Residency

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samven582

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Can someone please explain to me how a PGY-1 is equivalent to 3 years of direct patient care?

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Can someone please explain to me how a PGY-1 is equivalent to 3 years of direct patient care?
That's likely at least how long it'll take to be exposed to such a diverse array of experiences that most residencies provide. Also depends on what you construe as "direct patient care".
 
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A lot of hospitals are just preferring residency trained pharmacists. A lot of them probably don't even consider 9 years experience to be equal to residency trained. In my case, yeah I have 9 years experience working in central pharmacy, doing vanco, and warfarin monitoring but barely any experience asides from rotations on rounding, talking to the patients in the hospital, dealing with manufacturers, or doing drug usage reports, safety/ADE monitoring, research etc.
 
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I am not sure this is really a genuine question, but here goes.

The goal of residency is to be a concentrated learning environment. We are trying to cover absolutely as many things a possible in a year. That means more than 40hrs of work a week for most residents. It also means in a year they will should touch nearly every service offered by their pharmacy department.
Contrast that with a working pharmacist. The working pharmacist is limited by what area they cover and what tasks they must perform in a day. A pharmacist who works for 3 years may not have any experience outside of whatever unit they were assigned to or they may have spent 60-70% of their time on operational activities.

The truth is that residency should be a fairly consistent experience (at least in comparison to hospital jobs). Career experience varies widely. For some positions, 3 years is way to much. For others 10 years would be too little. Three years is the line at which pharmacy departments have decided that they will consider your application without a residency. It doesn't mean that those two things are actually equivalent. We have pharmacists who have been here 15-20 years who could not perform at the level of a PGY1 resident halfway through if I put them on a rounding team.
 
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I am not sure this is really a genuine question, but here goes.

The goal of residency is to be a concentrated learning environment. We are trying to cover absolutely as many things a possible in a year. That means more than 40hrs of work a week for most residents. It also means in a year they will should touch nearly every service offered by their pharmacy department.
Contrast that with a working pharmacist. The working pharmacist is limited by what area they cover and what tasks they must perform in a day. A pharmacist who works for 3 years may not have any experience outside of whatever unit they were assigned to or they may have spent 60-70% of their time on operational activities.

The truth is that residency should be a fairly consistent experience (at least in comparison to hospital jobs). Career experience varies widely. For some positions, 3 years is way to much. For others 10 years would be too little. Three years is the line at which pharmacy departments have decided that they will consider your application without a residency. It doesn't mean that those two things are actually equivalent. We have pharmacists who have been here 15-20 years who could not perform at the level of a PGY1 resident halfway through if I put them on a rounding team.
No it is a genuine question. I'm not sure why you're attacking me over it. Also your answer doesn't make any sense to me
 
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That's likely at least how long it'll take to be exposed to such a diverse array of experiences that most residencies provide. Also depends on what you construe as "direct patient care".
Depends on the hospital. You know where I work lol and we have no inpatient pharmacy preceptors. The residents we graduate from our program won't survive in a inpatient pharmacy setting (Community or level 1),
 
No it is a genuine question. I'm not sure why you're attacking me over it. Also your answer doesn't make any sense to me
I didn't meant to attack you over it, and I apologize if it came across this way. This sentiment/question gets expressed a lot here and it is mostly under the assumption that it is false.

Maybe with some additional explanation of what doesn't make sense I can clarify.

Depends on the hospital. You know where I work lol and we have no inpatient pharmacy preceptors. The residents we graduate from our program won't survive in a inpatient pharmacy setting (Community or level 1),
If you mean by "inpatient pharmacy" the operational central pharmacy - Then I think that is probably the intention. Residency was not designed to train operational pharmacists. I don't do anything that is truly operational except for decentralized order verification.
 
I didn't meant to attack you over it, and I apologize if it came across this way. This sentiment/question gets expressed a lot here and it is mostly under the assumption that it is false.

Maybe with some additional explanation of what doesn't make sense I can clarify.


If you mean by "inpatient pharmacy" the operational central pharmacy - Then I think that is probably the intention. Residency was not designed to train operational pharmacists. I don't do anything that is truly operational except for decentralized order verification.

As a Peds ER pharmacist, how often do you have to look stuff up versus knowing off the top of your head? That's what I feel would be my biggest weakness if I were to go for a clinical position. I'd always have to have the iPad out.
 
As a Peds ER pharmacist, how often do you have to look stuff up versus knowing off the top of your head? That's what I feel would be my biggest weakness if I were to go for a clinical position. I'd always have to have the iPad out.
I would say that the majority of things that I get asked, I know off the top of my head. The majority of things I don't know, I know exactly where to look. The rest of the stuff is usually so weird that I wouldn't expect anyone to know it off the top of their head (that's usually why they are asking). I don't know that the balance was exactly like that when I first left residency, but I got to Peds EM in a round about way.
 
