Experts Discuss Advantages, Disadvantages of Switching to Industry From Oncology Pharmacy Practice

Pharmacy Times® interviewed a panel of experts, including Scott Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, director of pharmacy cancer care, Mayo Clinic and Pharmacy Times Oncology Edition™ editorial advisory board member; Judith Alberto, MHA, RPh, BCOP, director of clinical initiatives, Community Oncology Alliance (COA); Kevin Pang, PharmD, associate oncology scientist and medical writer at the National Comprehensive Cancer Network (NCCN) and regular contributor to Pharmacy Times Oncology Edition; and Kirollos Hanna, PharmD, BCPS, BCOP, director of pharmacy, Minnesota Oncology and assistant professor of pharmacy, Mayo Clinic College of Medicine, as well as Pharmacy Times Oncology Edition editorial advisory board member.

In part 1 of this discussion, the panel discussed how they define traditional versus nontraditional roles in oncology pharmacy today. In part 2, the panel discusses the benefits and drawbacks of pursuing a career within a nontraditional career path, and in particular a role in industry.

Alana Hippensteele: Hi, I’m Alana Hippensteele with Pharmacy Times. Joining me is a panel of experts to discuss unconventional roles in the oncology pharmacy field and how we define what that means.

How would we describe moving to an industry role? Would that be nontraditional in scope?

Scott Soefje, PharmD, MBA, BCOP, FCCP, FHOPA: So, I've done that. I left clinical practice, went into industry, and then I'm going to make a statement here for the industry folks: I left industry and came back into practice. So, it's all doable, right? Is it a different job? Yes. I find it very interesting, because I don't think people understand, a lot of times, going into industry, how specialized you really become. You're not only a breast cancer expert, but you are also that-drug-in-breast-cancer expert. And so, it takes a different focus to know it's about depth, not breadth, and depends on how you want to approach things. Part of the reason I left is I got bored learning about one drug. I wanted to know about all the drugs, and just, because of the work, didn't have time to do it.

It is, I would say, a non-conventional role. It's got a different prospect, a different aspect. And then when you start talking about industries, there are tons of industry jobs, right? There's MSLs, there's account managers, there's medical writers, there's scientists, laboratory, I mean, you can go anywhere in the industry, to do a lot of different things. And so, depends upon what your focus is and where you want to go, how you end up reacting to that industry-type job. Industry from, I think, health systems is this mixed relationship, right? We have this kind of love-hate relationship with industry. We want their information we want their good research, we want to talk to them about what’s going on. But we also don’t want the price of the drugs and all the other things that go along with it.

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The other reason I left industry was that it got harder and harder for me to separate myself from the sales of the drug. And again, one of the things that I think people don’t understand when they walk into the industry is, if you don't sell drugs, your company's not in existence. Yes, I may be on the medical side, and it may not be my job to go promote and sell the drug, it's my job to provide the medical information. But I'm providing that medical information to someone that's been targeted by the sales team that says they need that medical information, right? And so, it takes a different mindset sometimes to be able to do it. The good ones are really good at it. And you really like them, and you want them, and you want to interact with them. And so, I think a pharmacist who chooses to go in there, and be really, really good at industry can be really good at it, and walk away feeling good about themselves, feeling good about what they do, and feel like they're helping people along the way.

Kirollos Hanna, PharmD, BCPS, BCOP: Alana, Scott couldn't have said it more perfectly. And I think that's always kind of been one of the areas. I mean, don't get me wrong, I think probably all of us probably get approached through LinkedIn or through whatever platform of hey, we have an MSL opening or we have this opportunity opening. And I think a big reservation has been just, do I want to subspecialize or—I don't even know if I consider it subspecialized—but only focus on one single branded entity for the rest of my career. And for me and kind of what I’m involved in, I feel that it would, I don’t know, it would get boring, potentially at times for me.

