lmay0001

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when looking for work retail is always more lucrative compared to clinical Pharmacy. I didnt find many clincal posts available and after a few months i still couldnt get a Hospital job
 

awval999

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Because clinical pharmacy jobs are just window dressing for large hospital/health-systems and clinical pharmacists don't bring in revenue to the hospital. So yes, large hospitals have them, because they are "nice to have" and the large hospitals can afford them because they want to be world-class hospitals, but clinical pharmacists don't make economic sense to the hospital bean counters, that is why there are few openings. Most pharmacists that land these jobs stay for life. Very little turnover.
 

gwarm01

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Unless it's affiliated with a university or is a large, prestigious institution, you aren't going to see a lot of "clinical pharmacist" positions. Hospital staff pharmacists still have clinical duties so don't get hung up on a name.
 

njac

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Are there so few clinical pharmacy jobs?

I keep an indeed.com search for my specialty and get emails about clinical jobs around the country every day.

And if I check linked in there are even more.

You need to be flexible geographically but there are tons of jobs posted at any time.


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Clinical jobs are everywhere. Unfortunately, you need a PGY-2 and years of experience for those specialties before landing one. By the time you have met those requirements the job will be gone.


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gwarm01

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Clinical jobs are everywhere. Unfortunately, you need a PGY-2 and years of experience for those specialties before landing one. By the time you have met those requirements the job will be gone.


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By the time you meet those requirements they will tack on a PGY3 (PGY2 pharmacists are now relegated to checking Pyxis carts).
 

PumpkinSmasher

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Because clinical pharmacy jobs are just window dressing for large hospital/health-systems and clinical pharmacists don't bring in revenue to the hospital. So yes, large hospitals have them, because they are "nice to have" and the large hospitals can afford them because they want to be world-class hospitals, but clinical pharmacists don't make economic sense to the hospital bean counters, that is why there are few openings. Most pharmacists that land these jobs stay for life. Very little turnover.
Agreed. I have no plans on leaving my job anytime soon. I love it and see myself staying for a longtime. I am the only amb care pharm for our clinic, so unless I leave, the position will never open...
 
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njac

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Moderately disagree.

I work in a community hospital that is about as community as you can get. But we have 1 ICU specialist, 2 ED specialists, 1 ID specialist, and 1 NICU/peds specialist. We're about a 350 bed hospital.

I will agree on the little to no turnover, but we're definitely not a major academic center or big name big hospital.

Outside of the specialists, the majority of the pharmacists are decentralized and out on the floors doing kinetics and whatnot.

I will say that our experiences with hiring people after working in retail have been not great, and we've starting hiring more new grads than people from retail because of it.


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Momus

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Statistics. People forget to mention there are way more retail stores than hospitals to begin with. Also, more staffing position than clinical in the hospital. Ergo...
 
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Moderately disagree.

I work in a community hospital that is about as community as you can get. But we have 1 ICU specialist, 2 ED specialists, 1 ID specialist, and 1 NICU/peds specialist. We're about a 350 bed hospital.

I will agree on the little to no turnover, but we're definitely not a major academic center or big name big hospital.

Outside of the specialists, the majority of the pharmacists are decentralized and out on the floors doing kinetics and whatnot.

I will say that our experiences with hiring people after working in retail have been not great, and we've starting hiring more new grads than people from retail because of it.


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What sort of functions are retail converts not able to perform?
 

njac

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What sort of functions are retail converts not able to perform?
Verifying Kphos 30mmol IV push.

Calculating pediatric pip/Tazo doses and converting to volume based on standardized concentration.

Had a nice discussion about how "off label" means "not in the package insert" with one recently.

Comprehending that prn bisacodyl and prn loperamide (zero doses of either given during the admission) doesn't require a call to the physician.

Maybe we've gotten some impressive duds, but the last two that came from retail have been very rough transitions, and continue to be.


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njac

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I'm not saying retail pharmacists aren't bright. I'm just saying we've had some not great transitions.

We've initiated a written exam with the interview that does help weed out generalized knowledge gaps.


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catalyzt

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I would love to see that written exam. I am a retail guy and it's boring and I don't like the irregular hours. A clinical pharmacist position at a hospital or amb. care sounds so much more fulfilling to me and I aced the Naplex exam when I graduated in '09. I just didn't do a residency and I'm regretting it now.
 

ldiot

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Verifying Kphos 30mmol IV push.

Calculating pediatric pip/Tazo doses and converting to volume based on standardized concentration.

Had a nice discussion about how "off label" means "not in the package insert" with one recently.

Comprehending that prn bisacodyl and prn loperamide (zero doses of either given during the admission) doesn't require a call to the physician.

Maybe we've gotten some impressive duds, but the last two that came from retail have been very rough transitions, and continue to be.