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Depends on the hospital. You know where I work lol and we have no inpatient pharmacy preceptors. The residents we graduate from our program won't survive in a inpatient pharmacy setting (Community or level 1),
Well, the employer will likely then evaluate your residents' experience on their CV and choose another resident from a hospital better equipped for the position.

My Friday morning of last week started with performing a nursing in-service on giving esomeprazole capsules via feeding tube, then reviewed a Midyear abstract for my resident's research project that I am precepting, then rounded, then ran a report for pulling ADRs and assigning them to residents, all in a few hours. Most jobs just won't set you up for that diverse array of experiences and a residency is intended to make you more "well-rounded" to be able to do whatever the jobs throws at you without a crazy amount of training, as well as contributing to their own residency program. That being said, I am sure there are residencies that do not do this, but then that will be taken into account when reviewing applicants.
 
so - I will give my two cents. First, I have a PGY-0 - but have been a preceptor and developed a residency for both PGY-1 and PGY-2 programs. I have 17 years experience - 14 of which have been at a large well-respected community hospital (ironically I often call it one of the best hospitals you haven't heard of).
I 100% agree the 3 year is very much an arbitrary number - like kidpharm said - it all depends on your experience (both residency and work experience). If you just check product in the basement - you can have 15 years experience and that isn't equivalent to a one year residency, or you could work a highly "clinical" position in a crazy busy environment where you pick up similiar experience to a residency. I think the reason the 3 year thought comes in because we are purposely giving you concentrated learning experiences in a more rapid fire environment that you will see working. Therefore you may have a more "academic" experience, but you may miss out on some of the common sense things - or just those really weird one offs that just come with experience.

I can tell you most of our PGY-2 may have a stronger pharmacy jeopardy knowledge than me (quote what random bug is most common in pt's who lived in the susquahana river valley while simultaneously being exposed to rat feces) but they may miss out on some of the common sense things or a better term "practical knowledge". The second thing is what I really focus on when precepting - I give real world examples that I have been in and find ways to work through them.

I am not anti-residency by any means, but I do thing there are many cases where the mgmt team just wants to be able to say "90% of our pharmacists are residency trained" so that is looks good to hospital administration. I have been very frustrated when we will only hire PGY-2 trained pharmacists for our ICU vs getting somebody with a decade of experience who doesn't have the right initials. I believe it is good to have a balance of people from both ends of the spectrum that can learn from each other. You can look at my post about the Cali job that they wouldn't even give me a second look for an ED position because they require a PGY-2 despite the fact I build an ED program from scratch, am a published author on ED studies, and have received compliments from a AHSP residency accreditation inspector that I had the most comprehensive ED program she has ever seen.

So ya - my two cents worth....
 
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Can someone please explain to me how a PGY-1 is equivalent to 3 years of direct patient care?
Like Dred Pirate said, I also have a PGY-0 with a decade of hospital experience and in my current organization, I will never be considered for a clinical position despite improving workflows, expanding programs, rounding, and excelling at each task they decide to throw at me because I do not have a residency. I am so disgusted by it.
That's likely at least how long it'll take to be exposed to such a diverse array of experiences that most residencies provide. Also depends on what you construe as "direct patient care".

I completely disagree with this. The residents trained at my pharmacy, I would never want them near me. They have zero guidance with no true preceptors. They get no exposure to multiple disease states. I am not sure if they would even know what the differences are among the beta-blockers.


so - I will give my two cents. First, I have a PGY-0 - but have been a preceptor and developed a residency for both PGY-1 and PGY-2 programs. I have 17 years experience - 14 of which have been at a large well-respected community hospital (ironically I often call it one of the best hospitals you haven't heard of).
I 100% agree the 3 year is very much an arbitrary number - like kidpharm said - it all depends on your experience (both residency and work experience). If you just check product in the basement - you can have 15 years experience and that isn't equivalent to a one year residency, or you could work a highly "clinical" position in a crazy busy environment where you pick up similiar experience to a residency. I think the reason the 3 year thought comes in because we are purposely giving you concentrated learning experiences in a more rapid fire environment that you will see working. Therefore you may have a more "academic" experience, but you may miss out on some of the common sense things - or just those really weird one offs that just come with experience.

I can tell you most of our PGY-2 may have a stronger pharmacy jeopardy knowledge than me (quote what random bug is most common in pt's who lived in the susquahana river valley while simultaneously being exposed to rat feces) but they may miss out on some of the common sense things or a better term "practical knowledge". The second thing is what I really focus on when precepting - I give real world examples that I have been in and find ways to work through them.

