Pharmacy Administration: The Intersection of Business and Pharmacy

Business, leadership, and communication are just a few of the other skills needed to be successful in pharmacy administration. In this interview, The Nontraditional Pharmacist talks with Anthony Boyd, inpatient pharmacy manager at the Cleveland Clinic in Ohio.

Matt: Matt Paterini here with The Nontraditional Pharmacist, part of the Pharmacy Podcast Network, and joined today by Dr. Anthony Boyd, inpatient pharmacy manager at the Cleveland Clinic, right here in Cleveland. We're broadcasting out of Cleveland, but this isn't it home for you, is it Anthony? Where is home for you?

Anthony: No it's not. I grew up about 2 and a half hours south of here. Grew up in Columbus Ohio.

Matt: OK. All right. So you might be a Buckeye fan, but you have Michigan roots too so that's that could be a little weird.

Anthony: I was a little torn. You jumped the gun a little bit here. I spent 2 years in Michigan, which is a little hard for me being a grown up a Buckeye but really in the end I was able to survive my fears of Ann Arbor.

Matt: Well today we're highlighting a nontraditional role. When we typically think of traditional pharmacy, we think of the retail setting, we think of the hospital setting but nothing traditional about pharmacy administration, with really all of the other areas of expertise that you need to excel in, in order to be successful. So, we'll be highlighting what it takes to be in pharmacy administration, some the key attributes that you need in pharmacy administration to go with management and things like that. So, great to have you on the show Anthony. Thank you so much for joining.

Anthony: No problem. I'm glad to have the opportunity to speak speak on this and let people know about the exciting area of pharmacy administration.

Matt: Fantastic. So let's start there with with your background. You kind of mentioned some of where you've lived in the past, but what is your background through pharmacy and what has led you to your role in pharmacy administration?

Anthony: Yeah, it's a good question it's pretty unique. So I grew up in Columbus, Ohio, the first 18 years of my life, and then I had the opportunity to go to University of Pittsburgh for both undergrad and pharmacy school. It was not a 6-year program there, so I was able to kind of jump right into things. While I was at Pittsburgh, I took a job at UPMC Presbyterian as an intern there, and I think that really really opened the door, not only an opportunity that informs the administration, but pharmacy in general. Big academic center at its campus and so we got involved in a lot of really neat things early on. We were one of the first teams to roll out transitions of care services throughout the entire hospital. I was on the transplant floors, and so I got to work with a really unique patient population there.

The other unique thing is we got involved in a lot of pharmacy administration projects early on, and that's really where my interest first started in this area. We had a management team that was very open, have interns help with projects and run different aspects of the project and the pharmacy team, and so I got involved in a lot of really neat things early on. There, it taught me not only to get by and from the other technicians and pharmacists that I work with, but be able to present to folks like our executive administration, our dean about the projects we're working on and ask for resources and things like that. So I got to learn a lot of those skills very early on in pharmacy school and really I attribute that internship to the opportunity I was provided there.

I was part of our Pharmacotherapy Scholars Program at Pitt. It was a residency track preparation program through the school. We were the second class to go through that. What that meant is I got to spend more time at UPMC and some of the places I'd spent as an intern, but really practicing there as a fourth year student. So, it was unique because in some ways I got to practice as a resident before I was officially a resident. I worked there on the weekends. I did rotations there are all different areas in the UPMC system and so it provided this continuous opportunity for me to learn and grow in that environment.

From there, I was looking for a residency program that would take me to challenge me. Michigan was pretty unique. Not only was there a strong clinical component to the residency there, but they also had a second year in administration. In some ways I knew that the direction I was headed but I had to find it there myself rather than your traditional two year administration program. While I was there, I interviewed with John Clark who later became one of my very close mentors. We talked about my interest in both the clinical side and the administrative side during my interview and realized that I thought I would actually be a really good fit at Michigan. Early on I had the opportunity to become the chief resident there and connect with two of my very close leadership mentors both John and then Stan Kent. Really I was torn trying to decide between a clinical residency for a second year or administrative PGY2.