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It's not that they are less intelligent, they just don't deal with this stuff in retail. The calculations are middle school level math but you can't expect them to be doing this in their sleep if they haven't done it since school. Don't get me wrong, their are plenty of idiots out there and someone sending out kphos 30mmol push is scary stuff. I just don't think all of retail can be viewed this way; I'll be in retail and easily destroy many of the residency/hospital route people in my class when it comes to calculations/dosing/etc
 

Digsbe

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I see several jobs looking for clinical pharmacists, most staffing positions also state "PGY1 preferred" or things along those lines. In my area retail is heavily saturated, clinical seems balanced with a few positions here and there.
 

confettiflyer

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I just don't think all of retail can be viewed this way; I'll be in retail and easily destroy many of the residency/hospital route people in my class when it comes to calculations/dosing/etc
No, but...we're still waiting for that secret clinical rock star diamond in the rough who spent 10 years in retail to come in and rock my panties off.

::crickets::
 

confettiflyer

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Verifying Kphos 30mmol IV push.

Calculating pediatric pip/Tazo doses and converting to volume based on standardized concentration.

Had a nice discussion about how "off label" means "not in the package insert" with one recently.

Comprehending that prn bisacodyl and prn loperamide (zero doses of either given during the admission) doesn't require a call to the physician.

Maybe we've gotten some impressive duds, but the last two that came from retail have been very rough transitions, and continue to be.


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Jesus on a bicycle, what the hell. :smack::smack::smack:

The last successful retail-to-hospital transition we had was < 2 years in the field, so still relatively fresh out of school.

75% of our retail applicants are like, 5-10 years experienced and burnt out. The other 25% are 2-5 years in the field and regret their choice of setting. I don't think we've officially called in a retail transition applicant since the shortage years pre-2007.
 

confettiflyer

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I would love to see that written exam. I am a retail guy and it's boring and I don't like the irregular hours. A clinical pharmacist position at a hospital or amb. care sounds so much more fulfilling to me and I aced the Naplex exam when I graduated in '09. I just didn't do a residency and I'm regretting it now.
One written exam had me build a TPN from scratch based on some patient factors, got a few equations given to me (like BEE and kcal content of lipids, etc..). The others had 3-4 patient cases, basic stuff...but it was for an oral clinical exam that covered things like anticoag, ID, and sedation/analgesia (basic tenets of hospital care).
 
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confettiflyer

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Because clinical pharmacy jobs are just window dressing for large hospital/health-systems and clinical pharmacists don't bring in revenue to the hospital. So yes, large hospitals have them, because they are "nice to have" and the large hospitals can afford them because they want to be world-class hospitals, but clinical pharmacists don't make economic sense to the hospital bean counters, that is why there are few openings. Most pharmacists that land these jobs stay for life. Very little turnover.
Our average tenure is something around 18 years, it's dropped slightly as we had a wave of promotions (to other hospitals in the system and outside) and so we went on a hiring spree (like.... 5 people) who are all PGY-1 grads. Consensus is we're not letting this gold nugget of a job go unless it's for... two gold nuggets.

As for window dressing, we don't differentiate between "clinical" and "staff" so all of our clinical pharmacists are legally required to meet things like ratio and to handle the basics of the clinical program. We could do some trimming though, but that would eat into clinical capacity and our hospitalist team and specialists would raise a stink (they're mildly possessive of us since we do a lot of minutiae....to the point that they'd have to consider adding another physician on since they already have 15 encounters (or more) on a regular basis).

Some of our functions, admittedly, could be taken over by less expensive highly trained individuals. For example, we don't do med reconciliation locally, but technicians could bang out a halfway decent one; transitional care could be taken on by MSW's; vancomycin/AMG dosing can be strictly weight based and/or nomogram but would have to be taken over by the physician or an NP.

Our value proposition is that strict pharmacy functions exist (often from a legal perspective), and our workload in the hospital guides the # of technicians required to fulfill those functions. We employ a high level of automation, so we've already cut to the core # of dispensing technicians needed... so all of the above become add-ons for the same price, so-to-speak.
 
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Dalteparin

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I would love to see that written exam. I am a retail guy and it's boring and I don't like the irregular hours. A clinical pharmacist position at a hospital or amb. care sounds so much more fulfilling to me and I aced the Naplex exam when I graduated in '09. I just didn't do a residency and I'm regretting it now.
The work is more interesting, but don't expect regular hours in hospital unless you work the graveyard shift. When I worked days, my schedule was extremely erratic and my boss was a procrastinator, so often I wouldn't know whether or not I was working until a couple of weeks beforehand. Nights, on the other hand, is almost always 7 on/7 off.


