Lol@residents1
That was my pharmacy school password. This is a shit post about residency.
I’d classify watching my classmates gear up for Match Day as full-blown embarrassing. Here are the two distinct groups of the residency hopefuls that I see:
Group 1 - The Hot Shots: Also known as the overly proud, Rho Chi, pharmacy advocacy, daily IG posters. These kids have been paraded around the school for the past 4 years as the administration worships the ground they walk on. Overall smart people, but when I read their acceptance speeches in a few days, I’ll ask myself the simple question…why aren’t they in medical school?
Group 2 - The Lost Souls: This is the ultra risk-averse pharmacy bunch that has been patiently waiting for the school to tell them exactly what they should be aiming for post-grad. Not satisfied with the community pharmacy job market and without a perfectly structured classroom environment to be lectured and tested on “industry”, they’ve applied to residency programs out of feeling stuck and pressured. These kids will never admit they’re in this group, but they know who they are deep down inside, and I know who they are just by looking at them.
Say something nice about pharmacy residency.
Pharmacy Admin Residency: Legit training programs, c-suite level upside. This group of PharmDs will acquire a skill set beyond clinical memorization nonsense and be molded for future health system leadership positions. General pharmacy residents will say things like “value-based care” and “provider status” to try and move the needle on “pharmacy reform”…this is just monkey business for medication history robots. Pharmacy admin-trained residents will walk away with analytical and operational know-how to foster care efficiency and quality.
PGY2 —> pharma route: Here’s the short end of it - this will only work out for a very select few. A large majority being the niche oncology/transplant pharmacist who sluggishly makes their way into an MSL role. Clinical residents lack the baseline ambition and networking capabilities to make a successful leap over to biopharma. Signing up for residency shifts your training and understanding very far away from the P&Ls of the business. While you spent your time “mastering” treatment guidelines, your colleagues in biopharma spent their time learning how to innovate and commercialize. If the clinical resident truly had any insider perspective, he/she would realize that the “intense clinical training” you signed up for doesn’t have much leverage once inside the walls of biopharma.
Residency gets you out of bed in the AM: I can’t knock your hustle if it gets you out of bed in the morning - but I could not empathize any less.
“Ummm…follow your dreams, yeah!” - Larry Fisherman
What your school forgot to mention about pharmacy residency.
Food for thought - maybe this isn’t your school’s responsibility at all. Maybe you should take some ownership of your career choice and question the status quo. Maybe then you wouldn’t be so terribly miserable after you complete all your training and realize you’re just another cog in the wheel permanently stuck in the middle class.
On a scale of depression to clinical pharmacist, how’re you feeling today?
I’ve interfaced with A LOT of licensed pharmacists working across A LOT of different care settings. The only common denominator I’ve noticed is that they’re all miserable.
Arrive at the hospital ridiculously early in the morning - complain about no sleep
Round on patients - complain about no one listening to your recommendations
Complete your work - complain about patients, complain about no one picking up the phone, complain about having to write notes
Receive your paycheck - complain about being underpaid
Spend a day walking around a pharmaceutical company - it’s a country club compared to whatever bullsh*t the hospital is. Sure, people still “complain” about work, because it’s work, but there is no group of professionals that bitch and moan like clinical pharmacists do inside their box of an office tucked deep within the ugly depths of a hospital. It was very comical listening to my APPE preceptors pitching me to sit for my license to turn around and “try to connect with me” by putting their classmates on a pedestal who are “living the life” across biopharma.
Here are two anecdotal scenarios that played out in front of me during my pharmacy training. Which would you rather be apart of?
Clinical pharmacy team stress: “Ugh! This is so frustrating! We need more pushcarts so we can all parade around with our laptops during rounds. I can’t deal with having to share these limited pushcarts with our entire department every morning.”
Biopharma team stress: “Last year we got a 1.3x multiplier for our bonus. You think we’ll snag 1.5x this year? Oh btw, with summer Fridays coming up, should I risk taking all my meetings over the phone to increase my time at the beach?”
Read r/pharmacy literally once. Clinical pharmacists are the bane of their own existence. They do extra underpaid training to be apart of something that doesn’t exist - hence, unhappy.
The “impact work” of a clinical pharmacist is elementary.
