Please assure me that clinical pharmacy is not... this

[kvl1027]

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I would say that the usefulness or acceptance of clinical pharmacists may not be so great in most hospitals, my personal experience was quite the opposite.

Because I have two children, I was able to get all of my rotations in the same city while I was a 4th year. The hospital I did most of my rotations at was a large (1100ish beds) teaching hospital. My two-month internal medicine rotation was excellent. I rounded everyday with the medical teaching service and they were very receptive to the professional opinion of both my preceptor and myself. All of our attendings would involve us in the patient discussions and asks our opinions of the patients current drug therapy. Each team consisted of an Attending, Upper-level Resident, two 1st year Residents, two med-students, and a Clinical Pharmacist. I learned more about clinical practice in that two month rotation, than I learned in 4 years of Pharm school.

I also had a Trauma/Surgical Critical Care rotation at the same hospital, which has a level 1 trauma unit. Because, of my performance during my Adult Med/Internal medicine rotation. I was given my own team for my trauma rotation and was basically treated as a pharmacy resident. I spent the first hour to hour and a half working up the teams patient's which varied from about 20-40 patients all admitted to the hospitals surgical department. We would round daily for about 3-4 hours all the time responding to every trauma call that came in for the day.
During trauma's we would go to the trauma bay and throw on some lead and start gathering information about the patient that was coming their way. We would need to asses based on vitals what type of pain meds we needed to get ready. What types of antibiotics we need to get ready based on type and location of open wounds. On several occasions I made infusions on the spot of pressors or vasotec if they were needed. I prepped syringes of atropine and epi when a pt crashed. My days were 12-14 hours long and I never once looked at the clock and wondered when I was going to be getting off. It was a complete hands on experience and something I will never forget. If I was in a different place in my life (not married with children) I would have done the residency and worked as a Trauma pharmacist. Instead I currently work at a small family pharmacy, where I don't has some corporate suits telling me how to practice.
The Hospital I rotated at has a very good, but physically and emotionally demanding residency program. If you are interested PM me.

 

[Requiem]

I see...so you want a dose of reality? Cool, I'll give it to you now

Actually, this is pretty much part of the clinical services you see. Don't expect too much from clinical pharmacy that you dreamt about during classroom lectures from your professors. A lot of ur professors are actually BS a lot , trying to prove that they r smart...but in reality, they're just a bunch of wimps at the hospitals.

Anyway, back to reality, yes...that's pretty much it. Clinical pharmacy is just a fancy term. The core of pharmacy is despensing model, and as long as pharmacy around, that is still the case. People still see you as a dispensing guy.

Surprisingly, how many times when i make rounds on the floor trying to dose a vancomycin or starting a new TPN order, a nurse from nowhere would come up and ask, "DO you bring my metoprolol dose for my patient?". Sometimes, they don't even look or bother care to look at ur badge (which says, Pharm.D btw) and then call pharmacy "The pharmacy guy is here but my metoprolol missing medication is not here. I need it NOW. My patient's BP is 160/100).

Welcome to the real world.!
Don't be so disappointed

I've seen a lot of similar stuff to this. I think you hit a lot of good points that students should realize, and I should have realized better myself at that time:

The ideal clinical pharmacy practice gig you hear about - rounding with teams waiting with bated breath for your ultimate "pharmacotherapeutic recommendation" (which by the way, is a recommendation. Keep that in mind, you suggest.). Or reviewing patient charts and coming up with superior cost-effective therapies with lower adverse effects and changing everyone's meds in win-win scenarios. This gig is certainly out there, but quite rare and not a reality for most hospitals or working relationships.

The problem is there is a huge amount of misinformation about what pharmacists can do. There are a pile of older pharmacy managers, DOPs (looking at you Z), etc., who are completely out of touch. As much as a staff pharmacist is rearing to go on rounds and show off that knowledge, the DOP just instituted another policy forcing pharmacists to double check a potassium chloride bag. So the leaders of pharmacy are often pushing it in a completely ridiculous direction, a direction better suited and better handled by technicians.

But you don't hear about that in school. You hear "on rounds you'd recommend X instead of Y to handle Z disease state". But, like rxforlife mentioned, a lot of these badass side effect memorizers don't have the personal confidence to effectively handle interpersonal relationships or get their point across. If a doc says no or doesn't explicitly say oh drug master please tell us how to dose this vanc, nothing is offered. Or when they get refused, the doc is a ******* or is a quack and blah blah blah ranting and whining followed by passive aggressive jabs at everyone else. He "hates" pharmacy so we don't recommend anything anymore. Well, you don't recommend for the docs approval, you recommend for the patient, so suck it up and voice your concern.

