The pessimistic pharmacy student

[Phart]

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Currently a pharmacy student entering my third year....

Anyone else currently (or in the past) sit there and listen to your PharmD professor in lecture talk about "my patients" this or "my patients" that, and you just sit there knowing damn well they do not have any patients, and if they do, its at a position paid for and fabricated by the school... I'm a cynical student looking to go clinical after graduation and I'm hoping for more insight into what to look forward to besides manipulating warfarin doses in a clinic.

Please save the "should have chosen a different career" and other cliche responses for the prepharms. I'm looking for realistic insight, no matter how negative or hopeful. Maybe list a few things you enjoy about your work? Thanks in advance.

 

[deleted480308]

Currently a pharmacy student entering my third year....

Anyone else currently (or in the past) sit there and listen to your PharmD professor in lecture talk about "my patients" this or "my patients" that, and you just sit there knowing damn well they do not have any patients, and if they do, its at a position paid for and fabricated by the school... I'm a cynical student looking to go clinical after graduation and I'm hoping for more insight into what to look forward to besides manipulating warfarin doses in a clinic.

Please save the "should have chosen a different career" and other cliche responses for the prepharms. I'm looking for realistic insight, no matter how negative or hopeful. Maybe list a few things you enjoy about your work? Thanks in advance.

Our ED pharmacists are great and help shape patient care in real time on occasion

 

[steveysmith54]

Currently a pharmacy student entering my third year....

Anyone else currently (or in the past) sit there and listen to your PharmD professor in lecture talk about "my patients" this or "my patients" that, and you just sit there knowing damn well they do not have any patients, and if they do, its at a position paid for and fabricated by the school... I'm a cynical student looking to go clinical after graduation and I'm hoping for more insight into what to look forward to besides manipulating warfarin doses in a clinic.

Please save the "should have chosen a different career" and other cliche responses for the prepharms. I'm looking for realistic insight, no matter how negative or hopeful. Maybe list a few things you enjoy about your work? Thanks in advance.

I don't know why professors need to use the word "clinical" all the time. Well, I do but that's off topic. Being a hospital pharmacist is not a bad gig if your hospital is adequately staffed and you like your coworkers for the most part. Doing order entry verification, checking and mixing IV's, helping nurses and docs, dosing and adjusting meds is a solid career. This is what most inpatient pharmacists do..

 

[Abby Atwood]

From what I've seen, inpatient work involves a lot of interprofessional collaboration while ambulatory care environments (including retail) are more focused on patient/pharmacist interaction. All pharmacist positions require medical expertise and professional judgement, so all positions are going to be somewhat clinical. If you want something that leans more clinical, you probably need to complete a residency, look in somewhat rural locations, or both. Specialty areas like psychiatry, critical care, or oncology may be the way to go.

As a side note, pharmacists often think about their patients as patients. Even in a retail setting, I wouldn't think it was weird or false to say, "my Medicare patients often have high copays on their insulin." In reality, I might leave off "my" because it sounds a little possessive 🙂 but I wouldn't flag it if someone else used it.

 

[pharmasaurusRex17]

Currently a pharmacy student entering my third year....

Anyone else currently (or in the past) sit there and listen to your PharmD professor in lecture talk about "my patients" this or "my patients" that, and you just sit there knowing damn well they do not have any patients, and if they do, its at a position paid for and fabricated by the school... I'm a cynical student looking to go clinical after graduation and I'm hoping for more insight into what to look forward to besides manipulating warfarin doses in a clinic.

Please save the "should have chosen a different career" and other cliche responses for the prepharms. I'm looking for realistic insight, no matter how negative or hopeful. Maybe list a few things you enjoy about your work? Thanks in advance.