Ultimately, I decided to pursue a PGY2 in administration because I could really impact the care of patients across the whole health system versus kind of one on one in a team based setting. However many of the same strategies are used to impact patient care, thinking about going back to the data and the literature, being able to speak about patient care with doctors on a clinical basis, impacting the clinical guidelines and pathways for how we care for patients. Basically, I took all of that in the individual team setting and was able to apply it across a pharmacy department health system etc. So it provided a unique opportunity and I realize that was the direction I wanted to go.

From there, I spent 2 years at Michigan. There were great 2 years and a job opened up at Cleveland. I had some personal ties to the area, so we can get into that a little bit later. But the role was pretty unique. When I was sitting back as a PGY1 and trying to decide really what direction to go, it was either administration or oncology. Here at the clinic I get to practice both on a daily basis so it combines both my interest areas and so that makes my job fun and interesting all at the same time. So as you highlighted before, I'm currently the inpatient pharmacy manager in the Taussig Cancer Center, so I oversee oncology operations for infusion area and then participate some on the inpatient side too. So it's a unique role, and I've really enjoyed my time here thus far been here going on 10 months now, beginning of next month.

Matt: Wow a lot of interesting experience, and experience early through pharmacy school and through residency and now in your management role at the clinic. Pharmacy administration is kind of a broad term. How would you define pharmacy administration and what's included under that term?

Anthony: I'm actually going to take a quote directly from my current pharmacy officer Scott Knoer. He really defined what's known as the 'pharmacy enterprise' as an integrated system of business units with accountability for clinical and financial outcomes related to medication use across a continuum of care in a health system. And so really where I see pharmacy administration is ensuring the provision of the medication used across the system in a consistent manner. So thinking about some of the things you talk about—the clinical and financial outcomes tied to medication use.

As you know as well as anyone, medication use is a large driver of costs in the health system. There are some statistics that report it's almost to a quarter of the total of a health systems budget. So medication use is important and so really pharmacy administration ties anywhere into helping ensure consistent care across health systems and so it is pretty broad in some ways, you hit the nail on the head. The way that I see it right now is a lot of the structures in your major health systems, you have a chief pharmacy officer who is kind of the CEO for medication use across the enterprise. And so you think about a place like right now where I'm at the clinic, we have both a national and international presence. So, you think about all the different types of medication used across all those health systems and outpatient facilities.

And really, our CPO is responsible for all of that. And so pharmacy administrators are folks that work with him to help make sure it's consistent across the board. I really kind of oversee that at a local level at the cancer center, but obviously we have we have folks everywhere across the entire health system. When I think about kind of what that encompasses within pharmacy administration it's the clinical pieces, operational, it's all the financial pieces to the care you get. Think about regulatory quality improvement. I work with really all those teams on a regular basis to make sure that we're best caring for patients, and so it's fairly broad and encompasses a lot of different portions.

Matt: 'Pharmacy enterprise'—did he put a patent on that or something? Can he get other people to use that?

Anthony: So I think it's been around for a little bit longer, but he did talk about it in an article and really helped define that and really I think it's pushed the profession forward, rather than just being pharmacy departments. You have to think about it at the enterprise level because it impacts care everywhere.

Matt: Yeah that is interesting. And pharmacy enterprise you mentioned a CEO. I mean a lot of business terms. How important is business training/business experience in pharmacy administration?

Anthony: Yeah I think if you look at most of the training programs that are out there right now in pharmacy administration a lot of them center around either a Master's of Science in Pharmacy Administration. Some newer programs have implemented Master's in Health Administration or MBA's as well. I know Michigan right as I left, we implemented the MBA a t the Ross School of Business at Michigan. So not only do you think about all the great things you learn with the health system, but all the great things you can also learn at the Ross School of Business at Michigan. So I think it is really important. There's different ways you can learn it. I think nothing replaces on the job learning, but I think the classroom can really supplement that. And as a whole, the pharmacy administration field sees it as important because a lot of the classes center around the basics of financials and being able to understand it. You're not going to be an expert by any means, but you have to understand it at least the basics.