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gwarm01

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Our pediatric concentration of piperacillin/tazobactam is 45mg/ml for IV syringes.

Some physicians order mg/kg doses as zosyn, and some order by the piperacillin component.




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This reminds me of when I started my first job. I asked the person training me if Zosyn was ordered by pip content or both components combined. Their answer was "just don't worry about it." I guess they couldn't get the doctors to come to a consensus, so they got whatever Epic says they got.
 

pezdispenser

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I got a hospital per diem job after being in retail for over 10 years, and have made the transition just fine. I've actually noticed that the hospital pharmacists do some things quite poorly as well due to their lack of knowledge about 'retail' drugs. For example, on the med reconciliation:

- didn't catch the difference between exenatide 2mg weekly (Bydureon) and 10mcg bid (Byetta)

- didn't understand the different indications and dosing of Victoza and Saxenda

- didn't understand the components of HAART regimens or the transition from tenofovir disoproxil fumarate to alafenamide

- pt was discharged with a script for Xarelto but it was prior auth on their insurance and the retail pharmacy was unable to contact the hospital doctor or anyone else at the hospital to facilitate the prior auth or get it changed. The pt ended up taking nothing at all.

The truth is, it behooves you to know the drugs and practices from both hospital and retail settings, so this bifurcation really doesn't help anyone and in some cases even harms the patient. It's best to get experience in both, and yes, that means maybe hospital pharmacists should get some retail experience once in a while :p
 

confettiflyer

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- didn't understand the components of HAART regimens or the transition from tenofovir disoproxil fumarate to alafenamide

- pt was discharged with a script for Xarelto but it was prior auth on their insurance and the retail pharmacy was unable to contact the hospital doctor or anyone else at the hospital to facilitate the prior auth or get it changed. The pt ended up taking nothing at all.
Stop speaking Egyptian, lol.

As for the discharge, that's poor discharge planning. Our MSW's are supposed to be the ones checking coverage. Discharge anything doesn't come across pharmacy desk unless a physician calls us.

Been cut down big time by real time formulary within the EMR at the time of prescribing...and our working assumption is Xarelto not covered unless otherwise proven!


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CUpharmD2013

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Jesus on a bicycle, what the hell. :smack::smack::smack:

The last successful retail-to-hospital transition we had was < 2 years in the field, so still relatively fresh out of school.

75% of our retail applicants are like, 5-10 years experienced and burnt out. The other 25% are 2-5 years in the field and regret their choice of setting. I don't think we've officially called in a retail transition applicant since the shortage years pre-2007.
I got a hospital per diem job after being in retail for over 10 years, and have made the transition just fine. I've actually noticed that the hospital pharmacists do some things quite poorly as well due to their lack of knowledge about 'retail' drugs. For example, on the med reconciliation:

- didn't catch the difference between exenatide 2mg weekly (Bydureon) and 10mcg bid (Byetta)

- didn't understand the different indications and dosing of Victoza and Saxenda

- didn't understand the components of HAART regimens or the transition from tenofovir disoproxil fumarate to alafenamide

- pt was discharged with a script for Xarelto but it was prior auth on their insurance and the retail pharmacy was unable to contact the hospital doctor or anyone else at the hospital to facilitate the prior auth or get it changed. The pt ended up taking nothing at all.

The truth is, it behooves you to know the drugs and practices from both hospital and retail settings, so this bifurcation really doesn't help anyone and in some cases even harms the patient. It's best to get experience in both, and yes, that means maybe hospital pharmacists should get some retail experience once in a while :p
I'm one of those retail for 2 years who was lucky enough to make the transition very successfully. I also agree with Pez, though, that there are some very good pharmacists in the retail setting who would be able to make the transition just fine and others who would struggle very mightily. I've also come across some pharmacists on the inpatient side who are lucky to still have a job and are frankly a disgrace to the profession. There are good and bad pharmacists everywhere. So I like the idea of a competency exam as a part of the hiring process because if a retail pharmacist is truly serious about getting out of retail, they'll keep up on their stuff so that they can be competitive. Keeping up with what's going on in the outside world is also helpful when making recommendations to doctors for therapy selection. Knowing that most insurance plans now cover Xarelto and many will require a PA for Eliquis may speed up a discharge or prevent a gap in therapy. One hospital I used to work at would have the outpatient pharmacists help with the discharges to handle therapeutic interchanges prior to discharge so that there are no gaps in therapy or unnecessary calls to the discharging MD.

There are also pharmacists at small community hospitals or rural hospitals that also perform "clinical" functions. These positions aren't limited to large medical centers or teaching institutions. For instance, at my hospital, the pharmacists rotate through antimicrobial stewardship, anticoagulation, oncology, and Coumadin clinic positions for a good mix of variety. We're small enough that we can't have pharmacists dedicated to specific units, but pharmacists are valued enough that we're looked at more than verification machines.
 