I'm a clinical pharmacist resident atm, and because I chose the west to land my residency, I can do a crap ton including prescribing under physician protocol as well as some other stuff. I just received my rotation schedule for residency as well and I have a community teaching practice where I do interact with patients and interact w/ professional providers. My interests lie along the harder subjects of ID-HIV-HepC ... though so I tend to focus a lot of my energy into that w/ projects and whatnot. If you're looking to go into clinical, the easiest way would be matching into residency and not just any residency... but it has to be the program of your choice and truly fit you as a person.

 

[Digsbe]

My school pushed residency and "clinical" pharmacy heavy. The only place I felt like a clinician was at the VA where pharmacists have expanded practice abilities inline with our education. Most other "clinical" sites felt like just going over labs, medication interactions (which you do everywhere), and dosing some drugs the MD's were too lazy to deal with (aminoglycosides, vanc, etc) in a basement with no real interaction. Don't know how things are outside the southeast/northeast. I knew I was not about to spend a year of residency to work in a basement dosing vanc and writing notes on who needs anticoag treatment to make 20k less per year.

 

[pharmasaurusRex17]

My school pushed residency and "clinical" pharmacy heavy. The only place I felt like a clinician was at the VA where pharmacists have expanded practice abilities inline with our education. Most other "clinical" sites felt like just going over labs, medication interactions (which you do everywhere), and dosing some drugs the MD's were too lazy to deal with (aminoglycosides, vanc, etc) in a basement with no real interaction. Don't know how things are outside the southeast/northeast. I knew I was not about to spend a year of residency to work in a basement dosing vanc and writing notes on who needs anticoag treatment to make 20k less per year.

Come to the west coast! We have the same amount of power as the MD/DO. That and we do a lot more and get paid a ton more than the east coast 😀 LOL

 

[Digsbe]

Come to the west coast! We have the same amount of power as the MD/DO. That and we do a lot more and get paid a ton more than the east coast 😀 LOL

Sometimes I consider trying to get a CA license, but when I work out cost of living and taxes it's about even if not lower. I'm hoping eventually the east coast will follow with labor/practice laws. It seems pharmacies there are not going under offering OT pay for 8+ hours of work, lunch breaks, and progressive practice environments...

 

[lane one]

As a side note, pharmacists often think about their patients as patients. Even in a retail setting, I wouldn't think it was weird or false to say, "my Medicare patients often have high copays on their insulin." In reality, I might leave off "my" because it sounds a little possessive 🙂 but I wouldn't flag it if someone else used it.

Couldn't agree more.

OP, I think you're mistaking the "my patient" thing an implication that you are the sole provider. Even if the federal government doesn't reimburse you as a "healthcare provider" pharmacists are still providing healthcare (especially in retail). Even though your patient sees doctors and you're just filling their scripts, if you consider yourself a healthcare provider then it makes sense to call those people your patients. You just might be the only person that convinces them to actually take their eliquis and prevent a stroke. I would say in that scenario you did your patient some good.

 

[Seriously Serious]

So far the responses have been positive. Hoping other students that are unsatisfied in their classes stumble across this thread. I've been interning at a DSM clinic in a poor part of town for the past couple of years, and the clinical/hospital pharmacist does some good work on educating the patients on their goals, and getting them into a routine of monitoring themselves daily, and making them feel like a million bucks when they come back for a follow up and they met their weight/blood pressure/A1c goals. Even the smallest of things count.

 

[Charcoales]

I call them patients in the retail pharmacy. Don't sell yourself short. We have the expertise to help overworked doctors from making suboptimal/deadly errors.

 

[PharmDBro2017]

Our professors were pharmacists in the ICU, on oncology floors, cardiac floors, etc. Some of them work in diabetic clinics or HIV clinics... these are positions for people with more qualifications than just your standard pharmacist... most of them have board certs in those speciality areas. These jobs aren't fabricated by the school... some other pharmacist would be doing them if your professor wasn't there.

 

[lord999]

Our professors were pharmacists in the ICU, on oncology floors, cardiac floors, etc. Some of them work in diabetic clinics or HIV clinics... these are positions for people with more qualifications than just your standard pharmacist... most of them have board certs in those speciality areas. These jobs aren't fabricated by the school... some other pharmacist would be doing them if your professor wasn't there.

