Career Planning:

Practice Areas in Pharmacy

• The major areas of practice are presented with general concepts of career planning and obtaining a job are presented in this lecture.

• One of the great benefits of having a degree in pharmacy is the wide variety of career options that it opens to the individual.

• The possibilities are endless for the new pharmacy graduate.

• If an area of practice appeals to you, contact alumni from your school or local practitioners who work in that part of pharmacy.

• The availability of increasingly sophisticated robotic equipment and computerized systems with the growing number of Certified Pharmacy Technicians are affecting the practice of pharmacy.• Times are changing: Medication Therapy management (MTM) is becoming

more common in community pharmacy and could be the dominant mode of practice in the near future.• The MTM service model in pharmacy practice includes the following 5 core elements: 1. Medication therapy review

2. Personal medication record 3. Medication-related action plan 4. Intervention and/or referral 5. Documentation & follow-up

• Identifying a Career Option in Pharmacy:• A successful career is built on: 1. Good Planning

& 2. Good Luck ** Without planning, one will not be ready to seize the opportunities when they do arise.• Find a good mentor: faculty member in your school who seems to

know about the parts of pharmacy that interest you• Try to identify your strengths and interests• Ask yourself if you are willing to devote extra time, money, and energy for

more studies.• Ask an alumni

**A tool that helps a pharmacy student or a pharmacist who considers a career switch to evaluate the importance to the individual of several factors that vary among pharmacy practice settings:• Applying scientific knowledge• Business management• Pressure• Work Schedule• Leisure/Family Time• Job security• Opportunity for Advancement• Community Prestige• Professional Prestige• Income

• Critical Factors (general headings)• Interaction With Patients

• Conducting Physical Assessments

• Interpreting Laboratory Values

• Continuity of Relationships

• Helping People

• Collaboration With Other Professionals

• Educating Other Professionals

• Variety of Daily Activities

• Multiple Task Handling

• Problem Solving

• Focus of Expertise

• Innovative Thinking

• Applying Scientific/Medical Knowledge

• Creating New Knowledge via Research

• Management/Supervision

• Pressure/Stress

• Work Schedule

• Part-Time/Job-Share Opportunities

• Leisure/Family Time/Parental Leave

• Exit/Re-entry Opportunities

• Job Security

• Opportunities for Advancement/Leadership

• Professional Involvement

• Income /Benefits

• Geographic Location

• Autonomy

• Self-Worth

• Future Focus

• Professional/Community Prestige

• Unique Practice Environment

• Advanced Degree

• Entrepreneurial Opportunity

• Additional Training

• Interacting With Colleagues

• Travel

• Writing

• Working With Teams

• “On-Call”

• Work on Holidays/Weekends

• Presentations

• On a scale of 1-10 & based on the above responses >>>>>>>>> the specific positions, & work settings most likely to fit your responses are identified along with detailed information about each.

** Descriptions of various pharmacy practice settings are available on the Web site ( www.aacp.org;click on “Career Options” in the student section of the site)

• Getting Ready to Pursue a Career:• One of the best ways to determine if you like a certain part of pharmacy

is to work in that setting.

• Gaining this work experience is important in 3 ways:1. It provides you with the chance to see what your daily activities

would be like in that setting,2. Your experience there makes your school work more relevant by

showing you why you need to know “all this stuff”,3. Your commitment to that career option will appear stronger to

potential employers when you are graduating

• Remember: Time spent searching for a job after graduating is money lost & the postgraduate salary will be many times greater than that made during school.

• Talking with alumni or faculty members who deal with alumni and visiting local pharmacies can be productive.

• Investigating the possibility of summer internships available at hospitals, pharmaceutical industry, governmental organizations, and pharmaceutical associations is important.

• Kinds of Skills needed in various parts of a pharmacy career:• Pharmacy school is designed to teach the technical aspects of the profession (Touching

only slightly on people and big picture skills)

• Throughout career>>People skills become very important (must learn how to live, work, & communicate with others)

• As promoted throughout career>>>what learned in school becomes less important than keeping the big picture in mind.

