Rejection Can Be a Good Thing

Have you ever thought of rejection as being something that can be utilized for greatness? While no one actively enjoys rejection on the job or in life, it is at least something that can propel you to another level in how you view its role in your expertise and willingness to continue moving forward despite what is usually considered a personal failure with the usual negative results.

Usually when most people face rejection the first impulse is to withdraw and criticize the methods; however, what if we turned it into an opportunity to learn? What if we sought out opportunities to be rejected to learn how to minimize the emotional reaction and criticism and turned it into something else?

Take for example the issue that comes up with a medication where you have to make the phone call to the prescriber about a prescriber’s choice in medication. How does a pharmacist approach it to not look like someone who is pointing out mistakes the prescriber made and at the same time can convince a change if you really believe it? I hear pharmacists in the field make comments about physicians’ personalities and how one physician always says no to any recommendation and another physician is just plain “not nice.” What one pharmacist may think as “not nice” another pharmacist may interpret in a different way. Hospitals many times are using clinical pharmacists to manage medications with a cost savings plan in mind and that aspect can sometimes clash with what the prescriber believes when medicine was more of an art and less money, or it could mean that the pharmacist is bringing a valuable piece of knowledge to the table that the prescriber will appreciate. Whatever the reason, learning how to approach the physician and using it as an opportunity to improve the approach and delivery can make rejection turn into a positive rather than a negative.

Overcome the fear of rejection: One of the reasons why we have such fear of rejection is that we take rejection personally. Rejections are not personal. The prescriber or manager did not reject YOU but the proposal or effort was rejected. Of course rejection should not make you feel less, but it somehow can. Don’t let it, dive in and ask why the recommendation isn’t accepted, move on. The more you ask and are rejected (or accepted!) the less it will sting. If a pharmacist can learn how to detach emotions from the results, whether a yes or a no, it will help gain real confidence in the face of possible rejection. Building a relationship with the prescriber by actually being physically on the floor and picking up the phone helps as well. Leaving a note on a chart doesn’t help build a relationship and can easily be ignored but asserting yourself helps not only improve your relationship with the prescriber but also gives the prescriber a chance to hear and respond in real-time to a request. And the more you are rejected, the less it will sting and in the meantime the prescriber is getting to know you better.

What if a prescriber responds with a no? What if you asked the right questions to find out about the no? You could learn a lot as to why your idea to change something was rejected or you could just learn it is the prescriber’s prerogative. If all of this is handled well, you could use that no to help build a relationship and eventually trust.

This is a study that reviewed inpatient pharmacy recommendations and their acceptance rate. Perhaps if we focused a little more on approach and building a relationship with the prescribers, the number of acceptances would increase and make more of a difference. In the meantime, don’t let a rejection keep you from asking and asking well. Those rejections help teach you how to handle rejection better which could be the very thing keeping you from excelling as a clinical pharmacist.

Should Pharmacists Become Board Certified?

I enjoy brainstorming with other pharmacists on becoming board certified.

I remember back in 1998-1999, the assistant dean of my alma mater, the University of Tennessee at Memphis, stressed how important it was to consider residency and board certification. At the time, I was 25 years old and making decisions that would impact me for life.

I decided back then to decline that path. I only saw the dollars that were before me in retail pharmacy and the student loan debt approaching 6 figures. So, I quipped, "Why would I want to work for half pay or less for a whole year?" and "Why would I want to spend money and time to become board certified when there are no immediate financial rewards?"

Hindsight is 20/20. Fast forward to a 40-something in the profession for more than 14 years experiencing all sorts of different pharmacy experiences. After trying most, I have regrets regarding my earlier decisions. I regret not doing a rotation overseas. I regret not doing a residency. I regret that I dismissed it all for more money.

I know that not everyone feels like me, and that is understandable. Perhaps I am just a different sort who realized fairly quickly that I was falling behind. Whatever the reason, I decided to pursue a Board Certified Pharmacotherapy Specialist (BCPS) certification a couple of years ago. I work in a small community setting in a smaller city, and although it is nothing like Memphis in terms of clinical opportunities, such opportunities can be found with a little luck. Passing the test was probably up there with my other personal accomplishments.

Why should you become board certified?

  1. According to the Board of Pharmacy Specialties (BPS) website, "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, but most BCPS-certified pharmacists I have spoken with did not receive a raise unless they changed jobs. While BCPS certification may have helped with landing a clinical job in the past, it might just be something to separate you from a PharmD without BCPS on any pharmacist job interview today.

