Pharmacy Residency or Not?

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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.

Tamiflu: Prepared From Tamiflu Capsules

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Extemporaneously Prepared

TamifluIf the commercially prepared oral suspension is not available, the manufacturer provides the following compounding information to prepare a 6 mg/mLsuspension in emergency situations.

1. Place the specified amount of water into a polyethyleneterephthalate (PET) or glass bottle.

2. Carefully separate the capsule body and cap and pour the contents of the required number of 75 mg capsules into the PET or glass bottle.

3. Gently swirl the suspension to ensure adequate wetting of the powder for at least 2 minutes.

4. Slowly add the specified amount of vehicle to the bottle.

5. Close the bottle using a child-resistant cap and shake well for 30 seconds to completely dissolve the active drug.

6. Label “Shake Well Before Use.”

Stable for 35 days refrigerated or 5 days at room temperature. Shake gently prior to use. Do not dispense with dosing device provided with commercially-available product.

Preparation of Oseltamivir 6 mg/mL Suspension
Body Weight Total Volume per Patient1 # of 75 mg Capsules2 Required Volume of Water Required Volume of Vehicle2,3 Treatment Dose (wt based)4 Prophylactic Dose (wt based)4
1Entire course of therapy.
2Based on total volume per patient.
3Acceptable vehicles are cherry syrup, Ora-Sweet® SF, or simple syrup.
4Using 6 mg/mL suspension.
≤15 kg 75 mL 6 5 mL 69 mL 5 mL (30 mg) twice daily for 5 days 5 mL (30 mg) once daily for 10 days
16-23 kg 100 mL 8 7 mL 91 mL 7.5 mL (45 mg) twice daily for 5 days 7.5 mL (45 mg) once daily for 10 days
24-40 kg 125 mL 10 8 mL 115 mL 10 mL (60 mg) twice daily for 5 days 10 mL (60 mg) once daily for 10 days
≥41 kg 150 mL 12 10 mL 137 mL 12.5 mL (75 mg) twice daily for 5 days 12.5 mL (75 mg) once daily for 10 days
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BCPS 2012 Results: Blonde Pharmacist will repeat!

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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.

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Antidepressants and High Blood Pressure

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Unfortunately, you may have to try several different antidepressants until you find the one that is right for you and your symptoms.  If you have depression and high blood pressure, you have to find the right med that won't exacerbate blood pressure. A good physician will find out several things.  First, he/she will examine you and your symptoms and take into consideration medications that have worked for others in your family.  Usually someone presenting with blood pressure and depression will have someone else in their family suffering with the same thing.  He/she should ask what other medications you are taking.  You don't want to select a drug that will interact with something you are already on.  For example, if you are taking imitrex for headaches, I wouldn't want to see an SSRI added, or maybe change the imitrex to something else.

A good physician should also ask what other conditions you suffer from, if you are pregnant or breastfeeding, what symptoms you are experiencing, and even what insurance you have or what will be covered.  I know this last one is overlooked, but if a patient can't afford a medicine, what is the point of even seeing a physician if cost isn't taken into consideration DURING the visit.

There are a few antidepressants that are documented to possibly cause an increase in blood pressure.  Bupropion (Wellbutrin, Zyban), venlafaxine (Effexor), and duloxetine (Cymbalta) are a few.  Ironically enough there are some studies out there to show that depression itself can cause a decrease in blood pressure and treating depression an increase.

Keep in mind, these medications are not off the table for treating depression, your physician just may have to adjust your blood pressure medications while you are taking antidepressants.  Close monitoring, adherence to regimen and lifestyle changes can make this situation a lot better.

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Just Take Care of Yourself

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Sitting in the waiting room of a pain clinic is more uncomfortable to me than seeing a cop's blue lights in my rear view mirror. Not only is it fairly evident that people in my area do not take care of themselves, I wonder why in the heck do I have to visit this place every six months or so? I have a very shoddy lower lumbar. The rest of my back is great, but for some reason God saw it fit for me to have some crappy genetics coupled with a severe love of running. I use the word severe because it is no secret that eventually most runners will have joint problems, and a severe love so great that it is worth the pain is nuts. There, I said it. I like to run. Even when it hurts. So I use radio frequency lesioning (RFL) to burn the nerves (they grow back) so I don't feel the pain in my lower back.

I watched a woman roll into the waiting room this morning still dressed in pajamas. She looked to be around 400 lbs, and I wonder, how have we allowed ourselves to get to the point where a donut or ten is worth being on a ton of medicine? How can we look in the mirror every day and know we are slowly poisoning ourselves? I'm preaching to the choir here because my diet is crap. Another patient limped in. He hadn't taken care of himself. I sort of stuck out like a sore thumb. This is a good thing.

These pain clinic docs would be out of a job if people took care of themselves!

A good friend of mine sent me this link: Why You Should Not Go to Medical School. Basically it really settled some things that my subconscious mind already knew. Although my dad wanted me to be a doctor, he had no idea what kind of life that would entail. It would mean telling someone to lose that weight so you could get off all the pain and hypertension meds. It would mean knowing that most wouldn't give a rats' ass and keep on stuffing their face with processed sugary foods contributing to diabetes and the like. I'm glad I didn't go to medical school. I'm not so sure I'm glad I chose pharmacy, but I seem to be pretty good at it.

The Perfect Medical Model

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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?

