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, FACCC, 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. The panel discussed definitions of “unconventional” roles in oncology pharmacy and the benefits and drawbacks of pursuing a career within one of these nontraditional career paths. This is part 1 of a 2 part discussion.
Pharmacy Times: Call for Papers
Pharmacy Times Oncology EditionTM and Pharmacy Times Health-System EditionTM are seeking to expand our current coverage offerings to include peer reviewed research on clinical topics and treatment of different disease states.
The publications are seeking to focus on a wide range of therapeutic categories in the oncology and health-system pharmacy space to educate readers and translate innovative clinical discoveries into improved health outcomes for patients. This new focus on clinical research seeks to accelerate adaptation of new therapeutics, techniques, and technologies from the publication’s pages to the clinical setting.
The clinical manuscripts sought will examine different treatments for and management of the different disease states and pharmacologic interventions. Of particular interest are papers that highlight the role of the pharmacist within the overall health care team and provide insight into the impact pharmacists have on patient outcomes. These submissions will be peer-reviewed and published in upcoming editions of Pharmacy Times Oncology Edition and Pharmacy Times Health-System Edition.
Some clinical topics of interest include:
- Transitions of Care
- Immuno-oncology
- Hematology
- Breast Cancer
- Lung Cancer
- Leukemia/Lymphoma
- Ovarian Cancer
- Melanoma
- Head and Neck Cancer
- Antimicrobial stewardship
- Cardiovascular disease
- Renal disease
- Metabolic disease
- 340B
- Biosimilar adoption
- Immunizations
- HIV and pre-exposure prophylaxis
To send in research paper submissions or if you have any questions, please email Alana Hippensteele (ahippensteele@mjhlifesciences.com).
Additionally, panel participant Kevin Pang, PharmD, encourages students and health care practitioners who are looking to improve their medical writing capabilities to reach out to him at kpangh@gmail.com for advice or recommendations. He and his co-authors write articles for Pharmacy Times Oncology Edition and other journals and are open to collaboration with new or experienced medical writers alike.
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.
On the panel, we have Scott Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, director of pharmacy cancer care at Mayo Clinic and member of the Pharmacy Times Oncology Edition editorial advisory board; Judith Alberto, MHA, RPh, BCOP, the director of clinical initiatives at [COA]; Kirollos Hanna, PharmD, BCPS, BCOP, FACCC, director of pharmacy at Minnesota Oncology, assistant professor of pharmacy at Mayo Clinic College of Medicine, and member of the Pharmacy Times Oncology Edition editorial advisory board; and Kevin Pang, PharmD, an associate oncology scientist and medical writer at [NCCN] and regular contributor to Pharmacy Times Oncology Edition.
So to get us started, I’d like to learn a bit more about each of your work within oncology pharmacy and whether you consider that work to be more traditional within the field or perhaps a bit more unconventional or nontraditional. Let’s start with Kevin.
Kevin Pang, PharmD: Sure. So my work at [NCCN] is more or less updating the recommendations for several of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) that I'm responsible for. I would definitely consider this quite an unconventional role because I pretty much work in more of an office setting, as opposed to an in-person kind of pharmacy setting.
Hippensteele: Next Kirollos Hanna.
Kirollos Hanna, PharmD, BCPS, BCOP: Thank you, Alana. I'm really excited that we're actually talking about this because I think as we see pharmacy becoming more and more specialized and subspecialized, a lot of pharmacists are having to find unique ways to leverage themselves or distinguish themselves within practice.
I would say on my end, a lot of the unconventional things I do—so I'm currently the director of pharmacy at Minnesota Oncology, I'm actually fairly new to this role, but prior to this role, I was a pharmacy manager at actually an academic center, also within the Twin Cities. A lot of the work that I do doesn't fall within that conventional realm. I'm no longer at this point in time seeing direct patient care. I'm not involved in anything like order verification, or order processing or product verification, because I did find myself over time to enjoy the business side of things and wanting to understand more and more of the business side of things. Definitely look forward during this interview to further elaborate more on that.