A lot of this disappointment gets funneled into a well I can't beat the system, so I'll be lazy in the system mentality where the then "clinical pharmacists" look at a patient per hour and surf various websites 40 mins per hour. You know, to make sure their savings account hasn't been dinged $1.50, or to find the cheapest restaurant downtown because pharmacists are tight like that.

Nurses, while they certainly deserve their own thread, in general see you as a living pyxis machine that receives med orders and spits out nice little unit dose baggies of meds. They like to call, send reqs, and argue that these fleshly robots should spit out meds faster. But, should there be an issue down the road with incorrect medication, will I-N-C-I-D-E-N-T R-E-P-O-R-T your ass and they will chop your balls off. As soon as they're off break.

None of this is always true and there a ton of exceptions to everything. But a bit of the "other side" of things you don't hear about in school.

 

[Its Z]

There are a pile of older pharmacy managers, DOPs (looking at you Z), etc., who are completely out of touch.

You do know I have not been a DOP in almost 4 years.... and what I promote is the hybrid staff/clinical model where pharmacists process medication orders from the floor.... so they dispense and make clinical interventions as a part of the team taking care of patients.

I do not endorse clipboard clinical pharmacists who just rounds and I also do not endorse dispensing only pharmacists.

 

[Requiem]

You do know I have not been a DOP in almost 4 years.... and what I promote is the hybrid staff/clinical model where pharmacists process medication orders from the floor.... so they dispense and make clinical interventions as a part of the team taking care of patients.

I do not endorse clipboard clinical pharmacists who just rounds and I also do not endorse dispensing only pharmacists.

My friend I was being completely sarcastic, I should have included a smiley.

You're one of the most progressive, big picture oriented pharmacists i've had pleasure to come across.

Edit: Further to that, I think we should start a market thread where we discuss trends, stocks, funds, etc.

 

[spacecowgirl]

Rather than quoting Requiem's entire post, just pretend I'm doing the dramatic, slow clap right here.

ETA: I'm sure someone can find an appropriate GIF for me.

 

[Its Z]

My friend I was being completely sarcastic, I should have included a smiley.

You're one of the most progressive, big picture oriented pharmacists i've had pleasure to come across.

Edit: Further to that, I think we should start a market thread where we discuss trends, stocks, funds, etc.

I've had a stock thread on MNTA... it was a big day..July 23rd.

I've posted about ARNA... the big day is Sept 16... I have some concerns about Cardiac Side Effects.

I'm hyped up on Stem Cells.. ATHX, GERN, and ACTC.

Federal Court ruled no federal funding for stem cell research last week. Department of Justice announced they'll appeal the decision.

Meanwhile, I watch this battle closely...

I'm so freakin excited about ATHX and their multistem cells and what it can do. If GERN can show embryonic stem cells can regenerate damaged spinal cord nerve cells..how great is it???

I have a couple of threads on this.

 

[gotdrugs]

You do know I have not been a DOP in almost 4 years.... and what I promote is the hybrid staff/clinical model where pharmacists process medication orders from the floor.... so they dispense and make clinical interventions as a part of the team taking care of patients.

What patient : pharmacist ratio have you found works best?

In general, most of the people I know who work this "hybrid" model their patient ratio is so high and there other operational responsibilities (e.g. point person to call for missing doses, ADC shortages, etc) that the "staff" component vastly outweighs the "clinical" component......they have basically become "staff" pharmacists that instead of performing these functions in the basement, they perform the basic same role at a desk/"office" on a nursing unit somewhere. (only putting the words 'staff' and 'clinical' in quotation marks as i know how sensitive some people are with the use of this verbiage)

If/when they get some time in for some non-dispensing activities, it's usually just some basic renal dosing and/or iv-to-po via protocol.

I think in theory this model if executed appopriately would kick-azz, but personally haven't seen success with it. Obviously though I've never worked for you, so am curious to how you execute it.

 

[Its Z]

25 to 50 general med surg beds per phamacist and up to 25 to 30 critical care beds per pharmacist 8 hours per day. and i can definitely show cost effectivenss and savings with this model. and 50plus psych beds per 1 pharmacist. of course central pharmacist has to be manned by some pharmacists also.

What patient : pharmacist ratio have you found works best?

In general, most of the people I know who work this "hybrid" model their patient ratio is so high and there other operational responsibilities (e.g. point person to call for missing doses, ADC shortages, etc) that the "staff" component vastly outweighs the "clinical" component......they have basically become "staff" pharmacists that instead of performing these functions in the basement, they perform the basic same role at a desk/"office" on a nursing unit somewhere. (only putting the words 'staff' and 'clinical' in quotation marks as i know how sensitive some people are with the use of this verbiage)

If/when they get some time in for some non-dispensing activities, it's usually just some basic renal dosing and/or iv-to-po via protocol.