But I also think that this is an important opportunity to put out a message out there for leadership. We see this mass exodus or the significant transition to pharma, because sometimes within clinical practice, the work-life balance has become challenging for people. Some health systems have put a significant demand on that pharmacist because they lack an infrastructure that is able to define what a clinical pharmacist FTE should and should not be responsible for. And that's where us as leaders really should be held responsible and accountable for that. And don't get me wrong, I also think from a monetary perspective, everybody knows that could be a little bit better on that side of the coin, on the pharma side. But shouldn't we be incentivizing those clinical pharmacists who are within practice, directly in patient care, coming into work when there are ice storms or when there's a pandemic, and still putting out their best foot forward for that patient? And this is something that I always try to do within clinical practice or within my current role is to justify that FTE, to really give a fair market value for the pharmacist that's really investing that time, energy and work. So, we don't see—and it's unfortunate that we're seeing some of it is due to a monetary aspect, and that work life balance, right. And I just think those are important things that leaders should also be looking into and considerate of.

I know there have been some pretty good workforces also in collaboration with HOPA, and various other organizations that are really looking at this. They've put out surveys, trying to really understand—one thing that I find hard to believe, I don't find that a mass exodus from clinical practice to pharma has to do because of the debilitating state of oncology. I think many people who go into oncology are very passionate about it and may have had personal experiences with it. And oncology practice today is incredible. We can cure and manage so many patients and they don’t succumb to their disease, because of the novel things that we’ve done. So, it's really interesting to see that and just kind of—I’m hoping that we can move into a world where we're supporting our pharmacists in clinical practice through a much better approach.

Judith Alberto, MHA, RPh, BCOP: I completely agree. I think very well said on all fronts. Industry offers a very unique opportunity, and it is not for everybody. On the flip side, they do offer a life-work balance. They offer something that in hospital administration, it's hard to compete with that. What I most loved about when I was a director is having that vision, and then really working with the staff to identify, what are your career aspirations? And how can we make that work? And how can we think outside the box? And while you can’t work in your pajamas every day from home, what can we do? And so obviously, if you’re rounding—and I think the pandemic showed us a lot, they showed us what we are capable of doing clinically from home—and so we did round from home. I had to get 50% of my staff, as you all did, at home overnight, because we weren’t allowed to work side by side. So, all of a sudden, we thought outside the box, and we did make this work.

And so now, on a post pandemic world, I think we need to consider what are we willing to do here for our staff and still offer excellent patient care, clinical service. And you think, there's a lot of opportunity to really find out what does your staff love to do? And how can you educate them and put them in the ambulatory clinics? How can you put them in a more managed care position? And how can you get that flexibility? You're working on a project, you can work from home. There are certain areas and scenarios that you can 100% work at home and have that flexibility. And so I think, as leaders in that arena, we have to be willing to do that and not just so narrow that we're not able to think outside the box. And I think pharmacists love oncology. They love doing that. So, if you offer that flexibility, if you offer that, work to the maximum of your license, work to what you love to do, let's work individually with you and see how we can advance your career, I think that turnover would lessen, and we'd see much less.

Soefje: I think it's going to be interesting, though, because a lot of the recent people who entered industry, entered it during a time of COVID when there's virtual visits, no travel involved, etc. But when I was in industry, we talked about work-life balance, I was missing little league games, because I had to be in Louisiana to do a presentation on a research clinical trial. There are these kinds of things that industry requires. When you start—if this all comes back, and you start looking at that you've got 100 days, 150 days, 200 days a year, that you're on the road, that's a whole lot different work-life balance than what we go through in clinical practice. So, I think that, while it's still a good job for some people, you got to really look at how the job is going—and it's like everything—you got to look at what the job requires, how it's going to fit into your personal situation, and whether it's truly a work-life balance situation or not.

Alberto: Yeah, interesting point, Scott. And I wonder that if people realize that before they go into it, because I lost a lot of moms at the time that said I want to work at home full time. And I wonder if, after getting into that, there was some disillusionment there.

Soefje: Well, it all depends, because, does industry go back to on-site visits? Are they continuing to keep everything as virtual, right? And I think that's what's going to make a big change. I do think you brought up a good point though. There's a lot of things. Like, in Minnesota, we can't verify orders remotely. We're not allowed to by law. That kind of stuff has got to go away. We got to remove those kinds of barriers to allow us to do some of those unique aspects in health care that allow us to keep people happy.

