After reviewing the position statement from ACCP please consider the following:
Do you agree that residency training should be required for all pharmacists participating in direct patient care?
How do you define direct patient care? More specifically, should this apply to all community pharmacists?
Should all pharmacy schools be able to prepare their graduates to function as independent clinical pharmacists by the time they graduate (thus preventing the need for mandatory residencies)?
If residencies were currently required to practice as a community pharmacist, would you still have chosen to enter pharmacy school?
48 comments:
Mandatory residency training for not only clinical pharmacy but also practicing pharmacy is a very great idea. We should be in a higher standard train in order to be prepared and provide better patient care.
We cannot say we are good enough to be a practicing pharmacy without residency. Knowledge is unimaginably large. Therefore, residency will be very helpful for pharmacists.
Also, our goal is direct patient care that means to help them improve their health and have a happy life. We do not become a pharmacists because of money primarily so that we should not concern about salary when doing residency. We should try to learn as much as we can to help our societies.
Doing residency benefits for all of us, bring no harm!
Ngan Tran - P1
I strongly agree that residency training should be required for all pharmacists participating in direct patient care; however I disagree that this should be applied to community pharmacists. According to ACCP, direct patient care means that pharmacists observe patients; then select, modify, and monitor the drug therapy. This is not what community pharmacists are practicing. Although residencies have not been required to practice as a community pharmacist, some of my friends, who are working for Rite Aid, said they use just a partial knowledge they learned from school.
Tai Tran, WUSOP, P1
I agree with Ngan Tran. Our duty as pharmacists is to help patients and cutstomers improve their health and lives. Any opportunity that presents itself that could help the pharmacist improve their abilities to do this should be taken advantage of. Partaking in a residency would only enhance their knowledge and ability to provide quality care to the patient.
When I decided to pursue pharmacy I had only a small glimpse into the vast field I was entering into. Would I need residency for the retail pharmacy I had witnessed? Probably not. Large retail stores I had seen had little time or interest in patient interaction to speak bluntly. That may not have been the company byline but it was what was practiced.
My interest is beyond retail and one of the main reasons I chose WUSOP was because of the immediate immersion into various parts of the field.
Will we have enough time to learn, actually, can we PROVE we UNDERSTAND what we learned by our 4th yr during rotations? My current thought is no, we will be so busy grasping the requirements of the position that we will not necessarily be concentrating on knowledge FROM the position.
Let's hope as WUSOP grads we excel but I am FOR residencies in clinical settings.
Here's a litmus test... how many of us READ all 12 pages? If that was too much to ask (another article? they expect us to read ALL of this?) then I believe this speaks to why residency is needed... many may be able to shortcut studies to pass an exam - but do you want a recent 'shortcut PharmD grad' monitoring your mother's hospital medication? I want someone who has proven themselves with supervision.
Direct patient care, in my opinion, is having any direct involvement with patients, such as checking their blood pressure or blood glucose and administering a vaccination to making rounds with doctors in a clinical setting. I do not think residencies, after pharmacy school, should be mandatory for all pharmacists participating in direct patient care. I think residencies should be mandatory in the event that a pharmacist desires to work in a clinical setting or a specialized area of pharmacy, just as they already are. It would be nice if pharmacy schools were be able to prepare their graduates to function as independent clinical pharmacists by the time they graduate. Perhaps this would eliminate mandatory residencies. However, unless the length of time one must attend pharmacy school is extended by several years, I do not see how pharmacy schools would incorporate this additional training. This would involve training every pharmacy student to be experts in every specialized area of pharmacy, in order to place everyone on a level playing field. If a residency was required to practice as a community pharmacist, I may not have chosen this profession. One reason I chose pharmacy instead of medical school was because a residency is not required.
To the mentors:
To any mentor who completed a residency, what has that residency allowed you to do that you otherwise would not be able to?
P1 - Amanda Flores
I like the current requirements as of Pharmacists today: if you want to work in a hospital then you must do the residency post-graduation and if you want to work in a more retail setting than one can obtain a position right after graduating. I think the current curriculum is set up in a manner that it cannot include the specificity that the residency provides. I like the fact that the residency can provide a more specific setting, in which the student decides if he/she wants to be a part of. As of right now, I do not see myself doing a residency; but if a residency was a requirement to become a pharmacist, I would have still chosen this profession. To me it is more advanced APPE course.
Stephanie Seda P1
YES, I agree that residency training should be required for all pharmacists participating in direct patient care. Not only does this push the whole profession of pharmacy into a higher standard, but it also benefits the patient as more qualified pharmacists, because of the knowledge and experience gained through a residency, are practicing in the field.
I would define direct patient care as any pharmacist who monitors drug therapy for patients. Therefore, I do think mandatory residencies should be required for all community pharmacists since I think the duties of a community pharmacist fall under that definition. Perhaps by elevating our standard for all pharmacists who are involved in direct patient care, which in my opinion includes community pharmacists, we can elevate the entire profession of pharmacy to a higher standard of care and responsibility.
