Residency: what for?

[Me_Gusta_Drugs]

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Seems like its great if you want to learn more....network.

But on the inpatient side
Your limited with only PGY1. With this you simply have made connections hopefully and have an edge over other pharmacists applying for a staffing position at a hospital. You need a PGY2 to really get become a "specialist" and be clinical. And yes theres always exceptions, a few PGY1 residents might land a more clinical non-staffing inpatient job

On the Am Care side
You do a PGY1 and your pretty much going to be running a boring ass coumadin clinic. Maybe an outpatient infusion center. The jobs every1 wants (primary care, lipid, diabetes clinics)....you'll have like a 10% chance of getting them it seems like if your in the right place right time. Otherwise your looking at a coumadin clinic...woopdidoo

I also find it funny that majority of all students applying to residencies dont even know why theyre doing it really. Theyre just going with the flow...or blindly hoping theres a light at the end of the tunnel (which is why alot of us went into pharmacy...or any job in the first place). They justify it loosely and i think they should think things through and know what theyre getting into. And yes this is a generalization.

 

[confettiflyer]

Seems like its great if you want to learn more....network.

But on the inpatient side
Your limited with only PGY1. With this you simply have made connections hopefully and have an edge over other pharmacists applying for a staffing position at a hospital. You need a PGY2 to really get become a "specialist" and be clinical. And yes theres always exceptions, a few PGY1 residents might land a more clinical non-staffing inpatient job

On the Am Care side
You do a PGY1 and your pretty much going to be running a boring ass coumadin clinic. Maybe an outpatient infusion center. The jobs every1 wants (primary care, lipid, diabetes clinics)....you'll have like a 10% chance of getting them it seems like if your in the right place right time. Otherwise your looking at a coumadin clinic...woopdidoo

I also find it funny that majority of all students applying to residencies dont even know why theyre doing it really. Theyre just going with the flow...or blindly hoping theres a light at the end of the tunnel (which is why alot of us went into pharmacy...or any job in the first place). They justify it loosely and i think they should think things through and know what theyre getting into. And yes this is a generalization.

i don't wanna do one, but for the purposes of competition and self-preservation, i will end up doing one.

 

[PumpkinSmasher]

OP:

What about looking into the IHS?

 

[type b pharmD]

i don't wanna do one, but for the purposes of competition and self-preservation, i will end up doing one.

probably a great idea if you're looking to do hospital in any type of metro area.

Btw your avatar kind of freaks me out. Looks like he's about to flip out and kill someone! The guy in the sombrero was funnier. I am eagerly awaiting your next choice though

 

[Sparda29]

probably a great idea if you're looking to do hospital in any type of metro area.

Btw your avatar kind of freaks me out. Looks like he's about to flip out and kill someone! The guy in the sombrero was funnier. I am eagerly awaiting your next choice though

Personally, I liked the earlier one he had, with the black dude that looked like he was just chilling with a beer.

 

[PharmDstudent]

Btw your avatar kind of freaks me out. Looks like he's about to flip out and kill someone! The guy in the sombrero was funnier. I am eagerly awaiting your next choice though

He said he was gonna pick an LOLcat. 🙁

 

[PharmDstudent]

Seems like its great if you want to learn more....network.

But on the inpatient side
Your limited with only PGY1. With this you simply have made connections hopefully and have an edge over other pharmacists applying for a staffing position at a hospital. You need a PGY2 to really get become a "specialist" and be clinical. And yes theres always exceptions, a few PGY1 residents might land a more clinical non-staffing inpatient job

On the Am Care side
You do a PGY1 and your pretty much going to be running a boring ass coumadin clinic. Maybe an outpatient infusion center. The jobs every1 wants (primary care, lipid, diabetes clinics)....you'll have like a 10% chance of getting them it seems like if your in the right place right time. Otherwise your looking at a coumadin clinic...woopdidoo

I also find it funny that majority of all students applying to residencies dont even know why theyre doing it really. Theyre just going with the flow...or blindly hoping theres a light at the end of the tunnel (which is why alot of us went into pharmacy...or any job in the first place). They justify it loosely and i think they should think things through and know what theyre getting into. And yes this is a generalization.