I am not anti-residency by any means, but I do thing there are many cases where the mgmt team just wants to be able to say "90% of our pharmacists are residency trained" so that is looks good to hospital administration. I have been very frustrated when we will only hire PGY-2 trained pharmacists for our ICU vs getting somebody with a decade of experience who doesn't have the right initials. I believe it is good to have a balance of people from both ends of the spectrum that can learn from each other. You can look at my post about the Cali job that they wouldn't even give me a second look for an ED position because they require a PGY-2 despite the fact I build an ED program from scratch, am a published author on ED studies, and have received compliments from a AHSP residency accreditation inspector that I had the most comprehensive ED program she has ever seen.

So ya - my two cents worth....
I am so mad for you, that a PGY-2 is more important than real-life experience.

On another note, our profession is so disgusting. Hospital management doesn't value experience and do not invest time in those who are willing to work. I am sure if management gave those pharmacists in the basement a chance to round, learn and be part of a team, they would outperform any PGY1/PGY2. But put a PGY1/PGY2 in the basement pharmacy, orders will be backed up, doses will be missing, technicians calling out because they don't want to work with this pharmacist, and phones ringing nonstop.

In my career, I have been wow by only one PGY2 resident. "Practical knowledge" is clearly a deficiency of PGY1 residents.

I just paid $200 for 20-30 minute lawyer consultation. Not sure if our profession will ever get recognized as medication experts and get paid close to that kind of money. Unless there are consultant pharmacists that gets paid this amount of money, that I am unaware of.
 
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Basement pharmacists? What is this, 1995?

If y’all ain’t on the hybrid staffing train, your management is lazy.
 
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Basement pharmacists? What is this, 1995?

If y’all ain’t on the hybrid staffing train, your management is lazy.

I know one of the hospitals in the Bronx uses that model at their main hospital for their day shift. As a result, they only hire residency trained pharmacists for day shift and non-residency trained pharmacists can only work evening shift or overnight shift. (Really dumb.)

If they are gonna do hybrid staffing, they should schedule it for 2-3 month blocks for assignments instead of changing it every week/pay period.
 
Like Dred Pirate said, I also have a PGY-0 with a decade of hospital experience and in my current organization, I will never be considered for a clinical position despite improving workflows, expanding programs, rounding, and excelling at each task they decide to throw at me because I do not have a residency. I am so disgusted by it.


I completely disagree with this. The residents trained at my pharmacy, I would never want them near me. They have zero guidance with no true preceptors. They get no exposure to multiple disease states. I am not sure if they would even know what the differences are among the beta-blockers.



I am so mad for you, that a PGY-2 is more important than real-life experience.

On another note, our profession is so disgusting. Hospital management doesn't value experience and do not invest time in those who are willing to work. I am sure if management gave those pharmacists in the basement a chance to round, learn and be part of a team, they would outperform any PGY1/PGY2. But put a PGY1/PGY2 in the basement pharmacy, orders will be backed up, doses will be missing, technicians calling out because they don't want to work with this pharmacist, and phones ringing nonstop.

In my career, I have been wow by only one PGY2 resident. "Practical knowledge" is clearly a deficiency of PGY1 residents.

I just paid $200 for 20-30 minute lawyer consultation. Not sure if our profession will ever get recognized as medication experts and get paid close to that kind of money. Unless there are consultant pharmacists that gets paid this amount of money, that I am unaware of.
Yes but having a residency is not just about 'Experience.'. It's a signal to future employers that you're willing to eat it or do what it takes to secure cushy employment as a credential signalling matter. Experience doesn't usually matter after about 5-8 years If the practice site is a reasonable one. But hunger, ambition, and a willingness to put yourself as a lower priority, priceless to supervision.
 
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Yes but having a residency is not just about 'Experience.'. It's a signal to future employers that you're willing to eat it or do what it takes to secure cushy employment as a credential signalling matter. Experience doesn't usually matter after about 5-8 years If the practice site is a reasonable one. But hunger, ambition, and a willingness to put yourself as a lower priority, priceless to supervision.
And this is why I will never take that route. I’d quit and do something else before doing a residency.
 
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Clinical specialist (past)... staffing is where it's at.

No residency and got lucky I was able to advance from basement to satellite pharmacy to rounding /ER coverage to clinical specialist. Changed gigs to get the specialist job - smaller hospital with less qualified applicants. Was so sick of on call and salary (and working 40 hours a week)

changed hospitals for a pay raise and 4 10s
 
Basement pharmacists? What is this, 1995?

If y’all ain’t on the hybrid staffing train, your management is lazy.
Hybrid is the way to go if you staff it adequately...but this isn't California and many pharmacists are "old school" and would be totally lost in a hybrid model. I wish we could pull it off though (and obviously management would need to be motivated to make this happen).

The downside of hybrid, however, is that you need lots of per diems to have the weekends adequately staffed. That is unlikely to happen at the VA, as hiring is a huge process, so many VAs either A)stay in an old-school "basement pharmacists" model or B)attempt a crazy hybrid schedule with very few pharmacists there on evenings/weekends who have to do way too much work.
 
