The Regrets of Pharmacy Students

During my pharmacy school days and years after, I’ve talked to many pharmacy school students at my program, and from many others at other schools I met from clerkship rotations or conferences about their pharmacy school experience.  One theme I recall were the regrets that some students expressed after coming to pharmacy school.  These regrets vary based on their interest, background, and the pharmacy school they chose.  Some of these issues may be of use to future pharmacy school students to consider so that those pursuing this career could view all of the angles and possibilities when making the best decision possible.

Many pharmacy school students in their senior years expressed some uncertainty about their job prospects.  According to an article in PharmacyTimes, there were 72 pharmacy schools in 1987.  In 2014, 130 pharmacy schools were accredited according to the American Association of Colleges of Pharmacy (AACP).  The rise in pharmacy schools and graduates will mean more competition for limited job openings, unless the number of vacancies available due to retirements or new opportunities match the number of job seekers year after year.

Pharmacy schools have evolved to incorporate clinical decision making into their curriculum.  This is evidenced by the trend from a Bachelor’s of Science in Pharmacy towards the Doctor of Pharmacy as the standard in today’s pharmacy schools to become a pharmacist; this may be due to the complexities found in drugs, diseases, and different aging populations to manage.  Additionally, the availability of opting for further board certifications in various specialties administered by the the Board of Pharmacy Specialities (BPS) allows pharmacists to attain further recognition in patient care.  However, pharmacists are not trained to diagnose patients in the same way as medical doctors, physician assistants, and nurse practitioners are.  They are trained as dispensers of prescriptions for the most part as opposed to prescribers (although some states allow clinical pharmacists some prescribing authority with limited scope under the supervision of a license patient care provider).  Therefore, for pharmacists interested in the clinical aspects of patient care such as diagnosing and treating patients, many pharmacy students have expressed frustration in the limited scope of their clinical involvement; they are being confined to reviewing or advising on medication regimens for complex patients such as vancomycin dosing for renally impaired patients, or managing nausea and vomiting for chemotherapy patients, and checking INR levels for anticoagulation patients.  Some students believe from their clerkship experiences that clinical pharmacists are not generally thought as being part of the essential “core” of a patient care team, and will always need to fight and earn their place in the team to be respected.  And they’ll have to  earn their place again each time a new team or leader is implemented which makes things even more difficult.   Therefore, many pharmacy students and graduates believe that pursuing a degree as an MD, physician assistant, or nurse practitioner as opposed to a PharmD  is a more preferred route for those interested solely in patient clinical care.

One last example expressed by pharmacy students include being “stuck” in the traditional retail pharmacy setting.  Because a lot of pharmacy students take on much debt to finance their education, they are also quick to accept a position in a traditional retail pharmacy immediately after graduation, and forego a chance at furthering their knowledge in other areas of pharmacy.  Such opportunities would be available in a paid post-graduate residency or fellowship program which could open doors to other opportunities beyond a job in a retail pharmacy.  A lot of hospitals look for residency experience for those who lack any type of hospital experience on their resume, especially for limited and competitive positions.  This may also be the best time to pursue a residency immediately after pharmacy school as their knowledge of pharmacy will be very fresh on their minds as opposed to someone who took a position in retail after graduation, and decided to pursue a residency and enter a new industry after many years in the retail setting.

 

Dual Degree Program: MD and PharmD

 

 

 

 

 

The Rutgers Ernest Mario School of Pharmacy currently offers a dual degree program for both the Doctor of Medicine (MD) and Doctor of Pharmacy (PharmD) in addition to several other dual degree programs such as PharmD / PhD, PharmD / MPH and PharmD / MBA.  Although, many pharmacy schools offer dual degree programs, this may be one of the first to offer some sort of pathway for an MD in addition to a PharmD.  According to the website’s current description for the program, only “enrolled” PharmD students are eligible to apply; they may apply during the Fall of their second or third professional years (P2/P3).  Once accepted, they may enter medical school after successfully finishing their PharmD program.  This is important to note because one feature many people may look for in a dual degree program is the reduced time it would take to receive both degrees at once as opposed to applying and obtaining each degree separately.  As a result, there appears to be no advantage in saving time;  it seems one would have to finish both the MD and PharmD programs in the same length of time as it would have taken to finish the MD and PharmD separately assuming the applicant enrolls into the programs sequentially.

