Do Pharmacists Eat Their Own? Pharmaceutical Care Lyceum 2018

I was recently at a conference called the Pharmaceutical Care Lyceum in the middle of nowhere in central Minnesota.  It was a great conference and with a very laid back environment.  How often could you wear sweatpants to a conference and no one cared? The temperature was FREEZING, but the debate was heated.  The Pharmaceutical Care Lyceum was about perceptions in pharmacy practice and really trying to figure out what the hell we are doing as a profession.  The group that attends is primarily ambulatory care, clinic based pharmacists.  There is definitely a smattering of other folks as well which enhances the discussions.

The discussion that really intrigued me was a fellow colleague bringing up the fact that we do so much infighting in pharmacy practice when really we should all being doing a better job of supporting each other.  A big challenge I see with pharmacy practice is that we are so different in our roles and that leads to different goals sometimes.

An example that came up was professional organizations and how some groups are working to get better reimbursement rates for the sale of medications, while others in the same organization are seeking provider status and to enhance the ability to expand the role of the pharmacist in the clinic setting.  In comparison to nursing groups, we don’t have that many people to be fighting against each other. We have all worked incredibly hard to demonstrate the value of what pharmacists can do and I think that shows in that we are one of the most trusted professions.

Something I have struggled with was not doing a residency.  I’ve gotten over it at this point, but there were several years where I definitely had a feeling of insecurity about this.  When I talk to students about this, if they are not applying for residency, they are almost apologetic as to why they aren’t doing one.  A residency can absolutely be a useful tool to help open doors for younger pharmacists, but it does not determine the trajectory of your career.

I also remember a situation in pharmacy school (about 10 years ago) where someone was implying that if you went to work at Walgreens or CVS you were inferior.  I can remember a classmate who was one of “those” pharmacists who was going to work there. She was very upset.  That’s the kind of attitude we don’t need.  We all bring value and the location you work at doesn’t determine your professional worth.

I have worked in community/retail pharmacy, long term care, and ambulatory care pharmacy.  We need to recognize what all brings us together.  We have a simple, common goal of getting the best, safest, most appropriate medications to our patients and ensure that they are taking them as prescribed.

I am very proud of the profession and the progress we have made on provider status.  I think everyone understands the urgency and need for us all to be recognized as healthcare providers.

I don’t have a perfect answer here in how to best create bridges amongst the variety of pharmacy practices, but I would ask that you recognize the value of each pharmacist and the challenges that each setting might present.  If you are in a clinic like I am, go out and try to meet some of the community pharmacists in your area to create a face to face connection.  You might be surprised how helpful that simple gesture can be.

What experiences do you have with the potential conflict that exists between the different pharmacist roles? Please be respectful.

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9 Comments

  1. Keri Hager

    Thanks for your post! I definitely concur that we need to support each other around a common philosophy of practice REGARDLESS of practice setting.

    Reply
  2. Megan Adelman

    Great post, thanks for writing this! Much of what you wrote resonated with me, particularly regret for not doing a residency and the insecurity I experience often as a result. I appreciate your blog!

    Reply
  3. Gopinath K Vinayakam

    What a value presented here. You are really great.

    Reply
  4. kam

    That is a great post. I have thought about these things since I graduated (10+ years ago). When BSPharm was the only thing, those that pursued a PharmD thought they were better/superior. When the BSPharm was replaced by the PharmD (around 1999 or 2000), the PharmD’s thought they were better/superior. Now EVERYONE graduates with a PharmD, so whats the differentiation?—Residencies. So those that pursue and complete a residency believe they are better/superior. However, with too many universities having built too many pharmacy schools, coupled with the 2008 financial crisis, there is a SATURATION in pharmacy. So now, many graduates are pursuing residencies but I’ll bet there are more applicants than there are residency positions. I’m sure there is infighting among residency completing pharmacists–how to differentiate–BOARD Certification. When will it end? Too many organizations, too many factions. The “im a better pharmacist than your kind of pharmacist is, as Eric stated, “the kind of attitude we do not need. We all bring value and the location you work at doesn’t determine your professional worth. Be RESPECTFUL.”