Hybrid is the way to go if you staff it adequately...but this isn't California and many pharmacists are "old school" and would be totally lost in a hybrid model. I wish we could pull it off though (and obviously management would need to be motivated to make this happen).

The downside of hybrid, however, is that you need lots of per diems to have the weekends adequately staffed. That is unlikely to happen at the VA, as hiring is a huge process, so many VAs either A)stay in an old-school "basement pharmacists" model or B)attempt a crazy hybrid schedule with very few pharmacists there on evenings/weekends who have to do way too much work.

Wait, why would you need per diems to keep the place staffed on the weekends? No rounding on the weekends? Wouldn't hybrid staff also be working on the weekends?

Another fix is to make 7 on 7 off the standard schedule whether it is day shift (6am-6pm), afternoon shift (12pm-12am), night shift (6pm-6am)?
 
Wait, why would you need per diems to keep the place staffed on the weekends? No rounding on the weekends? Wouldn't hybrid staff also be working on the weekends?

Another fix is to make 7 on 7 off the standard schedule whether it is day shift (6am-6pm), afternoon shift (12pm-12am), night shift (6pm-6am)?

7 on 7 off requires nearly double the number of full time employees. It's hard to argue for it. Most hospitals incentivize night/evening shift with 7-on-7-off as well, so there'd be much less incentive for those shifts if day shift also has it.
 
Like Dred Pirate said, I also have a PGY-0 with a decade of hospital experience and in my current organization, I will never be considered for a clinical position despite improving workflows, expanding programs, rounding, and excelling at each task they decide to throw at me because I do not have a residency. I am so disgusted by it.
Well that sounds like a problem with your department. This is one of the reasons that Pharmacists are often so mobile with their employers.
I completely disagree with this. The residents trained at my pharmacy, I would never want them near me. They have zero guidance with no true preceptors. They get no exposure to multiple disease states. I am not sure if they would even know what the differences are among the beta-blockers.
Again, this sounds like a problem with your program. In contrast, I would put our PGY-2 grads up against absolutely every one of our non-residency trained pharmacists, even the ones with decades of experience, and I think the PGY-1's would out perform 90% of them on a rounding team.
On another note, our profession is so disgusting. Hospital management doesn't value experience and do not invest time in those who are willing to work. I am sure if management gave those pharmacists in the basement a chance to round, learn and be part of a team, they would outperform any PGY1/PGY2. But put a PGY1/PGY2 in the basement pharmacy, orders will be backed up, doses will be missing, technicians calling out because they don't want to work with this pharmacist, and phones ringing nonstop.
The thing is, residency isn't training pharmacists to perform in that basement type of environment. The expectation will be that they are shooting for at least a hybrid position. That being said, our residents staff about every third weekend plus some evenings and do just fine as operational pharmacists acting as part of a team.

I was at an institution that tried to turn every daytime pharmacist into a hybrid position. The operational pharmacists all responded by saying that they weren't trained to do things like write vancomycin notes. We tried training them. We took time out of our days to walk them through the process. Every single one refused to put in the small amount of effort to even try to do the notes correctly. It was absolutely the most frustrated I have ever been trying to teach.

The hospital gave up and decided that new pharmacists would be preferred PGY1 grads that would be hired into hybrid positions.
 
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Yes but having a residency is not just about 'Experience.'. It's a signal to future employers that you're willing to eat it or do what it takes to secure cushy employment as a credential signalling matter. Experience doesn't usually matter after about 5-8 years If the practice site is a reasonable one. But hunger, ambition, and a willingness to put yourself as a lower priority, priceless to supervision.

The fact that this statement has any sort of credibility just shows you the state our profession is in right now. If you're a resident, prospective resident, or an ambulatory care pharmacist this quote should shake you to the core.
 
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7 on 7 off requires nearly double the number of full time employees. It's hard to argue for it. Most hospitals incentivize night/evening shift with 7-on-7-off as well, so there'd be much less incentive for those shifts if day shift also has it.

Is that why it is almost impossible to find a day shift position with a 7 on/7 off schedule?
 
Well that sounds like a problem with your department. This is one of the reasons that Pharmacists are often so mobile with their employers.

Again, this sounds like a problem with your program. In contrast, I would put our PGY-2 grads up against absolutely every one of our non-residency trained pharmacists, even the ones with decades of experience, and I think the PGY-1's would out perform 90% of them on a rounding team.

The thing is, residency isn't training pharmacists to perform in that basement type of environment. The expectation will be that they are shooting for at least a hybrid position. That being said, our residents staff about every third weekend plus some evenings and do just fine as operational pharmacists acting as part of a team.

