The community pharmacist working in the corner drugstore may be the most visible and best-known pharmacy practitioner, but the profession of pharmacy is far more diverse than most realize. Pharmacy students often think in terms of whether they will practice in a community or hospital, but the landscape of pharmacy practice encompasses a great deal more than those choices. While the majority of pharmacists work in the community, pharmacists are represented in a variety of settings and specialties. The Happy Pharmacist, in a blog post, identified nearly 50 different areas of pharmacy practice, and other sites like the American Pharmacist Association’s career site present an equally robust menu of choices for the pharmacy student or new practitioner to explore. This is the first article in a two-part series that will explore different areas of pharmacy practice and share resources for career exploration and development for those interested in learning more. Academia Academia is a career option for pharmacists who love teaching and engaging with students. Pharmacists may work in a variety of academic settings, including colleges and schools of pharmacy, other professional schools, and pharmacy technician training programs. Academic pharmacists who work in colleges or schools of pharmacy may follow several different paths. Many maintain a clinical practice site that is affiliated with the college or university and precept pharmacy student rotations at that site, in addition to teaching duties. Others may hold concurrent administrative positions such as Dean, Assistant Dean, or Director and spend most of their time engaged in work at the college or school of pharmacy. Research, scholarship, and professional service are also part of the workload of academic pharmacists. In general, most pharmacists who work in colleges and schools of pharmacy have residency or fellowship training, and/or an equivalent combination of pharmacy practice or industry experience. Brittany Riley PharmD BCPS MS is Clinical Associate Professor in the School of Pharmacy at Marshall University. Her first exposure to academia was during residency, where one of her preceptors held an appointment that combined practice and teaching activities. After residency, Dr. Riley gained a faculty position with a similar structure. Within a few years, she transitioned into a faculty roll that replaced the practice site with other responsibilities. Now, she is Director of Residencies and Director of the Center for Pharmacy Practice at Marshall SOP. Dr. Riley explains her passion for academia: “I love that lightbulb moment in students when they grasp a challenging topic. I also love the sense of pride that I get when my students go on to do great things for the profession. I also greatly enjoy the emphasis on service to the profession that is present in academia. This allows me to shape and improve the status of the profession.” According to Dr. Riley, students interested in academia should look for a mentor during pharmacy school and try to complete a teaching rotation or elective. It may also be beneficial to pursue coursework in education and learn about curriculum development, educational psychology, and develop skills relevant to the classroom. Dr. Riley continues: “My last piece of advice would be to read. There are great books and articles available on how to teach and the psychology of education.” Developing the skills of lifelong learning will help students not only in their path to academia, but in their development as practicing pharmacy professionals. The American Association Colleges of Pharmacy offers resources for pharmacists interested or working in academia. Clinical Specialties Clinical specialists work in many different sectors of the health-system. The most well-known area of employment for clinical specialists is hospitals, but clinical specialists can be found working in other settings, including outpatient clinics, cancer centers, community pharmacies, and managed care. Clinical specialties for pharmacists include, but are not limited to cardiology, critical care, oncology, internal medicine, neurology, pediatrics, psychiatry, and organ transplant. Some clinical specialties are associated with board certifications that can be earned after successful completion of an examination and a specific number of years in specialty practice. For more information on board certification, please visit the Board of Pharmacy Specialties. Each clinical specialty has its own body of knowledge and challenges/benefits. Kelley Carlstrom, PharmD BCOP (Board Certified Oncology Pharmacist), explains her choice of clinical specialty this way: “Oncology is an ideal specialty practice area for pharmacists as there are many challenges that patients and healthcare providers encounter that we are uniquely qualified to manage. Some examples include rapid drug approvals, use of drugs with narrow therapeutic windows, complex patient education needs, short- and long-term toxicity identification and management, pharmacogenomic implications, and ongoing drug shortages. Oncology pharmacists practice in a variety of practice settings including academic medical centers, community hospitals, infusion centers, specialty pharmacies, professional organizations, pharmaceutical industry, information technology departments, startup companies, payors, the government, and others.” An eye for details and strong math skills are good for those interested in pediatric pharmacy. Krista Cira, PharmD, is a pediatric pharmacist working in Chicago. She says, “I like pediatrics in that our problem lists tend to be small and manageable for each patient. Kids are also very resilient.” Cira elaborates, “My job as a pediatric clinical pharmacist and staffing pharmacist for the pediatric satellite is a unique position. Some days I get to round in the NICU or PICU as the clinical pharmacist and write TPNs, preform kinetics, make therapeutic recommendations. When I staff the satellite, I check and verify orders entered for any patient in the peds unit, Peds ED, and NICU. We also make and check all IVs and oral meds dispensed to the patients on