Health-Systems Pharmacists: Part of a Multidisciplinary Team

Although health-systems pharmacy may conjure the thought of simply working in a hospital pharmacy, it is really much more than that.

Pharmacy students and pharmacists looking for a new career venture may want to consider the path of health-systems pharmacy for the wide variety of options, practice settings, and unique responsibilities in this field.

Health-systems pharmacists do not just work in the hospital pharmacy—rather, they are part of a multidisciplinary team that includes physicians, nurses, dietitians, therapists, social workers, and many other health care practitioners, as explained by Marni D. Lun (Williams), PharmD, MBA, director of the Pharmacy Student Forum at the American Society of Health-System Pharmacists (ASHP). “The pharmacist advises the team and patients on how to use the medications appropriately,” she stated. The pharmacist really has a direct impact on patient care—providing counseling to patients, recommending safe and effective therapy, and monitoring medication therapy. This, in turn, often prevents and/or detects medication errors.

Opportunities in Different Practice Settings

The traditional hospital is, of course, a common setting for a health-systems pharmacist; however, the hospital could range from a rural setting to a large academic medical center. In addition, a growing area of the field is ambulatory care clinics, where pharmacists can interact directly with patients who are seeking treatment for conditions such as diabetes, hypertension, and hypercholesterolemia, described Lun.

Health-systems pharmacists who work in home care and long-term care focus mainly on the elderly population. They are actively involved with patient care, performing drug regimen reviews and monitoring for medication-related problems and inappropriate therapy. Another avenue that health-systems pharmacists may pursue is in health maintenance organizations, where pharmacists are involved in formulary decisions and disease state management. This is just a short list of the opportunities that are available to these pharmacists.

Residency Training

What Is a Residency?

Two types of residency programs are available after graduation: postgraduate year 1 (PGY-1) and postgraduate year 2 (PGY-2). Residencies are 1- or 2-year postgraduate training programs, which are designed to help the pharmacy student meet the various challenges presented by today’s dynamic and ever-changing environment. Throughout these training programs, residents receive mentoring from a senior pharmacist and experience working with other health care professionals.

In the PGY-1 programs, pharmacy students develop the basic skills required to provide pharmacy services. Then, students can decide to specialize in and develop skills in a specific area of pharmacy practice in PGY-2. In order to complete a PGY-2, the student must first complete a PGY-1 residency. A wide range of PGY-2 specialized residency programs are available, including programs in ambulatory care, drug information, geriatrics, infectious diseases, oncology, pediatrics, and more.

Why Complete a Residency?

In addition to working with a wide range of patients and developing the key relationship between the resident and preceptor, the ASHP lists other advantages of completing a residency:

• A competitive advantage in the job market
• Networking opportunities
• Career planning
• Professional vision

To learn more about the residency program process, consider attending the ASHP midyear meeting. Visit www.ashp.org to view the residency directory and to learn more about the national matching process.

A Case in Point: UNC Hospitals Department of Pharmacy

An excellent example of the dynamic and multifaceted career path of the health-systems pharmacist can be illustrated in the University of North Carolina (UNC) Hospitals Department of Pharmacy. Stephen Eckel, PharmD, assistant director of pharmacy at the UNC Hospitals Department, confirmed that a unique facet of health-systems pharmacy is that the pharmacist is considered an integral part of the patient care team. At UNC, all pharmacists are assigned to a patient care team, and thus have the opportunity to work closely with other medical staff in the hospital. The pharmacist is a well-respected member of this interdisciplinary team because of his or her knowledge of medications, which helps ensure that patients are placed on appropriate therapies.

Each day, pharmacists at UNC strive to uphold the department’s mission: to provide and promote comprehensive pharmaceutical care. In a typical day, pharmacists may come in and review patients’ records to become familiar with what happened overnight, and to prepare for patient care rounds. During the day, pharmacists will also verify medication orders for their patients. UNC has facilitated this process for pharmacists by providing wireless tablets to use on rounds, which give access to up-to-the-minute laboratory reports, patient information, medi- cation history, and more. Eckel believes this has streamlined their daily process: “We have found this access to be very critical. When completing patient care rounds, it is vital to have the unique information and knowledge that is specific to that patient.” In the 14 months that this new technology has been in place, it has been very well-received by staff members and allows the pharmacy to be decentralized 16 hours a day, 7 days a week.

After completing their rounds, pharmacists will follow up on any issues that are outstanding, including perhaps verifying orders for their patients, teaching and assisting students and residents whom they are precepting, completing work for a particular committee, and more.

The Ideal Candidate for UNC

According to Eckel, in evaluating candidates, “we try to look for leadership experiences, rotations within the hospital setting, some work experience in the hospital setting, and preparedness to come in and work in the model at UNC.” Many of their pharmacists are residency trained, and many are residency-trained right at UNC. UNC offers several residency programs; 18 pharmacy residents complete programs each year—half are in first-year residency programs, half are in second-year programs. UNC offers a wide variety of rotations for their residency students, in areas of medicine, surgery, pediatrics, ambulatory/primary care, electives, and others. Residents and pharmacists have the opportunity to complete these residencies and work within the wide range of settings in the department of pharmacy, which includes 2 retail pharmacies, a central inpatient pharmacy and several satellite pharmacies to include pediatrics, operating room, oncology, and investigational drugs.

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Unique Work Experience

UNC Hospitals Department of Pharmacy offers a unique work experience, as it is located right next door to the UNC School of Pharmacy. Because of this affiliation, it is truly a learning hospital. Residents from the school are required to complete research projects, and precepting pharmacists often help complete them—learning is constantly evolving at UNC. What also sets apart UNC from other institutions is the breadth of its residency program (which includes more than 30 unique rotations), its decentralized practice, its history of clinical practice for more than 40 years, and the strong role that its pharmacists can play in advancing patient care.

Recommendations for Entering Health-Systems Pharmacy

ASHP’s Lun advises that students have the opportunity to gain exposure to health-system pharmacy career options through experiential education rotations, internships, and by serving as a volunteer. “Each specialty area is unique, so if you are interested in learning more about any particular one, start planning now to seek out some firsthand experience,” she said. Several optional postgraduate training opportunities are available for health-systems pharmacists. For the student who is considering specializing in a specific clinical area, a residency program may be a good fit. If research or industry is of interest, a fellowship can provide many opportunities. If further education is of interest, consider a master’s or doctoral program. Eckel also recommends finding a good group of mentors to provide guidance when making career decisions, and ask them how they got to their current position.

Outlook for Healthsystems Pharmacy

This is a constantly expanding and evolving field where pharmacists can offer their expertise through evidence-based medicine, as told by Lun. Pharmacists have the opportunity to work with other health care professionals and the ability to choose from many unique and diverse practice areas with opportunities for specialization and advancement. Eckel is positive about the outlook for the future of the profession and sees only growth and expansion for the field. Working as a health-systems pharmacist is a well-rounded career and offers job fulfillment, satisfaction, and great earning potential.

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