Alberto: 100% agreed.

Kevin Pang, PharmD: Everyone brought up excellent points, I agree with all of them. And also want to bring to light that sometimes it might not necessarily be the fact that a clinical role is too demanding. It might just be because a life event comes up, and then it’s, you’re having a family, you need to move to a new location, and it just happens to be this job opened up in this area. So, that might attribute a lot to it. But I also want to bring to the fact that what people are saying about expectation we're coming into industry is that there's a lot of different roles, and each one of them is quite stressed and demanding in some sort of way. So, it's a role that I think a lot of people come into, and then they work a lot. And you may or may not necessarily be getting that best work-life balance in the first couple of years that you work in industry. So, I think a lot of it comes down to your ultimate career path goal that you want to work in, maybe not what you need immediately, because you might not necessarily get it.

Soefje: I think there's a misconception of work-life balance. Your work and your life are never balanced. If you think you're going to work 8 hours and be at home 8 hours, that's never going to happen. You got to take it in a big picture, right? There are going to be times when you work more. There’s going to be times when you play more. There's going to be times when you do things with your family. Many times you do things at work. The problem we have in today's society isn't work-life balance. It’s when you go home, you still work, and you don’t disconnect, and you don't turn off your phone, and you're not there in the moment. And so, those are the kinds of things I think we have to start teaching. And then you teach your family, I got 5 presentations over the next 3 months, I'm not around. But then 3 months after that, I’m going to focus on us, we're going to go on a vacation, etc. That's work-life balance.

Pang: Yeah, that is an excellent point. I'll just note that I work hybrid, but there are times that I just work longer hours because of the fact that it's so accessible to log into my computer. So, I guess a big pro when it comes to clinical practice is you have more strict hours, supposedly. You can’t really do work at home if you need to verify orders there in person. So, I guess it's one side of having strict hours could be nice.

Alberto: Very good points, yes. And just to add, I see that. Now that I do have a nontraditional work-at-home, I tend to work longer hours during the day because I'm home. I don't have a commute, so working till 6 o’clock is nothing, logging back on at 8 is nothing because I'm here. And so definitely being able to shut that off and turn around and be with your family when your office is at home is a completely different scenario. So, Scott, you bring up great, great points and when I do have to travel or work on a presentation, that has to get done. And so, it's being in the present moment and learning how to juggle everything. Great point.

Hippensteele: So, kind of elaborating on some of what's being discussed: would you all say that the great migration—as it's been termed—of hematology/oncology pharmacists from clinical practice into roles like industry and otherwise, are they potentially going to come back?

Soefje: I wish I knew the answer to that. I've said this in several meetings in the past, and it's kind of controversial, but I'm going to say it again here, because I think it needs to get out. I'm kind of curious what's changed over the last 5 years. Because this idea of working 10-hour days, I've been working 10-hour days since I started in 1992. I've been logging in since I've been able to log in. I've been doing extra work, because that's the way it was. And the question I'm asking myself was, was I burnt out 20 years ago and just didn't know it? Or has something fundamentally changed over the last 5 or 6 or 10 years, that's changed the way employees and pharmacists want to do their work? And, and I think it's probably something that's fundamentally changed, and we as health systems, we as organizations didn't keep up with that change.

So, the question is now can we make that change, to make whatever it is that caused those people to leave to become more attractive so that they come back? And if we can do that, then I think we've got a chance of the cycle coming back down, and we actually see the people coming back into practice. If we don't do that, then I think we're in trouble. And so, I don't know yet. I think part of the problem is trying to figure out what it was that caused people to leave. What changed? And it wasn't just COVID. It was starting before COVID. And so, what was it that changed? And how do we fix it? And it's not just working at home. It's all the administrative tasks that pharmacists get pulled in, because that's a drug, you should own it. Now, it's back to my statement, you should own it, it’s a drug. Well, that doesn't always mean everything, right? And so how do we make that balance? How do we make it work? And if we figure that out, then I think we'll be in good shape.