Based on my experience at work and school, I don't believe pharmacy schools can replace the knowledge gained in a residency, and therefore, NO, I do not believe that pharmacy schools can prepare their graduates to function as independent clinical pharmacists by the time they graduate. Therefore, I stand by my conclusions that required residencies cannot be replaced in the classroom. There are just certain aspects of pharmacy that probably won't "click" into place until one is out practicing in a real pharmacy. Thus, residencies should certainly be considered extensions of our schooling as pharmacists participate in them, but not taught in the classroom per say.
If residencies were currently required to practice as a community pharmacist, then YES, I still would have chosen to enter pharmacy school. My decision is based on a few reasons: First, my former job as a pharmacy technician was in a hospital that was deemed a "learning institution," so that we had many pharmacists who were involved in residencies at our hospital. Therefore, I already have a positive impression of residencies and desire to do one myself. Second, although at this point, I don't see myself practicing as a community pharmacist, I still think it would be beneficial to the entire field of pharmacy if all pharmacists involved in direct patient care were required to do residencies. However, I don't foresee many pharmacists seeking out community residencies until the profession demands it as a whole. Therefore, I believe for the future of pharmacy, the profession should begin to demand residencies, even for community pharmacists. I believe this will broaden the scope for pharmacists in seeking more patient-care related duties and allow pharmacy technicians to take care of the rest. As more advanced patient care duties are demanded of pharmacists, we push the future of pharmacy into a more advanced and respected profession. The community pharmacy is a great place to start with this goal since I have heard many uninformed people crack the joke of, "So as a pharmacist, you'll get paid 100 grand to count pills, huh?" Advancing our knowledge and scope of a responsibility will hopefully stop such misnomers.
I would define direct patient care as any pharmacist who monitors drug therapy for patients. Therefore, I do think mandatory residencies should be required for all community pharmacists since I think the duties of a community pharmacist fall under that definition. Perhaps by elevating our standard for all pharmacists who are involved in direct patient care, which in my opinion includes community pharmacists, we can elevate the entire profession of pharmacy to a higher standard of care and responsibility.
Based on my experience at work and school, I don't believe pharmacy schools can replace the knowledge gained in a residency, and therefore, NO, I do not believe that pharmacy schools can prepare their graduates to function as independent clinical pharmacists by the time they graduate. Therefore, I stand by my conclusions that required residencies cannot be replaced in the classroom. There are just certain aspects of pharmacy that probably won't "click" into place until one is out practicing in a real pharmacy. Thus, residencies should certainly be considered extensions of our schooling as pharmacists participate in them, but not taught in the classroom per say.
If residencies were currently required to practice as a community pharmacist, then YES, I still would have chosen to enter pharmacy school. My decision is based on a few reasons: First, my former job as a pharmacy technician was in a hospital that was deemed a "learning institution," so that we had many pharmacists who were involved in residencies at our hospital. Therefore, I already have a positive impression of residencies and desire to do one myself. Second, although at this point, I don't see myself practicing as a community pharmacist, I still think it would be beneficial to the entire field of pharmacy if all pharmacists involved in direct patient care were required to do residencies. However, I don't foresee many pharmacists seeking out community residencies until the profession demands it as a whole. Therefore, I believe for the future of pharmacy, the profession should begin to demand residencies, even for community pharmacists. I believe this will broaden the scope for pharmacists in seeking more patient-care related duties and allow pharmacy technicians to take care of the rest. As more advanced patient care duties are demanded of pharmacists, we push the future of pharmacy into a more advanced and respected profession. The community pharmacy is a great place to start with this goal since I have heard many uninformed people crack the joke of, "So as a pharmacist, you'll get paid 100 grand to count pills, huh?" Advancing our knowledge and scope of a responsibility will hopefully stop such misnomers.
Personally, I feel that residencies should only be mandated for specific pharmacy jobs. I like the current situation and requirements that are in place today. I feel that it is only necessary to do a residency if you want to specialize in a specific area. An example of this would be an ambulatory care clinical pharmacist. In a clinical setting a pharmacist would need more training because they would have more specific and complicated roles. Wingate University School of Pharmacy requires us to obtain more than 2,250 hours of pharmacy practice and clinical experience. I feel that this is sufficient experience if one wants to pursue a community pharmacy position. An overall broad knowledge is needed to practice in a community pharmacy setting and I feel that over the course of the next four years we will obtain the necessary knowledge and experience to become great community pharmacists. I would have still gone to pharmacy school if residencies were required because I have always wanted to become a pharmacist. I would not let an extra year or two stop me from pursuing my life goal and dream.
-Kevin Morris
WUSOP P1
I agree here with Greg when it comes to mandatory residencies, if something comes up that will improve patient care, along with our knowledge and abilities to guide that patient, we should take full advantage of it. Although, in a retail setting, I agree with Tai Tran it’s really hard to select, monitor, and modify every patient you come into contact with in a retail store. In a clinical practice, you may see a lot of patients, but in a community setting there is no way a pharmacist could keep up with the four hundred prescriptions they fill in one day. But, back to being professional and practicing pharmaceutical care, we as pharmacist should try our best to make personal contact with as many patients as possible. One never knows who they may come into contact with and what lives they can change with a few simple words.