I don't know why people are so caught up in the idea of clinical pharmacy. I guess it's different depending on the state, but inpatient order entry can be just as cool. At my internal medicine rotation, pharmacists did order entry and clinical stuff. They complained that they were having to work hard, but they seemed to enjoy it nonetheless.

I feel like the separation between inpatient and clinical pharmacy is unnecessary. Academia is another story, such as teaching hospitals, but general hospitals could combine duties without a problem.

 

[confettiflyer]

Jesus, I didn't know you all paid so much attention to my avatars, haha...now the pressure is on for the next one. Crap.

 

[njac]

damn. post disappeared. the jist was:

the clinical/staffing hybrid model is the way to go. Decentralized pharmacists, do your own order entry and then do kinetics/consults as needed on your own patients. By giving the pharmacist some ownership of the patients they take more pride in their work, and by being on the floor, the nurses and physicians see you more as a face than just a voice on the phone.

anyway, in the midst of my pgy-1, I have a couple interview offers after midyear. Most are for specialist positions. (this is post PPS interview)

for myself and my own nerdiness, I am likely pursuing a PGY-2. That said, I feel that I've not had the best PGY-1 experience and feel like I was more ready to be a "real pharmacist" last June than I do now. Hence some of the motivation to go forward.

 

[confettiflyer]

njac...what do you think of the argument that PGY-1 is essentially useless and that one should "go all the way" (PGY-2) or not going through with residency at all? The idea was that since PGY-1 is broad-based and not specialized, you were better off working at full salary since 2-3 years hospital experience gets you to where PGY-1 drops you off anyway, minus the salary slump during PGY-1.

Thoughts? I can't remember who made that argument on here.

 

[PharmDstudent]

Stupid internet connection...


I give up!

 

[PharmDstudent]

damn. post disappeared. the jist was:

the clinical/staffing hybrid model is the way to go. Decentralized pharmacists, do your own order entry and then do kinetics/consults as needed on your own patients. By giving the pharmacist some ownership of the patients they take more pride in their work, and by being on the floor, the nurses and physicians see you more as a face than just a voice on the phone.

anyway, in the midst of my pgy-1, I have a couple interview offers after midyear. Most are for specialist positions. (this is post PPS interview)

for myself and my own nerdiness, I am likely pursuing a PGY-2. That said, I feel that I've not had the best PGY-1 experience and feel like I was more ready to be a "real pharmacist" last June than I do now. Hence some of the motivation to go forward.

I have this gut feeling that PGY1 and PGY2 residencies will eventually be phased out, making pharmacy school 3 + 4 or 2 + 5 ---+/- 1 year of specialty training.

Med students have 2 years of didactic work and 2 years of practical stuff. Pharmacy students only have 1 year of practical stuff, i.e. P4 rotations.

There's something quirky about the current system. I wish I could put my finger on it...

 

[confettiflyer]

I thought I was the only one up at 540am!

Some schools are 2+2 (Touro CA comes to mind). I think the system we have now works...for some reason, 2 years didactic doesn't seem enough (on paper at least) unless you're running some sort of accelerated program. Granted, I've been taking classes that could easily be truncated/cut out, so maybe you're on to something.

I'd be a fan of 3yrs didactic + 2yrs rotation + only 1yr residency to specialize, but damn at least you get paid for PGY-1 vs. going into the hole the same amount.

 

[PharmDstudent]

I thought I was the only one up at 540am!

Some schools are 2+2 (Touro CA comes to mind). I think the system we have now works...for some reason, 2 years didactic doesn't seem enough (on paper at least) unless you're running some sort of accelerated program. Granted, I've been taking classes that could easily be truncated/cut out, so maybe you're on to something.

I'd be a fan of 3yrs didactic + 2yrs rotation + only 1yr residency to specialize, but damn at least you get paid for PGY-1 vs. going into the hole the same amount.

Now it's 5:40... 😉

True. But the idea of moving for 1 year of residency is disgusting. I have pets, a boyfriend, and family to think about. Those psychos who think it's no big deal to get up and leave your home and everything you've established in 4 years can kiss it! That pick-up-and-go, disregard **** could totally ruin your life!

