Starting Pharmacy School with second thoughts...

[Othelo]

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Hey guys... I probably deserve to be derided for saying this but I'm about to start my first year of pharmacy school and am really having second thoughts... I was all gun ho off the bat when I applied but my motivation has dramatically fizzled... The reason is a gradual realization that the profession does not afford much quality patient interaction (which I crave). Hate to harp on the retail side of things, but from what I hear from the pharmacists I know, on balance this area of practice is the least fulfilling when it comes to patient care. It seems that the more unusual patient centered pharmacy specialties that motivated me in the first place (namely ambulatory care) are more of a figment of the academic imagination rather than a reality. Around here hospital cuts and plain economics dictate that cheaper nursing labor takes over the patient care side of things in homecare/ambulatory care clinics. Am I incredibly nieve here? Are there patient focused pharmacy specialties where there are actual jobs and demand? Can someone wiser straighten me out here or am I making a big mistake?

PS> Yes I know I know, I should have figured this out long ago...no scorn necessary here...

 

[MountainPharmD]

Yeah.....Things you should have thought about before you applied.

 

[bigpharmD]

Hey guys... I probably deserve to be derided for saying this but I'm about to start my first year of pharmacy school and am really having second thoughts... I was all gun ho off the bat when I applied but my motivation has dramatically fizzled... The reason is a gradual realization that the profession does not afford much quality patient interaction (which I crave). Hate to harp on the retail side of things, but from what I hear from the pharmacists I know, on balance this area of practice is the least fulfilling when it comes to patient care. It seems that the more unusual patient centered pharmacy specialties that motivated me in the first place (namely ambulatory care) are more of a figment of the academic imagination rather than a reality. Around here hospital cuts and plain economics dictate that cheaper nursing labor takes over the patient care side of things in homecare/ambulatory care clinics. Am I incredibly nieve here? Are there patient focused pharmacy specialties where there are actual jobs and demand? Can someone wiser straighten me out here or am I making a big mistake?

PS> Yes I know I know, I should have figured this out long ago...no scorn necessary here...

sure go to nursing school....most nurses dont want to be nurses....most pa's dont want to be pa's....direct patient care is overrated

by the way i have sweet job and can see as many patients as I want.

 

[PharMed2016]

Hey guys... I probably deserve to be derided for saying this but I'm about to start my first year of pharmacy school and am really having second thoughts... I was all gun ho off the bat when I applied but my motivation has dramatically fizzled... The reason is a gradual realization that the profession does not afford much quality patient interaction (which I crave). Hate to harp on the retail side of things, but from what I hear from the pharmacists I know, on balance this area of practice is the least fulfilling when it comes to patient care. It seems that the more unusual patient centered pharmacy specialties that motivated me in the first place (namely ambulatory care) are more of a figment of the academic imagination rather than a reality. Around here hospital cuts and plain economics dictate that cheaper nursing labor takes over the patient care side of things in homecare/ambulatory care clinics. Am I incredibly nieve here? Are there patient focused pharmacy specialties where there are actual jobs and demand? Can someone wiser straighten me out here or am I making a big mistake?

PS> Yes I know I know, I should have figured this out long ago...no scorn necessary here...

First, I am going to say that everyone has doubts about their profession at one point or another. There are many pharmacist that hate their jobs, believe me. However, its what you do with your degree that matters. No one is making you work for a retail chain or as a staff pharmacist with no patient interaction. If you want ambulatory care, go to California where I think it is becoming prevalent or open your own pharmcy with a slant towards ambulatory care. And finally, you can change your profession to something that gives you more interaction.

 

[IWantTheGenetic]

Hey guys... I probably deserve to be derided for saying this but I'm about to start my first year of pharmacy school and am really having second thoughts... I was all gun ho off the bat when I applied but my motivation has dramatically fizzled... The reason is a gradual realization that the profession does not afford much quality patient interaction (which I crave). Hate to harp on the retail side of things, but from what I hear from the pharmacists I know, on balance this area of practice is the least fulfilling when it comes to patient care. It seems that the more unusual patient centered pharmacy specialties that motivated me in the first place (namely ambulatory care) are more of a figment of the academic imagination rather than a reality. Around here hospital cuts and plain economics dictate that cheaper nursing labor takes over the patient care side of things in homecare/ambulatory care clinics. Am I incredibly nieve here? Are there patient focused pharmacy specialties where there are actual jobs and demand? Can someone wiser straighten me out here or am I making a big mistake?

