Why Can't Rotation Sites Pay Student Pharmacists a Stipend?

The short answer is: the accreditation document says so.

Historically, however, students could earn a full pharmacist’s salary after 5 years of college. The 5-year bachelor’s degree prepared student pharmacists for entry-level positions, and those who wanted more clinical training would then move onto the Doctor of Pharmacy curriculum.

As the role of the pharmacist changed, so did the degree requirements to have every student pharmacist eventually earn a doctorate.

On the one hand, PharmD students can now reasonably earn a doctorate in 6 years instead of 5 years of undergraduate pharmacy school plus 2 years of doctoral training—a savings of 1 year. On the other hand, PharmD students spend their fourth professional (P4) year doing rotations and trying to squeeze in time for their previous intern position at an intern’s pay, rather than a pharmacist’s.

The perceived challenges of the experiential-heavy P4 year raises 3 questions:

1. Should student pharmacists quit their intern position in their P4 year?

Ideally, student pharmacists in their P4 year will begin exploring career options regionally, nationally, and even internationally. However, those who leave their intern positions may not secure a position after pharmacy school.

On the flip side, burning the candle at both ends—the paid and the unpaid position—likely makes student pharmacists less effective in both positions. The resulting poor performance reviews could hurt their chances of securing employment.

2. Should student pharmacists be called student-pharmacist-intern-rotation-student-job-residency-seekers instead?

Arnold Schwarzenegger provided some guidance on this point in his University of Southern California 2009 commencement speech. In it, he said, “I’ve always figured out that there are 24 hours in the day; you sleep 6 hours and have 18 hours left.”

Schwarzenegger, who has held roles as an actor, bodybuilder, college student, construction worker, and politician—often at the same time—would likely support the added hyphens.

3. How can preceptors help?

The P4 year can easily become an emotional roller coaster when you’re losing the support of surrounded by your classmates, earning a weekly income, having set hours, and living in the same apartment. Preceptors can provide housing, but that might not provide enough time apart.

When student pharmacists move site-to-site, they creatively find relatives, near relatives, distant friends, and new friends with housing. This makes holding down a place-based job difficult.

Some preceptors can work with a student’s work schedule, but others can’t. I worked up to 20 hours a week while I was in my P4 year, but I set 2 of my elective blocks in vacation destination states so I could look forward to them. Still, P4 was easily the most tumultuous year of my pharmacy school experience.

A Potential Solution

By providing stipends, student pharmacists would know ahead of their P4 year what income they could earn outside of a part-time job. A P4 year without the burden of a part-time job might provide more students the opportunity to excel in their rotations and earn a postgraduate position. Often, these rotation blocks provide de facto interviews for the student.

Imagine competing for a sought-after job in a 1-hour interview against someone who spent 5 weeks on a site. Which candidate could an employer trust more? A part-time job challenges the student to perform at his or her best.

The academic literature makes clear that student debt has increased dramatically. Adjusting the accreditation document to allow student pharmacists to receive a stipend—even if it’s capped at some arbitrary amount like $500 a rotation block—would provide some financial relief. It’s important to give sites the opportunity to tangibly acknowledge the financial sacrifices of students on rotation.