Pharmacy Forecast 2016-2020

The ASHP Foundation released a "Pharmacy Forecast: 2016-2020" Strategic Planning Advice back in December. My first thought is a pause thinking how long I have been out of pharmacy school. I start counting on my fingers from '99 and think, wait, what? SEVENTEEN years. I am officially the pharmacist I stood beside in one of my first pharmacy jobs. I considered him wiser. Maybe I am wiser, but I still sometimes feel like school was not too terribly long ago.

This is the fourth edition of this particular report, and I generally try to read every edition. This one somehow slipped by until this past week when I found it and read it rather quickly. There are some applicable topics for today's healthcare pharmacist that I want to dive into.

Strategic Planning versus Reactive Planning

I have not seen a lot of strategic planning within the hospital pharmacy model. We do a lot of reactive planning based on other departments mostly in line with cost management and saving money. We plan operations in how we staff our departments based solely on how many patients are in the hospital but do not use other metrics such how complicated medically is the patient? What if the patient comes in with a chronic infection versus the patient who comes in as a first-time infection? What if the patient has 20 or more home medications on board? Census is more than just number of patients. What if it is measured by a formula of disease states both acute and chronic along with number of hospital admissions in the past 5 years plus number of medications? A patient doesn't equal a patient. Maybe this applies in a surgical patient, but not in a patient with COPD, ARDS and decompensating on a ventilator due to a hospital-acquired infection.

Opening the report is a timely introduction:

"Since the start of the pay-for-performance movement1 and passage of the Patient Protection and Affordable Care Act (ACA), there has been intense pressure on healthcare organizations to improve quality while reducing costs. The stress created by this pressure has been exacerbated by proliferation of expensive specialty medications, egregious price increases for some sole-source drug products, and the escalation of generic drug prices. In response to this environment, many healthcare organizations are pursuing mergers and acquisitions in an attempt to create economies of scale without the cost of new construction. Another tactic is to partner with outside entities such as chain pharmacies."

Specifically what caught my eye this time was the section on work force. Change in practice models claim a shift from inpatient to ambulatory type practice.

"THE SHIFT TO AMBULATORY CARE As healthcare organizations respond to payment reforms that aim to lower costs and improve patient outcomes, health-system pharmacy practice leaders are challenged to optimize the role of the pharmacy work force in new models of care. One area of challenge is the shift in emphasis from inpatient to ambulatory care.1 Reflecting this change, three-fourths of Forecast Panelists (FPs) agreed that over the next five years, in at least 25% of health systems, patient care pharmacists will have umbrella responsibilities for both inpatients and outpatients (survey item 1). Further, 69% agreed that at least 25% of health systems will reallocate 10% or more of inpatient pharmacy positions to ambulatory-care positions (item 2). Consistent with anticipated growth in ambulatory care, 65% of FPs predicted a vacancy rate of greater than 10% for ambulatory-care pharmacy leadership positions over the next five years (item 5). Pharmacy staff development programs should ensure that there are adequate opportunities for education and training in management of ambulatory care pharmacy practice, transitions of care, and medication management of chronic illnesses. "

How do we lose money? Readmissions, using more inpatient days than necessary due to reasons in and out of our control, and not following certain standards that are attached to payment or removed when standards are not met while in-patient. 

Did you notice one thing? The salaries of newly hired entry-level pharmacists will decline by 10% while pharmacist technician salaries will increase?

You know I get excited about this one:

"PHARMACISTS AS PROVIDERS Nearly 80% of FPs predicted that at least 25% of health systems will have a formal plan for including pharmacists, along with nurse practitioners and physicians assistants, in advanced roles that allow primary-care physicians to care for more patients (item 4). Supporting the high level of agreement with this statement is the shortage of primary-care physicians, proposed federal legislation to grant provider status to pharmacists, and the large number of states that authorize pharmacists to establish collaborative practice agreements with physicians. 2 Recent changes in reimbursement rules related to complex chronic care and transitional care management3 support the addition of pharmacists to primary-care teams. Many health systems will be establishing a privileging process for pharmacists to ensure that those with expanded patient care roles have the necessary competence for those roles."

I suggest you read through the report. It is mostly put together through surveys, but has some very timely information for the next 4-5 years in pharmacy.