Josh Waters P1
I feel that residency training should not be mandatory for school, but it should be determined by the company that is hiring. They should be able to consider whether they want their staff to all have residency experience. Some pharmacy positions are probably not confronted with excessive direct patient care and residency may not be as helpful.
I define direct patient care as the interactions between the pharmacist and patient and not simply reviewing their history and checking their medications. I believe it applies to community pharmacists when they actually consult with patients about their medications.
I do not think an independent clinical pharmacists would be very functional coming straight from grad school without residencies because of the amount of interactions with the patients. This is a field it probably should be required.
How do many pharmacists feel about this, and if you did not go through residency, did you ever regret it.
Thanks, Leanne Wentz p1
I do think that many pharmacists need additional training after pharmacy school when one actually has his/her license. It's a whole new world when your name is on the prescription or inpatient order. There isn't anyone there to guide your decision as when you are a P4 on clinical rotations. As a current PGY1 resident, I am grateful that I am receiving additional training in order to be a confident clinical pharmacist. With that said, I could do it without a residency. I don't think there are enough residencies available in order for all pharmacists to be required to have one for direct patient care.
Community pharmacists have a different type of direct patient care and would also benefit from a residency. This would also allow the pharmacist to enhance their skills with MTMs and setting up programs for their patients.
As stated in the ACCP article, since residencies are not required for pharmacy nor dental students, I believe it does make a difference in the opportunites one has upon graduation. If residencies were required, then there would not be a difference in the experiences that new graduating pharmacists would have. Although ultimately our goal is to provide pharmaceutical care, we should be able to attain enough clinical knowledge during pharmacy school to accomplish it, and residencies should just continue to be an "extra". Residencies are definitely advantageous, but I do think it should be optional because it depends on what type of pharmacist you want to be. With MTM becoming a bigger part of our profession, choosing a residency would be a good decision.
Personally, I am really torn between the idea of mandatory residency training. I agree with the fact that a Pharmacy student should be fully prepared to give direct patient care when they graduate from Pharmacy School, but I think that residency should be a requirement for Pharmacists who choose to be extremely specialized in a certain area. Although I do agree with Renee in the fact that it would create a higher standard for the profession andI think that residencies are a very good practical learning experience, but they may not be absolutely necessary if more hands on training were mandatory during the four years of school.
Jamie Nix, P1
I agree with many of my classmates that residencies should be required for pharmacy graduates. I believe pharmacists who choose to practice in the community setting can also benefit from residencies and not only hospital pharmacists. With residencies, community pharmacists will be able to expand their level of care and practice. I believe residencies will enable all pharmacists to be better equiped to deliver advanced pharmaceutical care. And then maybe, pharmacists will start to get reimbersed for patient counseling, MTM, etc.
Sendra P-1
I agree with many of my classmates that residencies should be required for pharmacy graduates. I believe pharmacists who choose to practice in the community setting can also benefit from residencies and not only hospital pharmacists. With residencies, community pharmacists will be able to expand their level of care and practice. I believe residencies will enable all pharmacists to be better equiped to deliver advanced pharmaceutical care. And then maybe, pharmacists will start to get reimbersed for patient counseling, MTM, etc.
Sendra P-1
I wanted to amend a point I made in an earlier post. The point I wanted to make was that with pharmaceutical care, pharmacists will be able to expand their level of care. And by doing so, hopefully be reimbersed for counseling and other services like MTM.
Sendra P1
Even though residency is a great opportunity, I only believe that people planning to work in the clinical pharmacy fields should be "required" to participate. Residency allows you to really expand your knowledge of whatever pharmacy field you are in. I believe, however, that residencies should be something to set you apart from other pharmacists. I advise everyone to participate in a residency program to better themselves and gain more experience. Pharmacists in clinical fields of pharmacy experience a wider variety of circumstances that they need to be familiar with. Residency will allow pharmacists to be exposed to more situations and allow them to learn how to handle them appropriately.
I agree with Dineane. Should residencies be mandatory? Probably not. Would it be beneficial for some of us in fields outside of retail? Probably. These types of situations are different for everyone and will serve different purposes for everyone. Therefore it should be a personal decision on that of the individual.
As far as direct patient care, I do think it should be a responsibility that we all take upon ourselves. Why have all this knowledge if we aren't going to USE ALL of it?
I agree with Kevin, residencies should not be mandatory for all pharmacists. For example, in a community setting, residencies would be almost be a waste of time. In a clinical setting though, I can see why residencies would be important. And in regard to the question of would we have still chosen pharmacy if residencies were required for community pharmacy, I would probably have to say no. With my experience working as a technician in a community setting and my knowledge from WUSOP when I graduate, I think I will be prepared to work as a pharmacist without a residency.