I think in theory this model if executed appopriately would kick-azz, but personally haven't seen success with it. Obviously though I've never worked for you, so am curious to how you execute it.

 

[gotdrugs]

25 to 50 general med surg beds per phamacist and up to 25 to 30 critical care beds per pharmacist 8 hours per day. and i can definitely show cost effectivenss and savings with this model. and 50plus psych beds per 1 pharmacist. of course central pharmacist has to be manned by some pharmacists also.

Thanks for your insight.....

In your model, do you dictate the "clinical" responsibilities? You mention making interventions, what level of interventions does your model w typically produce? Do your pharmacists round with medical teams?

Also, for protocol development, other administrative responsibilities, do you buy into those activities? DO you have your pharmacists split them giving project time, or do you have them assigned to *almost* purely desk jockeys?

 

[FruitFly]

I see...so you want a dose of reality? Cool, I'll give it to you now

Actually, this is pretty much part of the clinical services you see. Don't expect too much from clinical pharmacy that you dreamt about during classroom lectures from your professors. A lot of ur professors are actually BS a lot , trying to prove that they r smart...but in reality, they're just a bunch of wimps at the hospitals.

Anyway, back to reality, yes...that's pretty much it. Clinical pharmacy is just a fancy term. The core of pharmacy is despensing model, and as long as pharmacy around, that is still the case. People still see you as a dispensing guy.

Surprisingly, how many times when i make rounds on the floor trying to dose a vancomycin or starting a new TPN order, a nurse from nowhere would come up and ask, "DO you bring my metoprolol dose for my patient?". Sometimes, they don't even look or bother care to look at ur badge (which says, Pharm.D btw) and then call pharmacy "The pharmacy guy is here but my metoprolol missing medication is not here. I need it NOW. My patient's BP is 160/100).

Welcome to the real world.!
Don't be so disappointed

Yep. A clinical pharmacist, from a nurses point of view, is like Johnny Cochran with a hat on: It's no disguise. It makes no sense. It doesn't fit.

 

[Its Z]

Thanks for your insight.....

In your model, do you dictate the "clinical" responsibilities? You mention making interventions, what level of interventions does your model w typically produce? Do your pharmacists round with medical teams?

Also, for protocol development, other administrative responsibilities, do you buy into those activities? DO you have your pharmacists split them giving project time, or do you have them assigned to *almost* purely desk jockeys?

"Dictate" is a strong word. I have expectations of what pharmacists should be doing besides order entry. That list can be big or short depending on the facility. We have a list of target drugs and activities, yes. Antibiotic Streamlining and C/S review is a major activity as a part of antibiotic stewardship program. Renal dosing of LMWH is an important task..how about dosing and monitoring of Argatroban or Lepirudin... TPN and electrolyte monitoring... PK - Vanc..aminoglycosides...

I used to give project days for my pharmacists.... it involved them doing chart reviews for MUE and also different PI projects. As far as protocols.. most of them are provided by my team and I...as I have almost every medical protocol you can think of...but I always involve the hospital DOP, CM and staff pharmacists in tailoring the Protocol to their spec.

Clinical/Staff Hybrid model is a robust and cost efficient model of clinical pharmacy practice. It is our future.

Rounding? That's a difficult task in a community hospital where most physicians are private. In teaching facilities, pharmacists work with residents. Very closely... because medical residents are learning.

 

[gotdrugs]

Thanks for the post.

Yeah, as soon as I hit "reply" I realize I should have meant rounding in a teaching facility.

I have some other comments but they were too lengthy and the site barfed at how long it was, maybe some other time I'll chat with you a bit as I like hearing your insights.

 

[rxforlife2004]

You do know I have not been a DOP in almost 4 years.... and what I promote is the hybrid staff/clinical model where pharmacists process medication orders from the floor.... so they dispense and make clinical interventions as a part of the team taking care of patients.

I do not endorse clipboard clinical pharmacists who just rounds and I also do not endorse dispensing only pharmacists.

I like this "hybrid" idea. I hate to work with pharmacists who just strictly wanna do clinical (avoiding staffing) , and when there is an emergency to dispense a medication...that pharmacist happens to be there screaming out loud, "I am a clinical pharmacist!!! I don't dispense medication! F****K"

 

[NormalSaline]

wow, There sure are a lot of people in here disparaging clinical pharmacy out of ignorance. I may not be surprised if the population here were the general public, but a message board full of people involved in the profession saying the most progressive thing we do is worthless?

We're screwed.

 

[spacecowgirl]

Clinical/Staff Hybrid model is a robust and cost efficient model of clinical pharmacy practice. It is our future.