But yes, I would definitely consider this to be unconventional. But also, outside of my our standard 8 am to 4 pm, 5 days a week type of job, I think majority of us on this panel are also involved within the pharmacy world in so many different unique ways, whether it's involvement in organizations, holding board offices within organizations. Just earlier today, Scott and I were actually on a call around various legislative processes within the Twin Cities to talk about white bagging. So all of those, I think, encompass some of the unconventional roles pharmacists can potentially hold.
Hippensteele: And Judith?
Judith Alberto, MHA, RPh, BCOP: Hi, thanks, Alana. I'd like to mirror a lot of what Kirollos just said in that I'm right now in a very unconventional role. I'm relatively new to COA; I've been here for 4 months now, and prior to that I was in a director role also at the Jefferson health system, and so still a very unconventional role. But as I came into oncology as a clinical pharmacist, I really fell in love with oncology and being able to treat patients. I had an opportunity to be a manager in that area and got very interested in the business side of it. And then as I started to see some of the payer issues, white bagging, PBMs, even at a hospital level, I was very passionate about really bringing all of the quality and making sure that patients with cancer on their treatment journey really receive non-delayed, quick, and high quality cancer treatment.
I think, in exploring that and really networking and starting to meet different people is where I became aware of [COA] and all of the work that they're doing at the legislative level. So not just making sure that community patients have quality care, and so for those patients who want to stay in their backyard, I think there's a passion there for me to really want to provide that quality. But also, at the government level, we're making sure that our patients receive the care, and the government is really supporting them.
In white bagging, we are making sure that inpatients aren't waiting weeks on end to get their medication. And so, to go back to the original question, very unconventional role. I think as we see that right out of pharmacy school, most of us started in a very traditional role. But there's so many opportunities and it's so, so great to explore what they are, and really be able to take part in such nontraditional roles as we have here today.
Hippensteele: Absolutely. And Scott?
Scott Soefje, PharmD, MBA, BCOP, FCCP, FHOPA: Yeah, I guess I'm the third administrator on the group here, because my role as director of pharmacy cancer care means that I coordinate cancer services between the pharmacy and the cancer center across a multi-site cancer center. Mayo Clinic is a multi-site cancer center in Florida, Arizona, Rochester, and then we have community sites in our health system. So my job is to make sure that the goals of the pharmacy department and the goals of the cancer center are in alignment.
I do have direct reporting responsibilities here on the Rochester campus, and I am responsible for program development, building processes, overseeing operations, all of those kinds of things. Again, I'm generally a level removed. I have managers that run the infusion center, and I'm the next step up.
Like Kirollos and Judith both said, I’m very involved in the business aspect. I can now quantify my revenue cycle time, whereas 5 years ago, I couldn't do that. So I spend 10% to 15% of my time dealing with revenue cycle now. And so it's one of those things that, as pharmacy, particularly as oncology pharmacy, becomes more complex, you're going to find people getting involved with all kinds of aspects.
I think the cool thing about being an administrator, though, is you never completely lose that clinical touch; you still have to know what's going on in the clinic, you still have to understand the practice. Because if you're trying to build a program, or you're trying to design a workflow, or develop a guideline, or whatever, you still have to understand what's going on with the patient. So I think that's what makes this job very unique.
I never considered myself unconventional. I think I'm more conventionally unconventional in that I started out in sort of that conventional administrator role that has begun to evolve over time into something maybe bigger or different. And I think that's what a lot of us are seeing as time goes on.
Hippensteele: Absolutely. So it might be valuable to define how we think of traditional versus nontraditional or unconventional roles in oncology pharmacy. Does anyone have any parameters or potentially standards available that could be a resource in kind of defining what would be traditional versus a nontraditional role in the field?
Soefje: The easiest one is do you see patients or not? Are you involved in direct patient care? But then when you start talking about the term "direct patient care," that begins to blur. Is direct patient care face to face with a patient? Well, how are we doing with our people who are working remotely now? I think the lines are all beginning to blur.
To me, it's someone that's involved with the patient, with the provider, with the care team that are making those day-to-day treatment decisions. To me, that's what I consider traditional oncology pharmacists at this point in time.