PHARMACY FORECAST 2016-2020

The Patient that Made the Difference

Her initials were the same as mine, and we greeted one another after a few phone conversations with "Hi, BB, it's BB." 

We had this connection. Two grown women. Both single and young. The big difference was that I was her home health pharmacist in charge of her pain pump and she had terminal cancer.

When you are halfway through your life (and maybe your career) there comes a time when you look back and remember the patients that change your life and maybe even validate the half-ass "I want to be a pharmacist" decision made by a young twenty-something with no idea how profound the decision would have on every aspect of your life. 

B wanted to go to Florida and be in the ocean one more time.  Her boyfriend was in Florida and since she knew her time was short, the ocean was on her bucket list... with the dilemma of a pain pump. That's where I fit into the story, finding a creative way to make it happen along with a couple home health nurses and some supplies. She was a nurse, too, and was a big part of her own end-of-life care.

It has been eleven years ago. B was 33 years old. I had been a pharmacist for only four years; a baby in the working world with little idea of how that year would change my life.

I had these biweekly chats with her concerning supplies she might need, including the intravenous pain medication itself but we often left the rigid discussion of how we were connected through pharmacist and patient to human conversation of "please do monthly self breast exams," to "live a full life and travel Beth!" to "who cares what people think about you, you certainly won't care when you are at the end of your life" and "I wish I could have been a mother." It was almost as if I had been granted insight into the world of a life ending way too soon and maybe learning my own lesson along the way. I sure did.

I finally went to meet her the last few days of her life. I waited much too long to meet my friend and that is my only regret. There is a professional line you have to keep in place with your patients, but sometimes that looks a little different patient to patient.  She squeezed my hand and had a picture of her vibrant former self before cancer ravaged her body sitting on her nightstand. "You are beautiful," I had said although wishing I had arrived months before.

Pharmacists and nurses along with other healthcare providers can make a difference. 

I witnessed the same thing with my father-in-law's nurse at the VA in Nashville caring for a man that had no family at bedside because of a lack of a relationship with his family. His nurse was amazing and was not only his nurse but his friend.  

I saw it again in Memphis on a hospice rotation where I saw different patients in different stages of terminal illness along with their families in different stages of grief. 

My life changed with each of these moments and patients who touched my life and maybe that young twenty-something college student knew more than I thought about selecting a career?

10 Rules of Email Etiquette at Work

One of the most frustrating things about pharmacy jobs today, for me at least, is the lack of email etiquette at work.  I know it sounds crazy to even bring this up, but I have been pondering this post for years.  You see, I have been guilty of not being the best at email, but over the years it is becoming crystal clear the errors people make every single day that not only make the sender look badly, but can actually fracture a team.  Without further ado, the email changes I would like to see in the pharmacy and hospital world with a disclaimer that since I have been practicing for almost 15 years, these examples go way back in time. 1.  REFRAIN FROM REACTIVE EMOTIONAL EMAILS.  If you find yourself getting worked up over what you are reading, do your best to avoid pressing reply and firing off a response.  Avoid sending emails when you’re feeling any type of negative emotion. These types of emails will ALWAYS make you look unprofessional and maybe even unstable.  Before you send off that email rant or reply to an email that angers you, try cooling off overnight.  Or, write an uncensored draft that you never actually send. Remember that all emails are forwardable.  If you don't want your whole department to read it, do not send it.

2.  RESIST THE REPLY ALL BUTTON.  This is the one that literally will make my entire head explode at work.  I have seen coworker after coworker make this mistake and it is not pretty.  This can make you look totally clueless all the way up the chain.  Coworkers don't let coworkers reply all.  In fact, I would love to see the day when reply all is no longer an option in Outlook, Gmail, or any other email client.  Why?  Because it creates mindless replies when all of the discussion could be tabled and then ONE single email sent out to a team.  Time after time in all of my jobs have seen emails go out - an official type declaration of what we are going to be doing - and someone else will reply all and jump in with something else essentially calling out critically all the things wrong with the initial.  Take the time to call the person that sent the email and give them the professional courtesy to make any corrections.  Don't shoot the messenger!