Now let’s review the time required to be a full-fledged MD/PharmD with a few examples:

Applicant A:  Two years of pre-professional studies + four years of professional PharmD program + four years of MD program + three to fives years of residency + year(s) fellowship (depending on specialty).

Total aggregate time spent obtaining both degrees and finishing residency after a high school diploma:  At least 13 years to 15 years or more (depending on fellowship/specialty).

Applicant B:  The second type of applicant would already have a bachelor’s degree which would have taken around four years to complete, and would have to apply to pharmacy school which would generally take another four years…plus four more years of medical school.  Applying to the MD / PharmD dual degree program would mean they would have to commit to at least 15 to 17 or more years of school and training after a high school  diploma before finishing residency, and even more if pursuing a fellowship/specialty.

Assuming the average age of a high school graduate is eighteen years of age, a person finishing a MD / PharmD program and residency would probably be around 31 to 33 years of age assuming no entry into a fellowship.

Such a person finishing years of rigorous schooling should be congratulated; it is a difficult task to accomplish even one professional degree.  But before one can bask in the glory of their dual titles, with the benefit of adding extra letters on their resumes and business cards along with their names, it would be prudent to review the pro’s and con’s of such a program, as each person’s life situation will vary.  Here are some factors to consider:

Pros:

Opportunities:  The dual title will surely grant more job opportunities…more so in leadership roles which may garner higher incomes.

Knowledge:  Someone with both an MD and PharmD would surely know a good deal about pharmacology and its applications in the clinical settings.

Prestige:  Having both degrees will draw prestige…as you may be part of a very limited pool of specialists holding both degrees.

Skip the MCATs:  No need to study for this tough exam if admitted into the program.  However, your grades, extra-curricular activities, leadership qualities, and other accomplishments and experience will probably be more scrutinized.

Cons:

Time horizon:  Having back-to-back degrees and training will require more time, which could affect your social life.  An eighteen year old will probably be in their mid-thirties before they can capture their full income potential.

Finances:  Staying in school longer while being financed by high interest loans could lead to an enormous amount of debt which may take years to pay back unless you come from wealth.  One would have to obtain a job after residency (or fellowship) that pays well enough to justify the time expended to earn both degrees.  Adding to these expenses for a typical mid-thirty year old something:  compounding interests on the loan, family expenses (e.g. wedding, children, mortgage, cars, etc).

Job placement:  A dual MD / PharmD graduate should probably pursue something related to both where both knowledge and skills could be best utilized…otherwise what would be the point in wasting all the time and money? This may narrow the job searches to teaching professions or medical research and drug companies.  Also, if accepting a position that could have been obtained with only one degree or the other (e.g. MD or PharmD), such as a pharmacist or as a general doctor, or even a doctor specializing in gastroenterology who may not need a PharmD, the cost-benefit for pursuing a dual-degree program with respect to time and money may not be worth it.  Why go to medical school if you’re going to end up working in a hospital as a pharmacist?  Or why pursue a fellowship in transplant surgery when you could without having a PharmD?

The above are only a few factors to consider for the future applicant.  Of course to each their own, as one’s preferences and dreams are different from the next.  Each person will need to evaluate in their own way on whether such a program with its costs and benefits fit their goals in life.

Measuring Demand for Pharmacists

It is not uncommon these days to hear from pharmacy students or pharmacists about the pharmacist job market:  that the supply of pharmacists have risen, probably exceeding the demand for them.  If this imbalance occurs, the competitiveness with which a newly minted pharmacist could vie for a limited position rises, which could lead to the lowering of income earnings, reduced benefits, and maybe disagreeable shift assignments (e.g. night shift, weekends, holidays, etc) assigned to new hires .  Some point to the high volume of pharmacy schools that have been forming in the past decade, and the increase in class sizes observed at already established schools.  It is commonly known in the pharmacist job market that the majority of pharmacist positions are held in the retail and hospital setting.  Therefore, the demand for pharmacists may depend on the openings available in existing and new retailers and hospitals.  Job openings will post when pharmacists retire, when employees transfer or leave the position, or when new growth opportunities occur such as opening new retail stores and hospitals, as well as expansion seen in established retailers and hospitals.  In any case, a prudent pharmacy school candidate should perform thorough research to view the outlook of pharmacists’ demand and future job outlook, pay, benefits, and growth opportunities that are projected from the time they graduate and up until they retire.    Although such projections may not come to fruition in the future, it is a good idea to be informed of the economic landscape surrounding the pharmacist job market.

