Expert: The Great Migration of Hematology, Oncology Pharmacists Brings a Call to Action for the Field

Pharmacy Times interviewed Zahra Mahmoudjafari, PharmD, BCOP, DPLA; Alison Gulbis, PharmD, BCOP; and Kamakshi Rao, PharmD, BCOP, FASHP, on a 2022 ATOPP Summit session they will be co-presenting addressing research they conducted assessing the underlying causes of the hematology-oncology pharmacist great migration.

Question: Where are hematology-oncology pharmacists migrating to for the most part?

Alison Gulbis: Well, that is a great question. That's not something we could pull out from the survey, but speaking from what we know of people going, I'd say a lot of them went into pharmaceutical industry, especially with the increase in CAR-T products and other opportunities out there that were opening up for medical science liaison positions, etc. I think a lot of people have gone to that.

But in addition to that, there have been a lot of other nontraditional pharmacy roles that have opened up that people with clinical expertise really are being recruited for. That includes things like working for insurance companies, as a clinical pharmacist to help with decisions they may have to make with formularies or other access issues patients might have. There's health information technology, tons of people are looking for clinical pharmacists to help with the sector of the electronic health record [(EHR)] and how to build orderable, especially for chemotherapy, etc, and best practices and data mining, and looking at how do you pull data and extract it out of the EHR and bring it back to take care of the patient better.

So those are some nontraditional roles that I think are becoming more appealing to people also, because they're remote positions, for the most part. So I think those will be trends that continue. You may see a more equal shift across different types of positions that might be out there, not just industry.

Zahra Mahmoudjafari: I would definitely echo that what we saw in our research, we have to absolutely acknowledge that our colleagues are well-trained and well-positioned to take on these roles, and that the title of clinical pharmacist is evolving.

There's also, to add to what Alison said, opportunities in continuing education, and some of our colleagues have moved onto support those types of roles. So there's no shortage of opportunities, and I have to acknowledge, that doesn't necessarily mean that clinical pharmacists are going to necessarily be in direct patient care roles like we were when we were training.

Question: Has there been any research conducted looking to assess this migration from the field?

Alison Gulbis: So there's a lot of research on burnout in health care professionals, and pharmacists get lumped into that in a lot of those surveys that have been done within the past 5 to 10 years. I think that what hasn't been addressed directly in terms of a study is how do you mitigate these migration issues, how do you keep and retain your employees, and how do you come up with ways to show that you appreciate them that you recognize their hard work their doing and that you're willing to give them time to do professional development activities.

There's commentary on that in some publications, but how do you make that go into play and how do you measure if that works to keep employees. That hasn't been research that's been done that I've been able to find.

Kamakshi Rao: Yeah, I would say that was that was the motivation here is that we've had those anecdotal stories, we've heard the commentary, and we've read the opinion papers, but what we really thought was there's power that could be had if we could aggregate that data and start to show that it's not an institutional issue, it's not a regional issue; it's a nationwide professional issue. So that was really the goal when we started was to make sure that every oncology pharmacist in the country had a voice that we could aggregate together to show some power, and I think that's exactly what we saw in the study.

In that survey that we sent out we asked some directed questions around job satisfaction, around how that correlated with a desire to consider alternate careers or changing careers, but then we actually left an open commentary section, and that was the part that I think when we got results, I sent Zarah and Alison an email saying we have a couple of hours or days of reading ahead of us, because people just bared their souls, and it was so powerful to read those words.

As we started to really affinitize that data, it was so clear that it was common themes coming across consistently, so as 3 of us really sat and all 3 of us have read all the comments, we feel really confident that this is a really powerful way of looking at this data as a whole. So ours is just one piece that I would say warrants repetition throughout the pharmacy profession.

Question:Is this migration occurring across the field among hematology-oncology professionals beyond pharmacy, or is it primarily occurring among pharmacists?

Alison Gulbis: I'd say yes, it is occurring across health care, not just hematology/oncology. I think even beyond health care, when you read articles about the “Great Resignation,” they don't focus just on health care professionals.

It's hard to pinpoint if, like we said earlier, is this because of the pandemic and all the things that occurred with it. Clearly, something has happening for people to notice it and talk about it, whether it be through a commentary in the Wall Street Journal or other places where they're talking about this, but yeah, I think it's an issue across the board.