 

[confettiflyer]

That pick-up-and-go, disregard **** could totally ruin your life!

...or it could make for a good story

i know a good # of people who just interviewed locally for residencies...granted, they had great stats/letters/stacked CV's. The rest of us on the lower end of the totem pole will have to cast a wide net, which explains why I'm in this town.

okay how about 3 didactic + 1 rotational + 1 built-in residency-esque program where you get paid but it's at the institution's (or affiliated) hospital. school wins w/ cheap PharmD labor, you win w/ staying in one spot, I win because I get paid.

Except I don't win because 5yrs in philly is SO NOT COOL AT ALL.

ok forreal time to nap

 

[njac]

Now it's 5:40... 😉

True. But the idea of moving for 1 year of residency is disgusting. I have pets, a boyfriend, and family to think about. Those psychos who think it's no big deal to get up and leave your home and everything you've established in 4 years can kiss it! That pick-up-and-go, disregard **** could totally ruin your life!

I dunno, I think it's been good for me to pick up, move across the country with my 2 dogs, leave the boyfriend 2000 miles behind etc.

It really does help get your bearings and figure out your priorities. It's only a year. or two.


As far as the PGY1 being useless? Not yet. In fact, one day it may be necessary for the staffing jobs. Lots of places I interviewed had a huge percentage of pharmacists on staff who were residency trained. Again, they operated mainly in the clinical:staffing hybrid. Several places that told me they would bring me in for an on-site interview also said that they thought it would be beneficial for me to do a PGY-2 and that they'd rather wait for quality than just a body. But I'm also looking at a specialty with <15 total PGY2 spots in the country (including accredited and not)

 

[SELDANE]

I've always had mixed feelings about residencies for pharmacists. I have no doubt that the information they receive over those extra year/years is valuable. However, 60% of the pharmacists I work with in the hospital have completed a residency ( I work in a hospital with about 20 pharmacists). Yet, only three of these pharmacists have a clinical position. The rest are with me doing order input, checking TPNs, IVs etc... I guess I am puzzled as to what distinguished these three from the others who completed a residency. Was it the type of residency they completed or was it being in the right place at the right time?

 

[Old Timer]

Except I don't win because 5yrs in philly is SO NOT COOL AT ALL.

No five years in West Philadelphia is NOT cool, in fact it's a sentence. Five years on the Parkway, Old City, Rittenhouse Square, or any of the may suburbs is very cool....

 

[bacillus1]

No five years in West Philadelphia is NOT cool, in fact it's a sentence. Five years on the Parkway, Old City, Rittenhouse Square, or any of the may suburbs is very cool....

He's at Jeff, that's 5 years in center city. West Philly's not bad either.

 

[StaviZFingerZ]

the clinical/staffing hybrid model is the way to go. Decentralized pharmacists, do your own order entry and then do kinetics/consults as needed on your own patients. By giving the pharmacist some ownership of the patients they take more pride in their work, and by being on the floor, the nurses and physicians see you more as a face than just a voice on the phone.

This is absolutely accurate. Clinical Pharmacy model has evolved from clipboard pharmacists walking around the hospital aimlessely 20 years ago to hybrid clinician pharmacist who process orders and intervene on the floor. This is the most cost effective model hospital administration embraced. The biggest road block to this model is antiquated DOPs who want their pharmacists in the centralized basement processing orders.

anyway, in the midst of my pgy-1, I have a couple interview offers after midyear. Most are for specialist positions. (this is post PPS interview)

You'd get bored being a specialist.

for myself and my own nerdiness, I am likely pursuing a PGY-2. That said, I feel that I've not had the best PGY-1 experience and feel like I was more ready to be a "real pharmacist" last June than I do now. Hence some of the motivation to go forward.

Make the best of it..

 

[StaviZFingerZ]

Residency does not guaranty the perfect job or a job period. But it does make a candidate more appealing then someone without it for a hospital pharmacist position.