For direct patient care, I think residencies should be required. At this point, I'm not 100% sure what part of pharmacy I want to go in to but if I do decide on going into a clinical setting, I would think that doing a residency would be important. I would want the extra learning experience. I don't know that pharmacy schools should prepare their grads to function as independant clinical pharmacists just because not everyone that goes to school is going to want to be a clinical pharmacist.
To the mentors, do you believe that completing a residency was worth it? Do you think you could have worked as a clinical pharmacist without doing one?
Beth Campbell
P1
Either though I want to do a residency, I feel like if it was mandatory, some would change their minds about the fact that they have to go to school for 5-6 years. For that reason, I think clinical/residency experience should be included in the third and forth years of school for students to specialize in what they want to do. And then, if they want to go on and do more practice, the option is available.
-Carly P1
I believe schools should impart the knowledge of each field in a general point of view before you graduate for whichever career path you choose so you will have some skills in each area to be able to learn make your choice in the path you choose. Learning never stops even though you graduate pharmacy school and choose your career path, you are still required to learn and stay in tuned over the years. Overall I don’t think there should be mandatory residencies because the schools should have thought you the knowledge in most part, but if you would like to be more specialized in a certain area you should take that extra effort in taking the residency yourself.
Shawn Jessup
WUSOP P1
I believe that instead of having a mandatory residency post-graduation, we should obtain the skills necessary to function in the pharmacy world before we graduate. Although Wingate stresses the necessity of practice experience from early on, many schools, and states for that matter, do not require as many "internship" hours to become a licensed pharmacist. I think if reform is to occur in the experience training aspect of pharmacy school, it should be through the accreditation agency--requiring more IPPE/APPE hours for each accredited pharmacy school, rather than a post-grad residency. This reform could also occur through at the national level through requiring more experiential hours before one can obtain a license to practice pharmacy in that state. I know that some states require as few as 1000 experiential hours.
I suppose there are some potential benefits of having a residency as opposed to more practice experience though. One would obtain a more focused education in a particular area during a residence, that might be more interesting to that particular student, rather than a generalized experience that all student would have with an increased number of IPPE/APPE hours.
Would these benefits outweigh the cons of doing a residency? And is it really necessary to have residency training for all aspects of pharmacy or could some pharmacists function perfectly fine in their profession without the extra training?
For example, I do not think that a residency should be required for general hospital inpatient pharmacists, nor for community pharmacists. One will be prepared for that situation with their experiences in pharmacy school. With any job, one will have to learn new things just by working there, whether that be a new computer system or the particular procedures for checking technician work.
I agree with mandatory residency training. Not only will it further our education, but I think it will also strengthen our profession’s stance on being a doctoral degree. We all know that many people do not consider pharmacists as holding a doctoral degree; therefore continued education could combat this. Plus, like many of you have already mentioned, the extra education can also benefit community pharmacist with hands on pharmaceutical care.
John Miller P1
For the scope of clinical pharmacists and academia, I do feel that mandatory residencies is possibly a good idea. Working as a tech. at a large hospital, I got to know most of the clinical pharmacist team and the vast majority of them had completed residencies. Not only did this get them going in their specialized field but it made them a lot more marketable. However, with growing pharmacy school class sizes every year, there only so many sites and preceptors so this in the future could present an issue. As for community pharmacists and even staff hospital pharmacists (not clinical team), I do not agree with mandatory residencies. All of the community pharmacists that I have ever spoken with about residencies didn't see it necessary. Also the hospital I worked at was hiring lots of new staff pharmacists that had not done residencies and they had to go through fairly extensive training when hired. Nothing beats on the job training and we as a class need to all assess our desired career pathways and see if a residency is necessary.
Even though I see the benefits of a residency and plan on applying to a residency program after graduation, I do not think that they should be mandatory for all pharmacy students.
Though no practice experience can prepare you for everything you will encounter as a pharmacist, Wingate's Introductory and Advanced Pharmacy Practice Experience programs will introduce us to and likely get us comfortable with working in a community setting. For those interested in working in a community setting, these experiences should suffice as they will make up a large portion of our rotations. Since there are community pharmacies on nearly every street corner, it's much less difficult to ensure that every student has experience in this setting in comparison with a clinical setting.
In most areas there are only a handful of (if not just one or two) hospitals. Even though hospitals are larger health care establishments than your neighborhood drug store, they tend to take very few pharmacy residents. With so few spaces available, there would be serious problems getting every pharmacy student into a clinical hospital setting for a full year to complete this additional requirement.
Furthermore, a student who is already well-versed in community pharmacy with no interest in clinical pharmacy would not want to spend a year learning information that they would rarely apply while making very little money.
Basically, it seems to me that our practice experiences throughout pharmacy school are enough preparation for a community pharmacy setting without requiring an additional year of training. While completing a residency would make every pharmacist more knowledgable, we must remember that pharmacists in many areas will use this additional knowledge so rarely that it is not worth an extra year of their time. Instead, it would be more productive for a community pharmacist to spend some time researching a specific clinical problem when necessary than to have a broad base of clinical knowledge that is almost never used.