Alberto: I broke it down a little bit differently, but very similar. In my mind, I see the traditional role as inpatient or outpatient. So when I graduated pharmacy school, I felt like they were my options. I could go to retail, work for CVS, work for a smaller outpatient pharmacy, or I could go inpatient. For inpatient, a lot of times you don't see patients, at least when I first started, we didn't. We were in the basement, we were making IVs, we were dispensing orals or any products that our patients needed, but it really took years to start to evolve into getting out of the basement and on the floor, being really part of that medical team. So I agree with Scott, those lines are really starting to expand and to blur on what is a traditional role.
Now we have so much more even in very traditional roles. Are you in oncology, are you an infusion pharmacist, are you an ambulatory clinic-based pharmacist, are you in a medically integrated dispensing pharmacy, are you in a specialty pharmacy dispensing oral oncolytics? So I think it's expanding, and I'm sure we're going to hear a lot of different definitions and ideas of what the traditional roles are.
Hanna: You know Alana, on my very first day of pharmacy school, my dean said what you put into pharmacy, pharmacy will give back to you. And that's something I couldn't agree more with.
I think when you look at pharmacists nowadays, a lot of what they do does tend to be unconventional outside of the image that we always had: You do pharmacy school, and you go into retail. Or you do pharmacy school, and you work in a hospital type of setting. Most students nowadays realize that subspecializing is really the key. And that's what I would consider where you do tend to be conventional.
But for example, you may have a PGY2-trained pharmacist who is in an admin type of residency that comes out and manages a cancer center. I wouldn't consider that would be sort of an unconventional role, but they were more so led along the administrative side. But I really value pharmacists, whether you are right there in that frontline, virtual, inpatient, infusion center, oral chemotherapy, or you’re manager level, director level and beyond, really seeing the involvement outside of your health care system. Publications—publications are huge, right? I believe Scott just published something out of Mayo Clinic with daratumumab (Darzalex; Janssen Biotech) and observation time—that's an unmet need and a question that has been asked across many sites across the country.
Again, community involvement through organizations, academic involvement through organizations—you look at your HOPA, NCODA, ACCC—all these different organizations are even recognizing the value of the pharmacist as part of that multidisciplinary team. And that's really where I start to look at even if you do have a conventional or conventionally unconventional, like Scott said, I think that brings a lot of value to work-life balance to some extent. People tend to feel rewarded from those recognitions, and that involvement, and that collaboration and that networking, which I think brings a lot outside of just your standard day to day work.
Pang: So what I define as unconventional is pretty subjective. I think anything that is outside the cookie cutter description of a pharmacist you learned in pharmacy school is pretty much unconventional, particularly as people have mentioned specializing. For me, I felt that I could specialize in heme/onc, and so I do a lot of medical writing. I would define that as very unconventional because it's something that you typically don't get a lot of experience with within school. So a lot of it is built upon time that you spend at experiences or just doing it on your own time. I think a lot of roles that start asking you to do things that you didn't necessarily learn a lot about in school is pretty unconventional. Like for instance, I'm starting to tackle and update recommendations regarding not only drugs, but surgery, radiation therapy, biomarker testing. So when things start to get outside the world of drugs, I think that's also a pretty key point in telling your role is pretty unconventional as a pharmacist.
Hippensteele: Absolutely. For those in what they would consider to be nontraditional or conventional unconventional oncology pharmacy roles, what brought you to this work? And what are the benefits and drawbacks of your particular role, as you would define it within this scope of the traditional versus nontraditional?
Alberto: So I think what brought me to this role was just many, many years of evolving into that nontraditional role. I started as a manager after coming from clinical oncology pharmacy then went into managing, and I was exposed to a whole world that I hadn't been in pharmacy school. And for many years, I worked as a hospital pharmacist even before going to clinical oncology. So all of a sudden, now I was a manager and the problems that I had to solve were so different than what I was used to. I didn't even really comprehend what a 340B purchase was, and what white bagging was, and now all of a sudden, I had to solve these problems. And I fell in love with that as well. So after really loving oncology pharmacy, now I could really help patients and empower the clinical pharmacist under me in a whole new way. So the more that I saw, the more that I enjoyed, and the more that I started to take on more responsibility and, like others on this call, went to the director level after really meeting so many more people, again, being so exposed to so much more.
