Residency: what for?

[BM2007E92]

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If I can add:

Personally I feel a residency is for someone who is 100% certain in specializing/yearning for a clinical specialty. However, despite all this hype and promotion for having one (at least my school drilled it into each of our heads hehe), it does not guarantee the perfect job or even a job at all. As other people mentioned here, it only opens up the doors of opportunity; but it does not mean you will pass through that ideal door.

I have two friends who participated in residencies. One of my friends ended up not finding any job related to her expertise, but eventually relocated to a rural area working in the field of pharmacy. Another friend also completed a PGY1, but after that she instead found work as a staff pharmacist. Does that mean residencies are useless? No. Does it mean residencies are a shoe-in into your ideal job? No. Residencies exist for pharmacists to rapidly broaden their knowledge and gain the experience of x number of years (I forget how much, but somewhere along the lines of 3-5 years experience per year of residency).

I still feel that residencies should be optional for new grads. Leave it to them to decide whether or not they want to gain additional experience as they progress through their career or quickly in 1-2 years. Although like others, I feel the shortage is already being filled up in the retail setting, so eventually residencies might become the new "weed out" step to prevent the influx of extra pharmacists into the workforce.

 

[bigpharmD]

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.

Exactly...why do you think i got hired....because they know absolutely NOTHING about what is going on....i actually did find that response humorous and was going to ignore it....

And by the way I meant we could use 3 or 4 of me...there is way too much work for one person

 

[type b pharmD]

it takes all kinds of people to run a pharmacy guys. im sure clinical people , even with their training , have less knowledge of managing technician workflow or pharmacy financials than staff or director type people

 

[SHC1984]

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.

It's called job security.

 

[PharmDstudent]

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?

What'll you know??? rxlist.com has a link! 🙄

You don't do CMV prophylaxis because of drug resistance. You only treat it. Duh!

You prophylax for PCP, toxo+, and MAC - but not CMV.

And I can read the guidelines like everyone else who went to pharmacy school...

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

Maybe they have a crush on you or the other pharmacists are too lazy and don't give a crap.

You really should get rid of this god complex or at least clear your head of these loose associations.

Now stop name dropping and go have a seat.

Just some ?s to ponder

Next...

 

[njac]

You don't do CMV prophylaxis because of drug resistance. You only treat it. Duh!

You prophylax for PCP, toxo+, and MAC - but not CMV.

are you sure on that? do you want a couple hours to come up with a different answer?

what if the donor is CMV+ and the recipient is CMV- ?

I only did a week of transplant, and that was the summer between 2nd and 3rd years, but this was a topic discussed on every single patient.

 

[PharmDstudent]

are you sure on that? do you want a couple hours to come up with a different answer?

what if the donor is CMV+ and the recipient is CMV- ?

I only did a week of transplant, and that was the summer between 2nd and 3rd years, but this was a topic discussed on every single patient.

I did an HIV/ID rotation and that was emphasized repeatedly, because resistance can develop within 6 months.

Maybe bigpharmD was talking about transplant, but he didn't specify. SO, I win. 😛

 

[type b pharmD]

And I can read the guidelines like everyone else who went to pharmacy school...


Maybe they have a crush on you or the other pharmacists are too lazy and don't give a crap.


Now stop name dropping and go have a seat.

Next...

I like your style

 

[njac]

it's well known that bigpharmD is a transplant specialist.

 

[bigpharmD]

What'll you know??? rxlist.com has a link! 🙄

You don't do CMV prophylaxis because of drug resistance. You only treat it. Duh!

Right and wrong...there are 2 schools of thought....but I personally would somewhat agree depending on the patients risk for CMV...

So you are telling me you wont prophylax a patient who is CMV - with a cmv + donor who received thymoglobulin induction? That is gutsy. Some studies have shown patients who receive up to ONE year of prophylaxis have less incidence of cmv, organ rejection, less risk of death, and no increased risk of resistance. There are actually centers who provide lifetime prophy for mismatches.

It becomes real muddy when you have a +/+ patient or a -/+ patient...and this would be a case where you could hold off on prophylaxis....but then again depending on the organ and induction agent some would say you should provide prophylaxis for at least 3m.

...what about CMV immune globulin?

what agent should we prophylax with...valgancyclovir, ganciclovir, valacyclovir, acyclovir?

You prophylax for PCP, toxo+, and MAC - but not CMV.