Obviously, this is just my perspective, so I would be interested to hear from the Mentors. Have any of you who are working in a community pharmacy completed a residency? If so, do you think that the information you gained is worth an additional year of practice experience?
Carolyn Kilbane
WUSOP 2014 (P1)
As a PharmD who completed residency training "backwards", I think I have a unique perspective on this topic. I practiced in community and inpatient pharmacy for 3 years before returning to complete a residency this year. I can honestly say that I have gained an enormous amount of experience in a very short time so far. When you become a practicing clinician, the opportunities to obtain this kind of experiential learning dramatically decrease. We are perfectly capable of learning patient care activities specific to our positions, but gaining an overall picture of patient care and becoming familiar with evidence-based medicine (and how to keep up with this) falls by the wayside.
I am a huge advocate for residency training. I recommend any student, regardless of your interests or intended path, complete a residency to solidify your pharmacy school foundation with actual clinical practice. I do not think this is something that can be completed through the curriculum of the pharmacy schools. This should be an additional requirement similar to that of medical students. Even if you plan to enter community pharmacy, being required to complete a residency is only going to allow pharmacists to demonstrate our abilities to provide more clinical services in that area. Should we not advance our profession in community pharmacy? I think so.
Would I have still obtained my PharmD? Of course! Actually, mandatory residency training would have forced me ahead in my career instead of giving me the option to achieve other goals before completing this training. Returning to complete a residency is obviously doable, but going through this process directly out of school has advantages, mainly a fresh perspective on the current information.
I encourage each of you to strongly consider completing a residency even though it is not required. You will have many doors opened that otherwise may remain closed, especially since pharmacy practice is moving in this direction. You will also find that you will gain a greater comfort level with actual clinical practice. Integrating your knowledge into practice under guidance will help your confidence as a clinician.
Requiring a pharmacy student graduate to complete a residency prior to beginning work in a pharmacy is a great idea…for a clinical pharmacist. The ACCP article mentioned that although a physician is not required to complete a residency in order to practice medicine, they are required to receive residency credentials in order to be eligible to receive payment from third-party payers. As a clinical pharmacist, a mandatory residency should be required as the pharmacist will be providing direct patient care. Direct patient care is the one-on-one care of a patient by the pharmacist. This individualized and personal care by a pharmacist will ensure a physician’s drug orders are being followed through, as well as ensuring patient compliance. Both of these issues should provide an improvement in the treatment and care of the patient. Patient care in the community pharmacy is not always as easy to provide for various reasons. The work load of the pharmacy is not going to adjust simply to accommodate the pharmacist’s need to provide direct patient care. In addition, not all patients will be eager to participate in this type of patient care. I don’t think all pharmacy schools should prepare graduates to function as independent clinical pharmacists, unless the school is offering this option as an elective or additional work similar to the MBA program. Let those students choose their future endeavors instead of requiring it. As far as the idea of a residency requirement for community pharmacy, I would not be opposed to the idea.
To our mentors: Have any of you ever considered completing, or have successfully completed a community pharmacy residency? If so, please give us your experience with the residency.
~~Chrissi Tyrrell, P1
At this point, I do not think that pharmacy residencies should be required in every aspect of pharmacy. I agree with many of my classmates when they say that pharmacy school should adequately prepare us for life as a pharmacist.
I think that the way residencies work now is ideal. The opportunities are there for people who feel as if their career path would benefit from a residency however, those who feel as if they wouldn't benefit do not have to do them. In order for residencies to be required, I think that the field of pharmacy needs to be further advanced. Although I realize that requiring all pharmacy students to complete a residency would most likely advance the profession, I don't think it would be fair to place this stipulation on the people who are interested solely in community pharmacy.
I think that the way the system works now is ideal. The opportunities are there but not required.
RE: direct patient care, mandatory residencies for one and all
It looks like we’re defining direct patient care as assessment/optimization of therapy/consultation in a place that is anything but a community pharmacy. In my opinion, that is a dangerous distinction to make – in reality, the community pharmacist is the last point of care before a patient actually takes the medication (for the most part, anyway) and is perhaps the easiest point of access to the healthcare system (my patients wait 15 minutes for a flu shot, as opposed to making an appointment at a doctor’s office in 15 days). Because of this, community pharmacy is probably the sector of the profession that needs post-graduate training the most. We are often a patient’s sounding board, and the ability to talk with patients (not AT them) is an acquired skill. The challenge in community pharmacy is that we quite frequently do not have a diagnosis on which to base a recommendation. In a traditional clinic setting, you are either seeing a patient BECAUSE of their condition (i.e. Coumadin clinic) or because they HAVE a condition (i.e. heart failure, MI, stroke, trauma, etc.), both determined by a physician. Patients have open access to community pharmacists - I talk to people on a daily basis who have probably never had a prescription filled with me, and yet, I’m expected to provide an intelligent response to their questions about what to take for this and that. Obviously, based on indication, I can infer what a patient is being treated for with prescription drugs, but I don’t have the luxuries of a diagnosis or any sort of medical history on which to stake my recommendations. Walking the fine line between recommending and diagnosing is nowhere more apparent than in the community pharmacy setting – a more distinct division could be gained for pharmacy practitioners that complete a community practice residency. And for those that would argue that community pharmacists don’t use “half of what they learned in pharmacy school” (hence, negating the need for post-grad training), I would argue that those pharmacists don’t WANT to use half of what they learned in school. Use it or lose it… don’t be lazy!