I wanted to be a retail pharmacist but I could not find a job. Of course this was before the retail pharmacy boom. I did have an extensive clinical training through almost 4 years of internship at a hospital. But I wanted to be a retail pharmacist..work 40 hours and enjoy life. And if retail is what you want, why do a residency.

I don't believe hospital pharmacy positions boomed alongside the retail sector. But the previous shortage did result from retail throwing money at pharmacists. For those of you who believe job market will improve once the recession is thawed, dream on. The recession won't improve for the next 10 years at least. We have yet to see the commercial real estate blood bath. If you think current recession is bad, just wait and brace for impact.

The expansion of retail pharmacy is over with or without the recession. Wags and CVS have met their expansion plans. Increasing prescription volume will be met with automation and mail orders. And that won't require much increase in manpower.

Yet, we are just entering into an era of diploma mill pharmacy schools cranking out PharmDs.

Residency... is one way to protect your investment in education...because those residency trained pharmacists will be the next wave of hospital pharmacists.

 

[confettiflyer]

No five years in West Philadelphia is NOT cool, in fact it's a sentence. Five years on the Parkway, Old City, Rittenhouse Square, or any of the may suburbs is very cool....

Okay I'll give you a 👍👍 for the suburbs...if I end up getting a residency here or other type of offer that I just can't refuse, off I go. Living 1 block from school is too convenient.

Even center city has its downsides...drunk people singing a bad rendition of Lady Gaga at 2am such that you can hear them with your windows closed = 👎

Oh and having to take anything SEPTA that's NOT regional rail is like stepping into a toilet that hasn't been flushed.

But there's good italian food, that's for sure. BYOB's rock my world.

 

[confettiflyer]

The recession won't improve for the next 10 years at least. We have yet to see the commercial real estate blood bath. If you think current recession is bad, just wait and brace for impact.

Are you referring to commercial RE or the mystic "third wave" of residential defaults? Or both?

Residency... is one way to protect your investment in education...because those residency trained pharmacists will be the next wave of hospital pharmacists.

This is why I want to do one...aside from mild interest in a specialty topic, I'll do it because going from $0 income to $40k when you're in your 20's with no kids is easy, I suspect going from $120k to $40k when you have a mortgage a baby may not be so easy....best to do it now as a hedge against the future.

I think this is the "big idea" that SDN has implanted in my mind over the past year or so.

 

[StaviZFingerZ]

Are you referring to commercial RE or the mystic "third wave" of residential defaults? Or both?

I didn't even think about the residential defaults...

Well.... I guess the Bank of BarryO will now own all the Commercial RE. 👍

 

[confettiflyer]

I didn't even think about the residential defaults...

Well.... I guess the Bank of BarryO will now own all the Commercial RE. 👍

I've been tracking default notices the past few months, they've been ticking up.

LA County data....that giant wall of 90+ delinquent will become a giant wall of NOD which then floods the market with cheap REO's. It'll be a good time to buy between 2011/2012 to 2015 if you're holding for 7-10+ years.

Z -- ever think about coming back to CA? forget that vegas matchbox you wanted to buy.

National data supports it too, I think we're at 14% of all mortgages are in default/some process of FC. Disturbing (interesting to me) trend is 33% of FC's in Q3 were A-paper/fixed rate loans. Strategic defaults? Subprime has come and gone.

sources: http://www.calculatedriskblog.com/2009/11/mba-record-144-percent-of-mortgage.html
http://mhanson.com/blog

 

[StaviZFingerZ]

Z -- ever think about coming back to CA? forget that vegas matchbox you wanted to buy.

I may have something cooking in Northern Cal.. will be visiting 1st Q of 2010.. but not for Real Estate. I don't think I'll be moving anywhere.. I enjoy being 3 hours from anywhere in the US, non-stop.

 

[Old Timer]

Okay I'll give you a 👍👍 for the suburbs...if I end up getting a residency here or other type of offer that I just can't refuse, off I go. Living 1 block from school is too convenient.

Even center city has its downsides...drunk people singing a bad rendition of Lady Gaga at 2am such that you can hear them with your windows closed = 👎

Oh and having to take anything SEPTA that's NOT regional rail is like stepping into a toilet that hasn't been flushed.