Really ..MAC, no CMV for anyone?

And I can read the guidelines like everyone else who went to pharmacy school...

Why do I care about guidelines for HIV...it is well known that I Have been talking about TRANSPLANT patients...completely different

Maybe they have a crush on you or the other pharmacists are too lazy and don't give a crap.

yeah maybe they do....i would

You really should get rid of this god complex or at least clear your head of these loose associations.

you should do the same before you go to med school

Now stop name dropping and go have a seat.

I am currently sitting

Next...

 

[bigpharmD]

...double post

 

[gotdrugs]

it takes all kinds of people to run a pharmacy guys. im sure clinical people , even with their training , have less knowledge of managing technician workflow or pharmacy financials than staff or director type people

👍👍

 

[PharmDstudent]

Now stop name dropping and go have a seat.

I am currently sitting

Next...

I'll have to get back to this.

And you're plagiarizing since you didn't quote "Next...". 😱

 

[bigpharmD]

i have to admit i was very impressed....

i love pre-optometry

 

[Me_Gusta_Drugs]

You really should get rid of this god complex or at least clear your head of these loose associations.

Now stop name dropping and go have a seat.

Next...

This is another reason NOT to do a residency. Sadly I find that most of the pharmacists that are preceptors have a god complex or are just plain a holes that shouldnt be in a position of power.
Yes these pharmacists are usually very smart and know their crap...but its not worth dealing with their drama/god complex. Theyre usually condescending also.
Why cant we have preceptors and managers that arent A-holes?

 

[type b pharmD]

This is another reason NOT to do a residency. Sadly I find that most of the pharmacists that are preceptors have a god complex or are just plain a holes that shouldnt be in a position of power.
Yes these pharmacists are usually very smart and know their crap...but its not worth dealing with their drama/god complex. Theyre usually condescending also.
Why cant we have preceptors and managers that arent A-holes?

I dont think bigpharmD is really an *******. Nothing wrong with being motivated or enthused about being a specialist/expert

 

[gotdrugs]

This is another reason NOT to do a residency. Sadly I find that most of the pharmacists that are preceptors have a god complex or are just plain a holes that shouldnt be in a position of power.
Yes these pharmacists are usually very smart and know their crap...but its not worth dealing with their drama/god complex. Theyre usually condescending also.
Why cant we have preceptors and managers that arent A-holes?

So you find that most people in a position of authority over you is/are an A-hole?

Gotcha.👍

 

[MountainPharmD]

Why cant we have preceptors and managers that arent A-holes?

Why can't we have students and employees that aren’t complete idiots? Just because someone one tells you what to do does not mean they are an A-hole or they have a "God" complex.

 

[Me_Gusta_Drugs]

ugh just lost a long reply...if i cared more id redo it

but basically that was a rhetorical question lol...should not have asked it. And no im not talking about bigpharmd i dont know him/her. And yes i agree there are crappy employees as well

 

[Rebel78]

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

I would assume so. Working at WAG for 5 years+OT got everything paid for though. I'm not knocking you or the idea of doing a residency and taking that kind of job. It's all about what makes you happy. Not paying bills make me happy, and I have a great staff position at a teaching hospital now. If you want a clinical position, you better do a residency, if that's what you want.

We have several pharmacy students at our hospital now trying to decide. I told them not to let anybody push them, one way or another. You have to weigh your options. In the current market, I'd probably do a residency. No more huge sign on bonuses with all the 1.5 OT you want anymore. But every situation is different. Just aggravates me when somebody pushes what they did on somebody because it was "right". What's right for one isn't right for all.

Don't take things so personal 😉

 

[PharmDstudent]

i have to admit i was very impressed....

i love pre-optometry

Ok. I've been wondering what that optometry status was for! 😕

After major arteries within the city were flooded and access to the movies was blocked off from all directions Saturday, I ended up going to the movies late Monday night. But then I worked the closing shift Tuesday night. So, I finally can get back to this thread. 😛


I had forgotten that you were transplant. I don't stalk the residency forum, contrary to popular belief 😉, so I didn't remember what area you were in.