Matt: You talked a little bit about on the job learning. It's so important and I'm sure you've done a lot of that over the last 10 months. Describe some of your day to day responsibilities. Just the description of your work in general. And then we'll get into a little bit of how that plays into your work-life balance.

Anthony: So when I was thinking about a role, I get stagnant. I like to be able to move around and see a lot of different things and my role really is evident with that. My day to day role changes really on a regular basis. Often my days are guided by the operation and clinical needs of the area in the cancer center. Part of my day I'll spend working on some projects related work area. I'll be in various meetings related to the clinical operation and quality, regulatory, informatics, and financial aspects of the care of oncology patients. I also spent a considerable amount of time checking in with staff at the various centralized/decentralized roles throughout the cancer center within that department. Also checking with nursing and physicians to see what else they really need.

I had an impactful conversation with a mentor of Michigan during my second year and really he stressed the importance of leaving your office and going to where the work's being performed. It's very easy to get caught up in some of the administrative tasks with the role, but it's really important to go out on the front line and see what's going well, where can we make improvements, and so getting up away and kind of taking a walk around and understanding what folks are working with is important, so it's something I try to do. So that's a little bit of my day in a nutshell and I have to tell you the truth, it's all a bit different every day. But that's one of the aspects that I enjoy.

Matt: Do you have a favorite task or work responsibility that you enjoy doing more than others? Or is it kind of nice to have the blend?

Anthony: I like the blend. When I think back to what some of the most impactful moments of the day are, I think it's any opportunity, whether it's a student, resident, staff member, to help to develop and build some of that skill set out. And so to help them kind of learn and grow or learn something new is important and then honestly, I don't get to see patients every day. But some of the interactions that I have with patients are still really impactful. I think back, we had a patient who was interested in why it took so long to prepare this medication from the infusion center. He had an engineering background and so being able to tie in the engineering background to the operations pieces that go in. We have robotics at the Cleveland Clinic, so being able to describe some of that to him and help him understand in a way that makes sense to him. Those interactions are always impactful. It's different than the direct patient care I used to perform but it's still a good opportunity to teach folks something new about how their medications.

Matt: That's a cool story. When you talk about health care and pharmacy, I think sometimes it gets a bad rap for work-life balance working on weekends, working at nights. How is your role in pharmacy administration fit in with your work-life balance?

Anthony: Yeah that's a good question. It's something that I'm constantly striving on. It's actually really hard going from a 2-year residency, where you're pushing and trying to get everything done, to taking that step back and realizing there's life outside of that bubble. So it's an ongoing struggle. Something I've been constantly working on, but getting better at over time. My fiance is also a pharmacist at the Cleveland Clinic which I think helps. She practices in the outpatient transplant clinic, so way different than my role. And I think it provides a good balance. Our roles are unique and so we don't overlap all that much in such a large department and so we get kind of a balance when we come home and we do such different things during the day that we don't always have to talk about it. But at the same time there is someone that understands what each of us is going through. And so it does provide that perspective. She's a good reminder to remember balance. Obviously, there's a lot of opportunity to delve back into that during the day and so making sure that at night phones are put away, not responding to e-mails/text anything like that.

On the weekends, putting the phones down and going outside and spending time enjoying the weather and especially the lake here in Cleveland. Finding those opportunities, I think you have to constantly work at it because you really can be tuned in all the time. And so it's important to find that balance and I think it's different for everyone. And something that I'm constantly working on to get better at.

Matt: I think we're all guilty of that to some degree, no matter what role you're in. If you let it work and take control, which is good in some ways, working hard is good, but it is important to have the balance, do things that you enjoy, spend time with the people that matter most is all really important stuff too. When we talk about your role currently, how is that helping you get to where you ultimately want to be? In other words how is this role helping you achieve your professional goals and personal goals?

Anthony: Yeah that's a good question. So I think back some, my parents are both involved in health care in some ways, and so my mom's an occupational therapist in The Ohio State system, so she directly sees patients, and then my dad is actually in engineering by background. Now, he's the Vice President of Medical and Health Care Research Analytics for a firm in Columbus. They both come from 2 different sides of health care, but that's something that I've always grown up with, and it's actually fairly unique because I think in my role now I really combine both of those pieces that they brought to healthcare. So it's funny how things overlap over time.