  2. If you have been out of school for more than 5 years, I bet you have already forgotten some of what you have learned. You can either depend on your local hospital's computer system to remind you of every little thing OR you can take charge of what you know and remain committed to being the best pharmacist you can be. Think of it like this: if you work in a hospital and are commanding larger salaries than new graduates with fresher knowledge, there comes a point at which you are replaceable. Remain competitive in your field, which means using continuing education to really learn something, rather than last-minute cramming to renew your state license.

  3. A paper published in 2006 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 in both clinical and staff positions. As pharmacists move in the direction of becoming reimbursed professionals for optimizing medications, there will be a trend toward licensing agencies requiring board certification in certain scenarios. Sure, that is not the case today, but if you would have told me in 2000 that the market would be in its current shape with oversaturation and residency demand, then I would have done things very differently in 1999-2002.

  4. The PharmD curriculum is not enough to get you in sync with other health care 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 new graduates in clinical positions without experience and expecting them to build relationships with clinicians is not the best-case scenario for building pharmacist clinical teams. Requiring board certification ensures a higher level of expertise and is moving toward becoming a requirement in many hospitals. The benefits in just preparing and studying for the test are immense, in my experience.

  5. Last, but not least, you should become board certified to give your patients the best care possible. This was my number 1 reason. I remember the day when I sat at my desk years ago and realized I had no idea about new practice guidelines and that order entry had essentially turned me into a robot dependent on the computer. I realized that it was time to make some personal changes that would cost me both dollar and time, yet result in amazing benefits for my patients.  

Most pharmacists are reluctant to pursue BCPS certification because no one wants to fail, much less fail twice. Although it is humbling to fail once, it is euphoric to pass, even the second time.

I hope to inspire more pharmacists to be their best in our profession. If you fail, realize that any amount of learning will significantly change how you practice pharmacy. 

California Pharmacists Will Soon Dispense Naloxone for Opioid Overdose

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California legislation will soon allow pharmacists to dispense naloxone without a prescription for opioid overdose according to the Pharmacy Naloxone Bill (AB 1535).

Naloxone is an opioid antagonist that competes and displaces opioids at opiod receptor sites. In opioid overdose, adults would take 0.4 to 2 mg IV every 2-3 minutes as needed. Repeated doses may be needed every 20 to 60 minutes, bit if no response is observed after 10 mg, the diagnosis should be questioned. Adverse reactions are mostly related to reversal of dependency/withdrawal including GI, cardiovascular, CNS and respiratory effects. 

Beginning January 1, 2015, California pharmacists can furnish naloxone to family members of patients at risk for overdose, those who might be in contact with someone at risk for OD, or anyone who requests the drug. Guidelines will be developed by the state's boards of pharmacy and medicine.

This is a great step for pharmacists combating a problem: drug overdoses.  Drug overdoses kill more people each year than either cars or guns. In 2010, the CDC reported, 38,329 people died of drug overdoses (mostly opioid related).

Read this article from back in February by Maia Szalavitz with Time Magazine, "Wider Use of Antidote Could Lower Overdose Deaths by Nearly 50%."



Pills, Thrills and Methadone Spills!

I have an exciting giveaway to mention!  A fellow twitter pharmacist has written a book available on amazon kindle!

Mr Dispenser is  a community pharmacist from England and has written a funny book about pharmacy called ‘Pills, Thrills and Methadone Spills: The Adventures of a Community Pharmacist’.
It’s a collection of the best blogs, tweets and anecdotes about the wonderful world of pharmacy.
There is a chapter of American anecdotes in there.

Get your Kindle version here: Paperback copy 

5% of sales are going to  Pharmacist Support which is a UK pharmacist charity.

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Retweet this post or share on Facebook for a chance to win a free copy!  Winner will be decided this coming Monday at noon!  Post a comment on THIS POST saying you retweeted or shared.  Drawing will be random!

 

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

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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. BestJobs2013#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.

 

The Power of Quizlet and Studying for the BCPS 2013

Quizlet is an amazing online flashcard storage site where there are many many sets of different types of collections of cards or "sets" to study.  I do not remember exactly how I found Quizlet, but suffice it to say that it is a great resource.  I am "lofgrenb" on there if you are looking for me.  I have tons of sets that are mostly set to private, but would be glad to share.  Just message me. Basically you create a profile either by hand or like everything else out there on the interwebs, just link it to your Facebook, because you KNOW you want everyone to know your business.  (wink wink)

In the "search Quizlet" box, you will type in BCPS.  Right now it's 2012 and 2011 cards that pop up, but as more and more BCPS pharmacists-to-be (including me) start creating new sets, you will be able to see them.  There is a "copy" button where you can copy the entire set that the user spent hours on and make it your own.  I know, slick right?  I have done a bit of both:  making my own and copying others and then editing to my liking.  Since there isn't a lot of ACCP material on regulations and stats, I highly recommend taking a look at some sets I like at the moment.

