We've touched on this subject during discussion and via comments the past few weeks. A few of the articles I've provided as background reading focus on it as well.
Before we address the pharmacy side of this issue, let's examine what our colleagues in medicine are required to do. Medical school graduates are required to complete at least 3 years of residency to practice autonomously as a physician in the civilian world (I say civilian because I think you can get away with less in some/all branches of the military). If they have a desire to become an endocrinologist, cardiologist, oncologist, a surgeon, etc. - then add two to seven years on top of that.
Now back to pharmacy. I've heard it said and seen it written a number of times that, "...if your PharmD program doesn't prepare you to practice as a clinical pharmacist by the time you graduate - you went to the wrong school!" Whoa! My interpretation of statements like these is that we as pharmacy educators should be trying to teach you everything and should expect you to learn everything. All of the physiology, pathophysiology, drug mechanisms, pharmacotherapy and all the changes that occur as you're moving through the curriculum....oh, and learn to communicate with patients, peers and other healthcare professionals...and give presentations and develop your business and leadership skills and...really? In four years? Maybe the reason it takes someone 13-15 years to go from high school graduate to practicing endocrinologist is because it simply takes that long to learn how to do it.
So, chew on this for next week: Based on our discussions leading up to this week and today's post, should we rethink postgraduate training for pharmacists? If so, how would you change it? If not, why do you feel a change isn't warranted or the current system is adequate?
Consider the pot stirred. 8^P
12 comments:
If postgraduate training is required, do you think there should be an increase in pay?
Do you think it's better for the profession to have more training before entering pharmacy school (bachelors) or after pharmacy school (postgraduate training)?
Do you feel that it is more beneficial to have a completion of a bachelor's degree, post graduate training, or both to provide optimal patient care?
Do you think monetary compensation for providing direct patient care or cognitive services could incite students to go for postgraduate education?
For those of you that completed a bachelors degree before doing your Pharm. D, did it help you in pharmacy school? For those of you that completed a postgraduate residency after pharmacy school, did it help you get your current job?
I definitely think that pharmacists with additional training (residency) should receive higher pay then someone that has not acquired this additional training.
It would be more beneficial if pharmacy students had more hands on training. For instance, having more intense book work for 2 to 3 years followed by 2 years of rotations. It would also make sense to have rotations mixed in with the book work so that principals learned could be applied directly to practice. It would also be helpful to work on teams with other healthcare professionals earlier then later so that other healthcare professionals learn to importance of having a pharmacist on their patient care team.
I think students should look at more then just compensation. It is always a good idea to step back and ask yourself what would be rewarding to you when you graduate. Most of our time is spent at a job so why not enjoy it. I talk to many of my friends that opted for retail pharmacy right out of school due to the monetary compensation. Everytime I talk to them, they seem extremely unhappy and not very career satisfied.
Although, there was a delay in monetary compensation since I completed a residency right after school. I can definitely say that I have enjoyed all the different job opportunities that I have been able to land due to my additional training. Completing a residency allows more networking and opens more doors then just graduating with a PharmD degree. Don't limit your options. Start researching now to find out what is available and what those positions require once you have graduated. It is always helpful to network with current pharmacists and find out if you can shadow them to find out how they obtained their current and previous positions.
Postgraduate Training may or may not be for every person. I truly enjoyed my clinical rotations and I even entered the ASHP pool to do a residency and even interviewed for a residency. I didn't send in my choices though because after a lot of consideration I decided that I would miss the patient contact I get in the retail setting. That was why I went into pharmacy. That is what a person has to look at. Why did they choose this field? Money? Practice options? Patient aid? Etc. Not to say that a person cannot have patient contact after doing extensive postgraduate training. I still feel that the training that most schools give during their programs is very good and does prepare most dedicated students for practicing pharmacy. Obviously if one wanted to specialize in a certain area, then certainly more training should be required. Also, some employers prefer residencies and it does give more opportunities, but currently for all clinical positions, especially in smaller communities, residencies are not required.
It all depends on where you want to work, what kind of work you want to do, and what your preferences are.
This is Zack...
I must disclose my bias to this posting since I am currently a resident.
Despite the stress of the application and interview process and all the work required during the residency year I know that this will pay off in the end. I am experiencing things most new grads cannot be exposed to right out of school.