I was at an institution that tried to turn every daytime pharmacist into a hybrid position. The operational pharmacists all responded by saying that they weren't trained to do things like write vancomycin notes. We tried training them. We took time out of our days to walk them through the process. Every single one refused to put in the small amount of effort to even try to do the notes correctly. It was absolutely the most frustrated I have ever been trying to teach.

The hospital gave up and decided that new pharmacists would be preferred PGY1 grads that would be hired into hybrid positions.
This part is definitely true. I've been talking to my boss that we really should have a pharmacist in the ER on all shifts to verify the ER orders as well as make the stat IVs in the ER. Boss said that it's an interesting proposal but that we can't just do it on my week on the overnight shift. When they polled the day shift about it, they were not interested, "I'm not trained for that. I don't want to be in that crazy environment. I don't know ACLS."

I kind of forgot that a lot of pharmacists went into pharmacy because they don't want to see blood and guts.
 
Is that why it is almost impossible to find a day shift position with a 7 on/7 off schedule?

Yup. Not only do 7-on-7-off people technically work 10 less hours than a 5 8's or a 4 10's position, an additional full time employees also means paying for more benefits.

I've never seen a day shift 7-on-7-off position.

Well that sounds like a problem with your department. This is one of the reasons that Pharmacists are often so mobile with their employers.

Again, this sounds like a problem with your program. In contrast, I would put our PGY-2 grads up against absolutely every one of our non-residency trained pharmacists, even the ones with decades of experience, and I think the PGY-1's would out perform 90% of them on a rounding team.

The thing is, residency isn't training pharmacists to perform in that basement type of environment. The expectation will be that they are shooting for at least a hybrid position. That being said, our residents staff about every third weekend plus some evenings and do just fine as operational pharmacists acting as part of a team.

I was at an institution that tried to turn every daytime pharmacist into a hybrid position. The operational pharmacists all responded by saying that they weren't trained to do things like write vancomycin notes. We tried training them. We took time out of our days to walk them through the process. Every single one refused to put in the small amount of effort to even try to do the notes correctly. It was absolutely the most frustrated I have ever been trying to teach.

The hospital gave up and decided that new pharmacists would be preferred PGY1 grads that would be hired into hybrid positions.

I believe my hospital has the opposite problem as yours. I think one of the problems that my hospital has is that day shift has specialized positions that take care of things for the day shift. Not to mention the very small number of orders, so they don't receive much exposure in the first place.

Weird antibiotic? Ask the ID pharmacist.
Chemo? Ask the chemo pharmacist.
Nutrition? Ask the Nutrition pharmacist.
Code blue? Ask the ICU or ED pharmacist.
Computer/program issue? Ask the "IT" pharmacist.
Surgery compound? Ask the OR pharmacist.
NICU/Pediatric Orders? Ask the NICU pharmacist.

The evening shift however still has to deal with all of the above in addition to antibiotic dosing, anticoagulant management/teaching, ect.

So when day shifts work on the occasional evening shift, they have no clue what to do and evening shift has to cover for them, both clinically and order entry wise.
 
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Yup. Not only do 7-on-7-off people technically work 10 less hours than a 5 8's or a 4 10's position, an additional full time employees also means paying for more benefits.

I've never seen a day shift 7-on-7-off position.



I believe my hospital has the opposite problem as yours. I think one of the problems that my hospital has is that day shift has specialized positions that take care of things for the day shift. Not to mention the very small number of orders, so they don't receive much exposure in the first place.

Weird antibiotic? Ask the ID pharmacist.
Chemo? Ask the chemo pharmacist.
Nutrition? Ask the Nutrition pharmacist.
Code blue? Ask the ICU or ED pharmacist.
Computer/program issue? Ask the "IT" pharmacist.
Surgery compound? Ask the OR pharmacist.
NICU/Pediatric Orders? Ask the NICU pharmacist.

The evening shift however still has to deal with all of the above in addition to antibiotic dosing, anticoagulant management/teaching, ect.

So when day shifts work on the occasional evening shift, they have no clue what to do and evening shift has to cover for them, both clinically and order entry wise.
Yeah, being alone during the overnight shift to cover the whole hospital forces you to become a jack of all trades.

The little bit of overlap that I see with the day shift pharmacists is always baffling to me. Any little problem order becomes a discussion. None of them are willing to just fix the order themselves without chasing the doctor for the answer. ICU or ER call with an emergency and they become frazzled and angry.
 
I believe my hospital has the opposite problem as yours. I think one of the problems that my hospital has is that day shift has specialized positions that take care of things for the day shift. Not to mention the very small number of orders, so they don't receive much exposure in the first place.

Weird antibiotic? Ask the ID pharmacist.
Chemo? Ask the chemo pharmacist.
Nutrition? Ask the Nutrition pharmacist.
Code blue? Ask the ICU or ED pharmacist.
Computer/program issue? Ask the "IT" pharmacist.
Surgery compound? Ask the OR pharmacist.
NICU/Pediatric Orders? Ask the NICU pharmacist.

