Try for residency or simply try to find a job?

[SeekerofTruth]

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I'm on my APPEs currently and graduating in 2017. Throughout school, I thought I wanted to get a residency and be clinical. I'm on my fourth rotation and honestly, I'm not all that impressed with being a clinical pharmacist. I am NOT bashing any of you that are clinical pharmacists or retail pharmacists, etc. I am simply saying that I don't see much excitement in it.

Here is my outlook on clinical/hospital so far: you need to know everything about the patients and why the physicians are doing what they are doing with minimal intervention power.

Honestly, I think it is very difficult so I am amazed at all of you clinical pharmacists but at the same time, it is a little boring for me. On another point, I wonder if it's simply the rotations I've taken that bore me because I'm not getting along too well with my preceptors but all that aside, for the past few three weeks I've just been questioning whether residency is what I really want with my life.

I thought I wanted to be a hospital pharmacist since I started pharmacy school but I think I want to be in a position to have more impact on patients and do more counseling. The sad part about the patients I've counseled on my internal medicine rotation is that most of the time it was a caregiver because the patient was completely out of it.

I really don't know what to do right now because I feel like I'm forcing myself to want residency at this point when I think it's not meant for me. Not only that, I struggled through school and I feel like waking up so early and working so late into the evening 12 days on and 2 off simply isn't the kind of life I can handle for one more year.

At the same time, I am worried about the future of pharmacists who will not be pursuing a residency. Will there be a place for them 10-15 years from now?

 

[mustang sally]

Have you worked a lot in retail? If you worked though out school and can see yourself doing it long term, then I say go for it.

If you haven't worked much in a pharmacy, then this question is a little bit harder to answer.

 

[CountBy5s]

I felt the same way on my clinical rotations. I thought residency was my thing, but rotations bored me to death.

Retail is rough, but the days go by quickly.

Just depends on the person and more importantly the people you work with.

 

[hye345]

I felt the same way on my clinical rotations. I thought residency was my thing, but rotations bored me to death.

Retail is rough, but the days go by quickly.

Just depends on the person and more importantly the people you work with.

This. I was on track to do residency, but my clinical rotations were like watching paint dry. One hell of a wake up call...

 

[Amicable Angora]

This. I was on track to do residency, but my clinical rotations were like watching paint dry. One hell of a wake up call...

Too bad you can't appreciate practicing REAL pharmacy!












(I'm being sarcastic)

 

[Lnsean]

This. I was on track to do residency, but my clinical rotations were like watching paint dry. One hell of a wake up call...

That's because you weren't doing anything clinical per se....we're not truly clinicians.

 

[awval999]

Don't let professors or your school or your classmates define what you want to do with your life. It's laughable how much they push residency.

I like hospital operations. Yes, the "basement" pharmacist. I like verifying orders. I like fixing problems. I like getting the right medications to the patients. I like making sure the orders are right. I found "clinical" pharmacy on the floors boring. I find educating patients with a printed handout worthless. I found rounds boring and worthless.

So you know what. I talked to my boss. We made up a new position for me. I'm the lead operations pharmacist. The ship runs smooth now. I'm the captain of the ship.

If you like retail pharmacy. Good for you. Remember you are the one that has to go to work everyday. Not your professors. Or your classmates. Who cares what they think. Do what you like. Who cares if it's not "clinical".

 

[wagrxm2000]

Clinical pharmacists, man I love that word lol. We will never truly be clinical until we have prescribing rights. Nurses should be doing these "clinical" roles instead of paying a "clinical" pharmacist to do them.

Skip residency, it doesn't do you any good anyways.

 

[SeekerofTruth]

Don't let professors or your school or your classmates define what you want to do with your life. It's laughable how much they push residency.

I like hospital operations. Yes, the "basement" pharmacist. I like verifying orders. I like fixing problems. I like getting the right medications to the patients. I like making sure the orders are right. I found "clinical" pharmacy on the floors boring. I find educating patients with a printed handout worthless. I found rounds boring and worthless.

So you know what. I talked to my boss. We made up a new position for me. I'm the lead operations pharmacist. The ship runs smooth now. I'm the captain of the ship.

If you like retail pharmacy. Good for you. Remember you are the one that has to go to work everyday. Not your professors. Or your classmates. Who cares what they think. Do what you like. Who cares if it's not "clinical".

I'm trying to figure out what to do right now because clinical pharmacy is definitely not for me. I might just go into a grocery store pharmacy or do operational staffing. I'm going to try and see if there is something else I can do at this point because hospital acute care residency isn't for me and I don't have the rotation experiences for another kind of residency =(

 

[BMBiology]

You have to do your own research. Don't let someone's title impress you.