***You can never stop learning***

**If you get involved in student organizations at pharmacy school>>> you can learn about small group decision making, conflict resolution, communication, teamwork, and goal setting

•Major Areas of Practice within Pharmacy:•Community Independent Pharmacy•Community Chain Pharmacy• Institutional Pharmacy•Consultant Pharmacy•Managed Care or Home Care•Pharmaceutical Industry, government, and associations

• For each of the above areas of pharmacy practice, the following components will be addressed in each synopsis:•Definition & scope of practice•Position availability• Salary• Typical day•Common rewards & frustrations•Prospects of growth & advancement

1. Community Independent Pharmacy:

• Where the profession began

• Still is the heart & soul of pharmacy

• Many of the pharmacists came into the profession because of the respect they had for the “doc” at the neighborhood pharmacy

• The spirit of entrepreneurship & the dream of owning one’s own business

• “Independent” is the key word

• Pharmacists uniquely are able to practice their profession the way they choose>>>>> can more quickly transition their practice into MTM if choose so

• Able to respond quickly to changing consumer needs & have a real & lasting impact in their community

• Each practitioner has the opportunity to succeed or to fail

• Each practitioner has the privilege as well as the risk of setting the rules & determining the policies for the pharmacy

• The community independent pharmacies are located in:

*Downtown areas

*Non-business residential areas

*Hospitals or medical professional centers

*Shopping malls

• A survey by NCPA showed 98% of independent pharmacist counsel patients & in a typical day, the independent pharmacist talks with physicians 3 times, and spends nearly 2 hours counseling patients.

• Starting salaries are often a little lower than in chain pharmacies but the prospects for advancement are different, especially if there is a chance to buy the pharmacy or start one’s own at some point.

• Independent pharmacies, like all industries, go though 3 stages of development:

1. Sales growth 2. Multiple locations 3. diversification >>>> increases sales, buying power, &/or diverse services (i.e.

compounding, durable medical equipment, long-term care, or IV therapy.

** The growth possibilities in these emerging areas of MTM & health care are limitless.

• For entry-level pharmacists >>> much of the day is spent in drug dispensing & patient counseling activities.

-Many have technicians to assist in filling of the prescription to be checked & dispensed by the pharmacist.

• Computers are very important in this setting, enabling the pharmacist to provide advanced services, i.e.: * Keeping patient profiles

* Checking for drug interactions * Providing pt.-specific information for counseling * Billing * Drug use review * Insurance purposes

* Some software packages facilitate MTM services ( conducting & documenting medication therapy reviews, providing patients with medication-related action plans )

-May compound special prescriptions or prepare I.V. drugs.

-Spends more time in direct patient contact for MTM & pharmaceutical care >>>> making communication skills, patient assessment techniques, & clinical knowledge all the more important.

**For managers & owners of community pharmacies, time is spent in:-Ordering merchandise & drugs.-Dealing with cash flow & account receivable or payable-Handling personnel problems-Marketing MTM & consulting services offered by the pharmacy-Planning for the future

** Most community pharmacies are small businesses & any employee can be called on to do almost anything from managing the store while manager is out of town to mopping the floor.

• Advantages:• Practicing in community pharmacy can be rewarding for those who:

* like to really know their patients* attracted by the entrepreneurship a small business

* want the flexibility of finding a job in any specific location

*Disadvantages (Frustrations):• Will have to deal with patients’ criticism about increasing prices of Rx drugs & problems with 3rd –party payers.* Long hours of standing on one’s feet with few breaks & much less sit down to

eat time

• In addition to the salary, many owners can benefit financially from the profit of the business & can sell the store to retire or move on.

• Because of owning their own business, many of the community pharmacists are leaders in the profession.

• Community Chain Pharmacy:• Practice in cities & towns of all sizes & shapes in a variety of settings,• Including: *The traditional chain pharmacy (i.e. CVS/Pharmacy & Rite Aid)

*Supermarkets *Mass Merchants (i.e. Target, Wal-Mart)

* Pharmacy is in the back of the store to encourage consumers to pick up other items while their prescriptions are being filled.

•Day-to-day operations: similar to those in independent pharmacies.

• A chain pharmacist is part of a larger corporate structure that provides numerous personal growth & career development opportunities.

• More than ½ of new pharmacy graduates in the U.S.A. enter chain practice each year.• Reasons include: 1) job availability in nearly any part of the country

2) excellent salary & fringe benefit packages3) store locations in areas of high population density4) the opportunity to interact with the public in a

healthy care environment (no matter what the size is, if the pharmacists can extract themselves from the Rx-filling process for pt. counseling & MTM & question-

answering)* If high Rx volume >>>> use trained technicians & automation

• Sophisticated software programs were developed by chains to:• Maintain each patient’s complete medication profile record• Detect any potential drug interactions when new meds are added to the

profile.• Online verification of patient’s eligibility under insurance plan >>>>. reduction in paperwork & claims handling• Inventory control & pricing accuracy

** The continual contact with patients is the primary key to a satisfying career **

• Many chain pharmacists serve as preceptors of student externs

• Some serve as practitioner members of schools’ curriculum committees

• Many chains are expanding the scope of their services into other health-related areas, i.e.:

* MTM * Immunizations * Nutrition * Weight loss programs (shopping tours to show pts. How to read food labels &

plan their diets) * Home health care * Nursing home consulting * Home infusion therapy>>> increasing the professional opportunities for those who choose to practice in a corporate chain setting

• Managed care: a growing area in most corporate chain pharmacy in which pharmacists negotiate contracts with health-maintenance organizations.