The evening shift however still has to deal with all of the above in addition to antibiotic dosing, anticoagulant management/teaching, ect.

That right there is why we have a lot of evening-night shift GS-12 clinical pharmacists arguing to be increased to GS-13 clinical specialists because we spend all of our evenings and nights doing all of those tasks. We can't call the specialists because they all leave at 330. I think it's a solid argument.
 
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That right there is why we have a lot of evening-night shift GS-12 clinical pharmacists arguing to be increased to GS-13 clinical specialists because we spend all of our evenings and nights doing all of those tasks. We can't call the specialists because they all leave at 330. I think it's a solid argument.

You could also argue that specialists should be working the night shift also but then they would bitch that "specialists should only work Monday-Friday day shift".

How does VA pay work by they way? Is it base pay + allowances?
 
You could also argue that specialists should be working the night shift also but then they would bitch that "specialists should only work Monday-Friday day shift".

How does VA pay work by they way? Is it base pay + allowances?

It's base pay (sort of) + locality pay. We are given a GS pay grade, and a series code. Then they increase your pay based off of where the VA is located. So a GS-12 pharmacist in the midwest is not going to get the same pay rate as one in LA. Then you get time in grade pay raises. Step 1-10. Advancement to step 2-4 is one year, 5-7 is 2 years and 8-10 is 3 years.
 
It's base pay (sort of) + locality pay. We are given a GS pay grade, and a series code. Then they increase your pay based off of where the VA is located. So a GS-12 pharmacist in the midwest is not going to get the same pay rate as one in LA. Then you get time in grade pay raises. Step 1-10. Advancement to step 2-4 is one year, 5-7 is 2 years and 8-10 is 3 years.

So say I get hired by the VA. Would I start as Step 1 or would I get higher because of 9 years experience?
 
So say I get hired by the VA. Would I start as Step 1 or would I get higher because of 9 years experience?
They might try to start you at step 1, but you could argue for higher pay based on your experience, and you may get it.
Also NYC pay at the VA is horrible. I make more in Baltimore, with much lower cost of living.
 
So say I get hired by the VA. Would I start as Step 1 or would I get higher because of 9 years experience?
Look up Title 38 pay schedule. There’s one for DoD and one for VA. It will give you a good idea of the pay for each location.

The initial offer will come in for step 1. You would have to negotiate starting at a higher step.
 
Look up Title 38 pay schedule. There’s one for DoD and one for VA. It will give you a good idea of the pay for each location.

The initial offer will come in for step 1. You would have to negotiate starting at a higher step.

Would it help knowing a big-wig at a VA Hospital to secure higher pay? Or would nepotism get that person in trouble?
 
That right there is why we have a lot of evening-night shift GS-12 clinical pharmacists arguing to be increased to GS-13 clinical specialists because we spend all of our evenings and nights doing all of those tasks. We can't call the specialists because they all leave at 330. I think it's a solid argument.
More power to you. Hope it succeeds; I'm planning on asking for a raise myself this year.
 
So say I get hired by the VA. Would I start as Step 1 or would I get higher because of 9 years experience?

They take experience into consideration. I got about 20% of my experience worth of credit. Had 8 years practicing but came in as Step 3 (two years). Granted I went into inpatient from retail so I don't feel too bad about it.
 
Yup. Not only do 7-on-7-off people technically work 10 less hours than a 5 8's or a 4 10's position, an additional full time employees also means paying for more benefits.

I've never seen a day shift 7-on-7-off position.
Our 7-on 7-off and other 7/14 day positions, are 12's and 10's. 12hr days on weekdays, 10's on weekends. Still makes for 80hr pay periods.
The benefits are the big problem though. Hospitals love part-timers and PRN's that don't get a hourly bonus. For example, our PRN's make the same hourly rate that makes up our full time base pay. So PRN's are actually cheaper than full time employees. They can even authorize overtime for less than it would take to convert a prn employee to full time. Nurses however, PRN's make about 1.75x what the full timers make hourly. That makes part-time or full time nurses cheaper than PRN's.

I believe my hospital has the opposite problem as yours. I think one of the problems that my hospital has is that day shift has specialized positions that take care of things for the day shift. Not to mention the very small number of orders, so they don't receive much exposure in the first place.

Weird antibiotic? Ask the ID pharmacist.
Chemo? Ask the chemo pharmacist.
Nutrition? Ask the Nutrition pharmacist.
Code blue? Ask the ICU or ED pharmacist.
Computer/program issue? Ask the "IT" pharmacist.
Surgery compound? Ask the OR pharmacist.
NICU/Pediatric Orders? Ask the NICU pharmacist.

The evening shift however still has to deal with all of the above in addition to antibiotic dosing, anticoagulant management/teaching, ect.

