Life as a VA Pharmacist

What might student pharmacists expect if they apply for a job with the US Department of Veterans Affairs?

The US Department of Veterans Affairs (VA) offers student pharmacists a unique practice setting that provides a direct patient care role.

Abril S. Atherton, PharmD, BCPS, BCPP, clinical pharmacy specialist in mental health and postgraduate year 2 (PGY-2) mental health residency program director at the VA Salt Lake City Health Care System, told Pharmacy Careers about her career path and what she enjoys most about her job at the VA.

Q: How did you get your job with the VA, and what made you interested in the position?A: My career at the VA began with a PGY-1 pharmacy practice residency at the Salt Lake City VA Medical Center. Around the time I was getting ready to graduate, I was offered a position in ambulatory care or mental health. My undergraduate degree involved recreation therapy.

In debating the 2 positions, I realized that mental health would likely be more of a challenge than ambulatory care. It was because of the challenge and my history with recreation therapy that I chose the mental health option. It definitely was the best decision I could have made!

Q: How does this practice setting compare with other jobs you’ve had?A: I previously worked in retail and in a home infusion facility. The biggest difference with practice at the VA is the degree of autonomy I have to make clinical decisions regarding patient care. Although I work with a team, there are times when I need to make a clinical decision to assist a patient in their transition from an outside facility back to the VA or to adjust an antidepressant medication dose in our antidepressant follow-up clinic.

The ability to prescribe in the VA allows me to make those adjustments using my scope of practice. I am also able to order appropriate labs and procedures when necessary to provide complete patient care. This direct patient care role is very fulfilling in the VA practice setting.

Q: What does your average day look like at the VA?A: I wear several hats at the VA, which include teaching, precepting, and direct patient care. I am 1 of 2 clinical pharmacists on a 21-bed inpatient psychiatric unit.

My day begins with preparing for rounds and conducting admission and discharge medication reconciliations. I attend rounds for around 3 hours with an interprofessional team that includes a psychiatrist, psychiatric residents, medical students, physician assistant, social worker, and a team nurse. We also have a psychologist, psychology interns, nutritionist, occupational therapist, and a recreation therapist. We also have an amazing team of nurses.

All the professions come together to treat patients with a variety of mental health conditions, such as post-traumatic stress disorder, suicidality, schizophrenia, anxiety, and substance use disorders.

As you can expect by the number of disciplines involved, the VA offers a variety of services for treating mental health. The services I provide include medication education, brief interventions related to substance use disorders, medication education groups, and medication management.

After rounds, I follow up on education requests and complete administrative tasks related to the PGY2 psychiatric residency program I direct. I also precept students and residents when they rotate at my site.

Throughout the year, I teach a course on the use and misuse of psychoactive medications for social work students. I also recently started an elective course on psychoactive medication therapeutics for pharmacy students. I am very involved with our local college of pharmacy and am a member of the curriculum committee and teach a module on schizophrenia in therapeutics.

At any given time, my day could include working on an upcoming lecture or coordinating lectures by my residents. We also recently developed a transition of care program where pharmacists coordinate medication reconciliations from facilities outside of the VA. I spend 1 to 2 days a week assisting patients in their transition back to the VA from outside psychiatric hospitalizations. There is also an antidepressant follow-up clinic that my residents and I run once a week.

Q: What advice would you give to students who want to work for the VA?A: If possible, look for the Valor Intern program, which trains pharmacy interns in the VA system. If a student is interested in a VA residency, getting a rotation at a local VA can help orient the student to the VA system and would make them more competitive for a residency.

At this time, all positions involving direct patient care require at least a PGY-1 residency and possibly a PGY2 in a specialty setting, such as psychiatry. Students who are interested in a direct patient care in the VA are encouraged to meet with the residency program directors if a residency program is offered at that facility.

If a student is interested in a career in the distributive side of the VA pharmacy system, there are options in inpatient and outpatient pharmacies. There is also research at most major VA centers, especially if the VA is associated with an academic institution. Pharmacists do everything from clinical trials to outcomes research at the VA.

Q: What’s the best and worst part of the job?A: I often feel the challenge of wearing multiple hats. This sometimes prevents me from being able to provide the direct patient care I enjoy the most. When my day is freer, I love to spend as much time as I can with patients. Sometimes that process is hindered by my multiple roles and responsibilities.

The best part of my job is when I have directly or indirectly influenced the trajectory of a patient’s care in a positive direction. I love being able to see a patient who enters our inpatient psychiatry unit in a very rough state improve over the course of their stay. Seeing their hope go from negligible to full of hope for their future is very rewarding. I love to be a part of that by providing motivational interviewing, education, or medication management. I also love to see when my trainees become independent and impact patient care in their own ways.