitive about their ego and will try to over justify it.

Shift Lead/PIC: immediate supervisor....nuff said

Middle management: DOPs/DMs----usually a revolving door, although i've seeen good DOPs and DMs that remain in their positions for 10+ years or so...much rarer in retail tho

Upper echelon: hospital execs/regional VPs---also revolving door but with bags of money out the door

Climb the ladder well young lad...and godspeed.

 

[Amicable Angora]

The DOP for a large hospital is like the DM/RXsupervisor in retail. Generally, there are only these levels:

The ants: these are your per diem/ PT staff---I call them leechers because they probably have another job somewhere or a side gig and just want to keep their foot in the door

Workerbees: Staff pharmacists (retail, clinical, specialists...no one cares). People in this range are very sensitive about their ego and will try to over justify it.

Shift Lead/PIC: immediate supervisor....nuff said

Middle management: DOPs/DMs----usually a revolving door, although i've seeen good DOPs and DMs that remain in their positions for 10+ years or so...much rarer in retail tho

Upper echelon: hospital execs/regional VPs---also revolving door but with bags of money out the door

Climb the ladder well young lad...and godspeed.

Hospital hierarchies vary from institution to institution. Here's an example from a hospital I used to work at:

Clinical pharmacist (staff) reports to director of pharmacy, who reports to some higher hospital administrator.

Clinical specialist reports to clinical coordinator who reports to director of pharmacy.

Technicians report to pharmacy supervisor who reports to operations manager who reports to director of pharmacy.

Of course, there is a lot of cross communication. A clinical staff person can discuss clinical issues with the clinical coordinator for insurance l insurance. As a pharmacist, while there is a definite chain of command, you also have a lot of leeway in professional judgement.

Thanks a lot!

I've always heard horrible things about becoming a PIC (in retail side) and how it's like 3x the work for a 5% pay increase. What about in other settings? For example becoming the "Shift Lead/PIC" of a hospital? Director of pharmacy?

 

[WVUPharm2007]

Pharmacy is rare in that you really want to remain as low on the totem pole as humanly possible while still being full time with benefits. The higher you go, it's more stress and responsibility with a negligible increase in pay.

 

[xiphoid2010]

Pharmacy is rare in that you really want to remain as low on the totem pole as humanly possible while still being full time with benefits. The higher you go, it's more stress and responsibility with a negligible increase in pay.

I find this sentiment quite unfortunate. While I also heard being a PIC doesn't pay, my personal experience is the additional pay for a DOP isn't negligible.

I wish more pharmacists would be willing and have a bit more ambition to push their comfort zone, to use their skills in a bigger scale to help more patients.

 

[Amicable Angora]

I find this sentiment quite unfortunate. While I also heard being a PIC doesn't pay, my personal experience is the additional pay for a DOP isn't negligible.

I wish more pharmacists would be willing and have a bit more ambition to push their comfort zone, to use their skills in a bigger scale to help more patients.

Thank you for your input, could you explain what a director of pharmacy does differently than a PIC?

 

[WVUPharm2007]

I find this sentiment quite unfortunate. While I also heard being a PIC doesn't pay, my personal experience is the additional pay for a DOP isn't negligible.

I wish more pharmacists would be willing and have a bit more ambition to push their comfort zone, to use their skills in a bigger scale to help more patients.

Unless they start paying about $180,000 for the director's position, I have zero interest. Same with PIC.

 

[TheBlaah]

From my observations of my DOP: Lots of meetings with other department heads means lots of politicking. Similar to a district supervisor, you're no longer performing the function of an actual pharmacist but rather an overseer. You're in charge of policy and projects to pursue. Lastly, you're also in charge of the schedule as well as disciplining the pharmacy team.

And my DOP really doesn't get that big of a pay increase to be worth it imo.

 

[Amicable Angora]

From my observations of my DOP: Lots of meetings with other department heads means lots of politicking. Similar to a district supervisor, you're no longer performing the function of an actual pharmacist but rather an overseer. You're in charge of policy and projects to pursue. Lastly, you're also in charge of the schedule as well as disciplining the pharmacy team.

And my DOP really doesn't get that big of a pay increase to be worth it imo.

Pardon my ignorance, (I really don't know) but how is this tiring? It sounds like you just literally manage people and talk and never really do any pharmacy work?

 

[TheBlaah]

Pardon my ignorance, (I really don't know) but how is this tiring? It sounds like you just literally manage people and talk and never really do any pharmacy work?

I forgot to mention: she's also in charge of financials and making sure we're complaint with Joint Commission, Medicare/Medicaid, ect standards.