PS> Yes I know I know, I should have figured this out long ago...no scorn necessary here...

There's little demand for pharmacists in ambulatory care clinics because there's nothing for us to do. I can't draw blood, insert an IV, or hear congested lungs. Nor do I want to do those things because it's not my job. That's the job of nurse practitioners who are trained to exam, diagnosis and treat patient illness that doesn't require a MD appointment. NPs can write prescriptions and order lab tests. What am I going to do in an am.care clinic? "I see you have a rash there. Maybe you should buy some hydrocortisone."

Retail pharmacists have the most opportunities for interaction with patients than any other setting. You can counsel patients on their Rx medications. You can recommend OTC products. The pharmacists who tell you retail is the least fufilling feel that way because they are not willing to leave the verifying screen to pursue patient interaction. Don't believe me? Put on a white lab coat and stand in the OTC cough/cold aisle. Patients will flock to you describing their symptoms.

All hope is not lost: VA anticoagulation pharmacists meet with patients all day long. Patient interaction is limited to the same 6 or 7 questions (Have you been sick recently? Any changes in diet?). But you get to play doctor by adjusting warfarin doses. Good luck.

 

[bigpharmD]

There's little demand for pharmacists in ambulatory care clinics because there's nothing for us to do. I can't draw blood, insert an IV, or hear congested lungs. Nor do I want to do those things because it's not my job. That's the job of nurse practitioners who are trained to exam, diagnosis and treat patient illness that doesn't require a MD appointment. NPs can write prescriptions and order lab tests. What am I going to do in an am.care clinic? "I see you have a rash there. Maybe you should buy some hydrocortisone."

Retail pharmacists have the most opportunities for interaction with patients than any other setting. You can counsel patients on their Rx medications. You can recommend OTC products. The pharmacists who tell you retail is the least fufilling feel that way because they are not willing to leave the verifying screen to pursue patient interaction. Don't believe me? Put on a white lab coat and stand in the OTC cough/cold aisle. Patients will flock to you describing their symptoms.

All hope is not lost: VA anticoagulation pharmacists meet with patients all day long. Patient interaction is limited to the same 6 or 7 questions (Have you been sick recently? Any changes in diet?). But you get to play doctor by adjusting warfarin doses. Good luck.

Not to mention look at other places like kaiser, and in my area of expertise many surgery programs hire pharmds to just work in their outpatient clinics. If you want to wipe butts go ahead be a nurse.

 

[Sevarious]

If you are really interested in direct patient care you may also wish to consider medical school. Depending on your finances and age it might be better for you to:

1) Quit pharmacy school, focus on killing the MCAT and apply to medical school.
2) Apply to med school and transfer as soon as you get accepted, regardless of whether you've finished pharmacy school or not.
3) Finish pharmacy school and then consider medical school if you still want to go.

I know two people who went to med school post pharmacy school. One hated being a doctor and went back to being a pharmacist. One is now happily a doctor.

If you do stay in pharmacy school, I would avoid retail like the plague. Yes, you are able to counsel patients, but you are still responsible for filling the 300+ rxs that come across the counter each day. No, you will not be getting any help. And no, no one is going to pay you to recommend an OTC or to counsel patients.

Do your best to get internships and do rotations in areas that have more patient contact. If you aren't sure how to land these, talk to your professors, rotation coordinator and student advisers. Someone in your school should be able to point you in the right direction.

 

[Othelo]

bigpharmD,
Curious what is your area of expertise? Can you elaborate on the keizer specialties? I've heard that Keizer is innovative in this respect.. I even tried to get in on a job shadow but they refused.. company policy is no shadows:[

Sevarious,
#2 is actually something I have considered. Curious to know what your thoughts are on the cross-applicability of Pharmacy and Med school? If I completed the first two years of pharmacy school would the knowledge be helpful in medical school and professional practice.. E.g. Will it make the material in med school more comprehensible and would it make me a better doc down the road? Or is it the case, that with the exception of a few classes, the stuff you learn unique to pharmacy practice. I'm curious to know if your pharmD to Medschool friends thought they had an easier time in med school.