RE: pre- vs. post- graduate preparation for practice
It seems as though we, as pharmacists, are putting ourselves into hierarchies. The profession as a whole is in such a rush to demand respect and be recognized as a higher entity of healthcare provision that we’re dividing ourselves into higher and lower ranking professionals. Maybe the real problem is that we’re competing with each other instead of working together to advance our profession. While the PharmD has been around since the 60’s, AACP made the degree mandatory in 1990… then practice residencies came along… at first, you could do a one-year postgraduate residency, opt into specialty training in a specific field during that residency, and come out a specialist. Now, you have to do a PGY2 residency to specialize. Why not diversify the possibilities to allow a pharmacist to tailor a residency to their needs? Why not incorporate a specialized P4 rotation year – where you could do advanced activities as part of your coursework to (A) determine if a residency is right for you, and (B) make you more marketable to postgraduate residency programs? Make this an option that pharmacy schools must provide their P4 students and then allow those students access to a specialized PGY1 residency instead of the current two years to specialize. What about part-time residencies? The profession should open up a more expansive set of possibilities for graduates instead of limiting the process to either one or two years.
_________________________________
Erica Harms, Pharm.D., R.Ph.
Executive Pharmacist
Target Pharmacy | Charlotte, NC
eharms@carolina.rr.com
For now, I don't feel that residencies should be required for all graduating pharmacists. By no means do I feel that residencies are unimportant, but as some of my classmates brought up in discussion during class yesterday, they do add on to the already expensive cost of education. There is also the point that was brought up about placement of each pharmacy school graduate into a residency program and whether or not residencies would be too saturated.
Having said that, if residencies were mandatory, I would just see it as another step along the way to becoming a great pharmacist. Of course it would add yet another intensive workload but what else would you expect from a doctoral program?
I don't think pharmacists who work in the community or retail setting are any less knowledgeable having not went through a residency but I do feel like they could definitely benefit from the experience. Direct patient care is such a major aspect of pharmaceutical care that we hear about so much in all of our classes. How better else to experience it than through a residency?
Briana Rhyne - P1
Both sides of the mandatory residency discussion have been defended with some great arguments, so I will expound on the point I made in class on Wednesday.
The PharmD degree has been around for a while, and it was made the education standard to practice as a licensed pharmacist within the last 20 years. The curriculum was tailored by each school to be an advanced practice degree to prepare students for a practice setting. Granted, in the last 20 years, the pharmaceutical world has grown exponentially with the amount of medications on the market. The need from the public for our profession is growing as one that harbors the information and uses that knowledge base to proactively improve public health (my definition of direct patient care). However, the industry norm is roughly 1,000 IPPE/APPE hours of practice during 3-4 years of pharmacy school. Wingate again is proactive in requiring 2,200+ hours from its graduates. We have heard that companies appreciate WUSOP graduates as they are better prepared for the business upon graduation. I think the educators play a part in this, but I do think the biggest piece of the puzzle is the extra IPPE/APPE hours.
Although I do agree that many benefits can be gained from a residency, I think a better step to take would be to subject current residency programs to an accreditation process and require those programs to maintain the accreditation. Secondly, I think that pharmacy schools nationally need to increase the total number of IPPE/APPE hours to 2,000+. The extra hands-on experience in a structured setting like pharmacy school can then be measured as beneficial.
There are also several limiting factors to making residencies mandatory. There will not be enough positions available for all graduating students, as well as the lack of total funding for those positions available now. Also, the competitive edge of completing a residency is removed, thereby forcing any competitive pharmacists to complete a PGY2 for that added edge. With the PGY2 being highly specialized, those total positions are also extremely limited compared to the PGY1.
In regards to the idea of community pharmacy residencies, I think they are a good idea for a student wanting to go into management, as it focuses more on the business side of pharmacy (from what I read). For my future, this is appealing to me, however I feel this is also accomplished by many other ways (Jr. Partnership in an independent store, management training for chain pharmacies, etc.) The notion that many residency positions can be opened up on the community level by the pharmacy building the hours into the normal budget is absurd. How does that make you any different than just working as a community pharmacist anyways? Sounds like cheap labor disguised as learning experience to me.
This post is getting extremely long, so I'll sum up my final 2 points. I feel that pharmacy schools need to train students to be independent clinical pharmacists without regards to clinical/ambulatory care/community practice setting. Ultimately, community pharmacists will have to process some clinical data semi-regularly, and understanding the meaning behind this information can open avenues to improving public health. If residencies were mandatory, I would have still chosen this field, yet I would have given more consideration to medical school. An optional residency is a good selling point to undergrad students to get into the field.