our units. To become a pediatric staffing or clinical pharmacist you must have attention to detail, stay up to date on guidelines, know your references and be proficient in calculations.” For more information on clinical specialties, including specialty-focused interest groups, please visit the American College of Clinical Pharmacy. Community Pharmacy Community pharmacy represents the largest area for pharmacist (and pharmacy technician) employment, with a majority of pharmacy school graduates finding work in this sector. Community practice includes chain retail (large companies like Walgreens and CVS), grocery and “big box” retail pharmacy (Kroger, Wal-Mart), and independently owned community pharmacies. Community pharmacists fill prescriptions for medications, devices, and supplies based on orders from prescribers like physicians and nurse-practitioners. These prescriptions are dispensed directly to patients or their representatives. Pharmacists in this setting must be adept at working with the public and be dedicated to providing outstanding service and patient care. This pharmacy setting offers opportunities for management training and pharmacy ownership to those who are interested. Bhavana Mutha RPh is a 20-year pharmacy veteran. Ms. Mutha explains that the community pharmacist role requires flexibility and the ability to multitask. Her daily tasks include drug utilization review, where she makes sure that the prescribed drug is safe and appropriate for the patient, checking drug interactions, monitoring therapy and counseling patients on adverse reactions and what to expect from their medications. She is also involved with her company’s efforts to manage cost, increase adherence rates, and decrease hospital admissions through various patient interventions. “Community pharmacists are the face of pharmacy because of our sheer number of face-to-face interactions with the patient,” she explains. Speed, accuracy, and the ability to remain calm under pressure are desirable attributes for the community practitioner. “A typical day can be very busy, so we must be able to multitask and stay composed.” In addition to these skills, a community practitioner sees drugs to treat the spectrum of disease and conditions, so staying up to date with clinical knowledge is critical to provide the best patient care and service. Ms. Mutha is motivated by making a difference in the lives of her patients. “Knowing how many people are affected by my knowledge and support and seeing that I made a difference in someone’s life is priceless,” she states. “I share my knowledge with my patients and they add knowledge and richness to my life as well.” Community practice is not without its challenges, however. “The biggest hurdle we face today is keeping up the pace with changing technologies, software, and expectations. Community practice can be high stress and metric-oriented.” Students who are exploring community practice should be ready to meet the demands of patient service, know how to access good sources of information, keep their knowledge up to date, have excellent communication skills, and be flexible. According to Ms. Mutha, “Community practice can be challenging, but it carries with it tremendous rewards.” For more information on community pharmacy, check out the National Community Pharmacy Association. Drug Information Drug information pharmacists provide educational and clinical information to other healthcare professionals and the public. Pharmacists working in this setting may be affiliated with academic institutions, health-systems, managed care organizations, or the pharmaceutical industry. The drug information pharmacist specializes in finding answers to complicated or sometimes obscure questions and summarizing the needed information in a usable format. The United States Food and Drug Administration (FDA) also employs drug information pharmacists to provide scientific and regulatory information on new drug approvals. Many drug information pharmacists have relevant residency and/or fellowship training. A drug information pharmacist’s skillset may include, but is not limited to research, teaching, precepting, formulary management, and medical writing. Zara Risoldi, PharmD, MS, FASCP, is Director of the Center for Drug Information and Evidence-Based Practice at Creighton University School of Pharmacy and Health Professions. According to Dr. Risoldi, “What I love most about working in drug information is that no two days are ever the same. It’s a little like detective work – you have to follow the clues, probe for more information, and use your resources in order to provide clinical recommendations that help improve care for patients and populations. Drug info pharmacists work in a variety of different practice settings: hospital and health systems, the pharmaceutical industry, academia, pharmacy benefit managers, the federal government, and more. If you like reading, writing, and research, drug information might be a good fit for you. Explore a residency in drug information or ask for drug info projects on each of your clinical rotations.” For more on drug information, please see the following guidelines from ASHP. Home Infusion Infusion therapy involves the administration of medication parenterally. The term “infusion therapy” can refer to drugs that are administered intravenously, but also to drugs that are given by other non-oral routes, like intramuscular injections or via epidural catheter. Infusion therapy may be required for diseases that are unresponsive to oral therapy, for medications that cannot be given via the oral route, and for patients who lack normal gastrointestinal function. Medications delivered via home infusion include antibiotics, antivirals, antifungals, cardiology medications, chemotherapy, nutrition therapy, immunosuppressive medications, specialty medications, and more. Home infusion pharmacists compound infusion medications based on a prescriber’s order, and provide those medications to patients either at home, or in outpatient infusion facilities. Home infusion pharmacists are also involved in counseling and clinical monitoring of patients