Now I came on to these quality initiatives that I could be a part of, the Oncology Medical Home being one of them, that I could really make an impact. And I was so passionate about bringing the entire care team together with their patients, which was so appealing to me that I wanted to continue it further. The benefits are we get to do what we love. And so when you're passionate about something and you have an opportunity to expand on that role, it is very satisfying, personally and career-wise.
The drawbacks are I'm probably not going to go back to clinical pharmacy. Are your options more limited? Hopefully you love what you're doing and will stay in this until you retire. If something should happen, that you don't love what you're doing, your options are a little bit more narrowed than they were when you first started. So that's what I see as the drawbacks.
Hippensteele: That is really interesting. Does anyone want to elaborate on that point, or discuss some of what they would describe within their own role?
Soefje: I have a similar but different story. I started out in clinical practice, and actually ended up at a VA in San Antonio, where many people said I had the perfect pharmacy job. I was seeing patients independently, I could sign chemo orders, every patient saw me before they got chemo, because it was a smaller practice, you could do that kind of thing. And then I jumped to industry, and for a variety of reasons decided I didn't like industry. When I came out, made that conscious decision to go into administration, and then have bounced around looking for the perfect job again, and finally found it—that kind of scenario. I think a lot of what Judith said is what brought me into administration—I like the business aspect, I like the questions of how do I optimize care? How do I make things more efficient? How do I do things like put more people per chair per hour in the infusion center so we can increase the access to care? How do we improve the quality for those people coming into the infusion center, so that we lower cost because we know that happens across the board.
And then I love the aspect of putting together my vision on how pharmacy practice should look and begin to build programs around what I think pharmacists should be doing in the clinic, and then watch that grow and evolve into something I never even considered could happen. So those have been the fun parts about it.
Now, I'm going to disagree with Judith on one thing, because I'm getting close to that retirement age. And I'm starting to think about is there a time soon where I pick a successor, I train them, and I step down and do clinical practice for a few years before I go back and retire. I still think I can do that. I do understand there can be a learning curve; I'm not just going to walk into the clinic and be that same guy that was at the VA 20 years ago. But besides the fact that there's five times more drugs than they were at that time. But again, I think it's one of those things that as a pharmacist, you always have those abilities, and you can do that if that's what you truly choose to do.
Now, I may also just retire from this job, I haven't decided yet. I may say what's the next step? Is there another step? Do I go into something even more unique? Those are the points that I'm starting to think about as time moves on.
Hanna: Alana, my trajectory was a little bit different. So I never thought out of residency that I would be in administration by any means. Right out of residency, I always loved the academic side of things. I loved publications, I loved research, I kind of went down that route. And I remember the very first HOPA conference after residency, I was invited to do a BCOP lecture, which that early out of residency with that few years under your belt in terms of experience, generally isn't a common thing. It was because of a big publication we had put out about bladder cancer research. I come to find out from that experience that I have received a lot of positive feedback and public presentations were one of my key strengths in terms of an educational perspective.
So over the next several years, those were a lot of the things I would be involved in, which indirectly identified me as a leader within the field, whether you want to consider that as a thought leader, whatever it may be in certain areas. So then, come January of 2020, there was an opportunity to move into management, which after having been involved with organizations and these kinds of academic experiences, I decided to dabble with it. But I had no idea a pandemic was coming at the time. And so I became the manager in January of 2020—pandemic hits in March. As you can imagine, as a new manager, I didn't go to school for an MBA or anything from that regard. The exponential growth that I had to be a part of—a lot of uncertainty, to some extent, sometimes difficult situations with employees and the health system. And my role wasn't also removed from the clinic. So I was still staffing, I was still very clinical, yet had the administrative responsibilities.
Over those next 3 years in that role, I really got to grow as a leader, but then got to learn a lot of the things like Scott mentioned—how do we become more efficient? How do we optimize workflow? How do we justify FTEs? I keep referencing Scott, but Scott's done a lot of lectures on how we justify the value of pharmacy. And I just continue to see the growth that we see out of Mayo Clinic down in Rochester and involved in pharmacists and outpatient clinical roles. And that just really helped me better understand and value that business side of it more.
