If you were a manager or director of a hospital pharmacy, what candidate would be the most desirable for your team:
- A fresh-out-of-school pharmacist who just passed the boards
- A fresh-out-of-school pharmacist a year ago that just completed a residency
- A seasoned 5-10 year pharmacist in the same type of pharmacy
This is the question I have been thinking about in the past few months, and a follower here has mentioned I should do a post on it and try to lend some insight without bias.
That’s the hard part because I fall into category 3 and you can better believe that I truly believe the seasoned 5-10 year pharmacist has a lot over the other two. So, can I do this without bias? At least I have gotten my opinion out of the way.
The pharmacist that just passed the boards is likely to have the most up-to-date knowledge at his/her fingertips… or rather brain. He or she more than likely has just memorized a plethora of information since we cannot bring Lexi-Comp or any other reference into the boards exam to help us pass. But is it true that knowing information is very different from applying it in practice? I remember graduating with that same idea of knowing my stuff but the job I chose helped me quickly forget about 80% of what I learned (retail). I did not need to know sterile technique. Gone. I memory dumped everything about IVs and anything else that I could and focused on classes of drugs commonly used in retail, the side effects, the interactions and giving flu shots. I obtained my immunization certification and let those that graduated with me that wanted to do a residency to go for it. Heck, they were making $40K to my 100K. Seriously. Easy decision with Sallie Mae knocking on my mailbox monthly for her piece of the pie. I wanted a bigger pie to have left for ME.
The new grad has the knowledge, but the application is not there yet. That’s my point.
The residency trained pharmacist, on the other hand, has had the knowledge memorized and hopefully had the opportunity to apply that knowledge surrounded by professional pharmacists who helped them to grow both in learning and application. It really depends on where you did your residency, but yes. If you did one, kudos to you. Would I do one now if I could do it all over again? YES and YES. Sorry, my opinion that your last rotation of clinicals being equal to a residency is not. To arrive at a facility for one month and to move on doesn’t even get you started on the nuances of the place much less dealing with the different personalities of physicians and nurses. It doesn’t matter if you did the same work as the resident. He/she will be there for awhile. It is just different. Plus, they are sacrificing about 80,000 in pay probably. Maybe less. It is just different.
The seasoned pharmacist. Big sigh. He/she could be really over it, could be the type that wants to do more (me), or could just really be doing what they love. The neat thing about experience is that it is priceless. A pharmacist that has been in the field for over 20 years really has an appreciation for it all. Yes, they may have moved on past order entry and clinical floor work. They may be in management at this point, but some remain in a operational/clinical role. I truly have more appreciation for this category because the truth is I’m heading there faster than I would like.
I have had this blog now for several years, and I remember when I started it I wanted to fall in the ranks with others that griped about retail. I had a different story for most every HOUR of the day. Things that you could never imagine were happening around me and it was so very entertaining.
I went through a conversion from retail to home infusion to LTC to hospital. The last move was made for me because the LTC I worked on sold to another company and lay-offs were happening. I had to find a place before it was my turn. I would probably still be there had it not fallen on hard times running customer service, the IV program and maybe even PIC. Who knows. Things change all the time just like in every area of life and you have to take the bull by the horns and work with what you have.
The original question: Pharmacy residency or not? If you are graduating from pharmacy, please for the love of God do a residency. There are too many pharmacists now and you have to differentiate yourself. If you are not or cannot do one, find a niche. Find something that doesn’t have a glass ceiling. Pass the BCPS exam after three years of experience.
Does the three year rule of working before you can take the BCPS equal one year of residency then? Perhaps. I can see how this is a good rule of thumb of knowledge.
Who would you hire of the three and why?
Read this article. Seriously a good read from the ACCP.
Well written! As a community and hospital pharmacist of 26 years, I can definately say that experinece makes a difference; however, if I had it all to do over again I would definatey do a residency. Find your passion and dig in. How about neo-natal ICU pharmacy, or what about Transitional Care Pharmacy?….both sound better than hnding out Rx’s through a drive by window.