Pharmacy school gives you a foundation to build upon. Most importantly you learn where to look things up. And when you complain about having to know doses of drugs for a test…you may want to think twice…you will need to know dosing in real life and physicians will expect you to know this :) Residency will allow you to dig deeper in an intense and structured environment. Now that I am out of school and licensed the training wheels of school are off but the preceptors in your program (especially for PGY1s) have their hand on the seat post. This new autonomy forces you to grow as a new clinician as you realize that now your interventions really will reach the patient.
I already feel that I have grown as a pharmacist in the short amount of time I have been a resident. My residency program has forced me to “rise to the occasion” in many areas. My administration rotation involved me in the actual interviewing and hiring of pharmacists and technicians. The following rotation, cardiac surgery ICU has allowed me to care for many complex patients and I interact with highly respected surgeons, anesthesiologists and cardiologists on a daily basis. Fortunately these practitioners are used to rounding with a clinical pharmacist on service but that also means they expect a lot out of you. We routinely see CABGs and have had total artificial hearts, transplants and even a Jarvik 2000 artificial heart (I was able to meet Dr. Jarvik from the Lipitor commercial). I was assigned P3 practicum students from the school of pharmacy and jumped into a role as clinical preceptor only 5 months out of school. I also see my own patients through a longitudinal Pharmacy Services Clinic. We routinely have medical and pharmacy students and now I am the one to check blood pressures behind the students. I also received BLS/ACLS training and have been carrying the pediatric code pager this month.
After four years tuition at a private (or any) pharmacy school, compensation plays a very large role in deciding what to do upon graduation. Currently tuition reimbursement is largely available through retail chains and with staff pharmacy positions at hospitals. Assistance for those interested in research, academia or clinical pharmacy is quite slim. Some help is available through the federal government (Armed Services, IHS/Commissioned Corp, Bureau of Prisons, NHSC or the VA health-system). Several states have developed programs for pharmacists who work in underserved areas. The Pharmacy Education Act of 2001 and 2003 was proposed but did not make it through the House. I feel that more tuition help for pharmacy students will encourage students to pursue a residency.
Monetary compensation for cognitive services would potentially help. If pharmacists could be less tied to dispensing fees for compensation we could more easily pursue other areas of patient care. A lot of our work is justified through prevention (such as preventing ED admissions). I think we need to define direct patient care before a residency is required…unless it is required for everyone. One could argue that all pharmacists are involved in direct patient care (especially community pharmacists).
I cannot speak on the benefit of a bachelors degree. I completed 3 years of pre pharmacy with some additional anatomy/physiology/biochem courses that were likely helpful in pharmacy school but not having a 4-year degree has not been a major issue for me. The greatest benefit has been from my choice to complete a residency. The hours have been long and I staff every other weekend but the growth I have realized in 2.5 month is remarkable and will continue over the course of the year.
Short answer: residencies may not be required for all career paths (we need to define direct patient care) and PharmD school cannot offer the same experience, finances commonly complicate the decision (more needs to be done with tuition forgiveness) but the long-term benefits of choosing to complete one are tremendous.
ZD
This is Zack...
I must disclose my bias to this posting since I am currently a resident.
Despite the stress of the application and interview process and all the work required during the residency year I know that this will pay off in the end. I am experiencing things most new grads cannot be exposed to right out of school.
Pharmacy school gives you a foundation to build upon. Most importantly you learn where to look things up. And when you complain about having to know doses of drugs for a test…you may want to think twice…you will need to know dosing in real life and physicians will expect you to know this :) Residency will allow you to dig deeper in an intense and structured environment. Now that I am out of school and licensed the training wheels of school are off but the preceptors in your program (especially for PGY1s) have their hand on the seat post. This new autonomy forces you to grow as a new clinician as you realize that now your interventions really will reach the patient.
I already feel that I have grown as a pharmacist in the short amount of time I have been a resident. My residency program has forced me to “rise to the occasion” in many areas. My administration rotation involved me in the actual interviewing and hiring of pharmacists and technicians. The following rotation, cardiac surgery ICU has allowed me to care for many complex patients and I interact with highly respected surgeons, anesthesiologists and cardiologists on a daily basis. Fortunately these practitioners are used to rounding with a clinical pharmacist on service but that also means they expect a lot out of you. We routinely see CABGs and have had total artificial hearts, transplants and even a Jarvik 2000 artificial heart (I was able to meet Dr. Jarvik from the Lipitor commercial). I was assigned P3 practicum students from the school of pharmacy and jumped into a role as clinical preceptor only 5 months out of school. I also see my own patients through a longitudinal Pharmacy Services Clinic. We routinely have medical and pharmacy students and now I am the one to check blood pressures behind the students. I also received BLS/ACLS training and have been carrying the pediatric code pager this month.