But there's good italian food, that's for sure. BYOB's rock my world.

Have you been to Spasso? Not a BYOB, but one of my favorite dining establishments in Philadelphia. Philly is one of the best restaurant towns in the country.

 

[Rebel78]

the clinical/staffing hybrid model is the way to go. Decentralized pharmacists, do your own order entry and then do kinetics/consults as needed on your own patients. By giving the pharmacist some ownership of the patients they take more pride in their work, and by being on the floor, the nurses and physicians see you more as a face than just a voice on the phone.

agreed 100%. I just took a job exactly like this a few months ago and I think this is where the profession is headed in institutions.

As far as a residency, I worked at Walgreens the last 5 years, no residency. It comes down to interviewing well, really knowing your stuff, and be willing to learn at the same time.

The best residency can't replace being a decentralized pharmacist for a couple of years and getting your hands dirty.

 

[SpirivaSunrise]

Have you been to Spasso? Not a BYOB, but one of my favorite dining establishments in Philadelphia. Philly is one of the best restaurant towns in the country.

I have! 😉

 

[Old Timer]

I have! 😉

I went to Moore Brother today to tide me over until the sale at the end of January. I"ll let you, we might finally meet....

 

[SpirivaSunrise]

I went to Moore Brother today to tide me over until the sale at the end of January. I"ll let you, we might finally meet....

Sounds good! Keep me posted, and I'll meet ya there. My wine fridge is almost on E.

 

[njac]

Sounds good! Keep me posted, and I'll meet ya there. My wine fridge is almost on E.

nooooo!!!

 

[bigpharmD]

i have been in a hybrid model and a specialist model and quite honestly i thought the "hybrid" model was much more ineffecient and didnt get the job done. Many of them had no guts (to be nice) and just didnt have the training needed to make changes and stand up to anyone. I am all for getting pharmacists on the floor doing stuff but I firmly believe few people could do my job, and any of the staff I work with would tell you that.

A hybrid model would not work for my particular position. I have to go to so many meetings, quality improvement stuff, update order sets and protocols, give lectures in the hospital, and try to round, it just doesnt work.

 

[bigpharmD]

agreed 100%. I just took a job exactly like this a few months ago and I think this is where the profession is headed in institutions.

As far as a residency, I worked at Walgreens the last 5 years, no residency. It comes down to interviewing well, really knowing your stuff, and be willing to learn at the same time.

The best residency can't replace being a decentralized pharmacist for a couple of years and getting your hands dirty.

HAHA ok you come give our group a presentation on what the best agent to use for induction in heart transplant is. And then tell us what we should be doing as far CMV prophylaxis and what would be most cost effective for the hospital...

 

[njac]

HAHA ok you come give our group a presentation on what the best agent to use for induction in heart transplant is. And then tell us what we should be doing as far CMV prophylaxis and what would be most cost effective for the hospital...

so what are you all using instead of daclizumab for induction for kidneys?

 

[bigpharmD]

so what are you all using instead of daclizumab for induction for kidneys?

we primarily use thymo anyways...but if we use an IL 2 we use simulect

 

[njac]

we primarily use thymo anyways...but if we use an IL 2 we use simulect

my old hospital a mix so I was curious to see what is going on elsewhere. we don't do transplants where I am now.

 

[bigpharmD]

my old hospital a mix so I was curious to see what is going on elsewhere. we don't do transplants where I am now.

most centers have already transitioned away from daclizumab

 

[Rebel78]

Like I said, I just started a couple months ago. My job basically entails entering orders, going on rounds, making drug recommendations, and working in the outpatient pharmacy when needed. I work all over the place, enjoy it so far.

Is it the most efficient? No. It would be much more efficient to have one pharmacist sitting downstairs entering orders all day, but I do think there is something to being accountable for the treatment of patients, and being on the floor for rounds, and entering orders for those patients does make you feel accountable.

When I say it's better than a residency, obviously I haven't done one. But I'm learning far more day in and day out than I did during my rotations, and I did several "presentations" during that time.