receiving home infusion services. Mary Bluthardt, PharmD, MBA, is completing a home infusion residency after recently earning her Doctor of Pharmacy. Dr. Bluthardt has compounding experience from working as a pharmacy technician, first in a hospital and then for a large home infusion pharmacy. She cites the patient-friendly practice of treating at home instead of in a hospital as one draw of home infusion. “We can treat a patient at home and set up services such as nursing, to facilitate their healing.” Pharmacists in home infusion work closely with nurses to monitor and manage patient therapy. Patients have access to a nurse and/or a pharmacist on call 24 hours a day. Home infusion pharmacies follow a team-based approach to managing patients. Dr. Bluthardt explains her passion for home infusion: “I was able to take my passion as a compounding technician and transition to a working as a pharmacist in an area of pharmacy that allows me to deliver excellent patient care in a growing field. I would encourage anyone interested in home infusion pharmacy to shadow or complete a rotation at a home infusion site to see all of the benefits we can provide to our patients in a non-traditional setting.” For more information about home infusion pharmacy, please visit the National Home Infusion Association. Hospital Pharmacy Hospital, or health-system pharmacy is concerned with the distribution of medications to patients in both inpatient and outpatient settings. Although hospital pharmacy is traditionally associated with the care of patients staying in the hospital, many hospitals and health-systems have expanded their services to include providing medications for patients to take home with them after a hospitalization and filling prescriptions for outpatients. On the inpatient side of health-system pharmacy, patients are often complicated and take multiple medications. A hospital staff pharmacist has exposure to medications for many conditions, including oncology drugs, intravenous (IV) therapy, total parenteral nutrition (TPN), antibiotics, pain medications, and much more. The responsibilities of an inpatient staff pharmacist include dispensing medications, drug therapy monitoring, sterile and non-sterile compounding, supervising technicians, making purchasing and inventory decisions, and serving as a resource to the medical and nursing staffs. Amanda Ingram, PharmD, Director of Pharmacy for two hospitals in West Texas, shares that her role allows her to practice at both ends of the pharmacy spectrum – inpatient and outpatient. She gets to know her patients and counsel members of the community while also working with the clinical team in the hospital. Dr. Ingram explains, “I am the Director of Pharmacy for two small, critical access hospitals. In Texas, if a facility meets certain criteria, you don’t always have to have a pharmacist present. For one of my facilities, I go once a week to retrospectively review charts and orders. The other facility has experienced many of the same financial dangers facing other rural hospitals, and to provide more value to the local population, the hospital decided to bring a full-time pharmacist on staff. I helped them set up a small retail pharmacy so in addition to doing all the usual inpatient pharmacy tasks, we also dispense outpatient medications. We set up 340b programs for both pharmacies (inpatient and outpatient). I have one retail and one hospital technician working with me, so I have to do a little bit of everything.” For more information on health-system pharmacy, please visit the American Society of Health-System Pharmacy. Long Term Care Long Term Care (LTC) pharmacy is a sub-specialty of senior care pharmacy. This area of pharmacy focuses on providing services to the older adult population, including the elderly residing in long term care facilities such as assisted living or skilled nursing facilities. Growth in the older adult population has increased the demand for senior care pharmacy services. Chad Worz, PharmD, BCGP, CEO of the American Society of Consultant Pharmacists explains, “The population of people over 65 years old and the sub-population of people over 80 years old are going to double in the next 15 years. This group consumes almost 40% of all the medications prescribed in the United States. To provide proper care, pharmacists are necessary to help physicians and patients manage their medication use, ensuring their regimens are safe and effective.” In general, there are two different career paths in LTC pharmacy. One focuses on dispensing medications, and the other on the provision of consultant services. Pharmacists who dispense medications in LTC settings may work for independently owned or corporate LTC pharmacies. Medications are usually dispensed from a centralized location and delivered on a daily or other schedule to the facility being served. Innovation in LTC pharmacy operations has come in the form of emergency contingency supplies for skilled nursing homes and in packaging. Blister cards and compliance pouches are a few examples of how medications are dispensed to efficiently serve older adults living in assisted living or skilled nursing environments. Consultant pharmacist services are required and provided in LTC facilities. Consultant pharmacists review patient charts every month and make sure that medication regimens are safe and appropriate for patients. They also help the facility comply with regulatory requirements around the provision of pharmacy services including proper storage and administration. The clinical skills employed by consultant pharmacists are used throughout senior care to better medication management. For more information about senior care pharmacy, please visit the American Society of Consultant Pharmacists. This concludes the first part of our series on pharmacy careers. It’s easy to see that landscape of pharmacy practice is diverse and offers many opportunities beyond the traditional areas of hospital and retail practice. Stay tuned for the next article in this series, where we’ll explore nuclear pharmacy, managed care, specialty pharmacy, and much more! Source
