Question

[VCU07]

I am considering doing a residency next yr, but would like some more info and advice. After completing a residency program what types of jobs are out there? Also, are there plenty of jobs or are they very competitive? I worry that if I do a residency I will not get to live in the area I want to be (atlanta) due to a lack of jobs. Thanks

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[kwizard]

I am considering doing a residency next yr, but would like some more info and advice. After completing a residency program what types of jobs are out there? Also, are there plenty of jobs or are they very competitive? I worry that if I do a residency I will not get to live in the area I want to be (atlanta) due to a lack of jobs. Thanks

After completing a residency many jobs are open. Basically the residency gives you a "leg up" on the competition when competing for jobs (typically all jobs except those in retail; unless of course you did a community pharmacy residency). You should also look into board certification as well (www.bpsweb.org) as that is necessary to validate you expertise in a given field.

Types of jobs and job market depend on the general availability within the area that you want to practice. As to whether the residency would limit your potential job oppurtunities I would think the opposite may be true (i.e. not doing a residency may limit your career options). You have to try to look at the "big picture". About 10-15 yrs ago the push for all PharmDs really began to become the "rule" w/i pharmacy schools. Up until that point the majority had RPh (clinical jobs were minimal) as most PharmD took the clinical positions at the major academic medical centers so it was hard to conceive how the PharmD would grow even though it had been around for decades. Now everybody has the PharmD so the question then becomes how do you separate yourself if you want to be more clinically oriented than the average pharmacist. Answer...do residency training. Right now since the transition is still in a process the reality is that residency training doesn't guarantee anything, but increases likelihood for you to get a clinical position. Much like nursing their is more of a market for entry level staffing jobs in retail or in hospitals (simply b/c that is where the supply is outweighed by demand). Often the clinical positions are newly created as the need for an expansion of pharmacy services is realized for various reasons (improved pt care, decrease side effects, pharmacist managed therapeutic drug monitoring and/or anticoag, pharmacist ran clinics (in VA setting), etc.). So the jobs are out there, it just depends whether you have the credentials for the job to present itself. I've mentioned in previous posts that it is hard to gauge demand of clinical pharmacist due to lack of ability to bill for services.

So basically you could do a yr of pharmacy practice and roll the dice to see what is out there. The specialties that typically pay the most and are the most available in all geographic areas are critical care and oncology. In the ambulatory settings pharmacists ran anticoagulation clinics are becoming much more popular in private sector. W/o residency training you have to realize that your options may be more limited in the future depending on what you want to do. You can get around this as well if you want to be more clinical by just educating yourself and keeping active with what is in the literature, but the transition is just easier w/ residency training. Your autonomy as a clinician will vary largely w/ what type of training and how many years you decide to complete. The VA setting by far provides the most autonomy giving prescribing privileges and focus on chronic care and ambulatory setting.

ACCP (www.accp.com) typically provides the best search engines for clinical jobs acroos the nation. APhA (www.aphanet.org) and Careerbuilder.com also typically provides a little bit of everything. Federal jobs can be searched via www.usajobs.gov and/or www.vacareers.va.gov. I hope this helps. For a more comprehensive review about clinical pharmacy and various career options a lot of people always point out the Pfizer Career Guide (http://www.pfizercareerguides.com/)

 

[mph2pharm]

After completing a residency many jobs are open. Basically the residency gives you a "leg up" on the competition when competing for jobs (typically all jobs except those in retail; unless of course you did a community pharmacy residency). You should also look into board certification as well (www.bpsweb.org) as that is necessary to validate you expertise in a given field.

Types of jobs and job market depend on the general availability within the area that you want to practice. As to whether the residency would limit your potential job oppurtunities I would think the opposite may be true (i.e. not doing a residency may limit your career options). You have to try to look at the "big picture". About 10-15 yrs ago the push for all PharmDs really began to become the "rule" w/i pharmacy schools. Up until that point the majority had RPh (clinical jobs were minimal) as most PharmD took the clinical positions at the major academic medical centers so it was hard to conceive how the PharmD would grow even though it had been around for decades. Now everybody has the PharmD so the question then becomes how do you separate yourself if you want to be more clinically oriented than the average pharmacist. Answer...do residency training. Right now since the transition is still in a process the reality is that residency training doesn't guarantee anything, but increases likelihood for you to get a clinical position. Much like nursing their is more of a market for entry level staffing jobs in retail or in hospitals (simply b/c that is where the supply is outweighed by demand). Often the clinical positions are newly created as the need for an expansion of pharmacy services is realized for various reasons (improved pt care, decrease side effects, pharmacist managed therapeutic drug monitoring and/or anticoag, pharmacist ran clinics (in VA setting), etc.). So the jobs are out there, it just depends whether you have the credentials for the job to present itself. I've mentioned in previous posts that it is hard to gauge demand of clinical pharmacist due to lack of ability to bill for services.