So when day shifts work on the occasional evening shift, they have no clue what to do and evening shift has to cover for them, both clinically and order entry wise.

That right there is why we have a lot of evening-night shift GS-12 clinical pharmacists arguing to be increased to GS-13 clinical specialists because we spend all of our evenings and nights doing all of those tasks. We can't call the specialists because they all leave at 330. I think it's a solid argument.

I think either my experience is very different than y'alls or you are missing something about specialists. For our specialists, taking care of our patients is only about 75% of my job.

Yes, other pharmacists must cover many of the clinical questions that come up when we are not here. However, some questions are not addressed in off hours but are held until the next time the team rounds. How much that happens depends on the team of course. For gen peds, it might only be 10% of things are held till the next day, for BMT or SOT, I'll bet that something like 75-80% of questions are held till the specialist returns.

Additionally, there is the other 25% of things that we do every day. Teaching, protocol development and review, nursing and physician education, research and QI, committees, error investigation, etc. - None of our operational pharmacists touch any of that kind of thing.

I love it when institutions are fully hybrid (everyone is the same amount clinical and operational) and think it works so much better in the long run. However, it is a drastic change to completely eliminate specialists and doesn't come with the same benefits in every situation (e.g. - its kind of the default for ED but really hard on oncology and transplant).
 
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I think either my experience is very different than y'alls or you are missing something about specialists. For our specialists, taking care of our patients is only about 75% of my job.

So that validates the argument that over 50% of our time is spent doing 75% of your job, hence the thought process that it seems fair to pay the GS-12s the same rate that they pay the GS-13s.
 
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Our 7-on 7-off and other 7/14 day positions, are 12's and 10's. 12hr days on weekdays, 10's on weekends. Still makes for 80hr pay periods.
The benefits are the big problem though. Hospitals love part-timers and PRN's that don't get a hourly bonus. For example, our PRN's make the same hourly rate that makes up our full time base pay. So PRN's are actually cheaper than full time employees. They can even authorize overtime for less than it would take to convert a prn employee to full time. Nurses however, PRN's make about 1.75x what the full timers make hourly. That makes part-time or full time nurses cheaper than PRN's.

So they still end up actually working 80 hours? That's a terrible shame. A lot of places I've been to, evening/night work 70hrs and get paid for 80 hrs. Or if they do work 80 hours, 10-20 hours of it is overtime.

Our PRN's get paid an extra $5/hr, but I've been told they still prefer prn positions compared to FTE.

Additionally, there is the other 25% of things that we do every day. Teaching, protocol development and review, nursing and physician education, research and QI, committees, error investigation, etc. - None of our operational pharmacists touch any of that kind of thing.

I love it when institutions are fully hybrid (everyone is the same amount clinical and operational) and think it works so much better in the long run. However, it is a drastic change to completely eliminate specialists and doesn't come with the same benefits in every situation (e.g. - its kind of the default for ED but really hard on oncology and transplant).

Our floor pharmacists do none of that other than teaching the occasional APPE student (we don't have residents). The last "project" I recall, other than student presentations, is the antibiogram the ID pharmacist works on annually. That and a inpatient stroke response review by the ED pharmacist (which...once again, only staff pharmacists are responsible for if it occurs to an inpatient).

In fact, it's generally staff pharmacists that conduct error investigations, forced to do our own nursing/physician educations (there's no overlap with nursing/physician nightshift and pharmacy dayshift), and solely maintains our resource directory.

Don't get me wrong though. Specialists *ARE* necessary and a huge boon. However, I feel like it also "spoils" our floor pharmacists and leaves them incapable of doing things they, quite frankly, should be able to.
 
So that validates the argument that over 50% of our time is spent doing 75% of your job, hence the thought process that it seems fair to pay the GS-12s the same rate that they pay the GS-13s.
For once I agree with you even though I can’t stand working for the VA. It’s the reason why I asked my initial question because I feel the gs13s at my station aren’t equivalent to my level of experience (level 1 trauma AMC).
 
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So that validates the argument that over 50% of our time is spent doing 75% of your job, hence the thought process that it seems fair to pay the GS-12s the same rate that they pay the GS-13s.
Again, your experience may be different than mine. I guarantee that our operational pharmacists don't spend anything like 50% doing what I am calling "patient care." I know that the VA is not like non-VA hospitals in many respects, so the comparison of our operational pharmacists vs our specialists may not hold true to the comparison of your two classes of pharmacists. The only VA experience I had was an APPE rotation many years ago.


I think the problem is that pharmacy models are all over the place, and thus much of this discussion is non-generalizable between our institutions.