3.  UNDERSTAND WHAT CC AND BCC MEAN.  The recipients listed in the To field are the direct addressees of your email. These are the people to whom you are writing directly.  CC, which stands for “carbon copy” or even “courtesy copy,” is for anyone you want to keep in the loop but are not addressing directly in the email. The person(s) in the CC field is being sent a copy of your email as an FYI. Commonly, people CC their supervisors to let them know an email has been sent/an action has been taken or to provide a record of communications. The general rule of thumb is that recipients in the To field are expected to reply or follow up to the email, while those in the CC field do not.  So many times I see the ones in the CC field adding in their two-cents and then the whole thing becomes a reply-all festival.

4. IF YOU ADD SOMEONE IN THE CC OR TO FIELD, LET THE OTHERS KNOW.  Guess what?  There are times when people are added willy-nilly for no good reason and you look back and notice it a couple of emails later.  Let people know.  Professional courtesy and politeness go a long way.

5.  BCC IS GOOD FOR ONE THING ONLY.  Let's say that only half in your department contributed to the annual walk fund.  Rather than sending out an email to all those that contribute in the TO field where each of them can see who did contribute and who did not, put your own name in the TO and the rest in the BCC.  That way, gossip about who gives and doesn't is stopped before it can even begin.  Don't use the BCC field to add someone random to eavesdrop on the email.

6.  PICK UP THE PHONE.  If you notice that you are going back and forth on an email and getting nowhere, the phone still works.  Guess what?  Voices can convey so much more than words and rarely are misinterpreted as much as typed words.  I remember an email I saw that was sent for the third time.  The second time it was heavily highlighted with quotes from the manager's email weeks before.  The third send apologized for resending the email yet again but someone was not doing it correctly.  Because of the sender's frustration, more time was wasted from the entire department reading about some small piece in the whole operation, and worse, half of the department had nothing to do with the infraction.

7.  DON'T PUT A QUOTE IN YOUR SIGNATURE.  There is no reason for it.  From The Wordsmith:

******Avoid quotes, witty sayings and colors in the signature.

8.  DON'T ASSUME EVERYONE READS THEIR EMAIL IMMEDIATELY.  If something is important and needs to be communicated quickly, pick up the phone.

9.  DO NOT FORWARD AN EMAIL UNTIL YOU ASK PERMISSION.  This is just plain common professional sense.

10.  DO NOT USE UNPROFESSIONAL FONTS OR BACKGROUND PAPERS.  They only distract.  This means NO comic sans.

Hope that helps.  And, by the way, I do mess up on some of these myself.

Why Should You Become Board Certified?

I enjoy brainstorming with other pharmacists and asking them their opinions on becoming board certified.  I remember back in 1998-1999, the assistant dean of my alma mater, University of Tennessee at Memphis stressed how important it was for us to consider residency and board certification.  At the time, I was a 25-26 year old making decisions that would impact me for life.  You see, I decided back then to decline that path.  I only saw the dollars that were before me and the student loan debt piling up.  I quipped, "Why would I want to work for half-pay or less for a whole year?" Why?  Hindsight is 20/20.  Fast forward to a 40 year-old in the profession for over 14 years experiencing all sorts of different experiences, and after trying most, I have a couple of regrets as far as my tenure in pharmacy school.  I regret not doing a rotation overseas.  I regret not doing an residency.  I regret that I dismissed more learning inferior to money.

I know not everyone feels like me, and that is understandable.  Perhaps I am just a different sort who becomes stir-crazy when bored.  Whatever the reason, I decided to pursue BCPS last year.  I missed it barely the first time and immediately jumped back up and started studying again.  I work in a small community setting in a smaller city and though it is nothing like Memphis was in terms of clinical opportunities, these opportunities can be found with a little thought.  Passing the test was probably up there with other accomplishments in life - like the time I finished my first marathon (26.2 mile run) in 2002.  Victory!

Why should you become board certified?