So it's something that's always been in my family growing up. I've known for a long time that I wanted to be involved in health care and help take care of patients. I started volunteering in my mom's hospital in high school and working my way through college. In high school, I spent a lot of time with pharmacists in a lot of different care settings and enjoyed the aspect that they were able to have on the care of patients.

My role is a little bit different than when I started pharmacy school and what I thought it would look like about at this time. But I've really enjoyed it and helping to care for patients on a broad scale and blend my interest in health care with some of my other strengths that suit me well in this current role. So professionally that that's that's where I'm at. Also, I wanted a position where I was challenged every day and each day, was unique, and I can confidently state that have found that in my current role and really have a positive impact in the role. From when I came in to where I leave it at some point. So that's another goal. So professionally those are the things I want to accomplish.

I think personally, I enjoy what I do and it's an intellectual challenge and it makes the day go by quick. Personally, I want to I want to find a career where I can support myself and my fiance and allow us to do the things that we want to do outside of work, too. So find something that will be able to take an interest at work but then apply it to things outside of that too and have the means to be able to do that. So it allows me to accomplish those personal goals. We're in the process of planning a wedding right now.

Matt: Congratulations. When's the big day?

Anthony: It should be June 15th of next year. We officially booked the venue.

Matt: Fantastic. You heard it here first on The Nontraditional Pharmacist. Are we going to see Chief Pharmacy Officer, Anthony Boyd in the future?

Anthony: That's a good question. To tell you the truth, I could sit here today and tell you that might be the path my career takes and it might not be. I'm not entirely sure. I think we can talk about that a little bit more. Within the pharmacy realm, there's a lot of great opportunities and really that's the penultimate in the pharmacy realm. But I think not only what pharmacy administration teaches you within the pharmacy department, it really can apply to a lot of other aspects of healthcare as well. I know there's been some other pharmacy leaders that have made their way up to the Chief Operating Officer (COO) of an organization or even the CEO of some hospitals. So I think the skill set you learn can really translate across healthcare, and so I don't know where my career is going to take quite yet, but I think all of this is building knowledge and skills that I can apply in many different aspects to help care for patients, whether it's in the pharmacy specifically or not.

Matt: Time will tell. What other roles are there for pharmacists in pharmacy administration? We mentioned how broad of a practice area it is. What other specific roles are there available?

Anthony: It's a good question. So obviously right now, I practice in the oncology setting, but really our team is about finding the people and putting them in the right positions to be successful based on their strengths. And so we have folks in a lot of different unique areas. I'm specifically in the oncology area. We have folks in pediatrics. We have folks that focus on sterile products and preparation. We have folks in medicine, and we have folks that work with the population health team to expand pharmacist presence in the ambulatory care areas, to impact care and on a broader scale, we have folks in informatics. And really that's just naming a few who is the first that I come up with in a list.

We have administrators who focus on the inpatient side, on the outpatient side. We have folks that help to develop clinical services and expand those. We have folks that work more on the operations side of things and so really, just from the pharmacy department there's a plethora of different areas that folks can work. Outside of the four walls of the pharmacy specifically, we have folks in the C-Suite, we have pharmacists that have made their way into supply chain and run kind of the supply chain aspect of healthcare. We have focus on the quality improvement department, really just they learned a lot of skill sets in the pharmacy department and then they're able to apply it in different areas that are impacting the entire health system. So I think from that standpoint the opportunities are an open door.

I think pharmacy administration opens more doors than it closes. It teaches invaluable skills, and in healthcare, that you can apply in a lot of different areas. I talked a little bit about the budgets earlier being such a large component of overall health system expenditures, so it's important stuff to learn and you're having a big impact on the on the care of patients in the entire health system. So really, I think taking what you learned in pharmacy administration, it can open the doors to a lot of different areas. I mean there are folks who are going into consulting and things like that. So I think it only opens more doors than it closes.

Matt: Really, roles across the board, it sounds like it. What does the landscape look like for those roles? Are there positions available? Just because those roles exist doesn't mean that they're available to everyone. So how's the landscape look like in pharmacy administration for pharmacists, pharmacy students looking to pursue that career path?