-Cole Herrell WUSOP P-1 Student
Could community pharmacists benefit from residencies? Yes. Should residencies be mandatory for community pharmacists? I don't think so. From what I've seen I don't think community pharmacists require the specialized training clinical pharmacists receive.
I do believe, however, that it would be wonderful if pharmacy schools could somehow integrate into their curricula some type of residency for students wanting to head in that direction.
Alisha Rivera-Menendez
WUSOP P1
A Mandatory Residency Training?? YES.. this is a good idea. The reason why is because this can only make you a better pharmacist. Everyone wants to strive to be the best they can be and a residency program can only help one achieve that goal. No matter what field one wants to partake in (even community), I personally think a residency is a good idea. Now, I understand why one wouldn't want to be involved in a Residency Program. Long Hours and Low Pay.. those are characteristics that describe very few dream jobs, but keep in mind most residencies are either one or two years and that is a small relative time period when compared to making you a better pharmacist for 20+ years. Perhaps more jobs can offer pharmacists special incentives if they have had experience from a residency to make the low pay, overworked hours more appealing.
- Nicholas Conley (P1)
I agree with those who said that residencies should only be required for specialty pharmacists. Community pharmacists and even some institutional pharmacists don't need a residency (or at least not a PGY2). I can see how extra education would be desirable for direct patient care, but if I'm in Walgreen's checking prescriptions all day why would I need yet another year of training?
To Mentors,
Have you done residency before? If so, could you tell us the pro and cons if we do the residency and be a community pharmacist?
Ngan Tran-P1
From Matthew Nguyen, PharmD
I believe I definitely can bring a unique light to this question, as I work in BOTH community pharmacy (Walgreens) and as a Clinical Pharmacy Specialist for critical care. I completed a PGY1 residency last year and tailored it to ICU training. My full time job is working in the MICU and CICU, but I pick up days here and there at Walgreens. I believe it's a great way to really practice as completely as I can. There are many instances where what I know in the clinical setting, I can apply to my patients at Walgreens and vice-versa.
Now for those of you who ask:
"why do I need to do residency if I work at Walgreens? All I do is fill prescriptions."
Just look at the direction Walgreens has in Phoenix (where I am now) and Florida (where I used to live). The focus there is completely aimed at the patient and counseling and asking questions. There have been so many times that I ask simple questions that lead me to numerous problems that patients need resolved with their medications that I would not have known as a pharmacist had I not done residency. So I definitely believe it helps.
HOWEVER, in regards to the questions of mandatory residency training...
I do NOT believe it should be mandatory. With the profession going in the direction it is, most (if not all) clinical positions demand residency training, and numerous hospital staffing positions are requiring it as well. The profession is already going in the direction of "mandatory" residency in the job description that I do not believe it will be make much of a difference if it is mandatory or not.
As I helped out with residency interviews this past year, many candidates were a few years removed from completing their PharmD and when asked about why they were applying, the answer was simply "I can't get a hospital job and the only way to get one is to do a residency." So many "direct" patient care positions are mandating it anyways.
Furthermore, I do not believe it is right to saturate the market with applicants who may not want to do a residency over those that do. Many individuals with true aspirations do not obtain a residency and those that do not care either way end up obtaining a position, which is unfair.
I believe the system is fine the way it is and it will continue to evolve without a mandate for mandatory residency training.
Matthew Nguyen, PharmD
Critical Care Pharmacy Specialist
It is a wonderful idea for creating professionals that are more apt to meet challenges in practice. However, keep in mind that residencies decrease demand to enter pharmacy school, if post residency wages stay the same. If demand for pharmacy school decreases, than the quality of students decrease as well. However, some could argue, that more successful pharmacists will create a demand for their services, and therefore increase their payment.
As a past resident at a children's hospital, I can tell you how valuable residency training it. I currently practice at a hospital, where pediatrics is not the most comfortable practice setting for most of the pharmacists. My training has enabled me to teach them how to cope more easily with a complicated patient (such as a child).
Do I think residency training should be mandatory? No. I agree with the comment I read stating this would "saturate" the current programs with students not necessarily motivated in that direction of pharmacy service. I am not, however, suggesting that community pharmacists should NOT get residency training.
I challange anyone who is/wants to be a community pharmacist to think about something for a minute...
If someone were to come up to the counter in a community pharmacy and ask for the pharmacist specifically, consulting them on a medication, asking any medical question of that pharmacist; would you not consider them a patient? Would that not then be direct patient care?
There are several community pharmacy residencies out there. They should be taken advantage of.
I can say, having residency experience gave me an advantage when applying for a job. It continues to give me an advantage over those without one. My colleagues will always view me as the "resident" expert in the pediatrics at my hospital.
