Why should i do pharmacy residency?

[deleted727644]

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What is the benefit of doing residency? Why should A student consider it? What do you learn and do during residency year that preceptors don’t teach you during APPEs? How Much of a difference does 1 year of residency make vs a full time pharmacy job?

 

[BC_89]

I can only give you my N=1 experience (approaching 6 months into my residency).

What is the benefit of doing residency?

1) Competition for hospital placement.

Many locations (think metro and/or nearby cities and counties) screen out applicants who do not have a PGY-1. Why? Its due to the ratio of applicants to job availability. Unless you are an expert of networking beforehand in certain regions with certain people, it is awfully difficult to simply apply for a hospital job when you have multiple applicants that have already gone through the rigors of residency. What do you bring to the table as a new pharmacy graduate vs licensed pharmacist with a PGY-1?

Why should A student consider it?

My above comment plus this:

1) Variety of experiences in different departments in a concentrated format.
Residency focuses on getting exposure to different departments of the hospital while working under your own license (critical care, internal medicine, ID). This expedites you to be "well rounded" in all settings in a short matter of time vs training a new graduate.

2) Specializing requires a PGY-2 (ID, Oncology, Informatics) and you can no longer skip a PGY-1 to go straight into a PGY-2 per ASHP.
If you wish to specialize and forgo a PGY-1, you won't be able to push forward with a PGY-2 in your specialty of choice. Outliers exist, but you'd be hard-pressed to climb that mountain without a PGY-1.

What do you learn and do during residency year that preceptors don’t teach you during APPEs?

1) Multi-tasking under your own license.

You still get assigned a preceptor to have your discussions (patient workups and case studies) but before long, you're on your own going to daily rounds, making medication adjustments, and following up DI questions in a fast-"er" pace environment without someone looking over your shoulder. This is part of the shaping and molding process. Again, with the variety of experiences in a short amount of time with a PGY-1, you should be able to walk into a hospital and be fundamentally & adequately prepared. Sure, you could do it straight out of graduation (so long as you're teachable), but your pace will be nowhere to that of a PGY-1 grad and (again) with plenty of applicants, the hospital would find it difficult to justify picking you over someone else for the position.

How Much of a difference does 1 year of residency make vs a full time pharmacy job?

3 years of experience is equated to 1 year of residency.
That is the ratio (YMMV)


So, if you want to work hospital with no desire to specialize and believe you can do it without a PGY-1 (or work retail/community), I say avoid residency altogether. Otherwise, you'll have to run the gauntlet and embrace the suck while working & rapidly building up your clinical skills.

 

[deleted727644]

Can we go back to your this answer: expedites you to be "well rounded" in all settings in a short matter of time vs training a new graduate.

So are you saying the resident doesn't get trained by preceptors before doing the clinical stuff?

 

[BC_89]

No, I am saying that by virtue of the residency (with preceptor guidance on polishing and adding to clinical skills), you would have hit all the major itineraries that pertain to working in different areas of the hospital. If you're a new grad, chances are you could be staffing the central pharmacy (verifying orders, doing the occasional vancomycin or warfarin dosing adjustments, and answering questions that get called to the pharmacy). You wouldn't have exposure and probably wouldn't be expected to cover rounds in the ICU/NICU, internal med, work the oncology outpatient infusion center, or do the forefront on antimicrobial stewardship (depending on the size of the hospital and what is offered).

Again though, a new grad with great APPE rotations and is teachable could possibly cover down in rural hospitals or work in a hospital staffing position in the central pharmacy. You could not however compare your clinical skills from APPEs to that of a resident (big difference in exposure and learning). Residency is a continuation of building from your foundation during APPEs.

Arguably, many residencies like to use residents as free labor for staffing roles so its subjective to say which programs are more robust vs others when it comes to exposure and learning.

 

[KidPharmD]

The answer to your title question might be that you shouldn't.

What do you want to do? What is your 5 year plan? If you don't know that then residency can at least delay that decision. I still don't think that PGY1 trained pharmacists are being called "over-qualified" for positions that don't require it.

 

[deleted727644]

No, I am saying that by virtue of the residency (with preceptor guidance on polishing and adding to clinical skills), you would have hit all the major itineraries that pertain to working in different areas of the hospital. If you're a new grad, chances are you could be staffing the central pharmacy (verifying orders, doing the occasional vancomycin or warfarin dosing adjustments, and answering questions that get called to the pharmacy). You wouldn't have exposure and probably wouldn't be expected to cover rounds in the ICU/NICU, internal med, work the oncology outpatient infusion center, or do the forefront on antimicrobial stewardship (depending on the size of the hospital and what is offered).

Again though, a new grad with great APPE rotations and is teachable could possibly cover down in rural hospitals or work in a hospital staffing position in the central pharmacy. You could not however compare your clinical skills from APPEs to that of a resident (big difference in exposure and learning). Residency is a continuation of building from your foundation during APPEs.

Arguably, many residencies like to use residents as free labor for staffing roles so its subjective to say which programs are more robust vs others when it comes to exposure and learning.

Why can’t hospitals invest in giving that exposure to staff pharmacists and having them work their way up if they want to do clinical tasks?
Like you mentioned in the last paragraph a lot of hospitals just use residents to make you work 2 times as much for half salary. What if a resident gets stuck doing that for a whole year or a toxic environment? It’s impossible to know how the environment will be through 1 interview.