Hanna: Alana, it’s also not just facing pharmacy. This is also an issue with mid-level providers, your NPs and PAs. Physician recruitment is also extremely challenging. I couldn't agree with Scott more. But I do think that people through the pandemic, and even before the pandemic, as mentioned, slowly and slowly started to get pulled into responsibilities that they didn't sign up for, or they may not be an expert at. And it's never a black-and-white question, which then segues into so many different issues and process developments and such. And if you didn't sign up to be in that administrative bucket, and that's kind of the hat that you wear, you then find yourself just stretched and pulled in so many different directions, that you don't have the capacity to be successful.

And then when you think about pharmacists, who love to be involved, right? Like Scott said, I mean, I don’t work 40 hours a week. We’re putting in well over that. We’re logging in, trying to still balance our home and everything else that we’re doing. But then you look at pharmacists, yes, who are traveling to conferences, who are maintaining their clinics and their clinical practice, who are publishing articles who are precepting students and residents, who are doing these different and unique and great unconventional things. But then again, getting pulled into things that may not be related to their specific role. And then that is what I think is a key driver to potentially that burnout or the exodus.

One thing I, at least, have seen some trends here in Minnesota, some physicians would get offered potentially an incredible salary with this type of work schedule where you're working these clinic hours. But then all of a sudden, the health system would recognize, we don't have someone to cover our inpatient unit, we don't have someone to cover the weekend, we don't have someone to cover on-call evenings. And then these physicians who signed up for an 8 to 4, or whatever you want to call it, are then getting pulled outside of that family balance that they potentially had in mind signing up for the role. A lot of different things that I've kind of seen there.

Alberto: I think what I've seen is when people come in to oncology, they know right away if they love it or they don't, they leave. If they love it, I do find they stay. They may move around in different fields, but I find, once you fall in love with it, you're staying. I feel like as far as the burnout goes, as leaders, we need to be in touch with our, again, the staff, and as an organization—wherever you are, whatever role you're in, whether it's industry or community or large academic—I think valuing, supporting, giving each other the resources that we need to do our job well, I find that people don't mind as much working over and above and beyond and taking on additional work. Sometimes it's temporary. During the pandemic, we all took on so much work outside of our traditional roles wherever we were.

But if we did that as a team, and we said, okay, here's the light at the end of the tunnel, this is what we need to do to get through. Let's collaborate, let's work together as a team, let's get through this. I think people don't mind that then. They don't feel taken advantage of. They don't feel like they're being used and not valued, and they'll go that extra step. And then again, as a team, you can work towards pulling out of that, whatever you’re in—whether you’re a hospital now, everybody’s in the red, in a post-pandemic world, and we're cutting, and everybody's getting burnt out, and people maybe are leaving. But if you can get your group together to say, look, let's all work together. This hopefully is temporary. Here’s our steps, and here’s how we can get out of this. I think people, then, they're incentivized to go that extra step, and then maybe don't feel so burnt out, because now they see something. They see a goal, they see a mission, they see a light at the end of the tunnel. They want to support their fellow, the partner, each other.

Hippensteele: Absolutely. That's beautifully said. So, how do some of these nontraditional roles as we're discussing throughout this panel, how might those nontraditional roles available in oncology pharmacy impact some of the great migration that's occurring? Is there perhaps a lack of broad knowledge and awareness of what some of these nontraditional roles might be and how they might potentially fit in for to somebody's career who might be feeling like they need to change? Or maybe it's a work-life balance issue? What might the interaction there be and how might greater awareness potentially impact things in the long term?

Hanna: It's a very good point, Alana. And I think school and residency training oftentimes don't prepare you for the potential opportunities that a pharmacist can tap into. I mean, that's inevitable. But I also think so too, this is really just a call out for various organizations that focus on pharmacy They need to work on ways to really send out the message of how pharmacists can get involved.