So basically you could do a yr of pharmacy practice and roll the dice to see what is out there. The specialties that typically pay the most and are the most available in all geographic areas are critical care and oncology. In the ambulatory settings pharmacists ran anticoagulation clinics are becoming much more popular in private sector. W/o residency training you have to realize that your options may be more limited in the future depending on what you want to do. You can get around this as well if you want to be more clinical by just educating yourself and keeping active with what is in the literature, but the transition is just easier w/ residency training. Your autonomy as a clinician will vary largely w/ what type of training and how many years you decide to complete. The VA setting by far provides the most autonomy giving prescribing privileges and focus on chronic care and ambulatory setting.

ACCP (www.accp.com) typically provides the best search engines for clinical jobs acroos the nation. APhA (www.aphanet.org) and Careerbuilder.com also typically provides a little bit of everything. Federal jobs can be searched via www.usajobs.gov and/or www.vacareers.va.gov. I hope this helps. For a more comprehensive review about clinical pharmacy and various career options a lot of people always point out the Pfizer Career Guide (http://www.pfizercareerguides.com/)

Thanks...this is great information. With all of the changes still happening in the field I do wonder what will be the "norm" when I get out in 2010 (assuming that I get in in 2006). Being older, I wonder if by the time I am ready to graduate, I will be looking at 2-4 years of residency training in order to be competitive in areas other than retail. Looking at it in years, that is pretty much the equivalent of the number of years of training for physicians. I really didn't anticipate that many years of school/training when I first began to explore this field. I just hope that I will be able to start working in the field before I turn forty!

 

[kwizard]

Thanks...this is great information. With all of the changes still happening in the field I do wonder what will be the "norm" when I get out in 2010 (assuming that I get in in 2006). Being older, I wonder if by the time I am ready to graduate, I will be looking at 2-4 years of residency training in order to be competitive in areas other than retail. Looking at it in years, that is pretty much the equivalent of the number of years of training for physicians. I really didn't anticipate that many years of school/training when I first began to explore this field. I just hope that I will be able to start working in the field before I turn forty!

Yep I know what you mean. I ended up spending 4yrs in undergrad + 4 yrs of pharmacy school + 2yrs of residency training. So 1-2 more years I could of been a family practice or internal medicine physician. I was even thinking of doing a fellowship training after the residency (in retrospect I'm really glad I didn't do the fellowship). Yep, and one of the original reasons for choosing pharmacy over medicine was the less time in school.

Honestly sometimes I used to wonder about going to med school when I became frustrated during residency training (most in my PGY1 yr), but every time I changed my mind b/c I began to realize that I really enjoyed pharmacy and most of my frustrations revolved around a lack of autonomy (whether it be from my superiors or just general function w/i the facility). During my
PGY-2 and now in practice I'm pretty happy w/ being a pharmacist. I no longer have the desire to go the MD route b/c it doesn't seem that glamorous as it used to be. Academia and residency training still kind of "sugar coat" the reality of professional aspirations so I've always found it good to moonlight at other facilities for exposure and now in clinical practice I think I've gained a better appreciation for my potential as a pharmacist and am more satisfied w/ the path I've chosen.

FYI...for clinical practice the requirements will like never exceed 2yrs of residency training. The key after residency training is to get board certification. There is a small possibility for clinical fellowships like in Medicine but this is probably highly unlikely until clinical pharmacists really start billing for service and are recognized as "true mid level practitioners" so we have a long way to go before such options can be considered.

 

[mph2pharm]

O.k. I just may have you beat by the time I am finished given that I also went two years for a master's degree. I too have thought about medicine but I feel like it is not the best route for me for many reasons (would I be doing it because of the prestige, $$$ and because as some people say "I am smart enough" or would it be because I could really see myself practicing medicine?). My sister is a physician and I definitely agree that it is not as glamorous as some may think. She loves being a physician but she has sacrificed a lot and still does (most days she is unhappy BUT alot has to do with where she works not what she does).