True story. There is this popular professor. Everybody loves her. I thought I lucked out when I got her as my preceptor. While on rotation with her, I found her she was just a volunteer. Yes, she wasn't even getting paid for her clinical work. We were paying her with our tuition money. She did not have any authority. She did not have any define role. She only made recommendations and often those recommendations were ignored.

I was shocked. How can pharmacy school push this crap down our throat without telling us there is no way for us to get paid?

I was pissed too, mainly at myself. I worked at a training store as an intern and I have heard this before. I just brushed it off...maybe because I didn't want to accept it. Who wants to go to school for 8 years just to slave away at CVS?

The way professors and pharmacy schools promote themselves is not only deceptive but they know they can get away with it.

Look at Chapman Associate Dean. He came to this forum touting this title as APhA President and telling pre-pharmacy students that the profession will need an additional 100,000 pharmacists. Did he provide any facts to back up his claim? Of course not. Just imagine what else he is telling his students.

APhA president- we need an additional 100,000 pharmacists!

http://www-forums.studentdoctor.net...d-an-additional-100,000-pharmacists!.1202378/

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[hye345]

That's because you weren't doing anything clinical per se....we're not truly clinicians.

Well, it depends on how we define, it, but I mean clinical in the realm of pharmacy: rounding with medical team, making recommendations, going over real patient cases with preceptor, doing anti-coagulation/diabetes counseling for newly diagnosed patients and adjusting dosages based on test results, etc... I don't know if it was the work itself, or the environment/preceptors, but my heart just wasn't in it. Even when we did recommend a change in therapy, nine times out of ten, the feedback was "well, the patient has been on it for a while, and they are being monitored while in the hospital, and the doctor OK'ed it, so..."

 

[bacillus1]

Well, it depends on how we define, it, but I mean clinical in the realm of pharmacy: rounding with medical team, making recommendations, going over real patient cases with preceptor, doing anti-coagulation/diabetes counseling for newly diagnosed patients and adjusting dosages based on test results, etc... I don't know if it was the work itself, or the environment/preceptors, but my heart just wasn't in it. Even when we did recommend a change in therapy, nine times out of ten, the feedback was "well, the patient has been on it for a while, and they are being monitored while in the hospital, and the doctor OK'ed it, so..."

Hmm...I feel like my recommendations get accepted at least 75% of the time. Guess that's the culture at your hospital 🙁

 

[owlegrad]

Hmm...I feel like my recommendations get accepted at least 75% of the time. Guess that's the culture at your hospital 🙁

Not to sound mean, but perhaps you make recommendations worth accepting?

 

[HealingTouch23]

I'm on my 2nd rotation and I'm kind of thinking of the same thing. Does anyone know when students should be decided and start working on the letter of intent? My professors keep telling me that we should be thinking about it but they haven't provided much guidance as to the timeline.

 

[wagrxm2000]

Hmm...I feel like my recommendations get accepted at least 75% of the time. Guess that's the culture at your hospital 🙁

Could you please give an example where you had this amazing recommendation that the doctor couldn't come up with on his own?

 

[sosoo]

when i was doing clinical rotations n going on rounds, the clinical pharmacist, my preceptor, was mostly absent.

 

[bacillus1]

Could you please give an example where you had this amazing recommendation that the doctor couldn't come up with on his own?

First of all, I don't appreciate the sarcasm in your post. People looking down on others in the profession is one of the reasons that this profession is falling apart. If I ran a hospital and had unlimited resources, trust me, I would not have "clinical-only" pharmacists but would rather opt for a hybrid model. Having been in a horribly run hybrid model before, however, I understand that to fully run a hybrid staffing model, you need a lot of staff during off-hours, and if that cannot happen, then having separate clinical and staff pharmacists has its merits. Right now I am doing the job that I am paid to do by the hospital, and I think I do it to the best of my ability, so I don't need people in MY OWN PROFESSION scoffing at it, when other professions already constantly try to take away from our scope of practice.

But to answer your question, sure. Better yet, I will upload all the recommendations that were accepted in the month of August. Don't pay attention to the dollar values. I acknowledge that they are super inflated, but they are the only dollar values I could find in any study, therefore I used them to "prove my worth" when requested by upper management. However, do pay attention to the amount of interventions. I only counted the interventions that were accepted, as rejected interventions do not save the institution money. Some categories where multiple interventions were made:
-Meds that patient is taking as outpatient but fell off, MD forgot to order for inpatient admission
-Renal dosing
-Retiming administration times (PPI, phosphate binders, etc...)
-Patient education (inhaler, insulin, etc...)
-Vancomycin and other antibiotics--coverage/dosing/duration
-Lab monitoring (ex: QTc for atypical antipsychotics when other agents added)
-Expiring meds falling off med list for patients admitted for a long time
-Smoking cessation pharmacological therapy
-Warfarin adjustment
-Inpatient insulin dosing
And more...