Thanks
Steve
ps…maybe you can change the comment font color so it is easire to read??
The font color whle typing is light yellow and difficult to see….thanks
Fixed! Thanks for pointing it out!
Nice piece. Residency has offered amazing opportunities and continue to do so. As a preceptor, I will absolutely encourage it.
Dr G, RPh
Writer at CareNovateMag.com
I believe it does separate new grads from one another…
Blonde Pharmacist Thanks for doing the post! When I got out of school and inquired about a residency my preceptor said to just get a job at a hospital and work in the area you are interested in. Since then I have worked in bone marrow transplant, outpatient chemo, roundingin ICU and general med floor. I don’t know how a one year residency can cover all of this experience. In addition I went back for Pharm D and BCPS certification. The truth is that some of the bigger hospitals can get these residents cheaper so why not? I am a clinical pharmacist/staff and my boss who is an rph says he doesn’t know how 1 year residency equals three years experience .So it just all depends who you work for. I have seen some with residency that don’t know how long to run vancomycin 2 gram or what is on formulary since they never work in IV room or main pharmacy! Kudos to you Blondie!
It is so much better to have experience, in my humble opinion.
Question of residency vs no residency. I’ve always been in the frame of mind considering that a piece about ‘barefoot doctors in China’ as portrayed in the National Geographic many years ago, pushes an astute person to utilize their hard-earned knowledge.
If anything, the post B.S. PharmD professional degree opened up a whole world of learning opportunities for me, more chance to credibly use information and expertise gained in my case to find myself in a work situation which wasn’t a best fit in more than one way.
As for the three years postgrad work experience = one year residency; really the order doesn’t matter whether the experience or the knowledge, although it may be ‘easier’ to do a residency with the pay decrease right after finishing school, than going for a residency after several years of well-paid work experience. Any way you look at it, when encountering different situations, if different ways to resolve a problem are presented, such as in residency, then there is a better chance in developing more effectively universal solutions.
After completing PharmD after 15 years experience and a residency immediately post pharmacy school, I came to the conclusion that a general mini-residency might be useful of about 30 days, every five years or so, in the hospital arena, just to keep up with multiple new chemical entities, and pharmaceutical knowledge! Doubt many agree with me, but sometimes in exploring solutions to a problem in a single setting, given completely different working conditions, another solution might be more readily apparent and useful.
For example, I work in a large hospital and small hospital funded in completely different ways. While the ‘job’ may be the same at either facility, I dose vancomycin differently depending where I work. In the larger facility, I may be more concerned with dosing based on availability of labs, IV hood used for preparation as to whether drugs are purchased pre-made, in vials of 1 gram or larger or meant to be compounded or ‘activated’ immediately prior to use, or whether I can make any dose I want whenever I want, and costs of drug, compounding products and contracted supplies, and even drug inventory availability. As to Bruce’s remark of how long to infuse vancomycin, there’s a question about labeled information, whether the patient has Redman’s, patient hydration or renal status, and then how to or not program an IV infusion pump, and if there’s a hospital protocol, and how many drips the patient is on as vancomycin is not compatible with every drug out there, and not every patient has access to a large bore blood vessel with fast-moving blood.
great comment thanks!!!
This is an interesting blog entry. I’ll admit up front that I am a residency director (ID) and that I’m sure my opinion is inherently biased (though my wife is a hospital pharmacist of 12 years). I think the answer to your question is: either #2 or #3, depending on the candidate. In my opinion, good experience can’t be beat, but it really depends on the type of experience that the person has. While there are many excellent, motivated pharmacists out there without residency experience who could excel in multiple positions, there are plenty as well who fall into a mold of a certain type of practice that shy away from questioning physician orders or taking the initiative to investigate a questionable pharmacotherapy decision. The shifting model of health-system pharmacy practice is churning these folks out of the basement or satellite and into patient care settings where they are not comfortable.