Beats the hell out of WAG in any case 😀

As far as giving presentations for formulary recommendations, we have pharmacists who sit in an office all day who handle that. I enjoy the patient interaction.

 

[bigpharmD]

Like I said, I just started a couple months ago. My job basically entails entering orders, going on rounds, making drug recommendations, and working in the outpatient pharmacy when needed. I work all over the place, enjoy it so far.

Is it the most efficient? No. It would be much more efficient to have one pharmacist sitting downstairs entering orders all day, but I do think there is something to being accountable for the treatment of patients, and being on the floor for rounds, and entering orders for those patients does make you feel accountable.

When I say it's better than a residency, obviously I haven't done one. But I'm learning far more day in and day out than I did during my rotations, and I did several "presentations" during that time.

Beats the hell out of WAG in any case 😀

As far as giving presentations for formulary recommendations, we have pharmacists who sit in an office all day who handle that. I enjoy the patient interaction.

I see patients all day...I am not talking about formulary recommendations...i am talking about telling our group of physicians what is the best way to do something and why...i dont think working at walgreens for 5 years and then staffing on the floor can give you the background to do that...our jobs are completely different

 

[PharmDstudent]

I see patients all day...I am not talking about formulary recommendations...i am talking about telling our group of physicians what is the best way to do something and why...i dont think working at walgreens for 5 years and then staffing on the floor can give you the background to do that...our jobs are completely different

A clinical coordinator and a couple of clinical pharmacists could do your job.

But creatinine clearance, INR, kayexalate and ADR monitoring, and Zyvox IV/PO could be done by a mixed staff. Stuff like that...

 

[njac]

A clinical coordinator and a couple of clinical pharmacists could do your job.

But creatinine clearance, INR, kayexalate and ADR monitoring, and Zyvox IV/PO could be done by a mixed staff. Stuff like that...

Absolutely. But some of us want to do more than that.

 

[bigpharmD]

A clinical coordinator and a couple of clinical pharmacists could do your job.

But creatinine clearance, INR, kayexalate and ADR monitoring, and Zyvox IV/PO could be done by a mixed staff. Stuff like that...

Really? ask your clinical coordinator if they even known what simulect is and why we use it in some patients and not in others.

Ask them if we should be doing 3m CMV prophylaxis vs 6 or 12 m, then follow-up with why are the physicians using CMV immune globulin which costs thousands of dollars per dose?

Why do I get paged by every other clinical pharmacist about transplant medications if they could do it?

Just some ?s to ponder

 

[gotdrugs]

A clinical coordinator and a couple of clinical pharmacists could do your job.

Interesting perspective from a student. Curious as to what experiences you've had that has led you to this conclusion regarding BigPharm's job or is this a matter where you are convincing yourself that you don't need to do a residency?

 

[bigpharmD]

she is correct in that it does take 3 or 4 people to do my job but currently I do it alone

 

[type b pharmD]

she is correct in that it does take 3 or 4 people to do my job but currently I do it alone

Settle down bigpharmd, we all know by now that you are the most highly trained and highly educated pharmacist here. 😉

 

[bigpharmD]

that would probably go to priapism......😎

 

[gotdrugs]

Probably not.

 

[DrugRX]

she is correct in that it does take 3 or 4 people to do my job but currently I do it alone

...

 

[gotdrugs]

Very interesting that you think your job needs 3 or 4 pharmacists but you can do it alone. You mean 3 or 4 new graduates. You probably know more than hospital staff pharmacist with 2~3 years of experience. However, you still have a lot to learn, and do not underestimate clinical coordinators with many years of experience. I bet my clinical coordinator (BSPharm with 20 years of hospital experience) know far more than you.

Very interesting post yourself. It sounds like BigPharm is in the transplant arena and I would say without knowing him that he probably does know more than what most experienced pharmacists and clinical coordinators/managers know in that specialty. If you think that a hospital pharmacist with 2-3 years of experience has the exact same knowledge skillsets as someone who specialized (i.e. Pgy-1/Pharmacy Practice and PGY-2/Specialty residency) in a particular area (transplant, oncology, critical care, etc) and can produce just as well in that specialized area, then frankly you are just kidding yourself.