• Some pharmacists get involved in corporate management & may be promoted into positions at the store or corporate level in:

* general merchandising* store lay-out & design* site selection & real-estate negotiations

* Some pharmacists combine their professional talents with business interests.

• Chain practice satisfactions: * Level of job security

* The provision of continuing education directly by the employer * The predictability that a corporate environment gives the careers & the personal lives

of the employees. * Rewarding patient contact if allowed by policies & workload

* A lifetime of professional growth & opportunity • Chain practice frustrations: * Patients complaining about prescription prices * Non-pharmacist managers who may interfere with the pharmacist’s obligations to the patient * Reaching a “terminal” position early in the career but being frozen into that position by the high salaries offered by the chain

• Institutional Pharmacy:• Traditionally practiced in hospitals & other “organized” health care settings• Offer an entire spectrum of pharmacist positions for new graduates

• Dispensing-only jobs require little contact with patients & h/c professionals outside the pharmacy, other than via telephone

• Clinical pharmacy was born in hospitals: Full-time clinical responsibilities (interactions with the h/c team members go on continuously)

• Pharmacists in management positions deal with personnel & budgets

• Separate divisions include: home care, outpatient pharmacy, inpatient pharmacy, drug information, drug research, nutritional therapy, narcotics, intravenous room,…

• Pharmacy management positions require completion of residency

• M.Sc. degree (e.g. in business or hospital administration) may be needed to leap from pharmacy to hospital administration

• Large hospitals are often affiliated with schools of medicine or pharmacy & most clinical positions require a PharmD degree + residencies &/or fellowships

• Career in hospital pharmacy can be affected by decisions made as student or young practitioner

• Different Areas of Pharmacy Practice:* Outpatient (ambulatory) Pharmacy

* Inpatient Pharmacy* Acute Care* Clinical Practice* Acute Care* Emergency Care* Nuclear Pharmacy ( dealing with radioactive drugs)* Long-term Care* Home Care * Drug Information* Narcotics* Purchasing & Inventory

• Historically, salaries of hospital pharmacists were lower than in chain pharmacy; but because of the pharmacists shortages, the salaries were increased in late 1990s & early 2000s.

• Strong possibilities for advancements, & favorable benefits

• For pharmacist responsible for drug distribution, the daily mission is: To get the right drug to the right patient @ the right time. Capable, trained, experienced, & certified technicians can be very

helpful in that.

• Clinical pharmacists are more involved in direct patient care & drug information activities:

*Some round with the healthcare team, *Others provide specialized services, i.e.: PK monitoring or nutritional support

• Drug Information pharmacists answer questions from h/c professionals, or public about drugs, poisonings, & medication use.

• Institutional pharmacy administrators (little time in direct pharmacy practice) are more involved in:

* Personnel schedules & problems * Budgeting * Purchasing * Dealing with medication errors & stolen controlled medications,…..

• A student pharmacist may be turned off by hospital practice when his/her preceptor (often the pharmacy director) is not around busy attending committee meetings & other activities.

• Advantages of Hospital Practice:1) It is rewarding when improvement is seen of quite ill patients after successful treatments (e.g. code blue)

2) Working hours are predictable (7a.m.-3p.m., 3p.m.-11p.m., 11p.m.-3a.m.) >>>>> Easy to trade schedules & get vacation time

3) Very good possibilities of professional growth

4) Provides an intellectually stimulating, exciting, & dynamic atmosphere without the frustrations of community practice

• Disappointments in Hospital Pharmacy:1) Feeling of isolation if confined to a windowless basement pharmacy for drug distribution

2) Difficulties with bureaucratic tendencies

3) Lack of face-to-face patient contact for those without clinical responsibilities

4) Many hospital pharmacies are open 24 hours a day each day of the year, & staffing requirements can lead to conflicts with pharmacists’ personal lives

5) Salaries are not overly aggressive but benefits are favorable

• Long-term Pharmacy:• The provision of pharmaceutical services to institutionalized patients in long-

term facilities • Rich with clinical opportunities• Usually provided by nursing homes• Now community-based long-term care is also available in the U.S.A• In nursing-homes: patients (residents) are deficient in one or more of the

daily normal activities • In community-based long-term care: *resident may just need help with

taking their medication @ the right time or with preparing a meal

*may be living @ home & needs nurse to come once a day to help

• The long-term care pharmacist is usually a consultant because the relationship is usually “contractual”

• Consultant pharmacists work from a variety of settings: *Community independent or a chain pharmacies

*Stand-alone long-term care pharmacies, owned either independently or by a chain pharmacy or large long-term care corporation

*Hospital pharmacies *Pharmacies located in nursing homes (pharmacist may be an employee)

**Consultant pharmacist services to nursing homes are mandated under federal law**

• Salaries for consultant pharmacists usually start out between independent/hospital range & the chain range.