 

[IWantTheGenetic]

And no, no one is going to pay you to recommend an OTC or to counsel patients

Uh, we do get paid to recommend an OTC and to counsel patients. It's included in our high salaries. Do you think the $45+/hr is just to make sure the white pill in the amber container is really HCTZ? If I walk into your pharmacy and ask you how to treat a bug bite, are you going to quote me a price?

 

[UBCmicrobi]

Don't believe me? Put on a white lab coat and stand in the OTC cough/cold aisle. Patients will flock to you describing their symptoms.

This is so true. I'm a pharm student/tech and every time I go out on to the floor in the pain/cough&cold/vitamins section I get stuck there with people asking me for recommendations (I of course have to refer them to the pharmacist for medical advice/recommendations). My pharmacists often disappear for long periods of time when they venture out from behind the counter.

 

[MountainPharmD]

Uh, we do get paid to recommend an OTC and to counsel patients. It's included in our high salaries. Do you think the $45+/hr is just to make sure the white pill in the amber container is really HCTZ? If I walk into your pharmacy and ask you how to treat a bug bite, are you going to quote me a price?

My thoughts exactly. That IS what we get paid for.

 

[pb9123]

Uh, we do get paid to recommend an OTC and to counsel patients. It's included in our high salaries. Do you think the $45+/hr is just to make sure the white pill in the amber container is really HCTZ? If I walk into your pharmacy and ask you how to treat a bug bite, are you going to quote me a price?

Probably tell me to go see a doctor, and I'd leave muttering words about how worthless he was in helping me.

 

[Praziquantel86]

Probably tell me to go see a doctor, and I'd leave muttering words about how worthless he was in helping me.

So would you like us to tell you to treat your CA-MRSA infected and rapidly expanding ulceration with Neosporin?

As long as you sign a notarized waiver to proper standards of care in the presence of your own legal counsel, I'm all for it.

 

[CYP3A4]

I had the discussion regarding ambulatory care with a preceptor of mine. She told me that while jobs are still limited in this area they are out they if you are willing to do a residency and look hard. The VA hospital system is very progressive when it comes to ambulatory care. I hear that Kaiser is also.

Don't drop out of pharmacy school until you have explored your options.

 

[BMBiology]

It is what it is. Most likely you will end up in retail or something similar. I was lucky to find something I enjoy (to my surprise) but I think I am an exception, not the norm. My advise to you is not to settle. It may take a longer time but you are still a student. Look around. Talk to people. Choose your elective and rotation wisely. Or maybe, you will just get lucky like I did.

 

[bananaface]

You can have "quality patient interaction" in retail. Just work someplace that staffs decently so you have a chance to do what everyone should be doing anyway, which is give people face time, listen critically, and find issues that the patient didn't come to you asking about.

 

[bigpharmD]

If you are really interested in direct patient care you may also wish to consider medical school. Depending on your finances and age it might be better for you to:

1) Quit pharmacy school, focus on killing the MCAT and apply to medical school.
2) Apply to med school and transfer as soon as you get accepted, regardless of whether you've finished pharmacy school or not.
3) Finish pharmacy school and then consider medical school if you still want to go.

I know two people who went to med school post pharmacy school. One hated being a doctor and went back to being a pharmacist. One is now happily a doctor.

If you do stay in pharmacy school, I would avoid retail like the plague. Yes, you are able to counsel patients, but you are still responsible for filling the 300+ rxs that come across the counter each day. No, you will not be getting any help. And no, no one is going to pay you to recommend an OTC or to counsel patients.

Do your best to get internships and do rotations in areas that have more patient contact. If you aren't sure how to land these, talk to your professors, rotation coordinator and student advisers. Someone in your school should be able to point you in the right direction.

Sevarious makes good points, but you have to ask yourself is it worth it, especially if you get a pharmd FIRST. Look at what he/she said. One friend did it and hated it while the other is happy. Is it worth going extra years of school to get a pharmd then go on to get an MD to possibly not like it? I work with a top physician at my institution and he tells me every week that I made a better decision to go into something like pharmacy than medicine (he was a former engineer by the way). It will take you a long time to realize it, but healthcare in general is overrated...

 

[MustLoveDrugs]

All hope is not lost: VA anticoagulation pharmacists meet with patients all day long. Patient interaction is limited to the same 6 or 7 questions (Have you been sick recently? Any changes in diet?). But you get to play doctor by adjusting warfarin doses. Good luck.