Ok. So if the patients CD4 is <50, they're at risk for CMV. (But it's recommended that if their CD4 < 200, they should be screened for CMV.) And I would think that if the donor was a family member, then immunosuppression would be less involved, meaning immune response and CD4 count would be higher. I saw one person who had an organ from their child, so the Cellcept and prednisone doses were low.
I came across several patients who were being cleared for transplants, and they had to have a CD4 200+, be virally undetectable, and no other chronic infections (like blasto, PCP, etc.)
If the donor is CMV+, then the CD4 count of the receiver would have to be low, like below 50, for there to even be a problem, right? Now, if patients with a CD4 count of like 3 aren't given prophylaxis, then I would be hard pressed to give it to a someone above 50 receiving a CMV+ organ.
If the patients receive regular eye screenings, then why prophylax? For something that isn't necessarily there? Hmmm...
I'm not a physician worried about malpractice, so maybe what I think is ballsy.

Now. For the drugs. There's an implant called Vitrasert (ganciclovir) that lasts for 6 months... cool dosage form! 😎 Then valgancyclovir PO, which is supposed to have higher bioavailability than ganciclovir, until converted to ganciclovir. Ganciclovir also comes IV.
Cidovovir IV and foscarnet IV are used for resistant CMV infections.


So what else do you know about OI infections? I loved that part of my rotation. 😍
I saw Bactrim switched to Dapsone due to hypersensitivity, Clari switched to Azithromycin for treatment of MAC due to GI side effects, and even photophoresis for graft vs host.

 

[bigpharmD]

Ok. I've been wondering what that optometry status was for! 😕

After major arteries within the city were flooded and access to the movies was blocked off from all directions Saturday, I ended up going to the movies late Monday night. But then I worked the closing shift Tuesday night. So, I finally can get back to this thread. 😛


I had forgotten that you were transplant. I don't stalk the residency forum, contrary to popular belief 😉, so I didn't remember what area you were in.

Ok. So if the patients CD4 is <50, they're at risk for CMV. (But it's recommended that if their CD4 < 200, they should be screened for CMV.) And I would think that if the donor was a family member, then immunosuppression would be less involved, meaning immune response and CD4 count would be higher. I saw one person who had an organ from their child, so the Cellcept and prednisone doses were low.
I came across several patients who were being cleared for transplants, and they had to have a CD4 200+, be virally undetectable, and no other chronic infections (like blasto, PCP, etc.)
If the donor is CMV+, then the CD4 count of the receiver would have to be low, like below 50, for there to even be a problem, right? Now, if patients with a CD4 count of like 3 aren't given prophylaxis, then I would be hard pressed to give it to a someone above 50 receiving a CMV+ organ.
If the patients receive regular eye screenings, then why prophylax? For something that isn't necessarily there? Hmmm...
I'm not a physician worried about malpractice, so maybe what I think is ballsy.

Now. For the drugs. There's an implant called Vitrasert (ganciclovir) that lasts for 6 months... cool dosage form! 😎 Then valgancyclovir PO, which is supposed to have higher bioavailability than ganciclovir, until converted to ganciclovir. Ganciclovir also comes IV.
Cidovovir IV and foscarnet IV are used for resistant CMV infections.


So what else do you know about OI infections? I loved that part of my rotation. 😍
I saw Bactrim switched to Dapsone due to hypersensitivity, Clari switched to Azithromycin for treatment of MAC due to GI side effects, and even photophoresis for graft vs host.

I am not sure what all of this talk about CD4 counts is about but you must be focusing on HIV. I dont know what they do.

CMV risk for transplant is as follows
high: CMV - recepient/CMV positive donor
Moderate: CMV + R/CMV+ donor
CMV + R/ CMV- donor
Low: CMV - R/CMV - Donor

Most centers will give prophy based on these risk categories. Some use valcyte for everyone. Others use valcyte for moderate and high risk and acyclovir in low risk patients (not for cmv). And then others only prophy the high risk patients and monitor PCR.

CMV in transplant is associated with worse outcomes and rejection.

 

[PharmDstudent]

I am not sure what all of this talk about CD4 counts is about but you must be focusing on HIV. I dont know what they do.

CMV risk for transplant is as follows
high: CMV - recepient/CMV positive donor
Moderate: CMV + R/CMV+ donor
CMV + R/ CMV- donor
Low: CMV - R/CMV - Donor

Most centers will give prophy based on these risk categories. Some use valcyte for everyone. Others use valcyte for moderate and high risk and acyclovir in low risk patients (not for cmv). And then others only prophy the high risk patients and monitor PCR.

CMV in transplant is associated with worse outcomes and rejection.

We're talking from two totally different directions. Nevermind... 🙁