 

[KidPharmD]

Why can’t hospitals invest in giving that exposure to staff pharmacists and having them work their way up if they want to do clinical tasks?
Like you mentioned in the last paragraph a lot of hospitals just use residents to make you work 2 times as much for half salary. What if a resident gets stuck doing that for a whole year or a toxic environment? It’s impossible to know how the environment will be through 1 interview.

For one, because we have to have staff pharmacists too. Giving staff pharmacists the same exposure residents get would cost significantly more with no real incentive. While I think residents work harder than we do, I don't think they are twice as productive. They work hard because they are still learning. The staffing component is learning but is also one of the things that makes it worth it to train residents.

Yes, there are toxic programs and poorly designed programs, but I'll bet they are less common than you think. Residents in good programs don't usually come on SDN or Reddit to talk about how good their program is. I'll bet that you would find that most programs like this have some indicator before match day. It is a problem that many of us want to solve, but it is really a problem with ASHP.

 

[Script1992]

I can only give you my N=1 experience (approaching 6 months into my residency).


1) Competition for hospital placement.

Many locations (think metro and/or nearby cities and counties) screen out applicants who do not have a PGY-1. Why? Its due to the ratio of applicants to job availability. Unless you are an expert of networking beforehand in certain regions with certain people, it is awfully difficult to simply apply for a hospital job when you have multiple applicants that have already gone through the rigors of residency. What do you bring to the table as a new pharmacy graduate vs licensed pharmacist with a PGY-1?

My above comment plus this:

1) Variety of experiences in different departments in a concentrated format.
Residency focuses on getting exposure to different departments of the hospital while working under your own license (critical care, internal medicine, ID). This expedites you to be "well rounded" in all settings in a short matter of time vs training a new graduate.

2) Specializing requires a PGY-2 (ID, Oncology, Informatics) and you can no longer skip a PGY-1 to go straight into a PGY-2 per ASHP.
If you wish to specialize and forgo a PGY-1, you won't be able to push forward with a PGY-2 in your specialty of choice. Outliers exist, but you'd be hard-pressed to climb that mountain without a PGY-1.


1) Multi-tasking under your own license.

You still get assigned a preceptor to have your discussions (patient workups and case studies) but before long, you're on your own going to daily rounds, making medication adjustments, and following up DI questions in a fast-"er" pace environment without someone looking over your shoulder. This is part of the shaping and molding process. Again, with the variety of experiences in a short amount of time with a PGY-1, you should be able to walk into a hospital and be fundamentally & adequately prepared. Sure, you could do it straight out of graduation (so long as you're teachable), but your pace will be nowhere to that of a PGY-1 grad and (again) with plenty of applicants, the hospital would find it difficult to justify picking you over someone else for the position.


3 years of experience is equated to 1 year of residency.
That is the ratio (YMMV)


So, if you want to work hospital with no desire to specialize and believe you can do it without a PGY-1 (or work retail/community), I say avoid residency altogether. Otherwise, you'll have to run the gauntlet and embrace the suck while working & rapidly building up your clinical skills.

I second that.

No, I am saying that by virtue of the residency (with preceptor guidance on polishing and adding to clinical skills), you would have hit all the major itineraries that pertain to working in different areas of the hospital. If you're a new grad, chances are you could be staffing the central pharmacy (verifying orders, doing the occasional vancomycin or warfarin dosing adjustments, and answering questions that get called to the pharmacy). You wouldn't have exposure and probably wouldn't be expected to cover rounds in the ICU/NICU, internal med, work the oncology outpatient infusion center, or do the forefront on antimicrobial stewardship (depending on the size of the hospital and what is offered).

Again though, a new grad with great APPE rotations and is teachable could possibly cover down in rural hospitals or work in a hospital staffing position in the central pharmacy. You could not however compare your clinical skills from APPEs to that of a resident (big difference in exposure and learning). Residency is a continuation of building from your foundation during APPEs.

Arguably, many residencies like to use residents as free labor for staffing roles so its subjective to say which programs are more robust vs others when it comes to exposure and learning.

I second that. cannot compare clinical skills of a new grad versus pharmacist with PGY-1 residency.

 

[sunnyandseventytwo]

Again though, a new grad with great APPE rotations and is teachable could possibly cover down in rural hospitals or work in a hospital staffing position in the central pharmacy. You could not however compare your clinical skills from APPEs to that of a resident (big difference in exposure and learning). Residency is a continuation of building from your foundation during APPEs.

I graduated from a new Pharm.D. program that was 1) still small and 2) really, really trying on their clinical rotations. Because there were almost no Pharm.Ds. in the city, my preceptors considered me a pharmacist from day 1. I remember being told at the beginning of an ID rotation: You don't need to run anything by me. Your team knows you're a student; they can ask me if they have any doubt about what you're saying.

My residency was a huge step down from that. Suddenly, I'm being babied...by preceptors far less knowledgeable than the ones I had the year before. I learned very little during the residency, but I would still do it again in a second if I could go back in time. I attribute every job interview/job offer I've received to that line on my resume--at least in this country and I was only employable in other countries because of the work experience I was able to collect from that line on my resume.