I think the adage of a residency counting as “3-5 years of experience” is a tired one and is not really valid, but what (good) residencies do is push residents to become “problem investigators” who also take responsibility for pharmacotherapy decisions by developing evidence-based recommendations. The knowledge that residents obtain is really secondary to the development of this process. This is where residency-trained pharmacists may have an advantage.
I’ve been involved in the hiring decisions of several clinical pharmacists and many faculty, both residency-trained and not. Looking at just the “#3′s”, I’ve seen both successes (our reigning teacher of the year) and failures (a recent staff -> clinical -> staff conversion). As lame as it is to say “it depends on the individual” (of course it does!), I think one of the primary reasons that it does is that the type of experience obtained and one’s willingness to adapt to changes are key.
On a side note, I stumbled upon your blog from a search for iPad pharmacy apps. Well done!
I would love tips on how to equip pharmacists in the basement on how to approach the physician.
. This would be a great post.
That’s a good question. I’d say that the most important thing for pharmacists who aren’t seeing physicians frequently to realize is that physician’s aren’t always right, but they have way more information than we do about the patient. A common mistake that I see is a pharmacist calling a physician to intervene on something without all in the information needed to do it, which can lead to either rejection or the physician taking the recommendation without questioning the order, possibly leading to an error. Either one can lead to a loss of confidence in or by the pharmacist. So I believe interventions should frequently be put in the form of a question to get information out of the doc that one is trying to influence, like “I see you prescribed rifampin for Mrs. X. Were you doing this with awareness of the interaction between that and voriconazole? It is likely to lead to failure of voriconazole therapy. Are you treating a presumed fungal infection, or is this prophylaxis? Is there a diagnosis of TB?” Etc, etc. I find this to be more successful than “You prescribed rifampin for Mrs. X and she is on voriconazole. You can’t give both.” That latter intervention is technically correct, but not very helpful.
Similarly, another error that I commonly see is pharmacists not getting to the real question when they receive one in the pharmacy. For example, a nurse calling to ask about compatibility between heparin and a continuous infusion PPI should prompt a question about a possible GI bleed, and a follow-up call to the MD about using an anticoagulant in that case. Or a physician calling to ask about renally dosing moxifloxacin should prompt a question about its use to ensure that it isn’t being used for a UTI. These types of questions are something we drill students on and they often bomb and I see pharmacists doing the same things in practice.
I appreciate your thoughts on this issue. I just want throw a few thoughts out here, and it involves the premise of your discussion: “If you were a manager or director of a hospital pharmacy, what candidate would be the most desirable for your team.” I squarely fall into category #2, having recently completed a residency. Another important piece of information about me is I work in a non-academic, non-teaching, for profit community hospital.
I found that there were very few hiring managers/pharmacy directors who cared at all about my having completed a residency. In fact, I’d say it actually hurt my chances in a few instances. Here are a couple of points I would like to add:
1. There are MANY managers and administrators in the institutional pharmacy world that have no concept of what a pharmacy residency is, I can’t tell you how many times I had to explain that I was indeed a fully licensed pharmacist to potential employers, not a student.
2. Those who somewhat know what a residency is but have never hired a residency trained pharmacist don’t know what to expect. Are they “overqualified”? Are all residency programs the same? It’s hard for these folks to know the difference between categories 1 and 2, or categories 2 and 3.
3. It’s hard for anyone to know what completing a PGY1 Pharmacy practice residency is like unless you’ve done it yourself. That’s nobody’s fault, nor is it a complaint, it’s just true.
I don’t want to discourage anyone from perusing a residency, I would do it again in a heartbeat. The reasons I would do it, however, have nothing to do with being employed. I would do it again because I know I am a better pharmacist because of my experiences, and I know my patients are better off as a result of my intensive training. I know that passing the BCPS exam this year was a direct result of my training, not my ‘stellar’ studying habits.
I’ll end by staying I am happy to call “the blonde pharmacist” a friend and I am very proud of her for how dedicated she has been in her BCPS pursuit. I’d wager it’s inspiring to more folks than just me.
Waiting on your web presence to grow!!