ALBERT EINSTEIN MEDICAL CENTER: EXPLORING PHARMACY SPECIALIZATIONS

RESIDENTS OF THE GREATERPhiladelphia area rely on the AlbertEinstein Healthcare Network to providehigh-quality care in its fast-paced,urban setting. This private,not-for-profit health system operates5 major facilities and a variety of outpatientcenters, including a behavioralhealth center, a rehabilitation facility,a subacute care facility, and a teachinghospital—Albert Einstein MedicalCenter. It is here where Einstein offersits patients advanced health servicesand its pharmacists an opportunity tocarve out rewarding careers in a varietyof specializations. Einstein's pharmacyservice includes 1 central pharmacyand 5 satellite pharmacies—specializing in critical care, oncology,and neonatal/pediatrics. A dedicationto patients and to progressive care ledU.S. News & World Report to nameMoss Rehabilitation Hospital (part ofAlbert Einstein Healthcare Network)one of America's best hospitals.

STARTING OUT

Thomas O'Connor, PharmD, MBA,is the clinical coordinator for studentsin Einstein's pharmacy program. Aftergraduating from the Philadelphia Collegeof Pharmacy, Dr. O'Connorbegan his career at Jefferson UniversityHospital in Philadelphia. Years later,while working in Ohio, he decidedto return to the "City of BrotherlyLove." He soon accepted a position asa pharmacist faculty member, teachingon-site, where he could combinehis love of pharmacy and teaching.Every 5 weeks, he greets12 new students eagerto begin a new rotation.These rotations—studentsmust complete 8in their last year—include drug information,rounds, drug therapyquestions, andpresentations on drugefficacy. Upon completionof the program,these pharmacists willmanage patient diseasestates and drug therapies,counsel patientsand consult with physiciansand nurses, as well as serve as apreceptor to new pharmacy students.

In addition, pharmacy residentsprovide direct patient care at Einstein'sImmunodeficiency Clinic.They are also certified smoking cessationcounselors and they coordinatethe outpatient deep vein thrombosistreatment program. Residents arealso in charge of counseling on low-molecular-weight heparin.

BIG-CITY RESPONSIBILITIES

Within the health care system andwithin the city, Einstein is not only ateaching hospital, but a neighborhoodhospital as well. This brings agreat sense of pride to the staff andstudents at the hospital, as they feelthat they are making a true differencein their community. Because Einsteinis a teaching hospital set in an urbansetting, though, it is presented withanother set of issues and responsibilities.Einstein's goal is not only toprovide patients with exceptionaltreatment, but also to educatepatients on how to alter their lifestyleto prevent diseases and infectionsonce they leave the hospital. "We providemedical support for a lot of preventablediseases. As a result, ourchallenge is to promote behaviormodification to support our therapy,"said O'Connor.

THE ROAD LESS TRAVELED

Staying on top of the policies andregulations that allow Einstein toprovide care for all of its patients is avital piece of the puzzle, yet managementis an often overlooked componentof the pharmacy service. "Themanagement aspect of pharmacy ispretty big in hospital pharmacy," saysO'Connor, adding,"You can't be a goodmanager if you're not first a good pharmacist.Pharmacy schools have notembraced management as its own discipline.Most pharmacists don't evenknow they want to be managers. Theystart off grumbling about things likeprocesses, scheduling, and coordination.This aspect of pharmacy takes youaway from the warm glow of talkingwith doctors about drugs and consulting with patients. They think there is a front line that we'resupposed to be on that does not include sitting on committees.But there's a real opportunity there to make a difference,and it's a good career, certainly. There areadvancements in pay and opportunities to grow in yourcareer. You can spend 4 to 5 years in a pharmacy and thenstart thinking of management," he suggests.

THE QUIET SIDE

What if management skills are not readily accessible forrecent grads? "There are a lot of other opportunities inwhat I call the ‘quiet side of pharmacy.'That includesinvestigational drug research, pharmaceutical auditing,managed care, drug utilization review, research, and soon." In fact, Einstein maintains the long-running ClinicalTrials Research Program, which serves as a home base forpharmaceutical, biotechnology, and medical device companiesinterested in conducting their research. More than 200active clinical trials are going on at Einstein today.

Whatever aspect of pharmacy a resident ends up in, he orshe must be adept at communication. While great emphasisis placed on the patient, there is not always an opportunity inhospital pharmacy for face-to-face contact. "That happenson a different level," notes O'Connor."As much as they want to bepatient-oriented, most interactions arewith the professional staff. Not toomany patients leave the hospital knowingthe name of their pharmacist." Ifinteraction with patients is not somethinga pharmacist strives for, there aremany other opportunities to practicethe profession—nuclear pharmacy,total parental nutrition, addiction services,compounding, etc.

While O'Connor recognizes the various sides ofpharmacy, he sees their inherent conflicts. Betweendispensing pharmacists and clinical pharmacists, thereis a barrier, he says. "We're trying to combine bothclinical services and distributive services. At Einstein,the clinical pharmacists are responsible for putting inan order. Bottom line, we don't have a ‘we're clinical,you're not'problem. Hospitals that integrate the clinicaland distributive roles of pharmacy support boththe need to be patient-oriented with the need to becompetent in the distributive policies and procedures.It's more important to integrate. We need to understandeach of the responsibilities and put the pharmacyback together again."

In most programs recent grads will usually begintheir clinical practice as a "generalist" in a 6-monthtraining program. Once they show proficiency, theycan decide whether or not they would like to pursue aspecialization such as acute care, infectious disease pharmacy,or oncology/chemotherapy.

THE PHARMACY OF TOMORROW

Based on his own experiences, O'Connor sees for thefuture of pharmacy a recentralized pharmacy service withmail orders increasing. He predicts patients will becomemore and more comfortable with Web services. "You'll continueto see emergency drugs and initial therapy providedlocally with centralization of prescription of chronic therapy.Pharmacists will be there for the initial counseling, but thefilling will be done elsewhere." That leaves pharmacistsworking for big organizations rather than small pharmacies,he says. "There will be big banks of pharmacists with headphonestaking drug information questions from patientsand doctors and nurses—via headphones, e-mail, phones—not in person. Face-to-face counseling is effective but not allpatients are ready to learn at the moment they pick up theirprescription. Therefore, following up with a phone call,printed material, or e-mails can supplement in-store counseling," says O'Connor. "In the future," he predicts, "therewill be more continuity of care."

Ms. Farley is a freelance medical writerbased in Wakefield, RI.