1. BPS website quotes:  "From patient to provider, the value of the BPS-certified practitioner registers throughout the health care continuum. For pharmacy professionals, documentation of specialized experience and skills yields the additional benefits of personal satisfaction, financial rewards and career advancement."  I definitely agree with most of this though most I have talked with did not receive a raise unless they changed jobs.  In the past where BCPS maybe helped with landing a clinical job, today it may be the thing to separate you from a PharmD without BCPS.
2. If you have been out of school for over four to five years, you can be sure you have already forgotten some of what you have learned and have not learned new material being presented to new graduates.  You can depend on your local hospitals' computer system to remind you of every little thing (trusting those that program such systems) OR you can take charge of what you know and remain committed to being the best you can be.  Think of it like this, if you work in a hospital and you are commanding larger salaries than new graduates with fresher knowledge, there comes a point where you are replaceable.  Be your best to remain competitive in your field.  This means utilizing continuing education to really learn something and not last-minute cramming to renew your state license.  (Guilty, by the way).
3. A paper wrote in 2006 (seven years ago) states that "Future Clinical Pharmacy Practitioners Should Be Board-Certified Specialists."  In the past clinical pharmacists have not made board certification a priority, but this is changing rapidly with not only clinical positions but in staff positions.  Clinical faculty and preceptors MUST be board certified, I believe.  As pharmacists move toward the direction of becoming reimbursed professionals for optimizing medications, there will be a trend toward licensing agencies requiring board certification in certain scenarios.  Sure, it is not TODAY, but if you would have asked me in 2000 if I thought the market would be in the shape it is with oversaturation, I would have done things VERY differently in 1999-2002.  Direct patient care IS coming.
4. The PharmD curriculum is not enough to be able to interact in sync with other healthcare professionals.  Experience in dealing with physicians and their assistance along with board certification will take you to the next level in recommending appropriate treatment.  Placing a new graduate in a clinical position without experience and expecting them to build relationships with clinicians is not the best case scenario for the patient.  Requiring a board certification ensures a higher level of expertise and should be a requirement of all hospitals (in my opinion).  I know, I know.  Not something anyone wants to enforce, but wow!  The benefits in just preparing and studying for the test are immense.
5. Last, but not least, you should become board certified to give your patients the best care possible.  This was my number one reason.  I remember the day I sat at my desk years ago and realized I had no idea about new guidelines (and even some not-so-new) and that centralized order entry had essentially turned me into a robot at a computer verifying at will, I realized it was time to make some personal changes that would cost me both dollar and more importantly time but result in amazing benefits for my patients.  BCPS.

I hope that you will consider these reasons.  For the most part most people are reluctant because no one wants to fail, much less fail twice.  Yes, it is humbling to fail once, but it is euphoric to pass (even the second time).  Especially for someone like me, I prove you can teach an old dog new tricks.  I hope to inspire more of you to seek to be your best in our profession, stop worrying about your coworkers and if you fail, and realize that any amount of learning that happens will significantly change how you practice pharmacy.

In the future, I am thinking about tackling another certification.  I hope you will, too!

Doing What You Love

There is this paradox of thought that creeps in most days (if I allow it) and most of the time I will even ask a fellow coworker, "Do you love what you do?"  or "If you could go back in time, would you choose pharmacy again?" This article by Paul Graham found its way to my feed this morning through another reading, and though it took me all morning to read and digest the whole thing, I feel validated.  There are moments when I look at myself from another's point-of-view and think, "Is she happy?"  Happiness is the thing that I tend to search for... you see I couldn't tell you exactly how much money I make to the penny.  I have no idea to the hour how much PTO I have built up.  I can tell you I have been a drug expert since 1999 and only recently so feel I can use that term and MEAN it.

Would I do my job without pay?  That, according to the article, seems to be one of the qualifiers of finding and doing what you love.  Would I do right now for money for free?  Maybe.  I mean, I would definitely change the job.  First, I wouldn't sit in a room and just enter orders all day.  I would probably do more of a clinical job but not clinical that is defined in my current job today.

What would that look like?  More patient contact.  More ER contact.  More of a presence where knowledge is valued and needed in a moment's notice.  I have that to offer.  It would make me happy, even if momentarily in that the Sallie Mae bill I continue to pay monthly would see more worthy.

But, if I was really honest with myself I would stop and say I may find something else someday.  Even if it is something on the side.  Being in-demand was a lovely time when district managers valued your license (not so much your credentials) and would throw new cars, sign-on bonuses and time off your way.  They would appear like vultures outside the retail pharmacy with a suit on and ready to beg.

Today?  The students are graduating and learning the art of begging.

The creative life doesn't seem to coincide with making money.