    Reply
  5. Sarah A. Fussy

    I remember “back in the day” when I graduated in 2005 residencies were just starting to become “a thing.” We maybe had 5 out of 75 classmates go on to residency. I myself contemplated residency however ended up being one “of those” retail and LTC pharmacists. I always regretted it. I think there is a culture out there that makes you feel “less than” or inferior if you u work retail…even more so now that residency has become the norm. But that wasn’t the case for me, I’m not a boastful person, but I know I rocked at being a retail/LTC pharmacist and made a genuine difference in my patient’s lives. I just knew I wasn’t working at my full potential, knew there was more I could do. This was even more evident after I left retail & started working as a staff pharmacist at the VA. Seeing how progressive & vast the scope of practice that pharmacists can have in the VA inspired me to do something crazy…I went back to complete a “PGY1” (which I joking called a PGY10) in 2015, ten years after graduation followed by a PGY2 in geriatrics in 2016. It was the hardest thing I’ve ever done but worth it 100%—and not because I’m no longer a “lowly retail” pharmacist. I know better than that. Retail & dispensing pharmacists will always be the rate limiting step in patient care in my opinion. The world will go on and will “make do” (albeit not as safely in my opinion) if a pharmacist working in clinic calls out sick for the day, but the world may stop for a patient that doesn’t receive their medications. Rather, the benefit for me was the enhanced knowledge and skill set, the job opportunities and doors that have now opened for me as a result of residency training that would not otherwise exist. I wasn’t fulfilled working in retail and knew I didn’t have the adequate skill set to do the job I wanted without residency. That is the reason to do a residency. Not because you feel pressure or “less than” by working in retail or feel like you have to because “everyone is doing it.” Not everyone needs to do a residency to have a fulfilling career. You should do it because you truly have a passion to work in a specialized area of pharmacy. As a result of my passion for geriatrics & getting my butt kicked through 2 years of residency I’ve landed my dream job as a geriatric clinical pharmacy specialist in hospice & palliative care at the VA. I did BCGP certification after my PGY1 for myself, to prove to myself that I had acquired the knowledge, not out of pressure or to collect initials behind my name. I have ZERO plans to pursue PGY3 (yeah, those are apparently becoming a thing) nor any other board certifications unless for personal career gain. And guess what? I still have the utmost respect and appreciation for my colleagues in dispensing roles and I depend greatly on them to do my job. I can’t do my job successfully without them, and I can guarantee you I’m a better clinical pharmacist because of my dispensing background. There are things that you only learn while being in the trenches and I’ve come across a number of clinical pharmacists who’ve never worked in a dispensing role who readily admit they wish they knew more about dispensing practices. I never realized the extent of interdependence until now that I’ve worked both sides of the spectrum. So no more residency bashing or retail/dispensing bashing. We all bring a special skill set to the table that is vital to our profession. Let’s acknowledge this, and the importance of all pharmacists in every setting.

    Reply
    • Sean

      Well said. Thanks for sharing your story about fulfilling your passion.

      Reply
  6. Alan Vogenberg

    I have been practicing for over 60 years. In 1955, Community Practice was the way to go. But even then, there was infighting among our “professional” organizations. Obviously, that is still too prevalent, and there are more organizations “representing” Pharmacy than every before. The 3 worst mistakes I have seen since graduation are 1. mandatory PharmD , 2. explosion of Pharmacy schools, residencies. The PharmD should have remained as an optional degree for those who wanted to pursue Clinical Pharmacy. Obviously,
    ACCP wanted to meet the demand for Pharmacists, and flooded the market (supply and demand). After
    6 years, it seems ludicrous to me that residencies add any value to a Pharmacist. There is not enough demand, and too large a supply. Throughout the ages, Pharmacists have stepped up to solve problems for their patients in many different ways. Research, manufacturing, hospital, education, community, long term care, specialty Pharmacy are all examples. Remember, “Community Pharmacies are the laboratories of innovation”

    Reply
  7. Michael

    In my humble opinion I do not believe pharmacists will ever achieve provider status. My reason is very simple, economics. Our legislature and the Medicare program well know that they cannot afford to give another 300,000 health professionals the ability to bill a financially failing Medicare system. All the things we want and deserve to be paid for We have basically been doing for free for over 50 years. There is no incentive for the United States government to suddenly pay for something they have been getting for free for that long. Unfortunately we have baked it in.

    Reply
  8. Jessica

    I’m a new pharmacist, finishing up my first year of residency (so as some would say not even a REAL pharmacist yet). One attitude I find disturbing is the obsession some pharmacists have with discouraging others from becoming pharmacists. I’ve heard it several times just in this past year, and countless times during pharmacy school— even from preceptors! Pharmacists saying “well, hope you can even get a job these days with the market so saturated. Good luck”. It’s catching on to the students who are bringing proposals to APhA-ASP about limiting the graduation class size or number of schools in a state. What happened to pushing to work at the top of our license, instead of limiting our numbers? I absolutely understand the frustration—I graduated in Florida where there are (in my opinion) too many schools for the amount of current jobs. However, this is not an excuse to bad mouth the profession to the actual FUTURE of our profession. Can we not grow with the times? The medical field is not and never has been static- we need to continue to grow and practice at the top of our license. If all you want to do is verify scrips and do the minimum required, I can guarantee someone or some robot can replace you. I’m not talking about the unrealistic corporate demands— I’m talking about the pharmacists like the one who told me as a student that he does the minimum he has to do to remain employed. Any career in medicine is a calling- we have a responsibility to patients (not customers). We actually have a huge opportunity to step in and fill in the gaps in healthcare. Times are changing— get with it or get out of the way!

    Reply

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Written By Eric Christianson

January 10, 2018

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