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BMBiology

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I don't work in retail or hospital. I am pretty sure I can train any pharmacist to do my job. Yeah you have to deal with some BS especially if you are a retail pharmacist but the actual work is not hard. That is why I chose pharmacy in the first place! There is nothing wrong with easy money. I am not getting younger. I am not getting smarter. I have other priorities now that I am older. I would rather save my brain cells for something else besides work.

Sometimes when I am sitting back and drinking my water, I would wonder how hard some people have to work just to make 6 figures then I would go back to checking my stocks. We have it good (unless you are working in retail).

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confettiflyer

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And I'm waiting for any prn floater from the hospital/LTC pharmacy to not leave with 100+ scripts in the red.
hahah, hospital people float to retail? I thought we cling to these jobs until death, or stick to prn hospital


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BidingMyTime

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Verifying Kphos 30mmol IV push.
Calculating pediatric pip/Tazo doses and converting to volume based on standardized concentration.
Had a nice discussion about how "off label" means "not in the package insert" with one recently.
Comprehending that prn bisacodyl and prn loperamide (zero doses of either given during the admission) doesn't require a call to the physician.
Maybe we've gotten some impressive duds, but the last two that came from retail have been very rough transitions, and continue to be.
Kphos is a serious knowledge gap, hopefully one that wouldn't be repeated.
The math should be easy for any pharmacist, although I could understand the pharmacist wasn't sure what the physician was asking, if s/he never dealt with that drug before--but this should have been easy to clarify and learn (there is a learning curve with any new job and even with just changing institutions, I hope you wouldn't count this against the pharmacist just because they had questions/difficulties the first time they saw the drug.) I mean, retail pharmacists do math and conversions as well, so being "Retail" is no excuse for a pharmacist not doing basic conversions.
How could any pharmacist not know what "off label" means?
Are you saying the pharmacist actually called the doctor because of the opposing actions of bisacodyl and loperamide? I'd say the pharmacist just didn't understand the concept of a standing order, but this pharmacist wouldn't last in retail either if s/he was calling doctors about such ludicious things ( even apart from the concept of the standing order, has that pharmacist never heard of IBS for example?)

One written exam had me build a TPN from scratch based on some patient factors, got a few equations given to me (like BEE and kcal content of lipids, etc..). The others had 3-4 patient cases, basic stuff...but it was for an oral clinical exam that covered things like anticoag, ID, and sedation/analgesia (basic tenets of hospital care).
Haha, I don't think I could build a TPN from scratch. Actually, I guess I would just copy the protocol we use, majority of doctors just go with the protocol, rarely a doctor might tweak with the electrolytes, adding insulin is the biggest tweak,

I got a hospital per diem job after being in retail for over 10 years, and have made the transition just fine. I've actually noticed that the hospital pharmacists do some things quite poorly as well due to their lack of knowledge about 'retail' drugs. For example, on the med reconciliation:
- didn't catch the difference between exenatide 2mg weekly (Bydureon) and 10mcg bid (Byetta)
- didn't understand the different indications and dosing of Victoza and Saxenda
- didn't understand the components of HAART regimens or the transition from tenofovir disoproxil fumarate to alafenamide
- pt was discharged with a script for Xarelto but it was prior auth on their insurance and the retail pharmacy was unable to contact the hospital doctor or anyone else at the hospital to facilitate the prior auth or get it changed. The pt ended up taking nothing at all.
Hospital pharmacy doesn't deal with pt's insurances and has no way to know what would be covered.

The truth is, it behooves you to know the drugs and practices from both hospital and retail settings, so this bifurcation really doesn't help anyone and in some cases even harms the patient. It's best to get experience in both, and yes, that means maybe hospital pharmacists should get some retail experience once in a while :p
A good point. But reality is, any pharmacist is only going to be familiar with drugs they deal with each day. It's not just hospital to retail or retail to hospital, it's also going from one store/hospital to another in a different area, where prescribers prescribing habits or different. Or moving into or out of a specialty niche. I like to think though that most pharmacist are educated and quick enough to fill in their deficiencies when they move to a different job dealing with different formularies.
 
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ldiot

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hahah, hospital people float to retail? I thought we cling to these jobs until death, or stick to prn hospital


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They have no plans of leaving hospital; I'm guessing they are just trying to make up lost earnings for the year or two they spent in residency. Some are older and are probably just bored, who knows.
 

njac

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They have no plans of leaving hospital; I'm guessing they are just trying to make up lost earnings for the year or two they spent in residency. Some are older and are probably just bored, who knows.
I know people who did it to save cash for weddings, or because they interned at retail places and wanted to maintain the relationships.


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