"The most important thing a creative per­son can learn professionally is where to draw the red line that separates what you are willing to do, and what you are not.

Art suffers the moment other people start paying for it. The more you need the money, the more people will tell you what to do. The less control you will have. The more bullshit you will have to swallow. The less joy it will bring. Know this and plan accordingly.” - Hugh McLeod

And this one by him:

"The best way to get approval is not to need it.

This is equally true in art and business. And love. And sex. And just about everything else worth having.”

What about approval from myself because I am so excited to face the day and go to work because it is not work but my passion?  Is that possible?

Steve Jobs:

Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don’t settle.

What if that looking takes more than 20 years because quite honestly I am THERE.  20 years and able to say apologetically I am still seeking.

The bottom line is start doing the things you love.  What do I love?  Well, I do love medicine.  I would be lying if I didn't admit that.  I do like how convoluted and complicated it can get.  Throw in another disease state and another medication and a genetic tendency to metabolize differently and weight changes.  Throw in some food or no food or grapefruit juice (though in some medications you would have to drink about a quart a day maybe?) and complicate the black and white definition.

Then give it some time because years ago hormone replacement therapy was all the rage and now it's not.  Thank you Women's Health Initiative for that one.

Back to the question at hand...

The realization:  A 21-year-old chose this career path for me.  She, in her silver spoon mentality felt it was prestigious but not to a fault.  She could forsee perhaps having a family and not being on call.  Oh, and Todd Gean's house was close to the biggest house in Adamsville, TN.  He owned and still owns his own drugstore.  Guess what?  I never spent ONE SINGLE DAY in his pharmacy prior to going to pharmacy school.  I am not even sure I was aware what went on except he put pills in a bottle all day.

“If one wanted to crush and destroy a man entirely, to mete out to him the most terrible punishment,”wrote Dostoevsky, “all one would have to do would be to make him do work that was completely and utterly devoid of usefulness and meaning.”

Yes, I am searching.

No Jobs | Pharmacy Keeps On Changing

I read this post by a young pharmacist.

That being said, I would like to talk a little more about pharmacy.  Where I live, the job market is getting saturated.  People are graduating without jobs.

Let me rephrase that.  People are graduating with $150,000+ in debt, without a job.... debt that never goes away... ever.

Really eye-opening right?  I remember the good ole days in 1999 prior to the turn of the century (had to make myself sound a little wiser and aged) when working at a retail counter to pay off my $85,000 student loan debt retail district managers would personally stroll in or call and try to steal you from the competition.  They would throw sign-on bonuses and jobs were a dime-a-dozen.  With that sort of market and shortage, a pharmacist had the power.  I didn't realize at the time what power it was.  There was a lot more negotiation for sure.  Today, not so much.  The good thing about a saturated market that it can weed out those that don't work hard.  Performance is more important.

In Tennessee alone in 1999, there was one pharmacy school.  University of Tennessee at Memphis (my alma mater ;)).  Today, I think I counted five or six?

Another wonderful article... and also think you should spend the time to read the comments.  Work hard, folks.  Work hard.  Jobs are scarce.

Another article...  Tennessee specific as well.

How One Patient Pharmacist Relationship Can Change Your Life

One patient can completely change your life.  Brenda was her name.   The website where there is an online cemetery mirroring how it looks in real life.  There are moments in my career where I sit back and remember the impact she had on my life.  Not only was she so vibrant (even over the phone) but she was also inspiring.  We were in the same generation though my life was about a young man I had met (and later married) and hers was about fighting for her life.  I was her pharmacist while she was at home battling breast cancer.  She had a boyfriend with the same maiden name as me, and well it was cool Brenda and I had the same initials. I always want to connect with patients, but unfortunately my current job does not afford me the opportunity very often.  I lingered outside one patient's room at the hospital yesterday wanting to go in and introduce myself letting him know I wished him the best with his new situation and just say hello.  I have to do this more often.  There is nothing at work keeping me from opening the door and saying hello.  I guess I worry the patients are bothered enough all day and night by nursing and physicians and lab techs and all.  They get little rest, and they are sick.  Perhaps some would want a friendly face just saying hello and asking them if they need anything.

