Residency Question

[HealingTouch23]

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Is getting a residency really just for getting a job in managed care, inpatient, internal med, and ambulatory care? Do pharmacists in the community setting need a residency?

 

[gwarm01]

Do pharmacists in the community setting need a residency?

If this is what your school is telling you I would highly recommend you ignore any other advice they give.

 

[hye345]

Is getting a residency really just for getting a job in managed care, inpatient, internal med, and ambulatory care? Do pharmacists in the community setting need a residency?

Not needed for community, unless you enjoy getting 1/3rd of retail pay for one year, only to end up with the same job you could have gotten without one.

 

[inverness2012]

Speaking as someone who did 2 years of residency and has a job that I couldn't have gotten without the training, it depends. What job do you want? You can get an inpatient staffing job without a residency. To work a more specialized job, you need a residency most of the time. In a minority of situations (right place, right time), you may be able to get a job without one.

 

[PharmDBro2017]

Speaking as someone who did 2 years of residency and has a job that I couldn't have gotten without the training, it depends. What job do you want? You can get an inpatient staffing job without a residency. To work a more specialized job, you need a residency most of the time. In a minority of situations (right place, right time), you may be able to get a job without one.

what is this highly "specialized" pharmacist position you speak of?

 

[inverness2012]

what is this highly "specialized" pharmacist position you speak of?

I am an ID pharmacist at an academic medical center. I round with the consult team and work on stewardship activities.

 

[gwarm01]

Sounds awful

Tell me about it. Back when I rounded with the ICU team it felt like I wasted half of my day, went to lunch, then had to rush to finish everything the second half of the day. It was nice hearing the treatment plan directly from the docs, but it was very rare that I had anything to contribute that couldn't have been easily handled with a five minute face to face conversation. It was just.. oh, this is day three of antibiotics. I'm getting a Xa level on him. Vanc trough on her. Why am I wasting three hours pushing a computer around with you people?!

You can't blame students for feeling cynical about clinical pharmacy when they go on a rotation and have to just follow you around as you follow the team around.

 

[beautifulrobot]

Tell me about it. Back when I rounded with the ICU team it felt like I wasted half of my day, went to lunch, then had to rush to finish everything the second half of the day. It was nice hearing the treatment plan directly from the docs, but it was very rare that I had anything to contribute that couldn't have been easily handled with a five minute face to face conversation. It was just.. oh, this is day three of antibiotics. I'm getting a Xa level on him. Vanc trough on her. Why am I wasting three hours pushing a computer around with you people?!

You can't blame students for feeling cynical about clinical pharmacy when they go on a rotation and have to just follow you around as you follow the team around.

I've definitely had those boring experiences on clinical rounds where I felt completely useless, but I've also had some really great experiences. It really depends on the culture of the institution, and what expectations other pharmacists before us have created for the clinical team. The inconsistency in terms of culture and how "pharmacist-inclusive" a certain clinic or clinical team is can be frustrating, but my point is that your individual experience, or even the experience of dozens of students that you are familiar with, does not paint the entire picture. I have had some very empowering experiences as a clinical pharmacist where I had my own patient roster and I was essentially the primary care provider for those patients - I was able to order labs and prescribe treatment under a broad collaborative practice protocol, without needing a physician to sign off on each patient interaction. I have seen attending physicians consult with clinical pharmacists on patient treatment plans, and who in general held pharmacists in a high regard and viewed them as colleagues.

 

[gwarm01]

I was able to order labs and prescribe treatment under a broad collaborative practice protocol, without needing a physician to sign off on each patient interaction.

That's kind of my point. I could also do these things, but I was instead wasting a lot of time on rounds. Afterward I had to scramble to do all of the important stuff.

 

[beautifulrobot]

That's kind of my point. I could also do these things, but I was instead wasting a lot of time on rounds. Afterward I had to scramble to do all of the important stuff.

Oh, okay, I guess I misunderstood your point.

I don't know, sometimes its helpful to be on rounds, saves some time when the team ends up doing something really weird or absolutely wrong and you can catch it earlier during rounds, but yeah, rounds were rarely the most riveting part of my clinical pharmacy experience.

 

[gwarm01]

Oh, okay, I guess I misunderstood your point.

I don't know, sometimes its helpful to be on rounds, saves some time when the team ends up doing something really weird or absolutely wrong and you can catch it earlier during rounds, but yeah, rounds were rarely the most riveting part of my clinical pharmacy experience.

Yeah, I can't argue there. It was always nice to know what the treatment plan was. You wouldn't have to call to clarify if there was some oddball stuff going on.

 

[confettiflyer]

That's kind of my point. I could also do these things, but I was instead wasting a lot of time on rounds. Afterward I had to scramble to do all of the important stuff.

I would jump out the window on 3hr rounds, we pound through like two dozen patients in under an hour and would side bar post-rounds on exceedingly complex patients (usually ID related), most other things could be resolved at the nursing level.


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[gwarm01]

I would jump out the window on 3hr rounds, we pound through like two dozen patients in under an hour and would side bar post-rounds on exceedingly complex patients (usually ID related), most other things could be resolved at the nursing level.


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Under an hour sounds like the way to do it! We spent a lot of time on patients that didn't have much to discuss, but it was a pediatric institution and we wanted the parents to be a part of it. Out of 30 or so patients maybe five had real issues for the team to discuss. The pharmacist station was adjacent to the physician station too, so even if I needed to speak with them it was very easy.

How big is your hospital? Mine was just a bit over 200 beds. Maybe 20 ICU and a few less in the stepdown units. My rounding time was dramatically reduced when I switched to oncology, but my time was then wasted by waiting for the oncologists to submit their treatment plans or release orders. Such is the life of a pharmacist I guess, but at least that job was far less stressful. PICU felt like we were always creating new treatments that hadn't exactly been tested and definitely didn't have entries built in Epic yet. Shifts went by quickly but I'm the kind of person that takes stress home with them and would have trouble unwinding after a difficult day. Don't even get me started on the day an ECMO patient was being transferred into the unit and a nurse accidentally disconnected a line from the circuit, shooting blood everywhere.. Maybe informatics was a great switch for me after all.

 

[confettiflyer]

Under an hour sounds like the way to do it! We spent a lot of time on patients that didn't have much to discuss, but it was a pediatric institution and we wanted the parents to be a part of it. Out of 30 or so patients maybe five had real issues for the team to discuss. The pharmacist station was adjacent to the physician station too, so even if I needed to speak with them it was very easy.

How big is your hospital? Mine was just a bit over 200 beds. Maybe 20 ICU and a few less in the stepdown units. My rounding time was dramatically reduced when I switched to oncology, but my time was then wasted by waiting for the oncologists to submit their treatment plans or release orders. Such is the life of a pharmacist I guess, but at least that job was far less stressful. PICU felt like we were always creating new treatments that hadn't exactly been tested and definitely didn't have entries built in Epic yet. Shifts went by quickly but I'm the kind of person that takes stress home with them and would have trouble unwinding after a difficult day. Don't even get me started on the day an ECMO patient was being transferred into the unit and a nurse accidentally disconnected a line from the circuit, shooting blood everywhere.. Maybe informatics was a great switch for me after all.

Yikes. All you had to say was peds and parent involvement, and my image of an inefficient rounding system has changed...I think you guys are doing it right, then. I'll PM you nitty gritty later but I gotta wrap up my orders for the day and scoot off.


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[HealingTouch23]

Thanks for everyone's input. I'll learn a lot by reading these conversations.