As for the meetings, it depends what the other department heads are like. They may think pharmacists are overpaid, or that some of the policies that the DOP's pushing are tiresome even though they're really from Joint Commission. Maybe you're pushing for money for more space or fridge, you'll need to convince whoever that you need it and why. Maybe you want to save some money but restricting the formulary, but a few doctors are adamant against it for arbitrary reasons.

It's not so much tiring as it is having to keep track of so many little things as well as somewhat demoralizing as you will almost ALWAYS get pushback for whatever recommendations you make.

 

[xiphoid2010]

Some people beat me to much of it. Besides small hospitals, DOP's work is mostly about quality, regulatory, financial, policies, managing staff, and facilitating interdepartmental cooperation. So yes, lots of reports, meetings, metrics, phone calls and emails. There is more power and responsibility. But I wouldn't say it's necessarily more stressful, just a different type. If you got the hang of it and have things pretty much running itself, most days are pretty normal.

As for pay, I can only speak from local experience. Staff RPh here make around low to mid 50s an hour. DOP's range is a bit wider, high 60s to mid 70s an hour, plus a bonus structure, a week more PTO, and a few other minor perks. There is also access to non-qualified deferred compensation plans, but not sure if that's really a good idea since it looks more like golden handcuffs to me.

 

[Amicable Angora]

Thanks a lot for the information.

 

[BidingMyTime]

Pardon my ignorance, (I really don't know) but how is this tiring? It sounds like you just literally manage people and talk and never really do any pharmacy work?

because of the politics involved and being forced to please several different groups of people (physicans, nursing, administration, legal/regulatory agencies) in order to keep your job, when these different groups want opposing things from you. See my post here for more explanation: http://forums.studentdoctor.net/thr...re-pharmacy-management.1126153/#post-16302144

Now some people are natural born talkers, these people could have been used sales people, but they went into pharmacy instead, and they can do this juggling/politicking, promising different groups of people things they can't/won't actually deliver. Many pharmacists aren't salespeople though, and they flounder horribly at being a manager.

I find pharmacy work, no matter how busy, no matter how short-staffed, is far more preferable to slick talking/politicking. Pharmacy work I can understand, slick talking/politicking I have no idea how to do.

 

[xiphoid2010]

Diplomacy and communication. Nurses will drive pharmacists nuts, but keep the DON/nurse manager on your side. Their turn over is much higher than pharmacy and have it worse. I went through 4 DONs, 3 nurse managers in the last 4 years. Each time I offered help to make their lives easier (help orientation them, help with heir reports, lend them a shoulder when they got beaten up by corporate..) At leadership level, we face similar pressures and issue with staffs, talk and help each other against those has worked for me.

And work hard in a way that shows. CEOs get their butts chewed when their numbers look bad. Again, help them with results. I drove the drug cost down by looking for inefficiencies, auto subs, antibiotic stewardship... Cut agency and overtime cost by hiring PRNs and filling in gaps myself. Work hard to get those results and communicate to the CEOs know how they are getting those good numbers, and they will want to keep and protect you.

Approach physicians humbly and build that relationship. Offer to be their eyes and ears, catch a few things they might have missed and let them know discreetly. Do your research before hand so they know you know what you are talking about... Soon they'll see you as their helper. Choose your battles on drugs. Often its betting to let go some cheaper non-formulary drugs to save up that political clot to ask for a pass on a big budget buster.

There a ton more that go into working in a complex organization. And you don't have to get it all right. I have gotten into trouble couple of times, but got enough right to stayed on the good-list.

 

[WVUPharm2007]

Diplomacy and communication. Nurses will drive pharmacists nuts, but keep the DON/nurse manager on your side. Their turn over is much higher than pharmacy and have it worse. I went through 4 DONs, 3 nurse managers in the last 4 years. Each time I offered help to make their lives easier (help orientation them, help with heir reports, lend them a shoulder when they got beaten up by corporate..) At leadership level, we face similar pressures and issue with staffs, talk and help each other against those has worked for me.

And work hard in a way that shows. CEOs get their butts chewed when their numbers look bad. Again, help them with results. I drove the drug cost down by looking for inefficiencies, auto subs, antibiotic stewardship... Cut agency and overtime cost by hiring PRNs and filling in gaps myself. Work hard to get those results and communicate to the CEOs know how they are getting those good numbers, and they will want to keep and protect you.

Approach physicians humbly and build that relationship. Offer to be their eyes and ears, catch a few things they might have missed and let them know discreetly. Do your research before hand so they know you know what you are talking about... Soon they'll see you as their helper. Choose your battles on drugs. Often its betting to let go some cheaper non-formulary drugs to save up that political clot to ask for a pass on a big budget buster.

There a ton more that go into working in a complex organization. And you don't have to get it all right. I have gotten into trouble couple of times, but got enough right to stayed on the good-list.