It was a little easier for me in home health because I had to call to find out how they were doing on their supplies, how nursing was handling things with the home IV antibiotics or TPN and it made it easier for me since I have this southern accent that sounds more southern even TO a southerner.  Ha!  That in itself was always an easy icebreaker.  "Where are you from?"  It always went from there.

Brenda wanted to go to Florida and jet ski.  With her pain pump.  We made it happen.  I'm proud of that memory.  I'm proud that I finally went out to meet her in person though I should have gone earlier when she was not in the final stage of life.  I saw a picture of her healthy.  Beautiful and full of life... same as most of us now.  We just can't waste this life we have!

I may have blogged about her before.  I haven't gone back to look because today I am thinking about her... it's been ten years, but I still think about how her life focus shifted with knowing she had little time left.  I am guilty of complaining quite a bit about my current job at times.  There are so many things that bug me mostly dealing with how things are handled, how pharmacists have those in control snowed, and how there's very little incentive (promotion, opportunities, salary increases, etc...) to even go above and beyond.  A new schedule comes out and I think why in the hell did I decide to do this job?  I mean, yes, it could be worse.  I know this.  But, could it not be better?

I think I am going to try to make these interactions with patients happen more often somehow.  If you have any ideas on how I can at the hospital, let me know... or if you have made it happen let me know.  These moments define major influences in my life (in the past), and I don't want to lose them by allowing my current situation to completely stifle who I am as a pharmacist.  Don't let your job dumb you down professionally or personally.

US News 100 Best Jobs of 2013 | Pharmacist is #3

I am a little baffled at Pharmacist being listed as #3 on this year's US News 100 Best Jobs because it seems to me that many of the pharmacists I read about on the internet are not very happy.  Personally pharmacy has been good to me.  I definitely would rather be a pharmacist than a dentist or an RN. #1 - Dentist Overall Score: 8.4 | Median Salary $142,740 Ever heard the phrase "Your face is your fortune"? For dentists, our smile is their fortune. They earn their living diagnosing and treating teeth and gums, performing oral surgery, and counseling and educating us on maintaining proper oral health. The profession should grow 21.1 percent by 2020.

#2 - Registered Nurse Overall Score: 8.2 | Median Salary $65,690 The nursing profession will almost always have great hiring opportunity because of its expanse (from pediatric care to geriatric care, and everything in between). And as a substantial chunk of our population ages, the necessity for qualified RNs intensifies.

#3 - Pharmacist Overall Score: 8.2 | Median Salary $113,390 With excellent job prospects and a solid average salary, the pharmacist profession nabs the No. 3 spot on our list. Possessors of a Pharm.D can anticipate nearly 70,000 available jobs this decade—the brunt in physician offices, outpatient care centers, and nursing homes.

#4 - Computer Systems Analyst Overall Score: 8.2 | Median Salary $78,770 Think of a computer systems analyst as a tech project manager. He or she is often a liaison between the IT department and a client, and has influence over both the budgetary and technical considerations of a project.

#5 - Physician Overall Score: 8.2 | Median Salary $183,170 At the top of the medical food chain, physicians diagnose and treat patients, plus they instruct on proper diet, hygiene, and disease prevention. And like other jobs in the healthcare industry, physicians will see abundant job growth to 2020.

And because I love this link mostly because I am included on the page, I will repost.  You will notice though who #1 is:

The Angry Pharmacist: For opinionated posts about drugs, patients, and pharmacy in general, read through this blog and see how this blogger earned his name.

He's angry.  I bet he wouldn't say his procession should be listed #3.

Read more about the top pharmacy blogs out there.

Pharmacy and Your Niche

What led you to choose pharmacy as a career? For me, it was a mention of "oh by the way, I am not only a chemistry advisor, I am a pre-pharmacy advisor" by a brilliant analytic chemistry professor, Dr. Anthony Harmon. I was just 21 years old, and I did not know what I wanted to be when I grew up. He pointed me toward pharmacy. I envied the quiet genius a lot of the serious chemistry majors seemed to possess. I was a more outgoing having fun type. Dr. Harmon told me a career in a chemistry lab may not mesh well with my personality. Well, let's be real... I wasn't an A student in his quantitative analysis class either. Pharmacy was suddenly on my radar.