I always thought I would be in clinical practice as a patient myself; my mom was a prior patient. Not to say that I wouldn’t ever go back to the clinical practice side; I think it will be quite some time. But I still do value the clinical aspect of certain disease states. Like Scott said, we have 5 times the drugs we had back when he was in the VA, and I couldn't agree more. It's extremely difficult for pharmacists, to be experts in everything in oncology. It is extremely challenging just because of the number of things; the cytogenetics, the drugs, etc. So I still value the clinical side from certain areas though as well.
Pang: So for me, I didn't jump around as much because it wasn't too long ago that I graduated pharmacy school. But I just knew from the beginning for quite a while during my schooling that I had a strong inclination towards hematology/oncology. I worked at Memorial Sloan Kettering Cancer Center and that's where I picked up some of that specialization. I knew from what I was good at school or what I enjoyed that I wanted more of an academic role, maybe something that's project-based in nature. So I applied to medical writing positions, and funny enough, also PhD programs in medicinal chemistry—I was doing a lot of soul searching at the time. I got acceptances both at NCCN and at Purdue University and decided to go with the medical writing position. And I'm very glad I did; it's great to be working for a nonprofit organization that, as a bonus, does guidelines work too.
So some benefits for both medical writing in general and my particular role is that it is project-based, and by the end of a couple of days or a couple of weeks of work, or months in terms of guidelines, I'm able to see a final product, like a paper or an abstract. Maybe if you're doing some more patient-centered or industry-type work, you do slide decks and monographs. But once you work on something and you see the final product, you can be quite proud of it.
The benefit also in medical writing is that you get quite a hybrid or fully virtual work-life balance. And also, in this particular field, you are always constantly learning. A lot of times it's really about up-to-date kind of developments, like there are some new FDA approvals, say for one of the immunotherapies or a new TKI was approved for a novel mutation. So you get to learn that material, and you can also directly apply it to perhaps a document or paper that you can write.
I think the last rewarding thing for me is that I'm able to really help out in the academic community more than I thought I would be able to. One of the things that my particular role enables me to do is do licensing review of clinical content from the NCCN Guidelines®. And I actually had the opportunity to review some BCOP slide decks for the HOPA conference and essentially proofread some of the material and the NCCN recommendations. So that's very unique to my position.
I would say some drawbacks to medical writing in general is that you're in a little bit of a less social environment; you're not really seeing patients, and if you work in hybrid or virtual settings, you might not really see your colleagues as much. And also, it requires a bit of a skillset outside of your training in pharmacy school. So you need to get proficiency with writing and need to get proficiency with citations and some of the publications, such as how to cite them or what information to incorporate, and that takes a bit of time to acquire that skillset. So it's not a field for everyone, but it really is nice if you do find yourself wanting a fluctuating and interesting role.
Hippensteele: Absolutely. So that brings me to my next question around how do you prepare for a nontraditional role or unconventional role like each of you are discussing?
Hanna: A couple of things I think, Alana. I think many of us will probably have different opinions on it. So obviously, there could be a standardized role. For people wanting to or desiring to go into administration, there's academic routes that they can do. So residency training, MBA training and such, which can then leverage them into that different type of role. You can also do fellowships, which could then help lead you into some type of industry role, which again, we don't have an industry representative with us, but that could also be potentially an unconventional role that's considered. I think, to some extent, numerous opportunities within oncology pharmacy present themselves, and it's really how each individual student or resident distinguishes themselves.
Number one, we always say pharmacy’s small, oncology pharmacies even smaller, so networking is critical. Developing strong relationships with known thought leaders throughout the field is key, and you have numerous opportunities for students to get involved and get to know people, right? Again, through HOPA, NCODA, ACCC, ASHP, ACCP, COA—almost every single one of us here is going to be present at almost every single one of those conferences, where we can partner together.