This is true. Aside from anticoagulation clinics, however, VA ambulatory care pharmacists work in a variety of other specialties. To name a few: DLD, HTN, DM, epilepsy, geriatrics, pain management, polypharmacy, heart failure, pulmonary, post-op medication reconciliation, smoking cessation, etc... Depending on the site, they may also be in charge of group clinic appointments, acting as the "attending pharmacist," with whom pharmacy students/residents and medical students/residents staff out patients. Outside the pharmacy realm, ambulatory care pharmacists lecture medical students/residents, lead case conferences, participate in public health fairs and conduct clinical research.

Are we practicing medicine? No, and we shouldn't be pretending to. Are we focusing on one, two or three disease states during a visit so the patient isn't overwhelmed? Are we giving patients more thorough counseling than they got when they first picked up their meds, and are we addressing/alleviating the side effects they experience afterward? Are we following up in 4-6 weeks instead of every 3 months, like their primary care provider does? Yes, yes and yes.

 

[Sevarious]

bigpharmD,
Sevarious,
#2 is actually something I have considered. Curious to know what your thoughts are on the cross-applicability of Pharmacy and Med school? If I completed the first two years of pharmacy school would the knowledge be helpful in medical school and professional practice.. E.g. Will it make the material in med school more comprehensible and would it make me a better doc down the road? Or is it the case, that with the exception of a few classes, the stuff you learn unique to pharmacy practice. I'm curious to know if your pharmD to Medschool friends thought they had an easier time in med school.

Having a pharmacy background will make med school easier and will make you a better doctor. For example, you'll actually know about the drugs. Med students have 1 class covering drugs and its not that great.

I would consider finishing pharmacy school. If you do that you can moonlight as a pharmacist on the side and make some extra beer money. It's really a question of whether or not you want to put in the extra time to go to med school and do a residency.

Another idea would be this: Finish pharmacy school and try to get a residency that lets you have more clinical practice and patient interaction. If it's not what you want then consider med school. You could even do part time pharmacy while studying for the MCAT. MCAT scores are only good for 3 years so I wouldn't take it until you are sure that med school is what you want. At the very least you'll have learned a ton of clinical and drug knowledge that will be invaluable to you when you go to Med school.

I don't want to sound discouraging, but med school is a huge commitment of time and money. You shouldn't jump into it unless you know that you can't get to where you want to go any other way.

 

[pharmdinfl]

I am in a different world I guess! I work for the VA and we have plenty of positions available (granted a spot may not be available in the exact location that you currently live; often times more desirable jobs can be find if you are able to relocate) for ambulatory care pharmacists who have DIRECT patient care with high risk patients who are referred by physicians for help managing some of the more complicated/time-consuming (sometimes due to patient's compliance 😉) patients for HTN, DM, and cholesterol managmement.

It is not necessary EASY to come by a job with direct patient care because there are definitely a lot more jobs available in retail per se, but such a job CAN be achieved!! Good luck to you!

 

[gsinccom]

I am in a different world I guess! I work for the VA and we have plenty of positions available (granted a spot may not be available in the exact location that you currently live; often times more desirable jobs can be find if you are able to relocate) for ambulatory care pharmacists who have DIRECT patient care with high risk patients who are referred by physicians for help managing some of the more complicated/time-consuming (sometimes due to patient's compliance 😉) patients for HTN, DM, and cholesterol managmement.

It is not necessary EASY to come by a job with direct patient care because there are definitely a lot more jobs available in retail per se, but such a job CAN be achieved!! Good luck to you!

did you do a 1 or 2 year residency to land this job? Also does it get frustrating working with the type of patient that you described?

 

[jyw003]

i think that its always difficult to truly believe you are doing the right thing until you've actually gotten to your goal and you look back at what you've done. like many have said...you've got to ask yourself if pharmacy is really what you want to do. if you want more patient care, retail is probably where you'll get to see the most patients. i thought working in a clinical setting would allow me to have more patient care, but when i shadowed my uncle...he walked around a lot but eventually found his way back to the computer...

 

[pharmdinfl]

did you do a 1 or 2 year residency to land this job? Also does it get frustrating working with the type of patient that you described?

I didn't do any residencies and actually - none of the clinical pharmacists at the VA I work at did, either. My boss says he just believes in promoting from within for those that have the potential and the want.