Is PGY3 the Future of Clinical Pharmacy Training?

A well-respected pharmacist-scholar and Pharmacy Times contributor recently penned a thought-provoking article that outlined scenarios where postgraduate pharmacy residency training may not be appropriate.

The points raised in the article were certainly salient, given the high standards of pharmacy education and the value that PharmD graduates can contribute to patient care in community pharmacy practice settings immediately after graduation.

However, I’d like to take the discussion to the other end of the spectrum and argue that for many specialties within our profession, 2 years of postgraduate training provide only the bare minimum level of expertise required for proficient practice. Indeed, there may even be subspecialties currently incubating in our profession for which the current model of 2-year postdoctoral training may no longer be sufficient.

This opinion is not entirely my own, as other pharmacy thought leaders have articulated the same point, going so far as to outline certain subspecialties within our profession that may be well suited for a postgraduate year 3 (PGY3) residency program (Box).

Box: Potential Areas for PGY3 Residency Training

• Advanced heart failure and cardiac transplantation
• Allergy/immunology
• Bone marrow transplant
• Endocrinology, diabetes, and metabolism
• Gastroenterology
• Maternal—fetal medicine (women’s health)
• Medical toxicology
• Neonatology
• Neurology
• Pediatric hematology/oncology

Considering my own career, these potential areas for PGY3 residency training certainly resonate with me.

I practice in advanced heart failure and cardiac transplant, which requires me to possess expert-level knowledge in cardiology and immunology/transplant, along with a highly functioning knowledge in critical care, general internal medicine, and infectious diseases. Although I completed a PGY2 in Cardiology Pharmacy Practice, it has taken me several years of additional practice, as well as mentoring from other seasoned practitioners, to acquire this skillset.

When I’m precepting pharmacy students or PGY1 pharmacy residents and I’m asked for advice on a training pathway to become an advanced heart failure pharmacist, I’m remised to inform them that no such pathway currently exists. In my opinion, neither a PGY2 in cardiology nor a PGY2 in solid organ transplant provides adequate training to produce a clinician capable of practicing in the realm of advanced heart failure.

An evolution toward PGY3 residency training in pharmacy would mirror what has already been happening in medicine for years. If a physician wants to become a heart failure cardiologist, he or she must first graduate medical school (4 years), then complete a general internal medicine residency (3 years), then complete a general cardiology fellowship (3 years), and then finally complete an advanced heart failure subspecialty fellowship (1 year).

Many other subspecialty fellowships exist in cardiology, including interventional, electrophysiology, and structural heart disease. These were all born out of necessity to keep pace with the evolving complexity of care required for treating cardiovascular disease.

I would argue that the same can be said for many subspecialty areas of pharmacy, and that our current postgraduate training structure may soon fall behind the rapidly evolving health care landscape.

There are several potential disadvantages to consider when broaching the topic of PGY3 residency training, including:

• Who will train this new generation of subspecialists?
• Are there enough jobs in these narrowly focused fields to justified expanded training?
• Is the current residency regulatory body (the American Society of Health-System Pharmacists) able to oversee and accredit additional training programs?
• Are potential candidates willing to forego another year of pharmacist salary to endure additional postgraduate work?
• Is there sufficient evidence to suggest that an additional year of postgraduate training provides a superior product (eg, a more highly functioning clinician-scientist) than a less structured environment (eg, on-the-job training) could generate?

These are all very relevant reservations that our profession must strongly consider before pushing forward with advanced postgraduate training. However, we must not let our natural inertia prevent us from at least considering that PGY3 residency training may be the future of specialized pharmacy training.

Consider our advancement from the Bachelor of Pharmacy degree to the PharmD, from PGY1 to PGY2, and from PGY2 to pharmacy fellowships. To me, PGY3 pharmacy residencies seem like the natural next step in our impressive evolution as a profession.

Reference

Helling DK, Johnson SG. The future of specialized pharmacy residencies: time for postgraduate year 3 subspecialty training. Am J Health Syst Pharm. 2014 Jul 15;71(14):1199-1203.