Lauren Levith, PharmD
Pharmacist
Emphasis: Pediatrics
I agree with mandatory residency training, especially if it is associated with desired career pathways. The experience obtained during a residency training would be extremely valuable relative to most pharmacy disciplines and improve proficiency upon completion. Furthermore, the
additional training could be significant in securing specific jobs. I think that it would be better received if the Residency program could beintegrated into the rotations for time and financial reasons.
-Kirsten Wood
P-1 Student
Thank Dr. Matthew Nguyen for replying my comment.
So I see the light here. I think why don't we try our best to study and train ourselves and residency training will be one of the best training environment for all of us? We will be able to know exactly what we are going to do after P4 I believe. But like Dr. Nguyen said, he does both clinical pharmacy and community pharmacy, so is it a good idea to complement both of them, achieve pharmaceutical care and our knowledge also.
So think about long-term goal,I recommend people doing residency. At least, think about it thoroughly.
Ngan Tran - P1
To mentors,
I think that residency training should be applied for every pharmacy setting. Pharmacists are in great now, and we pharmacists-to-be need to be at the top of our game. Our goal is to provide direct patient care and this kind of training will be very resource ful. But, I can't help but think how troublesome the expenses will be.
If I participate in residency training, will the hospital pay part of my tuition or will the hosptial give me the stipend to pay it myself?
I like what Dineane said in regard to having a “shortcut Pharm D monitoring our mother’s medication therapy. This is a real statement and I agree with what she is saying that the more specific the role the pharmacist plays in medication management then the more training that pharmacist needs! Therefore I feel that if a pharmacist is going to focus on managing medications, reviewing charts and helping to input on a patients care, they truly need a residency. On the same note if a pharmacist is going to be doing MTM in community pharmacy I do feel they need to have some relative training that is clinical based and in depth but I am not sure if a residency is the most beneficial route to get that training and added education.
Going off of what Renee input, I agree with her that if a residency was required I would have still come to pharmacy school as well. I also came from a teaching hospital as a technician and my focus is geared to the hospital setting so I too am looking at doing a residency.
Tiffany Benfield
P1
I agree with much of the class that residencies should be mandatory. Sure, if you want to be a community pharmacist it may seem unnecessary, but why not have extra training and experience under our belts? If we are earning a doctoral degree, I feel as if a residency would solidify this and give us more backing to our diplomas. Mentors, I had a question regarding these residencies...How specific can they be? Sure, I know you can do a pediatrics residency, but how specific can you be in those regards? Can you narrow the scope even more?
Emily Byrd
P1-Wingate
I believe mandatory residence training is a great idea because would we really want one of our close relatives under the provision of a "green" pharmacist who has had no clinical experience? Would I want to go an extra year or two with accruing interest on all my student loans? Probably not, but I should keep in mind that my wants come secondary to the health a quality of life of the patients. I believe if the patients would feel more comfortable with an experienced pharmacist then the extra years would be worth the quality of mind for the patients and their relatives. Within reason, I feel that practicing clinical pharmacists should have a mandatory residency after pharmacy school. If a pharmacist in a community pharmacist decides he/she is tired of filling 500 prescriptions/day, then I believe as long as the pharmacist has had 4 years practicing pharmacy then I could understand foregoing residency.
Jeremy Efird-P1
Emily,
There are many areas in which you can specialize. Of course there is pediatrics, but you can do pediatric emergency medicine, trauma, burn, etc. For adult you may do the same. I specialize in critical care with an emphasis in cardiac and medicine and non-trauma emergency medicine. There are other areas as well such as infectious disease, HIV, cardiology, neurology, psychology, and so on.
Matt Nguyen, PharmD
Critical care clinical specialist
I do believe that eventually a residency program will be required of all pharmacists because our previous main role of filling prescriptions will be taken over in the next several years by automated machines which can both fill those prescriptions faster and with less error than any human could. However, if a residency is going to be made a requirement my only questions would be then what is the difference between pharmacists and physicians? We go to school for the same amount of years: 4 yrs college, 4 yrs pharmacsy school and now with a 2 yr residency probably. We then have the same amount of student loans as medical students do. And our training is virtually identical with us having more background in pharmaceutics while they have more background in identifying the systemic disease their patient suffers from. I mean the purpose of the residency is to try to take over maybe 15-20% of what a primary healthcare physicians office would do on a normal basis. The same primary physician many of which make less than pharmacists do already and have far more overhead to worry about in paying their staff salaries and maintaining an office. The good thing about all of this is that I beleive both will be inevitable in that machines will take over many of our roles in filling prescriptions and we in turn will take over a good 20% of what a primary physician's office would do. I beleive this will happen because pharmacists are far more accessible than physicians are and if we're able to bill for our service then I think the healthcare system overall would benefit from it in reducing the number of ER visits from many people who cannot afford doctors visits. This will ultimately save the healthcare system money and I believe we will be able to prove we can do exactly this. While I don't really want to spend anymore time in training than I have to, I feel a mandatory residency is only a question of time, but with it will come the benefit of job security and improved patient care.
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