I would love to hear more specifics about what you currently do and what kind of residency training you have received. I just can't believe what I am getting myself into. I feel like I am becoming a "career student." I am not all about the money but I just hope that after all of those years of school, residency, etc. that I don't look back and say wow...I could have gone to medical school for the same amount of time and be making much more money.

 

[VCU07]

Thanks for your responses. I have also contemplated what to do after graduation. Like the two of you I also did 4 yrs of undergrad and now 4 yrs of PharmD. On one hand, I am kind of tired of school and just want to get on with my life and start making money, but I would like to work in academia which would require a residency. In addition to all this, I am an out of state student and will owe a crap load of money, not to mention being married and trying to support a family. Unfortunatly, it is difficult on a residency salary. Kwiz-what type of hrs do you work since you finished your residency? Is it still crazy hrs like you did during your residencies? I have heard horror stories. Finally, I worry about the state of community pharmacy with the decreasing reimbursment and the Medicare Part D implementation. What do you guys think?

 

[kwizard]

Thanks for your responses. I have also contemplated what to do after graduation. Like the two of you I also did 4 yrs of undergrad and now 4 yrs of PharmD. On one hand, I am kind of tired of school and just want to get on with my life and start making money, but I would like to work in academia which would require a residency. In addition to all this, I am an out of state student and will owe a crap load of money, not to mention being married and trying to support a family. Unfortunatly, it is difficult on a residency salary. Kwiz-what type of hrs do you work since you finished your residency? Is it still crazy hrs like you did during your residencies? I have heard horror stories. Finally, I worry about the state of community pharmacy with the decreasing reimbursment and the Medicare Part D implementation. What do you guys think?

Yep I understand where you are coming from and there is nothing wrong w/ being tired of school and being ready to begin the next chapter. Well I guess you have two options since academia is a potential career option. The 1st would be to take a yr off after graduating from school and make some money and consider residency training a yr later. Honestly I really don't care for this first option that much. It is kind of hard to consider a dramatic pay cut to do a yr of residency after working for a year (however many do it).

If you know that you may want to go into academia or pursue a clinical pharmacy position the best way to increase your marketability would be to do a residency (possibly just a pharmacy practice (i.e. 1 yr)) and then try to go straight into career field of your choice. This route would probably maximize your career potential assuming you don't want to do specialize in something (as many pharmacists are typically happy w/ just doing 1yr). Given the "real life" (i.e. family obligations) concerns you have, I would be very careful about which type of residency programs you consider. The quality of residency programs varies alot from one to the other, but I would really try to stick w/ programs that won't infringe on your personal life, but at the sametime enhance your clinical knowledge and develop you as a clinician in the process.

For instance stay away from programs that involve being on-call, limit the amount of hrs you can work part time outside of the program, or are in non-teaching hospitals. These types of programs may tend to look as pharmacy residents as "cheap-labor" as opposed to residents there to learn. The other side of it is a lot of the major medical centers have residents w/ crazy on-call responsibilities so the department can supplement any of their clinical deficits w/ pharmacy residents so you are still cheap labor, but just being used for clinical services as opposed to staffing purposes. If you are having to work in the evening and/or every other wknd then that makes moonlighting to supplement income kind of hard.

The ideal residencies that complement quality of life are in the VA (Veterans Affairs) system or in managed care (i.e. Kaiser Permanente). The Kaiser residencies may vary w/ area, but I'm only vaguely familiar w/ one in MD. The VA residencies on the other hand are typically consistent across the nation. Approximate hrs/wk are 40-50hrs/wk (Mon-Fri). Some have staffing requirements some don't. Staffing requirement depends on number of residents but is typically working every 3 wknds (no evenings) but you would get off the Friday and Monday before and after wknd. Some other VAs don't have a staffing requirement or consider the staffing requirement fulfilled by spending 1 day/wk in the anticoag clinic. Other VAs even provide the option for you to work part time on the wknd at regular pharmacist salary. The main knock on the VA is salary. Well this varies w/ each VA so I'd check out postings on various search engines for positions/salary (www.usajobs.gov or www.vacareers.va.gov). However pay for all VA residencies is slightly below avg residency pay depending on area at 33k/yr (supposedly they were to increase that to 38k/yr this yr or the next). Most residencies pay 35k-42k/yr. Other benefits of VA would be 13 days of sick and 13 days of vacation leave. Most private sectors include staffing of some evenings and possibly every other wknd staffing and typically 2wks of vacation and 5-15 days of sick leave.