Not necessarily. Many of those clinics get funded through the pharmacy school as part of accreditation. Outside of government (federal or local) or academia (pharmacy schools), it is incredibly difficult to fund a FTE clinical-only pharmacist that does no order entry. I do think it's a good model though for clinical services on top of localized order entry and Stat preparation (floor pharmacists c/s satellite pharmacy). But most of those unusual jobs with the exception of chemo (because most pharmacists don't want to deal with it) or sterile (same issues) tend not to be FTE positions without some external funding source.

 

[BMBiology]

Our professors were pharmacists in the ICU, on oncology floors, cardiac floors, etc. Some of them work in diabetic clinics or HIV clinics... these are positions for people with more qualifications than just your standard pharmacist... most of them have board certs in those speciality areas. These jobs aren't fabricated by the school... some other pharmacist would be doing them if your professor wasn't there.

I get what you are saying and I completely agree. I have no doubt that these pharmacists are making a huge difference. The problem is there is no way for the hospital to bill for these services done by these pharmacists. This is why most of your professors are just "volunteers" and are funded with student tuition. Take away student tuition and these positions would not exist. That is something your pharmacy school won't tell you.

What does this mean for you? It means unless you are a professor or affiliated with a pharmacy school, you won't be doing this kind of clinical work.


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[lord999]

I get what you are saying and I completely agree. I have no doubt that these pharmacists are making a huge difference. The problem is there is no way for the hospital to bill for these services done by these pharmacists. This is why most of your professors are just "volunteers" and are funded with student tuition. Take away student tuition and these positions would not exist. That is something your pharmacy school won't tell you.

What does this mean for you? It means unless you are a professor or affiliated with a pharmacy school, you won't be doing this kind of clinical work.


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And right now in the federal government, VA clinical pharmacists have a huge target painted on their backs due to budget cuts. We are already having issues with stations pulling clinical staff back into operations and other hiring issues. There is a specific office trying to advocate for them, but in the end, if the focus shifts back onto "billable" encounters and pharmacists just being either product or facility costs, then much of what even the federal side does in clinical pharmacy is at risk to being recalled back to billable activity (except ironically the technical specialists whom clinical looks down on: QM, technologists, and economists who are part of the accepted management bureaucracy).

 

[KARM12]

I get what you are saying and I completely agree. I have no doubt that these pharmacists are making a huge difference. The problem is there is no way for the hospital to bill for these services done by these pharmacists. This is why most of your professors are just "volunteers" and are funded with student tuition. Take away student tuition and these positions would not exist. That is something your pharmacy school won't tell you.

What does this mean for you? It means unless you are a professor or affiliated with a pharmacy school, you won't be doing this kind of clinical work.


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Not true. I've worked at academic medical centers that were not affiliated with colleges of pharmacy and none of the clinical specialists were paid faculty members. They were all paid for by the hospital 100%. My current position is purely clinical at a community teaching hospital.

 

[gwarm01]

And right now in the federal government, VA clinical pharmacists have a huge target painted on their backs due to budget cuts. We are already having issues with stations pulling clinical staff back into operations and other hiring issues. There is a specific office trying to advocate for them, but in the end, if the focus shifts back onto "billable" encounters and pharmacists just being either product or facility costs, then much of what even the federal side does in clinical pharmacy is at risk to being recalled back to billable activity (except ironically the technical specialists whom clinical looks down on: QM, technologists, and economists who are part of the accepted management bureaucracy).

I'm afraid that's the end game for any clinical pharmacist when a budget crunch happens. It's why I'm not too keen to give up my dispensing responsibilities. I'd rather my position be necessary than nice.

 

[PharmDBro2017]

I get what you are saying and I completely agree. I have no doubt that these pharmacists are making a huge difference. The problem is there is no way for the hospital to bill for these services done by these pharmacists. This is why most of your professors are just "volunteers" and are funded with student tuition. Take away student tuition and these positions would not exist. That is something your pharmacy school won't tell you.