Anthony: Yeah I think there's a lot of unique ways to get there. There's no specific way that folks specifically fall into pharmacy administrator role. I think the landscape is as I went through, so what I'm about a year out of looking for jobs right now, is very promising at this time last year and I think it still is at this point right now. There were a lot of good opportunities open within major academic centers and in all kinds of areas across the country and smaller hospitals, larger hospitals, there's a lot of different opportunities at different levels depending on what your interests are.

I think as the pharmacy enterprise continues to get larger and more complex, it only opens up more opportunities. I think as departments continue to grow, there's different places that pharmacy administrators can really fit in. I think it's a constant balance. We know in health care that health care is getting more expensive and for every FTE (Full-Time Employee) that you add to a pharmacy enterprise or department, you have to determine what their role will look like. For every administrator, that means 1 less person that's providing direct patient care for patients, so it's constantly a balance that I think we have to think about.

The health care costs continue to rise too. And again you have to think of that aspect. So you have to think about weighing out providing that direct patient care versus some other administrative roles. I think in any role that you're in, it's important that you can demonstrate value and how you can positively impact the care of patients. So whether you're frontline staff, you're working as a pharmacy administrator and you have to think about that.

So I can't predict exactly how the landscape will look like. Right now it's good, and I think any anywhere you can find a niche to help better care for patients is the important part. I think that's the whole role behind this podcast as well, right? It's finding different niches to help take care of folks and find unique roles. I think landscape-wise, there's a lot of different ways to get there. In some ways, I think traditionally out of school folks can pursue a pharmacy administration training/residency training and that will help you get there. But there's folks that practice for a long time and then decide that they want to pursue different opportunities so they go back and get a Master's Degree or they find themselves into a clinical lead type role that eventually develops into a manager role and things like that. So I think there's a lot of different unique paths to get there. There's no one where it's just finding that skillset and developing that skillset over time and finding the opportunities as they they open up.

Matt: What advice would you give to people looking to pursue pharmacy administration?

Anthony: Good question. I would say one of the biggest things, and it's actually how you and I met, finding a mentor. So I had some very good mentors from my time at Michigan, and you and I were able to connect through one of them while you were on rotation. So I think finding a mentor that can help you develop and grow over time is really important, and it's something that I'm trying to find in each stage of my career.

I think if you're potentially interested in pharmacy administration, find an administrator to spend some time with. Whether it's your manager or director or even the Chief Pharmacy Officer, folks are usually pretty open about having them spend some time just to see what the day to day looks like, to sit through a couple of meetings and understand, "do I have any interest in doing this, at least at least part of my day"? I would say ask to get involved there. There's no shortage of projects to work on and I'm always looking for team members, students, residents who want to get involved in that type of work. I think back to how I got to where I am today and those opportunities that were afforded to me allowed me to be in this role today. And so I think about, how do you give back and be able to provide those opportunities to the next set of learners that want to further develop that skill set?

I found pharmacy administration really because I happened to be at the right place at the right time. And so how do you make sure that other folks are at the right place at the right time, and they have those opportunities to go down? I think I've been privileged with great mentorship, not only in Pittsburgh, but in Michigan and then now at the Cleveland Clinic, and so making sure that other folks I can provide and give back the mentorship as well.

Matt: I forgot that's how we met, through a common mentor, Stan Kent. And Stan if you're listening, you will be getting a message from The Nontraditional Pharmacist. We want you on the show at some point, it'll be a great episode. Stan's a great guy and even better pharmacist and mentor, so we give Stan a hard time, but great guy.

Where do people go to learn more Anthony, to learn more about pharmacy administration, the opportunities that are out there, and just maybe even make some connections?

Anthony: Yeah, I think the first step in any setting you're in, so if you work in a hospital setting, if you're a student in a college of pharmacy and there's a local hospital nearby, ask the manager/director/chief pharmacy officer to spend some time. I think you need to understand firsthand what it looks like. I think it's one thing to read about it on the internet or learn about it on something like this. But ask to spend some time with folks, I think that's the best way to even begin to learn what the role looks like.