I took the PCAT. Who knows what I made. My undergrad GPA was 3.2. Being female used to be a minority, but not in pharmacy in 1993. In fact at the time, being male was the minority. I was finishing my third year of undergrad and decided I'd apply to a handful of universities.

I had a couple of acceptances but really wanted the University of Tennessee at Memphis. I was told on the phone I was 99.9% in, so go ahead and respond decline to the private universities who accepted you. I turned down the schools and then received a rejection letter from UT. Guess i was that 0.1% eluded by the assistant dean. Talk about a downer. A lot of students do go the political route and a lot of acceptances are based on who you know, but I didn't until the rejection.

I reached out to some "who you know" types with my story and got accepted for the next year. So... I spent my fourth year in undergrad finishing a degree and biding my time. At least I did not have to reapply.

So there you have it. I remember thinking the pharmacist who worked in my small hometown had a large house. I didn't realize it wasn't pharmacy more than the sheer fact he had his own business. This is key.

Thirteen years later I realize you can make a good living in pharmacy or a great one in finding your niche within.

Have you found your niche?

The Most Hilarious (and not-so-hilarious-moments) in the Past 10+ Years of Pharmacy

This post has been long time in the making, and also a move toward a coming out of sorts for the Blonde Pharmacist.  It is time to just be me, if you know what I mean, so let's start out with a post about the past.  The most hilarious moments in the past 10 years of being a pharmacist (and not-so-hilarious-moments). 1.  Sometime during 1999, Keith Urban was living in the middle Tennessee area where I was working.  He wasn't a bit name at all, and in fact, in the Country Music City to make it.  (Make it, he did).  I worked in a small retail pharmacy with a fabulous technician named Kim and another pharmacist named Ladona.  Keith came in from time to time with his fabulous Australian accent.  Of course, I cannot divulge what he took medication wise, but I can say that he is indeed short, and was friendly.  It wasn't too much longer he sent in a driver...  he made it big.  This is a hilarious moment only because it was my only brush with celebrity while working.  Fun stuff.

2.  I was a floater for the same retail company and was working in a store one afternoon.  The best part of being a floater is that there isn't a lot of responsibility as far as the operations part of the day.  I would go in, do my job, and leave.  However, this one day, there was a man that came in holding what looked like a five year old needing an early refill on his son's albuterol nebules.  I told him he'd have to pay for them because TennCare wouldn't cover them early.  He was irate and began squeezing his son.  "Daddy!  You're squeezing me.  You're hurting me!"  He replied to his son rather dramatically, "Son, I'm not hurting you, SHE is!!"  As a twenty-something pharmacist, I sort of lost it at that moment.  "What am I doing a jedi mind trick on your son?"  It wasn't long after that, I knew retail wasn't for me.  I couldn't let it roll. I kept going with him, "I'm gonna have your job!"  He said angrily.  "You can have it!"  I replied.

If I can give some advice here it would be... learn to let it roll.  Don't lose your cool.

3.  JB.  The HIV positive homeless man that threatened to have my brains on the parking lot if I didn't fill his alprazolam 2 mg QID two weeks early.  Needless to say I didn't, and he was my last straw.  Good-bye retail forever.  I figured JB didn't really have much to lose.

4.  AG the former crack addict who kicked the habit for many many years only to die after shooting up again.  Some of the conversations we had were priceless in hindsight during a time I needed friends so desperately.

5.  Not a hilarious moment or not - but a moment where this blonde pharmacist worked for THE BLONDE pharmacist.  She was such a positive influence and hired me for home infusion with no experience.  Glad she gave me a chance.

6.  Who could forget the boss I had once who wanted to know what I was thinking once during a meeting.  The guy had more degrees than anyone I've met but yet asked the strangest questions.  My response, "Last time I checked, thoughts were still private property."  LOL  Seriously though, he sort of lost cred with me when a close friend and coworker was in labor and he stalled her for awhile to wrap up some things with her job and then took time later to brag about how he stalled her while she was in labor.  Gag.

7.  Who could forget the manager who threatened a punitive write-up in one sentence and the next began talking about Jesus.  Asked me if I had found a church.  So wrong on so many levels.

8.  Or the job interview where the pharmacy manager dove right in with the first sentence, "We'll begin our interview."  The next sentence, "Do you have kids?"

What are your most hilarious and not-so-hilarious moments in pharmacy?