There are a few tips to gauge interest and demand for pharmacists which include but are not limited to job searches in your local area, and reviewing job statistics available from the Labor Department.  There are also searches that can be performed on the Internet, or information that may be of use from websites that offer some opinion or projected measures of such job demand. 

Here are a few of such resources:

Using a job search engines such as indeed.com will return available results within a locale.  For example, typing in the keyword, “pharmacist” in the “New York, NY” area generates 411 job results (see below) as of the time this search was performed.  Of course these results may change on a daily basis.  Using different job search engines may return similar and overlapping results, but some sites may return different information.

 

 

 

The same search performed on the same day returns 615 results in a different job search engine, simplyhired.com:

 

 

 

Therefore, it may be a good idea to use multiple job search engines when measuring openings in a specific city or area.  Using other keywords such as “pharmd” or “pharmacy” may generate a different set of results.

Another source of information is the United States Bureau of Labor Statistics.  Using the “Job Outlook” tab on their website will provide some information on the job prospects for pharmacists based on their data.  According to their page, the current information seems to be consistent with the perception of the rising competitiveness seen in this industry:

 

 

 

Finally, one interesting website (pharmacymanpower.com) measures the demand for pharmacists using a numbered scaled from 1 – 5:

 

 

 

 

 

 

 

 

The meanings of “unweighted”, “population adjusted”, and “response weighted” can be found on their website.  A further look in their site will show more information based on state, region, and job setting.

Viewing their map, the darker regions indicate higher demand, and lighter regions noting lower demand according to their website:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

However, it is important to note their disclaimer:

 

 

As all things, it is important to do your due diligence, and perform thorough research before committing to a decision.  Using a myriad and diversity of resources could provide a better picture about the market landscape, as well as seeking information from job search experts.

How to Use PharmD Program’s Unique Directory

As some may already know, our website not only takes contributions from real-life pharmacists and their perspectives, opinions, advice about working as a pharmacist, it also includes a unique pharmacy school directory unlike those offered from other educational websites.  The directory lists available pharmacy school and PharmD programs, along with scores on how easy your walk or commute will be to commercial or landmark locations.  The higher the score, the more walkable it is to the closest stores, restaurants, coffee shops, etc.  This directory may serve as an important tool when deciding how well you will adjust to the school’s location based on its convenience to areas where you could hang out, shop, tour, or just have fun.

Let’s take a closer look at how to use this website more effectively.  First, click on the “Pharmacy Schools” link at the top of the webpage:

 

 

Next, search for a school that you may be interested in.  Here, we will look at a school located in a pretty cool city:  Chicago.

 

 

 

Next, click on the link to the school to arrive at the program’s page:

 

 

 

 

 

 

 

 

You will notice three separate scores for (1) Walking, (2) Public Transportation, and (3) Biking.  Again, the higher the scores, the easy it may be to walk , to find public transportation, and to bike to notable landmarks or merchants.  These scores may serve you well if you will not be having a car, or if you do not live near the school.  Evidently, the higher the scores, the less likely you will need to worry about getting around town, or finding your own transportation.  If you click on any of the scores, a new webpage will open up in your browser with a map of the school, and more details regarding the relative times using different transportation methods:

 

 

 

 

 

 

 

 

Clicking the map, will open up the map with a flagged list of area merchants such as coffee shops, restaurants, bars, grocery stores, parks, and many other places.  Needless to say, most may prefer to attend a dream school that offers nearby places of interest where a drive or a walk to buy groceries, or grab a cup of coffee would not expected to be very difficult.