 

[MindGeek]

I love how you said "simply try to find a job."
Finding a job right out of school was the opposite of simple for me.
I had to apply to 157 jobs over a span of 195 days before I had a full-time job offer in hand!

 

[owlegrad]

Having to track recommendations manually was one of the parts of clinical pharmacy that didn't appeal to me. It seemed so petty having to write down all recommendations and track if they were accepted. It's a lot of time that could be spent actually being productive. No offense meant to anyone, that's just my perspective.

Sent from my SAMSUNG-SM-G920A using SDN mobile

 

[bacillus1]

Having to track recommendations manually was one of the parts of clinical pharmacy that didn't appeal to me. It seemed so petty having to write down all recommendations and track if they were accepted. It's a lot of time that could be spent actually being productive. No offense meant to anyone, that's just my perspective.

Sent from my SAMSUNG-SM-G920A using SDN mobile

Agreed, thankfully I only had to do it for a month.

 

[wagrxm2000]

First of all, I don't appreciate the sarcasm in your post. People looking down on others in the profession is one of the reasons that this profession is falling apart. If I ran a hospital and had unlimited resources, trust me, I would not have "clinical-only" pharmacists but would rather opt for a hybrid model. Having been in a horribly run hybrid model before, however, I understand that to fully run a hybrid staffing model, you need a lot of staff during off-hours, and if that cannot happen, then having separate clinical and staff pharmacists has its merits. Right now I am doing the job that I am paid to do by the hospital, and I think I do it to the best of my ability, so I don't need people in MY OWN PROFESSION scoffing at it, when other professions already constantly try to take away from our scope of practice.

But to answer your question, sure. Better yet, I will upload all the recommendations that were accepted in the month of August. Don't pay attention to the dollar values. I acknowledge that they are super inflated, but they are the only dollar values I could find in any study, therefore I used them to "prove my worth" when requested by upper management. However, do pay attention to the amount of interventions. I only counted the interventions that were accepted, as rejected interventions do not save the institution money. Some categories where multiple interventions were made:
-Meds that patient is taking as outpatient but fell off, MD forgot to order for inpatient admission
-Renal dosing
-Retiming administration times (PPI, phosphate binders, etc...)
-Patient education (inhaler, insulin, etc...)
-Vancomycin and other antibiotics--coverage/dosing/duration
-Lab monitoring (ex: QTc for atypical antipsychotics when other agents added)
-Expiring meds falling off med list for patients admitted for a long time
-Smoking cessation pharmacological therapy
-Warfarin adjustment
-Inpatient insulin dosing
And more...

So all the basic stuff, that's what I figured.

As for the sarcasm, it goes both ways. People rip on retail all the time.

 

[bacillus1]

So all the basic stuff, that's what I figured.

As for the sarcasm, it goes both ways. People rip on retail all the time.

Never said it wasn't basic...but still has to get done. "People" might rip on retail all the time, but it's always good to lead by example and not to. I appreciate all that retail people do, and know that I couldn't survive in that type of environment without having some sort of nervous breakdown.

 

[Pharmd = Phake Doctor]

First of all, I don't appreciate the sarcasm in your post. People looking down on others in the profession is one of the reasons that this profession is falling apart. If I ran a hospital and had unlimited resources, trust me, I would not have "clinical-only" pharmacists but would rather opt for a hybrid model. Having been in a horribly run hybrid model before, however, I understand that to fully run a hybrid staffing model, you need a lot of staff during off-hours, and if that cannot happen, then having separate clinical and staff pharmacists has its merits. Right now I am doing the job that I am paid to do by the hospital, and I think I do it to the best of my ability, so I don't need people in MY OWN PROFESSION scoffing at it, when other professions already constantly try to take away from our scope of practice.

But to answer your question, sure. Better yet, I will upload all the recommendations that were accepted in the month of August. Don't pay attention to the dollar values. I acknowledge that they are super inflated, but they are the only dollar values I could find in any study, therefore I used them to "prove my worth" when requested by upper management. However, do pay attention to the amount of interventions. I only counted the interventions that were accepted, as rejected interventions do not save the institution money. Some categories where multiple interventions were made:
-Meds that patient is taking as outpatient but fell off, MD forgot to order for inpatient admission
-Renal dosing
-Retiming administration times (PPI, phosphate binders, etc...)
-Patient education (inhaler, insulin, etc...)
-Vancomycin and other antibiotics--coverage/dosing/duration
-Lab monitoring (ex: QTc for atypical antipsychotics when other agents added)
-Expiring meds falling off med list for patients admitted for a long time
-Smoking cessation pharmacological therapy
-Warfarin adjustment
-Inpatient insulin dosing
And more...