This is what we do and I'm really glad because I would be bored to death if I didn't have so much variety.👍

 

[KARM12]

wow, There sure are a lot of people in here disparaging clinical pharmacy out of ignorance. I may not be surprised if the population here were the general public, but a message board full of people involved in the profession saying the most progressive thing we do is worthless?

We're screwed.

Agreed. Like anything, your job is what you make of it. If you want to sit back and verify orders all day that is fine. If you want to get involved with patient care and the team, then take hold of the opportunities that are present. You must work to establish yourself as a member of the team and learn how to do so tactfully.

Maybe some of you have a bad view because you are on rotations with professors that are only there 2-3 times a week. If you work with an established clinical specialist (not a resident) who is committed to a team, you may have a different view. Think about it, as a pharmacist you have to opportunity to be the most consistent member of a team because the attendings/residents change every so many weeks. There have been many instances where I have been able to provide a complete history than a fellow/resident because I have known the patient their whole stay (and usually repeat), I know what was done in the past and the reasoning behind it.

 

[p-rog]

wow, There sure are a lot of people in here disparaging clinical pharmacy out of ignorance.

I wouldn't call it ignorance. It's just their observations from rotations. I tend to agree with them as well. IV to PO conversions and renal dosing adjustments of antibiotics saves money, but it's not really that big of a deal. It's certainly not at the level of importance that clinical pharmacy is hyped up to be in school. Not to mention, I can leave 5 notes in chart for an MD suggesting that they "consider changing a pt's levaquin dosing based on crcl" and if the MD ignores it, there's nothing the pharmacist can do. Unless they ask for a PK consult, no MD's really seem to give a **** about the pharmacist's "suggestions". Even if I know the guidelines for a disease state like the back of my hand, I can make suggestions about why a patients dose should be altered or why a different agent is preferred based on the guidelines, but 90% of the time, the MD won't listen.

 

[njac]

I wouldn't call it ignorance. It's just their observations from rotations. I tend to agree with them as well. IV to PO conversions and renal dosing adjustments of antibiotics saves money, but it's not really that big of a deal. It's certainly not at the level of importance that clinical pharmacy is hyped up to be in school. Not to mention, I can leave 5 notes in chart for an MD suggesting that they "consider changing a pt's levaquin dosing based on crcl" and if the MD ignores it, there's nothing the pharmacist can do. Unless they ask for a PK consult, no MD's really seem to give a **** about the pharmacist's "suggestions". Even if I know the guidelines for a disease state like the back of my hand, I can make suggestions about why a patients dose should be altered or why a different agent is preferred based on the guidelines, but 90% of the time, the MD won't listen.

It must depend on where you are and the relationship between pharmacy and medicine.

I find my notes cut and pasted verbatim in the electronic chart every. single. day.

 

[Picard]

So today I got to hang around the clinical pharmacy dept at a relatively large inner city hospital (700 beds). Not going to lie... Im kind of dissapointed.

-The ER pharmacist works about 50% of the time out of the pharmacy. She does not enter orders at all (none of the clinicals do). What she does is looks at pts as they are admitted to the ER (nothing really pops up on her screen, she just needs to be vigilant and look out for them) and then examines the meds that they are on already, the meds they were administered, and the condition with which they came to the hospital. I walked in on her with her ipod in chilling and scrolling through patients. And when I asked her how she determines which patients to consult about their meds her response was: "Ehh i do whatever I want. Its pretty much a free-for-all".

-I went on rounds with a resident doing his ID rotation. The doctor did not speak to either of us during the entire two hours and the resident was only able to offer his support when the medical residents were not sure how to dose tygacil. 100mg loading, 50mg maintenance. Honestly a pharmacy tech could answer that question.

-Talked to the pediatric clinical. She told me that she doesnt really get a lot of questions about drugs from the doctors. Her main priority seemed to be creating a slogan for the pediatric unit to remind people that children require special dosing.

Ok so is this what should be expected going into clinical? I recognize that it is a new field and it is going to take some time before we are fully recognized for our knowledge. But I mean come on... sitting with your ipod in glancing over meds? Seems like a chill gig but i want more responsibility! And honestly thinking of slogans doesnt seem like the kind of this a pediatric clinical pharmacist should be worrying about. I understand that building your relationships with the doctors and gaining their respect (as well as the respect of all of your co-workers) takes time. But to me it seems like these individuals are just playing around, not doing actual significant clinical work.

Is this just a bad clinical program (its pretty new), or is this to be expected of clinical pharmacy?