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Fungal Meningitis and the End of Lackadaisical FDA Involvement in Compound Pharmacies

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New England Compounding Center (NECC) is at the center of this quite horrific tragedy that has affected the lives of many with fourteen already dead. I cannot personally fathom such a loss over something so seemingly accidental. As a pharmacist my thoughts immediately go to sterile technique and the FDA's regulation of our industry. You see, the states oversee the pharmacies compounding and normally that should be enough. However, something went terribly wrong here. But what is coming out lately is the role of compounding pharmacies and how in this case, there was a grey area they were working in. Basically compound pharmacies can make patient specific medications, what is not allowed is these compounding pharmacies acting as manufacturing and bulk shipping repackaged medications without FDA oversight.

It's all about the dollar, but in this case many priceless lives have been lost.

There are two fungi involved: aspergillus and Exserohilum rostratum.

In the past, these pharmacies have been the heroes making things like bioidentical hormones and other specialty concoctions.

Under the FDA's definition, compounding pharmacies are supposed to mix drugs to order only on a specific patient in response to a prescription from a doctor. Under this definition NECC was not operating as a compounding pharmacy but as a large-scale production of a drug. The FDa should have stepped in before these lives were lost.

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

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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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Drugmonkey Was Dooced by Rite-Aid

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Follow my blog with Bloglovin I've often had fears in the past about blogging.  I know I have personally taken great care to not blog about where I work, personal information regarding work (HIPAA violations), negative posts about current management, or anything that would seem inappropriate from the standpoint of the corporation I draw my living.  To be honest, I don't work for a retail big pharma organization as this blogger did.  I USED to work for Eckerd before it was bought (I think?) by Rite Aid, and I do remember the day-to-day struggles.  It was the reason I begged for a home health infusion job with a $20,000 pay cut per year just to leave retail forever back in 2002.  Back then though... retail jobs were a dime a dozen.  I don't know how it is where Drugmonkey lives today (CA, I think?) but here... crickets.

David Stanley (Drugmonkey).  Seemingly someone I would want on my team, perhaps.  Seemingly someone who tells it like it is and also writes for Drug Topics.  Well, he was fired by Rite-Aid.  And though he and I are different in many ways (political, for one), I kind of like to imagine had I stayed in retail ten years ago this is what I would have become.  I do believe that this is his chance to change and that something so out-of-ordinary as firing for a blog post (which has happened before... thus the term Dooced) can turn into something better.  He deserves better than Rite-Aid!

Did you know he can write really well?  No I'm not saying he can write well.  He can write really REALLY well.

Rite-Aid was probably scared of that and waiting for the perfect post to bring down the guillotine to his career with Rite-Aid.  What they didn't expect though is the result of this firing and what this is going to do to their company.

I'm expecting to see this story go viral, only if enough people get a hold of it and pass it on.

Rite-Aid fires pharmacist for a blog post.

Pass it on...

From Drug Topics by David Stanley, RPh just a few days ago:
Members of seven Southern California locals of the United Food and Commercial Workers (UFCW) have voted to reject a contract offer from drug retailer Rite Aid and to authorize union leaders to call a strike if an agreement can’t be reached.

Although specific numbers weren’t immediately released, the union called the vote, which took place from July 26 through July 30, “overwhelming” and said in a statement, “The members’ emphatic rejection of Rite Aid’s demands and their vote for strike authorization will push management toward negotiating an agreement the workers can ratify.”

According to the same statement, the UFCW says that Rite Aid is seeking 34 concessions from workers, including:

• Effective elimination of healthcare for workers' spouses and children

• An increase in out-of-pocket costs for healthcare benefits of up to $10,000 a year

• Virtual elimination of all accumulated sick leave pay

• Reduction of the number of hours workers are allowed to work

• Elimination of the 40-hour work week and 24-hour guarantee for part-time employees

In a statement of its own, Rite Aid announced, “The specifics of our proposal are matters we will be discussing at the bargaining table with the Union as we continue to work hard to reach a fair agreement for all involved.

“We’re disappointed that the Union has called for a strike authorization vote and think such a vote is premature, especially since the Union hasn’t even given us a counter proposal to our first proposal.”

The proposal would affect all store employees except store managers, including pharmacists, at Rite Aid locations from Kern County south to the Mexican border. The soonest a strike could begin would be August 8, 72 hours after the current contract extension is set to expire.

The union is also currently in negotiations with CVS/Caremark.

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BCPS - some flashcards from quizlet

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So as promised, I'm sitting here studying (not really) for the BCPS and wanted to share with you some flashcards that I have found online.  I did personally purchase the ACCP study materials in print and I bought last year's audio lectures.  I really don't think I have enough time to devote entirely the amount of time that I need; however, I'm going to just go for it.  If I fail, I will retake in 2013.  Goals.  You need goals in your personal and professional life, ok? Enjoy.  I would like to personally thank the pharmacists that created these.  I've made a few sets, but once I stumbled upon these I realized it is all about studying smarter, correct? So today's set:  GI

Choose a Study ModeScatterLearnFlashcards

This should get you going.  Better yet go to http://www.quizlet.com and search "BCPS."  I promise you'll find a lot of study materials that will help.

There's a study guide online.  Of course we are almost two months out.  (UNREAL):
Jul 23 Amb Care
Outpt Cards
M/W Health
Jul 30 GI
Nephrology
Oncology
Aug 06 Biostats
Policy/Practice
Economics
Aug 13 Pediatrics
Geriatrics
Kinetics
Aug 20 Neurology
Psychiatry
Fluids/Elytes
Aug 27 Ac Care Cards
Crit Care
Sep 03 ID
HIV/ID
Endocrine
Sep 10 Amb Care
Outpt Cards
M/W Health
Sep 17 GI
Nephrology
Oncology
Sep 24 Free Study
Oct 01 Free Study
Oct 06, 2012 BCPS Exam

I am also subscribed to http://www.highyieldmedreviews.com.  We'll see if it helps after October 6th, right?