Clinical pharmacists pride themselves on pushing the envelope of patient care. Some even go as far as calling themselves “doctors”. This whole premise is hilarious and wildly inaccurate. A simp like myself, who stopped applying himself after the second year of pharmacy school, can complete > 50% of clinical pharmacy functions at a high level. Here’s why:
Monitor ABx —> Excel does this for you
Drug information question —> UpToDate tells you the answer
Transitions of care for HTN, DM, HF, etc. —> all guidelines have the same chart that communicates “iF ThE pAtIenT iS tHIs ThEn THey sHOuLd taKe THat”
Problem solve on rounds —> baseline confidence to communicate and articulate opinions
Writing notes —> the attending physician, and the PAs, and the NPs, and the specialists, and the nurses wrote them already
Speaking of writing patient notes, aka the pride and joy of every clinical pharmacist…where’s the utility? Zero other stakeholders read pharmacy notes and the workflow for writing them revolves 90% around just copying and pasting everyone else’s work. Rewriting the MD’s opinion is not even close to practicing medicine…it’s plagiarism.
Here are my top 2 clinical pharmacy pet peeves that clinical pharmacists have brainwashed themselves into believing are deserving of wearing a white coat:
Medication Histories - I completed my first medication history probably like a week into pharmacy school. At that point, I was certain that anyone with a high school diploma could complete a med history just as well. Clinical pharmacists continue this “high-level patient care activity” through 4th year, through 2 years of residency, and then direct and continue completing them daily as a clinical pharmacist. Hope you enjoyed your countless hours of studying and taking a two-year pay cut to call CVS, wait on hold for 15 minutes, and confirm Mrs. Jones picked up her super basic generic drugs.
Oh, btw, your residency project about implementing a new transition of care service isn’t interesting or innovative. It’s silly.
“Poop Patrol”- I died inside every time I had to look a surgeon in the eye on rounds and say, “Mrs. Jones hasn’t had a bowel movement in 3 days so we should add a laxative.” Pharmacists hang their hats on recommendations that my mother can figure out.
Limited benefits and career stagnation.
Congrats! You completed your PGY2 and landed your first gig. You’re probably bringing home somewhere between $110-140k pre-tax. Not bad for year 1…do you think you’ll still be pumped about that package at year 10?
Listen to this. My comp package (which I’ve written about in previous blogs) is at the upper end of that range at year 1. That’s two years before you get there, and I get bonuses, and I get raises/promotions every two-ish years, and my health benefits are ridiculous, and I get more time off, etc…etc…etc.
Although we got the same degree - the clinical pharmacist chose “patients” and “the hospital” and I chose not to pigeonhole myself into a dying industry. Think about hiring and retaining a clinical pharmacist from the employer’s (e.g. the hospital’s) perspective:
There are like 1 billion PharmDs simping for every clinical pharmacy job I post. Simple supply and demand dictates that I can keep offering them less lucrative compensation packages and I’ll still be able to find talent.
PGY2 trained PharmDs look more like commodities year over year as they all have a general PGY1 and an acute care PGY2. Since they all have the same skill set, there’s no incentive for me to actively look for “top tier talent”. When it comes down to it, 90% of the job is order verification anyway, so it doesn’t even matter what the training is in.
The job at my hospital is the same as the job at the hospital down the street. Thus, there’s no incentive for me to put effort into retaining you with promotions and raises.
All my “innovative pharmacy services” are funded through ACO contracts and 340B savings. Thus, I have a limited (and capped) cash pool to pay any pharmacists from.
My business runs on razor-thin margins, so even if I do have extra cash in the budget, I’ll pass it along to employees like my surgeons who have different talent tiers and account for most of my margin through their elective procedures.
Where do you go after you sign up for your first clinical pharmacy job? Where’s the upside? If helping patients is your passion, why didn’t you become a PA or an MD?
Physician Assistant - less school, similar salary upside, actually practices medicine
Medical Doctor - more school, but hella salary upside (also c-suite potential), actually practices medicine
Pharmacist - ….
Let me take a wild guess. You weren’t smart enough to get into medical school but too prideful to be a PA because you “wanted to be a doctor”. You signed up for pharmacy school, got lost in the shine of the white coat ceremony, and won’t look back until your 5 years into your professional career and realize it was all a huge mistake.
One of the Discord homies uses this line when someone asks him why he got a pharmacy degree, and I conquer:
“Pharmacy school was the easiest terminal life science degree I could obtain to work across biopharma” - FreedRadical
Conclusion.
Am I biased? Hell yeah I am. But know this - I haven’t even started my post-grad employment and I’ve already had multiple PGY2 trained sheep reach out trying to figure their way into what I have.
Don’t bring your white coat to a gunfight. And miss me with that residency bullsh*t.
I am angry
Lol you sound bitter