After four years tuition at a private (or any) pharmacy school, compensation plays a very large role in deciding what to do upon graduation. Currently tuition reimbursement is largely available through retail chains and with staff pharmacy positions at hospitals. Assistance for those interested in research, academia or clinical pharmacy is quite slim. Some help is available through the federal government (Armed Services, IHS/Commissioned Corp, Bureau of Prisons, NHSC or the VA health-system). Several states have developed programs for pharmacists who work in underserved areas. The Pharmacy Education Act of 2001 and 2003 was proposed but did not make it through the House. I feel that more tuition help for pharmacy students will encourage students to pursue a residency.
Monetary compensation for cognitive services would potentially help. If pharmacists could be less tied to dispensing fees for compensation we could more easily pursue other areas of patient care. A lot of our work is justified through prevention (such as preventing ED admissions). I think we need to define direct patient care before a residency is required…unless it is required for everyone. One could argue that all pharmacists are involved in direct patient care (especially community pharmacists).
I cannot speak on the benefit of a bachelors degree. I completed 3 years of pre pharmacy with some additional anatomy/physiology/biochem courses that were likely helpful in pharmacy school but not having a 4-year degree has not been a major issue for me. The greatest benefit has been from my choice to complete a residency. The hours have been long and I staff every other weekend but the growth I have realized in 2.5 month is remarkable and will continue over the course of the year.
Short answer: residencies may not be required for all career paths (we need to define direct patient care) and PharmD school cannot offer the same experience, finances commonly complicate the decision (more needs to be done with tuition forgiveness) but the long-term benefits of choosing to complete one are tremendous.
ZD
To answer the question about having a bachelors degree before going to pharmacy school. I honestly do not think it matters. For me I had three bachelors in the sciences before entering pharmacy school. It helped me out considerable. However I did work for a year in the science related position before I came to Wingate. So I was apply to apply and use things that I learned in undergraduate classes. Others that recieved on prior to school that I know it did not help. Its that learn and dump situation we have all gone through. You know memorize prior to the test then afterwards you go and forget it. With that note that is how I feel about residencies. I took a year off and worked retail applying the fundamentals from class into practice. I hit a wall after about a year. I could not really apply all the clinical skill that we learned. So know I am in a residency program applying the clinical skill we learned in school. Learning new skill that I did not have access to and enhancing my knowledge base.
As for the need for more training in this profession. You never stop learning if you do you might as well retire. It only takes a few month's before you get left behind.
And last of all to answer nicole question. Yes, I think there should be a increase in pay for residents.
I also am biased and should state that I am a first year ambulatory care resident.
Ambulatory care has always been a passion ever since a rotation at Wingate. I really enjoyed my patient interaction and the ability to help patients by preventing hospital and doctor visits. The idea of requiring a pharmacy residency for direct patient care is important for the profession and definitely in my field. When you work retail you have limited effect on outcomes of the patient, minus preventing unsafe drug practices. My profession gives the point of view of guiding therapy at the primary point of contact...in the clinic. This requires a lot of practice with other practitioners and colleagues to achieve these goals. This would be difficult for a normal graduate of a school of pharmacy to achieve right out of school. It takes a broad experience in all types of clinics to develop into a competent practitioner. The statement of requiring a residency for direct patient care makes sense. The more contact you have with a patient, the more other health care providers will expect from those pharmacists. They need to be properly trained to achieve those expectations. A job in a specific area will not provide the broad base on knowledge needed to be effective in my environment. I think the articles for next week also will be interesting discussion as to the role of pharmacist in the 21st century. Pharmacy residency will have a big impact on that role.
Nathan Culver
Ohh and to answer questions above, job satisfaction is payment enough (nicole) hours and lunch time is a great benefit. Training after pharmacy school is way more beneficial who cares about upper level organic chemistry.(blaire/nicole) Monetary compensation would incite students to go into residencies, but then would be there for the wrong reason, so really doesn't accomplish the goal. Residency should always be optional.(Michelle)
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