 

 

 

 

When clicking on a specific category, the navigation window on the left will change to a list of businesses or landmarks within the category:

 

 

 

 

These scores on the website should obviously be used with some caution, and only for information purposes only.  You should not base your decision on these scores, and it would be recommended to apply to the school that you desire based on what the school can offer you, whether you can get in and afford it, and whether it would be a good match for you.   The scores offer information about ease of walkability, or how convenient it would be to walk to the nearest merchant.  However, it does not provide any indications on the favorability or satisfaction the location may bring to anyone.  Some areas with high walking or transportation scores could also resemble congested, urban areas with lots of pollution and noise, and higher cost of living.  On the flip-side, schools with lower walking and transit scores may offer an area that is peaceful, quiet, and less-congested.  Take for example the University of Hawaii at Hilo College of Pharmacy which currently has a relatively lower score.

 

 

 

 

 

 

 

 

 

However, the school is in Hawaii!  How would you not want to live there if you desire paradise, warm weather, water sports, and the beach?  To each their own, as some people prefer being around crowds, and others may enjoy living in a place that offers a serene and quiet environment.  Therefore, enjoy using the scores for researching information about the location of your schools…or for your own amusement.

Tips to avoid getting stuck in the retail pharmacy setting

Many pharmacists have asked how they could get out of retail pharmacy.  Well, first of all, not getting stuck there in the first place is the easiest way to avoid it.  For example, if you are confident that you do not see yourself in a retail pharmacy position in the long run, try to work in the clinical setting right out of pharmacy school.  Many pharmacists in a retail pharmacy setting may find themselves in a bind because they want to earn money as quickly as possible to provide for themselves and their families, or paying off debts after toiling in pharmacy school for years and losing money to pay for tuition and its compounding interest.  This may be fine in the short run to take care of financial issues, but the long term career aspirations and goals may be compromised, stunted, or delayed by years for doing so.  Therefore, for those of you not interested in a retail pharmacy career, it may be beneficial to work towards a non-retail (e.g. clinical) career early on as long as financial issues could be deferred for a few more years after graduation.  Just like anything else in life, preparing and planning early may allow one to avoid long term regrets.  Here are some tips to land a clinical gig after pharmacy school.

Aim for a pharmacy internship or technician position in a hospital before or during pharmacy school to gain exposure to the work and services provided by a hospital pharmacy.  Learning how to compound intravenous admixtures, total parenteral admixtures, answering frantic phone calls, working with nurses, filling medication carts, and delivering medications to dispensing cabinets may provide a good comprehensive background of what to expect in the clinical setting.

Networking with other hospital inclined pharmacy students, professors, and pharmacists is a great way to get connected to the hospital world.  Networking with them may provide helpful and interesting tips and assistance.  They may be the first to know about hospital job openings at their own hospital, and even refer you to the right hiring managers so that you may receive a proper introduction.  Networking, regardless or pharmacy settings, is probably one of the most powerful tools at your disposal for any type of career and job.  Be sure to participate in relevant organizations, clubs, and social activities to expose yourself to meeting new people who may be of assistance later on.  For those that have already been in retail pharmacy for some time, and are having a difficult time landing a hospital pharmacy position, networking is probably one of the best ways to transition over to the clinical setting.  Joining a local hospital pharmacy organization, and attending local pharmacy conferences will allow one to network with many other local professionals, some who may work in the hospital setting, and provide you with tips and information about job openings.

Applying for a hospital residency or fellowship is another great way to get acclimated to the hospital environment.  After the conclusion of the residency and fellowship, a position may even be offered to you by your supervisor if there are openings upon successful completion of the residency or fellowship.  Having completed a residency is one of the best ways to be considered for a hospital position after graduation.  It may set you apart and above those that lack of a residency, or put you on par with those that have hospital experience.

Obtaining a board certification, such as board certified pharmacotherapy specialist (BCPS) may also beef up one’s resume to compete for the limited openings for hospital pharmacists.  This is not the easiest or cheapest route, but many hospitals appreciate the knowledge and skill provided by the BCPS pharmacist.  There are books and courses offered at pharmacy conferences dedicated to preparing pharmacists for this test.