Just out of curiosity...are you ever worried that CPS or some other huge firm will slip a letter in front of your boss's eyes that shows how their purchasing and formulary programs can save the boss man millions...and that you'll get the axe because of it? Because in reality, the biggest thing a director brings to an institution is money saved. Dancing that complex dance with all of the drug companies & distributors. Is it worth the savings I might get on antibiotic X if I have to contractually buy products Y & Z? And you know those corporate giants have that stuff ironed out in ways a singular guy in the basement who also has to wrangle the pharmacists and deal with hospital politics can't. Unless I was a director working or one of those companies, I'd be worried every day. Capitalism tends to lead to consolidation, not competition. And middle management ain't where you want to be when it happens.

 

[xiphoid2010]

Just out of curiosity...are you ever worried that CPS or some other huge firm will slip a letter in front of your boss's eyes that shows how their purchasing and formulary programs can save the boss man millions...and that you'll get the axe because of it? Because in reality, the biggest thing a director brings to an institution is money saved. Dancing that complex dance with all of the drug companies & distributors. Is it worth the savings I might get on antibiotic X if I have to contractually buy products Y & Z? And you know those corporate giants have that stuff ironed out in ways a singular guy in the basement who also has to wrangle the pharmacists and deal with hospital politics can't. Unless I was a director working or one of those companies, I'd be worried every day. Capitalism tends to lead to consolidation, not competition. And middle management ain't where you want to be when it happens.

Honestly I have not had to worry.

(1) pharmacy management company cost money. The cost is passed-through. So whatever wages of the staff and director + drug cost are passed onto the hospital, PLUS a management fee. So an efficiently run hospital pharmacy is usually cheaper to keep internal.
(2) pharmacy management company don't have a stash of pharmacists sitting around, getting paid and waiting for new hospitals to sign contracts. So even if a hospital decides to go external, the existing pharmacy staff (including the director) are usually hired on as employees of the new company (minus the few bad eggs that people have been waiting for an opportunity to get rid off).
(3) making deals with drug companies and distributors are mostly the duty of the corporate level pharmacy management -- corporate pharmacy director/VP. Most hospital system takes part in a GPO, has contract with a primary wholesaler with x% of rebates, negotiate with drug company as a system for market share based discounts. This is usually beyond the scope of the hospital level DOP.

So the most threatened by companies such as Cardinal that I can see are actually corporate level pharmacy executive positions. Say you have 6 hospitals in the system. Whether you keep pharmacy internal or go with Cardinal, you will be paying DOPs and pharmacy staff at each facility either way. The question is whether it's more cost-effective to hire a corporate pharmacy director/VP to oversee 6 hospitals or use his/her cost to pay say Cardinal? What about a 50 hospital system? This is what I think is the main reason why large hospital systems have internally managed pharmacy.

 

[xiphoid2010]

Every job has its risks. Inaction has a cost as well. Everyone up and down the corporate ladder must justify their existence. One of the things I was told during my interview for my next post is that there is a significant difference in opinions between hospital administration and corporate pharmacy regarding how this hospital's pharmacy should be staffed/run. Without knowing and going into all the details, at least 2 FTE worth of pharmacist positions are on the line, easily $300K or more a year to wages and benefits. Unlike most other departments where cost of staff is by far the biggest cost. Drug cost is 70-80% of the pharmacy budget. So I personally rather go after that or expand pharmacy services to justify the expense. We'll see.

I'm not going to the larger hospital to have a cushier job. I had it pretty sweet, good pay, moderate workload, an administration that's happy as can be with pharmacy. But I wanted new challenges, to learn new things and grow new skills. In a changing healthcare system, there are few places where one can staying at one place doing the same thing for 40 years and retire. If you have to adapt to changes anyway, why not grow in the process and try to use the new skills do some more good.

 

[Caffeine QAM]

Pardon my ignorance, (I really don't know) but how is this tiring? It sounds like you just literally manage people and talk and never really do any pharmacy work?

Couldn't be further from the truth, but it might depend on what you mean by "pharmacy work". A director has to be aware of everything that happens pertaining to their department, either personally, or by proxy with pharmacy managers or PICs depending on the organizational structure at a particular institution. For example, where I am at, I report directly to the CEO, and staff pharmacists report directly to me, but larger hospitals may have clinical coordinators and supervisors that would help the director manage various aspects of the pharmacy. I don't have a clinical coordinator, so I'm responsible for implementing and monitoring clinical projects myself. Most of the director's work should be "pharmacy work". You do manage people and talk, but you're managing pharmacists and everything you talk about is pharmacy related. Antimicrobial stewardship, formulary, medications safety...I'm pretty sure all of that qualifies as "pharmacy work".