I graduated in 1995, when they were just starting to really push the "clinical pharmacist" stuff. What you described above sounds EXACTLY like what I witnessed during my teaching hospital rotations during pharmacy school in the early '90's. And now I hear, 15 years later, that nothing has changed. That is truly laughable. Of course the doctors don't want your advice-it's their butts on the line so they are going to figure it out for themselves, which is what they like to do as the primary caregiver anyways. Plus, it's an ego buster for some doctors if they have to ask someone else for info they figure they should know themselves.
This is a good example of people, academia in this case (the same people who brought us the all important PharmD designation), telling the market what it needs, instead of letting the market tell them (this is also similiar to what is happening to our economy under the Obama Administration.)
There is nothing wrong with trying to create a new demand/market for something that doesn't exist at the time; it worked for Bill Gates. It is, typically however, a long battle to get everyone convinced that your new service/product is in fact, indispensible. Let us hope that time will rule in favor of pharmacy.
But hey,look at the bright side-in the meantime you can use this experience as an excuse to get yourself a new Ipod Touch, download a bunch of cool tunes and chill for a living. Compared to retail, it sounds like paradise. Sign me up!

 

[ajh88]

"Dictate" is a strong word. I have expectations of what pharmacists should be doing besides order entry. That list can be big or short depending on the facility. We have a list of target drugs and activities, yes. Antibiotic Streamlining and C/S review is a major activity as a part of antibiotic stewardship program. Renal dosing of LMWH is an important task..how about dosing and monitoring of Argatroban or Lepirudin... TPN and electrolyte monitoring... PK - Vanc..aminoglycosides...

I used to give project days for my pharmacists.... it involved them doing chart reviews for MUE and also different PI projects. As far as protocols.. most of them are provided by my team and I...as I have almost every medical protocol you can think of...but I always involve the hospital DOP, CM and staff pharmacists in tailoring the Protocol to their spec.

Clinical/Staff Hybrid model is a robust and cost efficient model of clinical pharmacy practice. It is our future.

Rounding? That's a difficult task in a community hospital where most physicians are private. In teaching facilities, pharmacists work with residents. Very closely... because medical residents are learning.

I'm on a 4th year Critical Care rotation now - and the hospital employs this hybrid model. It is easier now because they recently "upgraded" their order entry system, so the ICU pharmacist can parse out the ICU/CVICU orders and focus on them.

I agree with others who say that the relationships that are built are crucial. In my brief experience here, it appears as though the physicians want the pharmacists' input and they rely on them for a lot of information and monitoring (e.g. pharmacy to dose).

My day as a rotation student consists of running the clinical meds list and antibiotic streamlining list, checking renal dose adjustments, checking lab values to see if anything should be started, stopped, or held, and checking platelets/PTT on our heparin/LMWH patients - that isn't all, but those are the things I do every day.

The pharmacy has done a relatively good job of builing a mutually respectful relationship with the intensivist staff - in "rounds" (their weak version of rounds - definitely an area that could improve), the physician commented that he was missing the notes he used to get from pharmacy regarding his antibiotic use - he noticed and wondered why. IMHO, I don't think he would have noticed, cared, or mentioned it if it wasn't something he thought was important (the ID pharmacist used to be the ICU pharmacist, and he now manages ID pharmacy for the entire hospital, so he doesn't leave quite as many notes in ICU anymore).

I didn't think I would like it when I chose it as a rotation - but I wanted to try it out and see. Now, having been there for 3 weeks, it is a lot more interesting than what I expected - and there is still room for more improvement. I could actually see myself working at this hospital after graduation, which is not something I expected in the beginning.

ETA: I know that this wouldn't be the job for everyone and that every hospital experience is different - but this particular hospital seems to have a really good program going, which could get even better. I will also say that my preceptor has worked central staffing 2 days plus 1 weekend since I've been there (I believe she does 1 weekend a month and covers central based on staffing needs).

 

[104921]

My last pharm rotation was with MDs....so they treated me more like a med student since they did not have that much experience with pharm students and they knew I was heading to med school....

So, I got to see how MDs think about the pharm services at that hospital....they laughed at several of my professors and their "knowledge".

It was great. I had my own attending each day and most taught at my med school.

And, I defer med school for a yr because I have been having some health issues......

This is ridiculous and I hope you aren't saying this in earnest. How embarrassing.

 

[104921]

wow, There sure are a lot of people in here disparaging clinical pharmacy out of ignorance. I may not be surprised if the population here were the general public, but a message board full of people involved in the profession saying the most progressive thing we do is worthless?

We're screwed.

This. So many pharmacy students themselves are huge haters of pharmacy. I don't understand, why did they go to pharmacy school if they're going to talk trash about how much pharmacists don't do anything? I swear half of them have MDs for parents or siblings.
I'm also tired of the whole "you have to gain the respect of the doctor". You're graduating with a PharmD. Most of us have done the 4 years undergrad, 4 years pharmacy school thing. It's getting to be the same as the MD, we just don't need as much residency training because we aren't doing surgery or anything hands on. We just do drugs.
If you're in pharmacy, stop hating on pharmacy! Or at least quit so I can take your spot.

