Remaining Relevant in an Saturated Market

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ASHP has set a goal for 2020 that all pharmacists involved in direct patient care should have residencies. This makes me confused because aren’t we all involved in direct patient care if we work in a hospital? What are the odds that a pharmacist who has been out of school for over ten years would find it beneficial  to complete a pharmacy residency? Does fifteen years of experience mean anything? Were non-PharmDs made to go back to school that extra year to practice direct care? As it is there are not enough residencies to fill current graduates much less the more experienced pharmacists.

In the past, pharmacists were chosen for clinical positions in hospitals based on experience. I experienced many pharmacists earning their way to a different position by learning on-the-job. Isn’t that what residencies are? What is the difference? One difference is the money. Hospitals are making money on residents. They are paid half the salary of a regular staff pharmacist and then find reimbursement from the government. They are given the jobs that cannot be done with normal staffing due to corporations limiting staffing due to budgets. After a year, these “residency-trained” pharmacists leave their position for another residency or mostly hired right in the same hospital where they completed on-the-job half-the-price training for a whole year. This is a large sacrifice for some pharmacists but with the thousands graduating with over $100,000 in debt and a requirement looming for all to have a residency on their CV, it is becoming a no-brainer.

One of the things I have noticed as a pharmacist over the past 14 years is that experience is becoming less and less valued and the initials behind one’s name more valued. If you did a residency, you are a little better off than the ones who didn’t regardless of where or what hospital sponsored the residency.  The irony of this is that non-resident pharmacists are training residents. If it is good enough for the residents, isn’t it good enough for the patients?  I can see the need for more specialized training in the scope of a practitioner (i.e., nurse practitioner type position) but not in the current setting where we write orders based on P&T approved protocols and scopes of practice that are signed by MDs. We are utilized as cost conscientious employees changing a patient’s medication from IV to oral to save some money. We slash and burn certain therapies based on approvals. Why would I need additional training for these functions above and beyond what I have learned in the past fourteen years?

I am an advocate for keeping up with the industry.  Do not for the love of all things pharmacy sign up for a free CE live opportunity and just wait on the music to get the credit.  You are cheating yourself.  Think about it, while you are sitting in your BS or PharmD non-residency non-BCPS life letting the new updates and guidelines passing you by dumping questions on who has been designated “clinical” in your department, you are losing ground.  We are not safe, guys.  This mandate makes me nervous because it COULD happen, “I’m sorry we are no longer allowing those that work here without a PGY-1 continue.”  I know the odds seem low, but read this idea of residency equivalency for those of us without one who may want to compete.  This is what ASHP has to say about it:

“1109:  RESIDENCY EQUIVALENCY:  https://www.ashp.org/DocLibrary/BestPractices/EducationPositions.aspx

                Source: Council on Education and Workforce Development – to acknowledge the distinct role of ASHP-accredited residency training in preparing pharmacists to be direct patient-care providers; further, to recognize the importance of clinical experience in developing practitioner expertise; further, to affirm that there are no objective means to convert or express clinical experience as equivalent to or a substitute for the successful completion of an ASHP-accredited residency.

                Rationale: ASHP’s position on the need for residency-trained pharmacists is well established and described in the ASHP Long-Range Vision for the Pharmacy Workforce in Hospitals and Health Systems.  It has been suggested that a way to achieve the goal of having all pharmacists in direct patient-care roles be residency trained would be to establish a process for reviewing a “portfolio” against pre-established criteria to grant a “residency equivalency.” The Council, Board, and House concluded that both residency training and experience are important and valuable, but different, and that it would not be appropriate to create a process that attempts to convert one into the other.  The intent of the goal of having all new college of pharmacy graduates who provide direct patient care residency trained by 2020 is to enhance the skills of those practitioners, and the creation of a residency equivalency process might dilute the value of that residency training and undermine achievement of the goal. The Council, Board, and House also discussed the process used by ASHP to waive the requirement for a postgraduate year one (PGY1) residency directly. While the process does consider total experience in granting the waiver, and may seem to contradict the recommended policy, the applicant still completes a residency, ultimately gaining those experiences unique to residency training.”

I do notice that the statement “all new college of pharmacy graduates who provide direct patient care…” may protect me, but does it?

ACCP (American College of Clinical Pharmacy), another agency, commented on the postgraduate year one pharmacy residency program equivalency.  http://www.accp.com/docs/positions/commentaries/Jordan_PGY1.pdf

“Although ACCP continues to strongly advocate the importance of these postgraduate training programs in preparing a competent clinician, nontraditional approaches to evaluate the abilities of seasoned pharmacists who have not completed residency training are needed. Hence, in 2006, the Task Force on Residency Equivalency was created and charged to (1) define the professional experience that should serve as “postgraduate year one (PGY1) residency equivalency,” (2) determine qualitatively and quantitatively the experience that practitioners could document by a “residency equivalency portfolio,” and (3) identify mechanisms for filling the gaps that exist between a practitioner’s experience and the existing standard for PGY1 pharmacy residency programs.”

Guide for Residency Equivalency Portfolio Development:

                ACCP encourages the development of a residency equivalency portfolio.  What should this contain?  ACCP recommends three things:

  • A personal statement
  • Self-assessment
  • Personal goals and objectives for the future
  • Reasons for pursuing residency equivalency certification
  • Accomplishments and activities
  • Education
  • Work experience
  • Licensure status
  • Publications
  • Relevant personal statements
  • Verification of the success of those activities through supporting documents and feedback from colleagues.

What is the answer?  I still stand by ACCP’s vision of BCPS certification perhaps being equivalent or at least seemingly equivalent to a residency (maybe with or without valid experience?).  Since ASHP is responsible for accrediting residencies, they will not see value in the more experienced pharmacist and how they can be grandfathered in with a BCPS. 

Did we not run into this same thing back when PharmDs arrived on the Bachelor of Pharmacy scene?  Perhaps the problem of too many graduates makes it much easier to say a residency is required to find the type of work we have been doing all along.  With 20% of new graduates having a hard time finding employment, I think it is vital that current pharmacists keep up-to-date with current guidelines and remain the "fittest."  What does this mean?  It means being involved in pharmacy organizations, challenging yourself with certification (most popular ACCP), and doing everything possible to keep from being labeled as less capable.