• Entry-level pharmacists may work for large corporations similar to chain pharmacies.

• Communication is by fax or through physician order entry system

• Some consultant pharmacists spend most or all of their time reviewing the drug regimens of residents working in closed –shop pharmacies & may also spend a lot of their time on the road from one home to another (very clinical position leaving notes for the physicians about patients’ drug regimens.

• Other pharmacists go into management or own consultant operations with jobs similar to managers in hospital or community pharmacy ( very strong entrepreneurial spirit) focusing on marketing to expand their business.

• Advantages :• Consultant pharmacy combines the clinical aspect of hospital pharmacy

with the patient contact & business challenge of community pharmacy. >>>> many pharmacists love this kind of work.

• Frustrations of Long-Term Care:

1) Travel associated with monthly drug regimen review 2) Lack of direct contact with the nurses & physicians caring for residents3) Work is not as dramatically rewarding as in the hospitals because most

residents are older or with incurable conditions4) Nursing homes expect pharmacists to be “on-call” @ nights or on

weekends

• Managed Care, Home-Care, & Mail-Service Pharmacy: • Health care provided by corporations (a form of insurance), i.e. health-maintenance (HMO) or Preferred-provider organizations (PPO).

• Rapidly growing because this way contains health care cost.

• They collect a prepaid premium from a consumer or employer & in return provide all needed health care services.

• Patients obtain care from the organization’s employees (HMO) or from designated physicians or hospitals (PPO).

• A typical day for a managed care pharmacist is similar to that in community setting, with key exceptions.

• Contact with the physician is easy & productive since the HMO pharmacist is located in a building with prescribers where institution-like policies & procedures are used.

• HMO pharmacy managers responsibilities are similar to those hospital pharmacy managers which require business skills.

• Salaries in managed care & home care are similar to those of hospital, independent, and consultant pharmacists.

• The managed care provides the pharmacist with:* job security* professional contact * schedule flexibility* role specialization

• Home-Care Pharmacy:• Centered around specialized needs of patients who have short- or long-term need for products, i.e. I.V. antibiotic or nutritional solutions

• Requires the formation of health care team & delivery personnel to transport all the goods needed to the patients’ homes.

• Pharmacists’ activities are similar to those in the I.V. preparations in hospital pharmacy or as a clinical consultant managing patients’ therapies

• Not filled with rules & regulations common to larger bureaucracies

• Mail-Service Pharmacy:*Controversial with no opportunity of face-to-face pt-pharmacist contact• Growing because:

*toll-free telephone numbers*e-mail communication*fax machines*computerized physician order entry systems*automated drug-dispensing technology*overnight-delivery services i.e. FedEx

• For many elderly & other patients for whom traveling is difficult or impossible• Some state boards of pharmacy have banned mail-service pharmacy • Pharmacists are in quality control & authorize the drugs to be mailed to the

patients.

• Pharmaceutical Industry:• Employs pharmacists in: * Sales

* Marketing * Government Affairs * Drug Information * Research * Management * Professional Relations * Executive Positions

• Long-term (not starting) salaries & benefits can be higher in industry.

• In industry, pharmacists usually start as pharmaceutical representatives then often can be promoted into marketing or government affairs.

• Limited positions are available in drug information.

• Summer internships are extremely valuable in assessing industry as a career option.

• Government (Federal Organizations) :

• i.e. FDA, Public Health Service, MOH

• Located in the capital city

• Pharmacists work in governmental positions for the opportunity to influence public policy related to pharmaceuticals & pharmacy services

(Not for salaries or job stability)

• Association Management:• Positions located in the capital city• Different Positions include:

* Professional Affairs (making policies about how pharmacists should practice or be educated)

* Legal Affairs (interfacing with the legislative, judicial, & executive branches of the government to ensure that pharmacists

provide quality pharmaceutical care)

* Educational Affairs (setting up conferences or study programs for pharmacists’ continuing education)

* Editorial Work (writing or editing books, journals, software , & other pharmacy works)

* Executive Activities (managing association offices & dealing with members who volunteer for leadership positions)

• Salaries are not much higher than those in government, but benefits are good, with travels to pharmacy conventions & lots of contact with colleagues.

• Several internships are available in association management

• Residencies in association managements are available @ ASHP, ASCP, & NCPA

** You can select the path that is just right for you by:

1) Studying the differences between various choices

2) Learning more about yourself

3) Meeting people working in the different parts of pharmacy practice