 

[tungsten87]

This. So many pharmacy students themselves are huge haters of pharmacy. I don't understand, why did they go to pharmacy school if they're going to talk trash about how much pharmacists don't do anything? I swear half of them have MDs for parents or siblings.
I'm also tired of the whole "you have to gain the respect of the doctor". You're graduating with a PharmD. Most of us have done the 4 years undergrad, 4 years pharmacy school thing. It's getting to be the same as the MD, we just don't need as much residency training because we aren't doing surgery or anything hands on. We just do drugs.
If you're in pharmacy, stop hating on pharmacy! Or at least quit so I can take your spot.

it's not fair to put all the blame on the pharmacy students, you have to consider the pharmacy schools and their role. pharmacy schools mislead students into believing that clinical pharmacists are a necessary part of the health care team and that their roles are currently expanding (they definitely skew reality to make it seem like a more appealing career so they can get their money). while this may be true in certain situations, these are far and few between. i wouldn't really say that pharmacists as a whole are expanding their role in healthcare, but the studs in pharmacy school are definitely able to go to a hospital and carve their own niche if they prove themselves to a certain extent. if students don't do proper research when considering a career in pharmacy and eat up what these schools are promoting, yes, they will be pissed off and disappointed.

 

[Praziquantel86]

it's not fair to put all the blame on the pharmacy students, you have to consider the pharmacy schools and their role. pharmacy schools mislead students into believing that clinical pharmacists are a necessary part of the health care team and that their roles are currently expanding (they definitely skew reality to make it seem like a more appealing career so they can get their money). while this may be true in certain situations, these are far and few between. i wouldn't really say that pharmacists as a whole are expanding their role in healthcare, but the studs in pharmacy school are definitely able to go to a hospital and carve their own niche if they prove themselves to a certain extent. if students don't do proper research when considering a career in pharmacy and eat up what these schools are promoting, yes, they will be pissed off and disappointed.

I think this a fair assessment. The students certainly don't do enough research into the career they're getting into, and the schools don't do a very good job of presenting multiple sides of the story.

Pharmacy is expanding though, I just don't think you see it during your time in school. Some of the best work that gets done by "clinical" pharmacists doesn't have anything to do with rounding; it's the behind the scenes stuff like P&T, staff education, therapeutic pathway design, medication error prevention, etc. that really ends up saving money and helping people. That's not to say rounding with the team is a bad thing, pharmacists do (and have been proven to) make useful interventions, but you'll notice that the team functions just fine without the pharmacist on weekends.

During school, you don't see this. You work with a professor who mostly rounds with the team, and has very little to do (if anything) with the day to day operations of the pharmacy. You'll learn about diseases and medication therapy, but not necessarily how to be a pharmacist.There's nothing wrong with this, and you certainly can't fault the school. It's just the system that they work in.

End rant.

 

[p-rog]

This. So many pharmacy students themselves are huge haters of pharmacy. I don't understand, why did they go to pharmacy school if they're going to talk trash about how much pharmacists don't do anything? I swear half of them have MDs for parents or siblings.
I'm also tired of the whole "you have to gain the respect of the doctor". You're graduating with a PharmD. Most of us have done the 4 years undergrad, 4 years pharmacy school thing. It's getting to be the same as the MD, we just don't need as much residency training because we aren't doing surgery or anything hands on. We just do drugs.
If you're in pharmacy, stop hating on pharmacy! Or at least quit so I can take your spot.

It's hard not to "hate on pharmacy" when you realize that all your recommendations are getting ignored and that you know way more from pharmacy school than you'll ever get to put to real use on the job.

I mean, I guess you're right, more research beforehand would've been smart but I was never interested in "clinical pharmacy" before pharm school. I still think the schools are hyping it way too much. Not to mention, I had the word residency crammed down my throat every 3 seconds in school, but I never once heard someone talk about fellowships or other post grad options for pharmacists. IMO, you could have way impact if you had the right research training.

 

[KARM12]

This. So many pharmacy students themselves are huge haters of pharmacy. I don't understand, why did they go to pharmacy school if they're going to talk trash about how much pharmacists don't do anything? I swear half of them have MDs for parents or siblings.
I'm also tired of the whole "you have to gain the respect of the doctor". You're graduating with a PharmD. Most of us have done the 4 years undergrad, 4 years pharmacy school thing. It's getting to be the same as the MD, we just don't need as much residency training because we aren't doing surgery or anything hands on. We just do drugs.
If you're in pharmacy, stop hating on pharmacy! Or at least quit so I can take your spot.

I disagree with your point about a PharmD meaning automated respect. All pharmD's and pharmacists are not created equal. You have to prove you know what you are talking about before physicians will seek your advice.