This is a regulatory one.

 

 

See this user:  rx_jenn:  All of her sets are fabulous.

If anyone knows her, tell her Blonde Pharmacist thanks her.  I should have spent a little more time studying to pass rather than barely failing, but I'm ready to tackle the beast again.

Anyone want to join in on flashcard creating?

Anyone up for meeting in Reno, NV at the ACCP 2013 Update in Therapeutics?  I will be there!

Pharmacy Residency or Not?

Pharmacy Resident Yes or No?If you were a manager or director of a hospital pharmacy, what candidate would be the most desirable for your team:

  1. A fresh-out-of-school pharmacist who just passed the boards
  2. A fresh-out-of-school pharmacist a year ago that just completed a residency
  3. 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.

BCPS 2012 Results: Blonde Pharmacist will repeat!

BCPS Pharmacotherapy ExamSo the results are rolling in now, and if you are at all finding this post because you are frantic about finding your results, you will know today or early next week.  Mine arrived yesterday and though I am a bit disappointed, I am ready to start studying again as soon as Christmas is over.  In hindsight, since it is 20/20, I can say I am proud of how I did.  I graduated with a Doctor of Pharmacy in 1999.  Things have changed a lot since then, including my personal life.  I now manage two toddlers, a full-time job, and a part-time gig.  (Multi-task much?)  I have dreams of all kinds as far as online things are concerned, want to change the world, and decided to take this BCPS challenge on as a way to propel myself, not only in my current knowledge, but as a great resume builder.  There are many reasons pharmacists take this test. The passing score this year is 122.  The average was 130.  The range was 50-188.  Standard deviation 25.

Domain 1:  Maximum score 120, Average score 77

Domain 2:  Maximum score 50, Average score 33

Domain 3:  Maximum score 30, Average score 20

I missed it by very little.  I am not at all upset and depressed or any of that.  I went into it as a practice because being out of school for 13.5 years is very significant.  New drugs have arrived, new guidelines have changed the scope of practice, and residency trained pharmacists along with newer grads (>3 yrs) are the majority of the test takers.  This last point may be an incorrect assumption because I do remember a couple of ladies I met who "had something to prove to the younger pharmacists."  I truly hope both of them passed because those are the types that will be a lot more disappointed with a fail letter than me.  I have a pharmacist friend that was so upset with her fail that she refused to talk to anyone about it and threw away all the material.  I guess if I went into it thinking I would pass, I would feel that way.

Do I plan to retake?

YES.

That was my plan all along, ask anyone who knows me.  I know that many may have thought my comments of "It was tricky.  I know I didn't pass or if I did 'barely.'" was an attempt to pretend or whatever, but it was the truth.

It was tricky.

Know your guidelines.

Realize that A LOT of studying is required unless you have a very diverse clinical program at your large hospital.  For example, we don't see any trauma, very few TPNs, and other big topics on the test.

And if you have children, especially babies/toddlers... it is VERY tough.  Where is the time?

I should have taken this back when I had a more clinical position at a larger hospital, wasn't married, and certainly had no children absorbing every single free moment.  So if that's your current situation, PLEASE for the love of God take the test.  It will be tougher later.  I am PROOF!

So there.  There's my result (missed it by just a hair)... and had I taken it last year (passing was 111) I would have passed by several points.

Every year is different.

I plan to start studying very soon.  May start listening to the lectures in my family van (HA) starting now since I know.

Nothing hard should be attained easily.

 

The Perfect Medical Model

I have been doing a lot of thinking lately in regards to my career.  I am still in waiting mode about the BCPS exam, but in the meantime have spent some time making lists of how pharmacists are utilized and even on a smaller level within pharmacy departments.  You see, it is tough being on this side of a career.  I guess you could say I'm in the middle in regards to time and experience.  I have been a pharmacist now for thirteen years. I have watched, usually with protest unfortunately, as pharmacists are labeled and grouped depending on different criteria.  Back in 1999, it was about having a residency in order to be a "clinical" pharmacist.  That is still the case today except in the smaller hospital where residency trained pharmacists aren't in supply.  Other criteria is used at that point.

In a perfect medical model, especially in the small hospital, I think it would be beneficial if the physician handled diagnoses, testing, and collaborated with the clinical pharmacist for treatment.  It is fairly obvious when you study the medical school curriculum that the focus is on diagnosis.  Yes, it is important to know what we are treating, but it does no good if you throwing ertapenem at pseudomonas or if you are dosing vancomycin at 1 gm every 12 hours in a young obese man for MRSA.