What does this mean for you? It means unless you are a professor or affiliated with a pharmacy school, you won't be doing this kind of clinical work.


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I mostly meant that on days where my professor didn't show up to rotation, one of the other staff pharmacists took their role and had to pick up the slack and verify those orders for that floor. Or the APN was there to see patients instead of my professor, and try and prescribe the correct meds and insulin for diabetics (disaster). I think it's ridiculous to think you won't be verifying orders at some point in your day if you're a pharmacist. Even if all you do is "clinical" you're still making I-vents, changing therapy around, and verifying a new dose/drug when necessary. I hate the word clinical ffs... every pharmacist is clinical, retail included imo.


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[DexterMorganSK]

So what would the pay difference between the East & the West coasts be, after residency? Say PGY-2.

Are we talking about 80K (East) vs 120K (West)? Or 80K (East) vs 140K (West)?

 

[sakigt]

I'm afraid that's the end game for any clinical pharmacist when a budget crunch happens. It's why I'm not too keen to give up my dispensing responsibilities. I'd rather my position be necessary than nice.

I chart the heck out of my interventions. Especially the ones that save green. Other pharmacists complain they don't have time to do it. Personally, I have all the time in the world to prophylactically save my career.

 

[gwarm01]

I chart the heck out of my interventions. Especially the ones that save green. Other pharmacists complain they don't have time to do it. Personally, I have all the time in the world to prophylactically save my career.

Hey man, you and me both. I was a clinical pharmacist in Florida for a few years.. I over documented almost everything I did, and it was mainly just to explain myself before some other pharmacist swooped in and filed an error report about what I did because they didn't understand my rationale.

In fact, one time a colleague approached me and said that what I did was wrong, you should never do it, but... technically, in this particular situation, it was the right call and was a good move for the patient. My mouth must have dropped. I was being confronted on this in front of several peers. I had to explain that I did what I did because it was the right move for this patient in this particular circumstance, just like he said, which is exactly why I did it. He said he agreed with my move, but I should never do it again. That was an insulting statement for several reasons, but to wrap things up.. yes, always document.

You see the sort of silly **** that clinical pharmacists argue about, meanwhile the guys who are actually getting medications to patients are concerned with ensuring medications are prepared properly, and that the doses are both safe and appropriate.

 

[pharmacycheetah]

Currently a pharmacy student entering my third year....

Anyone else currently (or in the past) sit there and listen to your PharmD professor in lecture talk about "my patients" this or "my patients" that, and you just sit there knowing damn well they do not have any patients, and if they do, its at a position paid for and fabricated by the school... I'm a cynical student looking to go clinical after graduation and I'm hoping for more insight into what to look forward to besides manipulating warfarin doses in a clinic.

Please save the "should have chosen a different career" and other cliche responses for the prepharms. I'm looking for realistic insight, no matter how negative or hopeful. Maybe list a few things you enjoy about your work? Thanks in advance.

Love your patients and be the best pharmacy student you can be!

 

[CYP-0]

Currently a pharmacy student entering my third year....

Anyone else currently (or in the past) sit there and listen to your PharmD professor in lecture talk about "my patients" this or "my patients" that, and you just sit there knowing damn well they do not have any patients, and if they do, its at a position paid for and fabricated by the school... I'm a cynical student looking to go clinical after graduation and I'm hoping for more insight into what to look forward to besides manipulating warfarin doses in a clinic.

Please save the "should have chosen a different career" and other cliche responses for the prepharms. I'm looking for realistic insight, no matter how negative or hopeful. Maybe list a few things you enjoy about your work? Thanks in advance.

In defense of the professors, it is almost second nature, or a form of muscle-memory thing to refer to the people you've provided a pharmaceutical service to as "my patients." This is especially true in an ambulatory care setting, where you can easily become emotionally attached to the patients (the very nice/amicable ones in particular).