 

[StevePerry]

I disagree with your point about a PharmD meaning automated respect. All pharmD's and pharmacists are not created equal. You have to prove you know what you are talking about before physicians will seek your advice.

This is sooooo true... especially in the clinical setting... if you are on top of your game you will get respect from some MD's... and to echo what J Dub said -- others will never care what anyone below and outside of their specialty (including other MD's) have to say...

 

[RPHTXRE]

Hence, why I am going to do a "real" residency....I want the responsibility and the ability to prescribe and diagnose folks....so MD here I come.

Amen to that brother/sister, a pharmacy "residency" is nothing to brag about. I've worked with some pharmacy residents and all I can think of is "ugh, you again? go get me lunch instead of wasting your time here".

If you're in a residency, drop out right now and save your time and money.

 

[Farcus]

some resident being key word

 

[deleted205891]

Amen to that brother/sister, a pharmacy "residency" is nothing to brag about. I've worked with some pharmacy residents and all I can think of is "ugh, you again? go get me lunch instead of wasting your time here".

If you're in a residency, drop out right now and save your time and money.

OK, may be a waste, but quite possibly the only way to get a job that's at least semi-clinical in nature.
If I could get a 50-50 clinical/staff hybrid job on the East Coast (basically anywhere from MA to NC) in a town of more than 30,000 people without a residency, I'd so do that.

 

[spacecowgirl]

Amen to that brother/sister, a pharmacy "residency" is nothing to brag about. I've worked with some pharmacy residents and all I can think of is "ugh, you again? go get me lunch instead of wasting your time here".

If you're in a residency, drop out right now and save your time and money.

Oh please. 🙄 I'm not even going to explain why that's an asinine thing to say, but can expand on it if you want me to.

I could do the job I have without a residency, but I have been able to *do* so much more because of my training. I also feel like a have a lot more job security. There is sooo much more to non-staffing duties than some sort of bedside, work alongside the doctors, roll-up-your-sleeves work. I feel like people on here think if you're not on some bedside care team, you're not doing anything "advanced".

Residency is not for everyone, but to discount the entire idea of a residency is idiotic. Especially based on limited experience with "some" residents.

 

[PharmaTope]

OK, may be a waste, but quite possibly the only way to get a job that's at least semi-clinical in nature.
If I could get a 50-50 clinical/staff hybrid job on the East Coast (basically anywhere from MA to NC) in a town of more than 30,000 people without a residency, I'd so do that.

good luck with that to be honest. you need a residency these days now. those positions are incredibly tough to come by

 

[Confused321]

I just finished a rotation with clinical pharmacists on the Home Based Primary Care unit at the VA. We also covered a 7 bed Hospice unit.

On HBPC each pharmacist is responsible for reviewing their patients' medications and health status (labs, tests, social issues, etc) every 90 days and charting a report that documents their findings. It works out to about 10 - 15 reports/week. They attend patient conference 2-3 times weekly and discuss each patient with the interdisciplinary team. Working in their office, I observed the primary care providers (MD and ARNP) and other members of the team (dietary, PT/OT, social work, etc) come in to ask questions or discuss patients pretty much all day. The pharmacists are responsible for evaluating and processing all requests for non-formulary medications for HBPC patients. If there are any issues with meds getting to patients (through the mail) they handle that. The pharmacist covering Hospice goes through the Hospice census every morning and identifies drug therapy problems and then brings them up at daily Hospice rounds.

There's not a lot of direct patient contact, but I think it's a pretty good clinical job. They have quite a few things they are responsible for and the patients tend to be pretty complex and interesting.

what is an example of direct patient contact a clinical pharmacist has? everything you explained seemed more like paper work

 

[Digsbe]

I've had rotations at the VA. Those pharmacists really do clinical work. Some run clinics, see patients, put in orders, go on rounds, and anywhere I've been there the physicians seem to strongly respect the PharmDs and value their contributions. They're also properly addressed as "doctors" most of the time. I actually witnessed a chief physician tell the PharmD resident to introduce herself as "Dr. X" and told her how she earned that title and how patients should know your educational background when you treat them.

At other hospitals I've been at it's mainly been chart reviews, discharge counselling, warfarin/anticoag teaching, etc. Pretty standard stuff and hardly much of anything "clinical." Sometimes you get to dose drugs when you're consulted to do so...

The difference is at the VA pharmacists have approved scopes. They're allowed to prescribe meds, order labs, and do genuine clinical reviews on patients. In other institutions it's much much much more restricted and you're not so much allowed to change a warfarin dose for a high INR unless "consulted" to do so. As long as pharmacists have pretty much no legal authority to do clinical work or it's not common place to enter into collaborate practice agreements like PAs and NPs (which is pretty much legal in most states) clinical pharmacy is going to remain pretty dull.