Our non-PGY-trained "STAFF" pharmacists do this stuff all the time. Maybe the thing holding back pharmacy is the inability of PGY-trained pharmacists to take constructive criticism. If residency is so great, why is it that non-PGY-trained pharmacists are capable of the same thing you are doing???

Jeez, if anyone says anything critical about residency or "clinical" pharmacy, the "clinical" pharmacists lose their mind. Its no wonder that the hospital staff pharmacists and the retail pharmacists don't give a **** about your "clinical" position.

 

[TheBlaah]

In some specialty areas, I'd say residency is pretty helpful as they often use meds and need to know about procedures that aren't seen very often outside of their setting. Oncology, NICU, transplant, and maybe ICU are just some examples. It's a shame they have to go through PGY1 first though; more times than not you really can learn just as much as PGY1 by staffing.

 

[Rockinacoustic]

There's nothing wrong with being a community pharmacist. If your career priorities are patient interaction and education then you won't beat it (or have the time for it, sadly).

It's easily the one thing I miss the most working inpatient.

 

[Dred Pirate]

So all the basic stuff, that's what I figured.

As for the sarcasm, it goes both ways. People rip on retail all the time.

I think when people "rip on retail" they are ripping on the corporate BS that goes on - not on the actual RPh's that are doing the job - yes there are a-holes everywhere - i want to encourage people to go into retail - that means less people for me to compete with (and thus drive down salaries) of hospital RPh's - even if I am not looking for a new job (I did apply to a several recently and received offers from 4 out of the 5 I interviewed with - just throwing that out there to say - you can find jobs) - the more people that apply for open positions at my hospital, the more difficult it is for me to negotiate for a higher salary come review time. As long as it looks hard for my boss to hire quality Rph's - the more likely they are to make sure I don't get upset and leave.

And as far as recommendations - I would honestly say 90% of mine are taken - (I work in a hybrid model - do not have MD residents-so our recommendations are the low hanging fruit that those guys miss) - and when looking at the list bacillus sent - I am thankful my hospital allows automatic changes for many of those things (I NEVER have to call to change a dose of an abx - I just do it). I am also glad my boss/hospital upper mgmt understands the importance of having a good pharmacist that we have never felt we have to justify our worth by tracking interventions.

 

[wagrxm2000]

I think when people "rip on retail" they are ripping on the corporate BS that goes on - not on the actual RPh's that are doing the job - yes there are a-holes everywhere - i want to encourage people to go into retail - that means less people for me to compete with (and thus drive down salaries) of hospital RPh's - even if I am not looking for a new job (I did apply to a several recently and received offers from 4 out of the 5 I interviewed with - just throwing that out there to say - you can find jobs) - the more people that apply for open positions at my hospital, the more difficult it is for me to negotiate for a higher salary come review time. As long as it looks hard for my boss to hire quality Rph's - the more likely they are to make sure I don't get upset and leave.

And as far as recommendations - I would honestly say 90% of mine are taken - (I work in a hybrid model - do not have MD residents-so our recommendations are the low hanging fruit that those guys miss) - and when looking at the list bacillus sent - I am thankful my hospital allows automatic changes for many of those things (I NEVER have to call to change a dose of an abx - I just do it). I am also glad my boss/hospital upper mgmt understands the importance of having a good pharmacist that we have never felt we have to justify our worth by tracking interventions.

Don't get me wrong, there are plenty of hospitals that use their pharmacists, I just hear from my interns about how pointless their rotations are. Sure they get to round with everyone but they never get the pharmacists opinion. Now you want these pharmacists to do a residency? What more can you possibly learn? If you want to do a residency to specialize in a certain area then go right ahead, but in general its pointless.

When it comes to ripping retail, its more who uses their clinical knowledge ie who is a real pharmacist and who simply dispenses drugs. I for one feel retail pharmacists use their knowledge just as much, possibly more. I can be asked any question at any moment (yes including where the restroom is at).

 

[PAtoPharm]

From what I've heard by talking to several pharmacists I know locally (GA) who work in hospitals, the only thing pharmacy residencies have really accomplished is the instating of a PGY-1 as the new entry-level requirement for any hospital pharmacist job, whether clinical or staffing. So now, to get the same $80k job that a new grad pharmacist could have gotten ~8 years ago right out of school, a pharmacist must complete, at minimum, a PGY-1. Apparently, this requirement will soon be upped to a PGY-2 residency.