Hospitals really should consider encouraging all their pharmacists, especially PharmDs to learn the material that the BCPS requires.  It has seriously helped me in the past several months personally.  It is worth the investment of money and time and makes a FABULOUS resume' builder.

And in the end, it's about the patient receiving the best care possible.  Wouldn't a collaboration encourage that?

BCPS 2012 | a small review of my thoughts of the test

The BCPS is the abbreviation for Board Certified Pharmacotherapy Specialist.  Basically according to the BPS website:

Pharmacotherapy is that area of pharmacy practice that is responsible for ensuring the safe, appropriate, and economical use of drugs in patient care. The pharmacotherapy specialist has responsibility for direct patient care, often functions as a member of a multidisciplinary team and is frequently the primary source of drug information for other healthcare professionals. Those who are granted certification in this specialty may use the designation Board Certified Pharmacotherapy Specialist and the initials BCPS, as long as certification is valid.

So, this is what I have been doing with every (or most) every free moment since April.  It is over now, and this is the first day I have had to sit and reflect.  I did not have the opportunity to finish the review of the test itself, and I was seated last (my own choice) for the second part so did not receive the handwritten review of the test.  I really spent all my time on the test itself, and my feedback wasn't given.

I wish it had been in hindsight.

I signed this paragraph at the beginning of the test but I don't remember what it said.  Something about not trying to memorize the test itself or copying the questions in any way.  So with that in mind, my review will not be specific but broad.

I am a hospital pharmacist who graduated in 1999 from the University of TN School of Pharmacy.  At the time we were rated number 7 in the United States, and I have never had any issues with being clinical minded in the jobs that required that role in the past 13 years.  Times have changed.  Schools have multiplied, and the residency which was a "side thought" in 1999 is a must today.  BCPS certification is also important if one did not do a residency or the cherry on the top if you did.

So, I decided at the ripe old age of 39 to study like a fiend and pay all sort of money to this organization to have study materials including written, web, and audio.  I spent most days listening to the likes of pharmacy lecturers discuss things from stats to ID to cardiology to oncology to nephrology.  It kind of made me realize I haven't really been using my brain at work, and to all the patients out there I have treated, I am sorry I haven't been a more thorough and clinically-minded pharmacist.

You see, an order entry pharmacist enters orders and most of the time relies on the computer system itself to flag for interactions and other things, but you know what?  Just yesterday I found something pretty profound.  The computer fails.  I found a place in our current process where I made a difference.  Just one of the many that are to come.

The test:  200 questions.  2 sections of 100 questions each.  I found the first part harder; but many I heard said the reverse.  I have always been the one marching at the beat of a different drummer.  Topics:  tons of stats, pharmacy regulations was everywhere.  I wasn't prepared for regs.  Psoriasis.  Acne.  Both of those disappointing as I haven't had an acute admission to the hospital yet for either.  And I have not found acne guidelines with the American  Dermatological Society yet.  I know I missed the psoriasis question.  Tons of COPD, albuterol, and not so much STEMI.  Angina more stressed.  Maybe due to the new Chest Guidelines that came out.  One chemo question I remember.  Tons of stats.  Did I already say that?

There were a couple kinetics questions.  Guess what?  I bought a $5 cheapie calculator from Walgreens that died.  YEP.  I had THAT luck.

Temperature was given in C rather than F.  I was bummed about that.  Guess it's time to join the rest of the world on that one!

There was one INR question I remember.  Pretty specific.  I got it right ;).

And the usual question that appears every year was there.  I don't think I can say what it is on here, but if you talk to anyone that has taken the test, they can tell you what it is ;).

Psychiatry a couple of times.  All side effects of drugs.  CYP3A4.  All CYP really.  Pharmacoeconomics more than I would have liked.

Guideline driven.  Mostly accp.com material so would recommend studying that.  Keep in mind if there's something not in that material though, you may want to find a review book to read on the side.

If I failed, which is possible (last year passed 70% of test takers with cut-off being 111/200 or so) I will retake it again next October.  I really liked the challenge, liked the things I have learned, and like the possibility of continuing my education in this field to grow in my career.

What did I study?

1.  ACCP materials.  I purchased the slides, handouts, and audio to listen in the car on my iPhone.

2.  http://quizlet.com/  There were tons of BCPS flashcards made by some pretty smart pharmacists.  Just search BCPS on Quizlet.

3.  High Yield Med Reviews  We will see how this goes.  It's a subscription service with test questions.  I think it helped me.  I will probably resubscribe around July if I failed for next year.

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