For some of these "clinical" hospital pharmacist jobs I can hardly fathom why a residency is required. You don't need a residency to do some chart reviews and dose a handful of meds when you're asked to. Then again, my experiences are still pretty limited.

 

[npage148]

Since we bumped a 6yo thread let's think of slogans that would make clinical unicorns twitch

peds: 1/2 the size, 1/2 the dose

Warfarin: get the blood flowing quick loading doses for the sick

Stay On that PPI, until the day they die

 

[owlegrad]

peds: 1/2 the size, 1/2 the dose

I always liked "small people, small doses"

 

[njac]

Since we bumped a 6yo thread let's think of slogans that would make clinical unicorns twitch

peds: 1/2 the size, 1/2 the dose

Warfarin: get the blood flowing quick loading doses for the sick

Stay On that PPI, until the day they die

"Vanc 1gm Q12H. Because why not?"




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[npage148]

Bedtime with Granny not going swell? Give her 100mg of seroquel

 

[EyeTeeFarmer]

1. Seeing a patient on aztreonam and a carbapenem of any sort.

2. Treatment for asymptomatic bacteriuria in non-pregnant people.

3. Not de-escalating after C&S is back.

4. Doing a med rec and a nurse comes in during the middle of it and starts stripping the patient and changing the bedpan. Or maybe this only made me twitch.

 

[gwarm01]

peds: 1/2 the size, 1/2 the dose

Kids: They're just small adults!

 

[ICPharmD]

Patient was NPO for a bit and now can take PO all meds are still IV should probably change that.

 

[Dalteparin]

NPO for one day? Better send a TPN their way!

 

[ACE_Dx]

I work in a big academic teaching hospital with 700+ beds in a level 1 trauma center. My position is that of a clinical/staff hybrid position where I'm on the floor 99% of the time unless I'm on my lunch break or in a meeting. I enter/verify orders for my floor, check/order any labs I see fit for the day, change any home meds if there are any discrepancies in the orders after doing med recs, write daily notes on my patients, renal/kinetically dose medications, and of course tackle the daily "where's my meds? and is this compatible with this?" questions. Of course, all of this comes with developing rapport with the MDs to the point where it becomes like "do what you think is best."

 

[gwarm01]

Of course, all of this comes with developing rapport with the MDs to the point where it becomes like "do what you think is best."

Yeah, this was my experience at my last job. A lot of our pharmacists didn't have this relationship with the docs, especially if they were too academic in their thinking and didn't understand the full picture. Some people get caught up insignificant details while missing really clinically relevant things.

Clinical pharmacists were definitely a great source for our PAs and NPs. I can't tell you how many times I was asked to review a new admission and just change anything I saw fit.

 

[gwarm01]

Wtf do you write in a daily note?!

Whatever it is, rest assured no one is reading it.

 

[Lnsean]

Clinical pharmacists were definitely a great source for our PAs and NPs. I can't tell you how many times I was asked to review a new admission and just change anything I saw fit.

HAH! You lie through your teeth. It's funny the length people on here will go to justify their ego.

 

[njac]

Whatever it is, rest assured no one is reading it.

This is absolutely true. We're in the process of standardizing shortening our pharmacy notes because they're ridiculous.


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[njac]

HAH! You lie through your teeth. It's funny the length people on here will go to justify their ego.

Nah.

Many of us are fortunate enough to have this rapport. But it doesn't happen overnight.


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[gwarm01]

HAH! You lie through your teeth. It's funny the length people on here will go to justify their ego.

Uhh.. What? Have you ever read any of my posts before? I'm sure you have because I remember you completely misinterpreting my posts before. Check my post history and you'll see I'm the first one to call clinical pharmacy a joke or complain about pharmacists that think they are too good to verify orders or dispense meds. I'm a self-loathing pharmacist if anything, no delusional ego.

What's so crazy about working with someone every day and developing that relationship? You call them often enough to fix their silly issues, eventually they'll call you first and say just fix it. This was specially PAs and NPs. There was really only one doctor who would say that.

 

[ACE_Dx]

Wtf do you write in a daily note?!

I'm not sure if you meant to write this comment as an attack or just genuinely do not know but for sake of argument I'm thinking its the latter. I write daily notes but not all patients. But when I make a recommendation or make any adjustments based on labs, results, or whatever comes up that requires an intervention, I let them know and/or write in it and take ownership/responsibility for that action/plan. I keeps me updated on what I did and also as documentation that this is per pharmacy recommendations.

I know many hospitals have a barebones internal documentation system that tracks interventions that may or may not include any objective substance besides I did this because of this. What is the point of a system where you just pat yourselves on the back while no one else has any idea of what you did? Take credit for your work, that's the only way to be recognized for the work that we do.