Debatably, I also think that ambulatory care setting is nearly a perfect blend of community & clinical pharmacy practice. If you get high via direct patient interactions, chances are that you may end up not working a day in your life...because you will love it!

 

[PharmDBro2017]

In defense of the professors, it is almost second nature, or a form of muscle-memory thing to refer to the people you've provided a pharmaceutical service to as "my patients." This is especially true in an ambulatory care setting, where you can easily become emotionally attached to the patients (the very nice/amicable ones in particular).

Debatably, I also think that ambulatory care setting is nearly a perfect blend of community & clinical pharmacy practice. If you get high via direct patient interactions, chances are that you may end up not working a day in your life...because you will love it!

I do agree, and I have seen the passion that teachers in ambulatory care setting have for their patients.

So what would the pay difference between the East & the West coasts be, after residency? Say PGY-2.

Are we talking about 80K (East) vs 120K (West)? Or 80K (East) vs 140K (West)?

I've yet to see someone get a bump in pay from solely doing a residency, but it's not to say that it couldn't happen (especially further down the road and in your career). I've seen people that have done residency and then taken jobs in rural places making 30-40k less than other hospital pharmacists with no residency.

 

[DexterMorganSK]

I do agree, and I have seen the passion that teachers in ambulatory care setting have for their patients.



I've yet to see someone get a bump in pay from solely doing a residency, but it's not to say that it couldn't happen (especially further down the road and in your career). I've seen people that have done residency and then taken jobs in rural places making 30-40k less than other hospital pharmacists with no residency.

I have heard that those after residency make about 80K in NY.

Those in retail, right after graduation, would make about 110K in NY.

Do you agree with those numbers?


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[PharmDBro2017]

I have heard that those after residency make about 80K in NY.

Those in retail, right after graduation, would make about 110K in NY.

Do you agree with those numbers?


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No idea about NY.

Retail in the midsouth is 120-130k, hospital is anywhere from 80-130k... Regardless of residency.


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[gwarm01]

80k in NYC sounds insane. My hospital, smaller city in the South, starts new graduates in the 90k range. We have a reputation for paying poorly (now that I think about it, every hospital I've ever worked for has had that rep. that explains my pitiful salary), but 90k here would be the equivalent of $180k in NYC. Those poor, unfortunate souls.

 

[Saiyo]

We have a reputation for paying poorly (now that I think about it, every hospital I've ever worked for has had that rep.

Maybe the hospitals are using the extra money to improve patient services and staffing ratios!

 

[gwarm01]

Maybe the hospitals are using the extra money to improve patient services and staffing ratios!

Oh how I wish I could believe that.

 

[cj98]

I think government is a good route to get into if you're not super passionate about pharmacy. It's is a lot more difficult to find a job in that field, but worth it if you care more about work-life balance and having hobbies/other interests outside of work.

 

[brianuseruser]

I think government is a good route to get into if you're not super passionate about pharmacy. It's is a lot more difficult to find a job in that field, but worth it if you care more about work-life balance and having hobbies/other interests outside of work.

I concur. Look into IHS if you want to do the most clinical work.

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[WVUPharm2007]

Currently a pharmacy student entering my third year....

Anyone else currently (or in the past) sit there and listen to your PharmD professor in lecture talk about "my patients" this or "my patients" that, and you just sit there knowing damn well they do not have any patients, and if they do, its at a position paid for and fabricated by the school... I'm a cynical student looking to go clinical after graduation and I'm hoping for more insight into what to look forward to besides manipulating warfarin doses in a clinic.

Please save the "should have chosen a different career" and other cliche responses for the prepharms. I'm looking for realistic insight, no matter how negative or hopeful. Maybe list a few things you enjoy about your work? Thanks in advance.

Those people live in a fantasy world. Just nod your head, let them read their Powerpoint slides, memorize the stuff, regurgitate it on the test...and move on.