It might be that maybe we need to revisit all human professionals or all health care professionals, and are they doing what they should do at the top of their license? Do we need to make sure we're not giving administrative tasks to people who shouldn't be getting certain administrative tasks? Do we need to make sure we're giving protected time to all these people to develop professionally, because professional development is vital in health care in general, to make sure that you're on top of things, and you're in the know, with the new research and that you're networking with people. I think that was a big thing COVID-19 took away from us to networking with people. That's made an impact on how people rethink what they're doing across health care, and is this what they want doing and be in?

Question: What is your outlook on the future for hematology-oncology pharmacy?

Kamakshi Rao: That's a big question because there's a lot of weight behind that answer. But, quite honestly, I've been a hematology/oncology pharmacist for over 20 years now, and I remain optimistic about the impact and the value that hematology/oncology pharmacy professionals and pharmacists can have.

It is so clear the value that we have in helping optimize patient care and collaborating with our other health care providers and professionals to do strong research to teach and to advance care. Those opportunities all exist, and they will continue to grow over time. As all 3 of us are involved heavily in education as well, it's great to see the amount of interest there is in joining this profession and being part of that.

I would say there's a challenge to the profession as well. I think it is going to require local institutions and our profession as a whole to really embark on some very serious cultural change: It's about changing our value proposition and it's about trying to blend the business-minded pharmacy with the idea that we are a people-oriented profession, not just for our patients, but for the people that actually do the work. I think that the evolving focus and the evolving attention around building inclusive work environments is absolutely necessary to be leaned into.

So I think there is a challenge ahead for those that are trying to leave this profession to make it one that continues to be someplace that people choose to join, and maybe more importantly, a place that people choose to stay. I think a lot of people see clinical practice as that first entry point out of postgraduate training, our challenge is going to be how do we get them to see it as a place where they can continue to grow and evolve for a long swath of their career.

Question: Any closing thoughts?

Kamakshi Rao: Well, I feel like we've laid a lot out the issues and the problems, but I think there's also strategies to mitigate and make things better. So I don't think we want to leave this all doom and gloom. I think there's great promise for us.

I think from a mitigation and how do we move this in the right direction standpoint, I think it's a couple of things, and I invite my co-authors here to chime in. I think, on one hand, is just recognition that the landscape of opportunity has changed and supporting our people so that every individual has the opportunity to realize their best potential, whether that be within the patient care environment or outside is part of our job to move people into the roles that they best deserve.

I think a lot of times people migrating into roles outside of direct patient care, we've all heard the terms people say, ‘Oh, they're moving to the dark side of admin or the dark side of industry.’ Realistically, there are just so many sides, so I am more interested in people finding where they belong versus feeling like they are running from jobs that aren't satisfying and that don't have the right reward ratio.

I think individuals have a responsibility to communicate with their managers and managers have a responsibility to open, vulnerable, and thoughtful conversations with employees so you can understand what each individual is looking for. If we can really engage in getting to know the people who are helping us deliver care, then there's nothing that we can't do and there's nothing that we can't get past.

Zahra Mahmoudjafari: Well, I agree, I would say we have an opportunity now. We understand the issue, we understand what it is our team members are asking for, so I think, as practice managers, we have to continue to advocate for, like Kamakshi said, our value, not only within our organizations but within ourselves, but also outside of our departments, with our providers, with our nursing colleagues, etc so they can give support to our pharmacists that are with us and are working day in and day out, trying to make their lives a little bit easier, giving them that time that they need to do the teaching, do the research, supporting them in whatever support means to them. And then recognizing that patient care is extra ordinary, it should not be ordinary, and making sure that they feel valued as well.

We also have an opportunity, as Kamakshi said, to figure out this value metric and apply it to clinical pharmacy in a way that's meaningful and not just institutionally specific, as that's something we definitely have yet to define from a clinical pharmacy standpoint. So I see opportunity to talk about this, and we've looked up the data and now we need to work on the next steps. So we're really looking forward to the discussion in San Diego and presenting the research. It's near and dear to us so it’s a exciting to present it because we've been sitting on it for a little bit and we're really excited to show it off and to really start the discussion with everyone.