I'm going to put a plug in here for some of the ASHP resources because I think they're very invaluable. I think the pharmacy practice section of the ASHP website is good for management related resources. There's also the section on Informatics and Technology which provide some really good resources, just to get some background to understand kind of what makes up pharmacy administration and the informatics side of things, too which is an evergrowing part of my role as well. ASHP has the Chief Pharmacy Officer Perspectives column, which I think helps you get in the mindset and the framework of what pharmacy administrators are thinking about. And so I think it's a good way to understand at a high level what folks are thinking about on a regular basis, and I think the other thing that I think about is the pharmacy forecasts as well. It provides a good perspective on what the future of pharmacy may or may not look like from some experts in the field. And so being able to understand what that looks like and helping to build that over time.

The other thing I find pretty invaluable there are really short, quick tidbits is the Harvard Business Review e-mails. They provide just just tidbits, management-type resources. They're a quick read, it's usually one of the first things I look out in the morning and provides a little tidbit for you to think about throughout the day. Outside of that I think there's all kinds of resources, there's Harvard Business Review, LinkedIn is great resource to learn more about what others are thinking in health care, especially related to health care finance and drug pricing moving forward. So I think any information is at our fingertips now, and it's pretty unique. You can read and learn a lot and be able to have educated conversations with folks about what the landscape looks like.

Matt: We talked a lot about the landscape of pharmacy administration, but we like to conclude all of our episodes with your thoughts on the the pharmacy profession in general. What do you think our profession will look like moving forward in the next, upcoming years?

Anthony: I can tell you the way that it looks now will not look the way in the future. If I could predict exactly what it looks like, I'd probably play the lottery and bet on some other sports games or something like that as well, because I'd be able to read minds. I do think it's going to change a lot over time. And I think really it's going to be driven by a lot of the data we're producing.

I hear statistics all the time about the amount of data that we're generating in health care and how much that's doubling and tripling over the years, and so how do you take all of these disparate data sources be able apply them to better care for patients? I think about whether it's pharmacogenomics. We know medication adherence is a problem where patients aren't taking their medications when they go home. And how do we use that data to better care for patients? How do we customize doses for patients?

There's discussion about 3D printing custom doses for patients at home. So pharmacy is going to change, just as technology is changing and so how do we get along on that train with it? I think the importance of pharmacy is going to be again centered around patients. I think less on the dispensing side of things. I think about all the technology systems we've already implemented in the hospital settings, so the various automation systems are robotic systems that we have that help improve medication safety and help be able to reapply the pharmacist to more active clinical roles. I talk about this with my fiance all the time. The traditional role of the pharmacist is not going exist in the future. And so I think it's really it's going to be about how do we best care for patients? Interacting with patients,and medication regimens get more and more complex, and so how do we simplify them for patients to make sure they're doing the right things when they go home?

I think that there's going to be a need to be a continued focus on that for the pharmacy profession, because the traditional roles as they exist, I think it's one thing to talk about this in this podcast, but really the traditional role of the pharmacist is going to look different than it ever has before. And I think all of health care is going to look different. And so how do we think about not only taking the expertise that we've built in the inpatient setting and apply in the ambultory care setting, because care's transitioning in that way too. So I wish I could predict the future exactly as it is. But I think as long as you're remembering the patient on the forefront and going back to that, and how do we best care for patients when they're at home and make sure they understand their medications fully, is going to be the core component to what pharmacy care looks like in the future.

Matt: Well, there you have it. Future Chief Pharmacy Officer Dr. Anthony Boyd, "Go where the work is being performed." Spoken like a true leader. Anthony, thank you so much for your time for this episode of The Nontraditional Pharmacist, part of the Pharmacy Podcast Network. Please connect with Anthony on LinkedIn, The Pharmacy Network, and leave a comment below this podcast episode and connect with us at https://www.TheNontraditionalPharmacist.com. Anthony thanks again. We will see everyone next time.

Anthony: Matt, I appreciate your time. Thanks a lot guys.

Matt: Thanks.