I'd love to hear if you guys have an idea of what the best way to do that is, but sometimes pharmacists may not feel maybe the confidence or feel equipped to be involved in a BCOP committee, for example, that focuses on BCOP educational deliverables. They may say, oh, I don’t have the years of experience or I don't have this. But also from an organization perspective, as we're picking different pharmacists to be involved in committees and such, it's very important for us to have a mindset that's all inclusive. A lot of times in various deliverables that you see through LinkedIn, through Facebook, through Twitter, through all these different things, you may see key thought leaders that you're seeing in a lot of deliverables, right. And I think that's an area where it may steer someone away from feeling the confidence to be involved. So, how do we gage those people to really leverage their expertise, I think is also one of the unique ways of how we can improve this whole exodus kind of thing that we're talking about. I'd love to hear what the others have to say as well.

Soefje: I think that the remote work that we were doing with COVID showed people that working at home is not so bad. And I think what's happened now is those days of you get up, you get dressed, you go to the hospital, you go to your office, are gone. And it’s like, I'm at home today. And so, it's one of those things where, how do we learn to balance that in an oncology pharmacy practice, such that if my pharmacists are doing administrative days, they're at home, and they get less interruptions, and they're getting more administrative work done? How do we balance it, where you're sitting in a pharmacist in one part of the state, but you have an affiliation with a hospital in the other part, that hospital’s getting slammed. So, our pharmacists who are not working as hard pick up the work and get it all done, so we're sharing across the system. Those are the things that technology and what COVID has shown us we can do. How do we integrate that?

I think the next thing that’s coming, and it’s going to be fun to watch, is how do we integrate AI into automation that relieves us from those rote tasks. And, I keep telling the pharmacists and pharmacy students, if you think your job is order verification for the next 20 years, you're out of a job, because I firmly believe computers are going to be doing order verification. All of it, not just some of it, all of it. And then they will flag us for those things that they say, pharmacist human, you need to look at this one, but otherwise, this looks good, go for it. Right? And I even think it's going to happen in oncology. People are freaking out in my institution because I'm talking about do we really need the second verification in oncology. And I'm beginning to believe we don't. And I'm even thinking about if the doctor enters the order into the treatment plan, doesn't change anything, why does it even need to have a pharmacist review it? Now I get the responses, well, the labs might be wrong, the weight might have been entered wrong. Well, the computer can flag me for that kind of stuff.

And so, as we put all of this together, then what do the roles become? And I think that's where we as administrators, we as thought leaders have to start thinking about. Where is the value of the pharmacists, and what do we , what are we doing? And that's what we're trying to do here. That's why we're pushing pharmacists out in the clinic, letting them sign chemo orders, doing all of those kinds of things. Because that's a role people want to do. And I think then that'll bring people back.

Alberto: I think they're great points, Scott. And I think looking at how to get pharmacists in these more nontraditional roles by freeing up some of the traditional roles I think is a great point. And, looking for an avenue then to explain, I mean, I would have even never known this was a possibility. And so how do we get that message out earlier on? Maybe we open up more areas for students to shadow. Maybe we develop programs that will really allow, while they're in school, all of these nontraditional, and we offer a shadow a semester, that they can have the opportunity to spend a day in the life of all of these nontraditional roles. Maybe we create an organization that can bring that together and say, here's your opportunities, and that organization would be willing to allow some students to see inside of what could be in their future.

Pang: Yeah, I agree with everything that's been said. I particularly like the idea of, reaching out to students that are currently being educated about the roles that pharmacists can do. And I think the trickiest thing about it is that, because of the fact that a lot of these nontraditional roles are not in academia, you don't really have that connection back.

Like, for instance, I would not be equipped to teach a class in diabetes management. And a lot of the professor roles, I imagine, require you to be specialized in that field and practice for many years, and then you reach back to come back and teach. So, I think a lot of the awareness can be increased if it was incorporated into pharmacy curriculums, but not really sure how that will progress. I would say that people that are looking to get just greater awareness of the things that can be done outside of traditional pharmacy could always reach out to people that are working in those roles. I'm sure more than the majority of people in these types of roles would be happy to explain and perhaps let people shadow.