So if I were you I'd go for 1yr of residency training and then take BCPS the October following residency training to validate your clinical experience and optimize your job marketability.

To answer your original question about hrs...I typically work about 40-50hrs/wk (all days M-F) w/ minimal staffing requirements occasional wknd coverage at every 3rd or every 4th wknd.

I am sorry about all of the VA promoting and I don't want to seem one dimensional. However, in my experience it is far too often that pharmacists or students who enjoy pt care and pt contact think that their only option is retail. If you are into critical care or oncology then the decision process is much easier as those jobs are all over. However if you enjoy pt contact, managing pts for chronic conditions (HTN, Lipid, Depression, etc) the VA offers a great oppurtunity until private sector catches up w/ private sector med management clinics.

Seconldy, don't stress over the financial burden as you can supplement your income during residency training to help alleviate the issue and if hrs aren't that demanding (i.e. <50/wk) you can live a normal life while completing residency training. Also when all those bills are paid you really want to enjoy what you do as opposed to potentially being stuck in a situation that may not be what you originally had in mind. Just my opinion so I hope it helps and good luck.

 

[mph2pharm]

Thanks for your responses. I have also contemplated what to do after graduation. Like the two of you I also did 4 yrs of undergrad and now 4 yrs of PharmD. On one hand, I am kind of tired of school and just want to get on with my life and start making money, but I would like to work in academia which would require a residency. In addition to all this, I am an out of state student and will owe a crap load of money, not to mention being married and trying to support a family. Unfortunatly, it is difficult on a residency salary. Kwiz-what type of hrs do you work since you finished your residency? Is it still crazy hrs like you did during your residencies? I have heard horror stories. Finally, I worry about the state of community pharmacy with the decreasing reimbursment and the Medicare Part D implementation. What do you guys think?

Well I haven't even started pharmacy school yet so you guys are way ahead of me but I really want to think things through more clearly this time because like you VCU07, I am married and this new journey that I am embarking on is going to turn our finances upside down. My husband is really supportive and has said that he will work 2 jobs if necessary for me to get through my PharmD program but I think that he is really banking on me getting a job after 4 years and starting to bring in real money again. I really want to be upfront with him if 4 years will potentially turn into 5 or 6 years once you factor in a residency.

I keep hearing about Medicare Part D and that it will have some impact on community pharmacy but I am not completely clear on how. Can either of you shed some light on this?

 

[mph2pharm]

I found the answer to my own question

Below is the link to an interesting article on how Medicare Part D will impact community pharmacy:


http://pub.ucsf.edu/today/cache/news/200603173.html

 

[kwizard]

I found the answer to my own question

Below is the link to an interesting article on how Medicare Part D will impact community pharmacy:


http://pub.ucsf.edu/today/cache/news/200603173.html

Thanks for the link to the article. I'm honestly not sure what the impact of the various Medicare Part D issues will be, but would say that only time will tell. I realize that technological changes are supposed to dramatically change the profession and that more and more scripts will be sent out to mail order, but how fast this will occur (assuming it over really ever does and to what extent) is anyone's guess. For mail order pharmacies to be successful then they will eventually need pharmacists to work there and the working conditions in mail order, while stress free in regards to not having any customers to deal with, provide very little mental stimulation and tend to treat the employee like they work at UPS as opposed to a pharmacy (i.e. scheduled break times, little autonomy, overbearing supervisors, etc). So while mail order tends to pay well I'm a little skeptical about their ability to retain enough pharmacists to replace the bulk of the services currently provided by local community stores (or perhaps you won't need too many and bar coding will do most of the work??). I don't know, but its anyone's guess??

 

[patmcd]

I'm sure pharmacy will take a dramatic move away from the traditional count, lick and stick image of the field. Why pay someone 80K a year to count pills when a machine can do it faster and more accurately. Hopefully with pharmacists having more time to interact with patients combined with the rapid development of new drugs will allow pharmacists to move towards actually deciding on drug plans based on a diagnosis.