I have been at places with fully hybridized models (every staff pharmacist is clinical), I have been at places with completely operational and completely specialist pharmacists, and I have been at places in-between. There is a wide spectrum of pharmacists, experiences, and abilities. All this goes back to the problem with OP's original question. At your institution, two years of experience on evening shift might give you 90% of the experience that a PGY1 (if you have them) coming out of your hospital would have. At another institution (mine for example) 10 years of experience on evening shift still wouldn't give you half the experiences of one of our PGY1's.
 
So they still end up actually working 80 hours? That's a terrible shame. A lot of places I've been to, evening/night work 70hrs and get paid for 80 hrs. Or if they do work 80 hours, 10-20 hours of it is overtime.

Our PRN's get paid an extra $5/hr, but I've been told they still prefer prn positions compared to FTE.
Yep. The place I trained at did the work 70hr, get paid for 80hr thing. Then someone figured out that was too much of a benefit. We do get an evening shift and weekend differential though that does make us better paid than our daytime counterparts.
Our floor pharmacists do none of that other than teaching the occasional APPE student (we don't have residents). The last "project" I recall, other than student presentations, is the antibiogram the ID pharmacist works on annually. That and a inpatient stroke response review by the ED pharmacist (which...once again, only staff pharmacists are responsible for if it occurs to an inpatient).

In fact, it's generally staff pharmacists that conduct error investigations, forced to do our own nursing/physician educations (there's no overlap with nursing/physician nightshift and pharmacy dayshift), and solely maintains our resource directory.

Don't get me wrong though. Specialists *ARE* necessary and a huge boon. However, I feel like it also "spoils" our floor pharmacists and leaves them incapable of doing things they, quite frankly, should be able to.

I just think this highlights the differences in the different pharmacy models. We have just started to have what you would call "floor pharmacists" because some of our units have gotten to big for our specialists to take care of on their own. Our staff pharmacists don't touch anything really that isn't part of the verify, prepare, dispense operational chain.
 
I am so mad for you, that a PGY-2 is more important than real-life experience.

On another note, our profession is so disgusting. Hospital management doesn't value experience and do not invest time in those who are willing to work.

It isn't just management either. People in this profession love to tear each other down, and they especially love feeling superior because that have this or that credential. That was a big reason why I left clinical practice. My colleagues were obsessed with residency and board certification, and I just. do. not. care.
 
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I was at an institution that tried to turn every daytime pharmacist into a hybrid position. The operational pharmacists all responded by saying that they weren't trained to do things like write vancomycin notes. We tried training them. We took time out of our days to walk them through the process. Every single one refused to put in the small amount of effort to even try to do the notes correctly. It was absolutely the most frustrated I have ever been trying to teach.

The hospital gave up and decided that new pharmacists would be preferred PGY1 grads that would be hired into hybrid positions.
Wow, those pharmacists are ridiculous. Vancomycin is a pretty easy "clinical" thing to do, there is no reason why any licensed pharmacist can't do that (even if they haven't done it since pharmacy school, it is pretty easy to relearn.)

I agree that experience doesn't always equal residency, because environments are so different. But it is a number that places can easily use to compare. I work in a pretty small hospital, and we do hybrid, order verification and clinical. We don't have a lot of variety of patients, just the common stuff, pneumonia, heart attack, post-op care, low-risk OB, now tons of COVID. Anything esoteric is transferred out. But while doing clinical, my decades experience would likely be way behind someone who did a residency at a big hospital. But likewise, not all residencies are equal either, I am sure their are non-resident pharmacists who are way and above many residency trained pharmacists (like Dred Pirate) But its easier for employers just to look at someone who has done a residency, then to try to actually figure out if someone's experience equals another person's residency.
 
Straight from ASHP. Very insulting to be honest. No wonder pharmacy is so fractured
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Straight from ASHP. Very insulting to be honest. No wonder pharmacy is so fractured View attachment 347779
I can't disagree more with this statement. Again - I teach residents as a PGY-0 (not bashing a residency at all) but there is something that years of experience cannot teach. I am amazed how often I bring up something that is common place to myself, but a recent PGY-2 graduate has never heard of. Just a few examples from the past month.
1. you don't give midodrine right before bedtime due to risk of postural hypotension.
2. The difference in absorption between cyclosprine (sandimune) and cyclosporine, modified (neoral)
3. If you paralyze someone with roc (and use etomidate as a sedative) you need to give additional sedation - a opioid push alone is not sufficient.
 
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If residency doesn’t offer additional training, what’s the point?

But realistically it’s probably just a different skill set, not really “additional” skills. I mean staff pharmacists are going to be more efficient and more knowledgeable about common issues but I know lots of staff pharmacists I wouldn’t trust to do a literature review. Now would I trust a residency trained pharmacist to do that? Unsure, I don’t have much personal experience with them. Of my classmates that went on to do residency…yeah, I would trust them to make a poster or research an esoteric topic more so than those of us who didn’t. Is that controversial?
 
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