The reason it can be tiring is because of the sheer volume and breadth of responsibility as well as the problems you need to deal with. As a director, you have your agenda and plan for what you need done, but you will find that there are many obstacles and barriers that prevent you from implementing your plans. It's not as easy as telling other people what to do. It's about understanding the problems and working with many different people to figure out a solution that's acceptable to the relevant bodies.

As for PIC vs director, the director is most likely the PIC on paper with the board of pharmacy, however in practice, they may or may not be the same person. Many places have a schedule of who is PIC on what day...so more of a responsibility than a job title. Generally, the PIC is responsible for maintaining daily operations running smoothly and dealing with day to day problems. The director is more interested in the larger picture, fixing systemic issues, and implementing performance improvement activities. If the pharmacy were a ship, the director could be likened to the captain that determines the destination and charts the course whereas the PIC would be more like the master/quartermaster of the ship in charge of overseeing maintenance and operation duties. Of course that makes the director's job sound pretty easy...

 

[gwarm01]

I've had directors that seemingly have no idea what actually happens in a pharmacy. Every time a nurse complained to them, no matter how trivial the issue or ridiculous their demand, they would bend over backwards to make it happen and always assigned the blame to us. Not a lot of goodwill there.

 

[Caffeine QAM]

I've had directors that seemingly have no idea what actually happens in a pharmacy. Every time a nurse complained to them, no matter how trivial the issue or ridiculous their demand, they would bend over backwards to make it happen and always assigned the blame to us. Not a lot of goodwill there.

Then this director doesn't realize that fixing the problem can ameliorate the nurses (sometimes actually will, on the contrary, aggrevate them), but ameliorating the nurses doesn't fix the problem in and of itself. Blame is always a bad thing, regardless of who it is layed on. People care too much about "whose fault it is" rather than what caused the problem and what can be done by all parties to reduce future occurences. This sounds like a person who just ignored the problem...didn't investigate the cause and monitor patterns over time, didn't encourage communication between pharmacy and nursing etc...

I get peeved when people have no sense of accountability though. I don't equate accountability with blame. Sometimes pharmacists will try to blame the tech. or the nurse. I tell them it's a shared responsibility. I don't like it when blame gets thrown around...ultimately, I'm held accountable for my department if mistakes happen, regardless of whether or not I was personally involved and so likewise I hold my staff accountable for the people and tasks they are responsible for, whether or not they were personally involved. Yes, the tech messed up - but the pharmacists oversee the techs. Man (or woman) up and acknowledge that there was an issue or oversight that needs to be addressed, don't just say "not my fault = not my problem". I don't let nurses blame the pharmacists, but I also don't let pharmacists blame the nurses. Too much of an "us vs. them", mentality and not enough realizing that we are in the same boat and that we have a lot of shared issues that are not purely within the domain of pharmacy or purely within the domain of nursing.

 

[gwarm01]

Then this director doesn't realize that fixing the problem can ameliorate the nurses (sometimes actually will, on the contrary, aggrevate them), but ameliorating the nurses doesn't fix the problem in and of itself. Blame is always a bad thing, regardless of who it is layed on. People care too much about "whose fault it is" rather than what caused the problem and what can be done by all parties to reduce future occurences. This sounds like a person who just ignored the problem...didn't investigate the cause and monitor patterns over time, didn't encourage communication between pharmacy and nursing etc...

That director doesn't realize much about anything, heh. Poor soul was overly educated and under-experienced.

I get peeved when people have no sense of accountability though. I don't equate accountability with blame. Sometimes pharmacists will try to blame the tech. or the nurse. I tell them it's a shared responsibility. I don't like it when blame gets thrown around...ultimately, I'm held accountable for my department if mistakes happen, regardless of whether or not I was personally involved and so likewise I hold my staff accountable for the people and tasks they are responsible for, whether or not they were personally involved. Yes, the tech messed up - but the pharmacists oversee the techs. Man (or woman) up and acknowledge that there was an issue or oversight that needs to be addressed, don't just say "not my fault = not my problem". I don't let nurses blame the pharmacists, but I also don't let pharmacists blame the nurses. Too much of an "us vs. them", mentality and not enough realizing that we are in the same boat and that we have a lot of shared issues that are not purely within the domain of pharmacy or purely within the domain of nursing.

Agreed. The blame game doesn't solve anything when issues are often systemic/policy/practice based. It's better to tackle the problem objectively, hear the grievances and suggestions, and pound out a solution that is workable. Too many people bring emotions into the process and it just becomes a slug fest.

 

[ChalupaBatman86]

CPS is not cheaper than internal. They pay their traveling DOP around $80 per hour plus travel/housing costs + benefits. They mark that up 1/3 to the client. It's usually short term solution to get rid of a bad director.

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