Health-System Pharmacists: Key Players in a Changing Health Care System

Having expanded from traditional hospitals to serve as the medication expert in a range of other settings, health-system pharmacists are poised to play an important role in the health care system of the future.

For the student pharmacist who wants to play a hands-on role in caring for patients while routinely collaborating with other health care providers, health-system pharmacy presents an appealing option. What’s more, the field offers a range of practice settings wide enough to satisfy the inclinations of any aspiring pharmacist.

The Medication Expert: From Hospitals to Ambulatory Care Clinics

In addition to traditional hospitals, an area of particular growth in recent years for health-system pharmacy has been ambulatory care clinics, where pharmacists help treat patients with chronic conditions such as diabetes, hypertension, and hypercholesterolemia. In addition, health-system pharmacists can find work in home care and long-term care settings, where they primarily treat elderly patients; health maintenance organizations, where they work on formulary management, disease state management, and claims processing and adjudication; and universities and academic health centers, where they educate and train student pharmacists and participate in research and drug development.

Regardless of the setting, the health-system pharmacist’s fundamental role is to serve as the medication expert on a team of health care providers that may include physicians and nurses, as well as others. Health-system pharmacists recommend safe and effective medication therapies for patients and monitor these therapies. They work to prevent and detect medication errors— and to manage these errors when they occur. They advise patients as well as their fellow health care providers on the appropriate use of medications. In addition, health-system pharmacists are responsible for supervising, storing, dispensing, and distributing medications and maintaining medication supplies in their facility.

Health-system pharmacists generally have a daily routine (see sidebar for a description of a “day in the life” of a health-system pharmacist), but they must also be prepared to deal with regular crises, says Stephen F. Eckel, PharmD, MHA, BCPS, FCCP, FASHP, FAPhA, editor of the Health-System Edition of Pharmacy Times: “Some of the smaller crises might be drug shortages. A medication might be needed for a patient’s well-being, but the hospital does not have that medication at that point in time. Or the pharmacist might recognize that there is an impending shortage of a given medication and need to decide how to limit their use of the supply that they have to make sure it meets the needs of the patients who have the greatest need.”

In addition, health-system pharmacists need to be able to deal with a rapidly changing health care system. “The foundation of any pharmacist is good knowledge of drugs and disease states and how they work together,” says Dr. Eckel. “But beyond that, I think a great skill for the future pharmacist is to be ready for the coming changes in the health care system. Secondly, we recognize that health care is going to be a team-based activity. So you need to be able to communicate with other health care providers and you need to be able to communicate with the patient. Finally, we don’t have all the answers, so innovation is going to be key for future pharmacists.”

Postgraduate Residency: Almost Essential for Health-System Pharmacists

Pharmacy students who are considering a career in health-system pharmacy should strongly consider taking part in a postgraduate residency program, says Dr. Eckel, who is also director of pharmacy residency programs at UNC Hospitals.

“For those individuals that are going into a health-system practice, doing a pharmacy residency is almost essential for a couple different reasons,” he says. “One is, in a residency, you learn much beyond your drug knowledge. You learn how to critically analyze, you learn how to communicate, and you learn other sorts of skills that are important to your future. Secondly, you don’t know when you’re in pharmacy school all the different jobs you may be doing 5, 10, 15 years out. And those individuals who have done a residency are in a much better position to take advantage of those opportunities because they have been exposed to a lot more.”

Pharmacy residencies are training programs designed to help pharmacy students meet the challenges of a dynamic and ever-changing environment. Participants receive mentoring from senior pharmacists and hands-on experience working with other health care professionals. Residencies are generally divided into 2 years: postgraduate year 1 (PGY-1) programs allow pharmacists to develop basic skills required to provide pharmacy services, and post graduate year 2 (PGY-2) programs allow for specialization in areas such as ambulatory care, drug information, geriatrics, infectious disease, oncology, and pediatrics.

These residencies also offer the opportunity to build relationships with experienced pharmacists and offer an advantage in the job market through networking, career planning exercises, and a framework to develop one’s professional vision. Those interested in taking part in a residency program are advised to participate in the Residency Showcase at the American Society of Health-System Pharmacists’ Midyear Clinical Meeting, where representatives of residencies from across the country are available to discuss their programs’ offerings with students in their final year of pharmacy school.

A Promising Future

Those who pursue a career in health-system pharmacy face a promising future. “Opportunities in health-system pharmacy continue to grow,” says Dr. Eckel. “If you looked about 10 years ago, most of the emphasis was on the acute care setting or the inpatient setting.

“Now, there is a tremendous recognition of the role of the pharmacist in the ambulatory care or the outpatient setting. There are lots of opportunities out there depending on what your interests are, depending on where you practice, for both innovation and advancement.”