One thing that I would always do is, locally, reach out to the University of Minnesota students, and let them know, hey, I'm thinking of publishing this review article, do I have interest? We developed this hematology/oncology collaborative with the University of Minnesota, where students could sign up and, ultimately, they would volunteer to help me write a publication, and then their name is out there.
I'll stop there, just because I also want to hear what others think. But numerous opportunities can present themselves and it's just really how that student wants to potentially tap into it.
Alberto: I'd like to confirm what Kirollos said is so true and so important: Networking is probably the single most important thing if you're looking for a nonconventional role. I think in addition to that, what helped me is that I kind of fell into my role; while there was an open manager position, I didn't see myself in administration necessarily. I loved it, but I just didn't see myself going that way. What I have told my team since is if you see a need, fill it; if you see a gap, fill it. So be willing to go that extra step, be willing to come out of your comfort zone. And that's what I started to do. The manager role is a newly created manager role, and nobody could fill it. So eventually just started doing the jobs because it just came naturally, and then my director at the time said, why don't you apply to this role? And I did, and the rest is history, but really continuing to fill a gap. So if somebody from revenue cycle needed help, I would, as a manager, volunteer to help with that. That continued to expose me and move me in a direction that was relatively unconventional.
I think the other thing that I've learned, when I saw I was going in this direction, I got my master’s in health administration. So by taking classes and maybe being willing, either to get a certification or another degree, while not always easy for sure, can set us up. I think that goes hand in hand with networking because you also in addition to learning these new skills that you'll need, you also do meet people and places that you are in that expose you to the opportunities that unconventional roles present.
Soefje: I would also suggest that if a student wants to get into administration that they focus on leadership skills. I always tell the PGY2 oncology residents, as a student in PGY1, take medicine; I don't have time to teach you medicine, but I can teach you the oncology in PGY2. So if you come in strong in medicine, then I can teach you everything else.
Too often in administration, we promote the best clinician, but they don't always have the best leadership skills. We should probably promote the person with the leadership skills and teach them how to be administrators. And so I think it's one of those things that if a student really wants to be an administrator, focus on those leadership skills, focus on those things that set you apart to be a leader. Like Judith said, do those things that other people don't always want to do, and particularly if it's around the pharmacy aspect, the drug aspect of whatever you're talking about. Again, I tell our PGY2s, we should own drugs, and all of the things they associate with drugs, own that. We should be offended if people are doing things around drugs and not asking us about them. If you take on that kind of attitude, plus leadership skills, then learning how to be an administrator is just the skillset that you learn, and you have to learn whenever you go into any new job; it's just the way it is. So focus on the leadership stuff.
Pang: And as for me, within the medical writing pathway, as I said before, there is a little bit of a barrier to entry. Most of it comes around skillset development and in order to build that skillset, I recommend quite a number of things. One of the easiest things you can do is read journal articles, and some high impact journals like the New England Journal of Medicine or Journal of Clinical Oncology, if you're going down the oncology pathway. I encourage people to be proactive. If you're searching this career path, things really don't come your way. So I encourage you to be part of a collaborative group of peers that works to perhaps publish articles or work on other short-form documents.
For instance, I had to be fairly proactive in getting myself published. I got myself together with a good number of practitioners and students to essentially consistently write articles for publication either in the Pharmacy Times Oncology Edition or in other peer-reviewed journals. Essentially, being able to work with other people is the best writing experience.
I would also piggyback off what Judith said, and education could be very beneficial. You can go for a short certificate program, maybe for like a year or maybe portion of a year at a university and essentially learn some medical writing skills, if you don't necessarily have the connections.
So once you acquire that skillset, you have quite a number of different ways that you can actually get some sort of entry position. You could of course search online at a job forum, but you could also attend conferences, and you can network with a number of different professionals. I would recommend going to the exhibit booths and asking what positions are available at your company at the time being. There’s also the opportunity to go for a postgraduate education program like a fellowship, where they teach you skills over a number of one or two years. For a fellowship, for instance, you don't necessarily need to have that skillset because they will train you as long as you're willing to put in the effort for a continuous period of time. So with that, I think that you could find these positions, but you need to build that skillset up first.
