The Case for Establishing a Residency Program in Specialty Pharmacy

Pharmacy residency programs offer postgraduate training to launch pharmacists from their formal education into successful careers. These programs have significantly expanded in the past several decades from their humble beginning as internships in the 1930s, to prepare pharmacists for hospital management positions.¹

Accreditation standards were first implemented by the American Society of Health-System Pharmacists (ASHP) in 1962, which is when the nomenclature of postgraduate pharmacy training transitioned from internship to residency.¹ While hospital pharmacy residencies have had a long history of training recent pharmacy graduates, it wasn’t until 1984 that accreditation standards were developed by ASHP for community pharmacy residency programs.² The initial vision of community residencies was to “train the recent graduate in all aspects of community practice, including pharmacy management, community involvement, community health programs, clinical practice, teaching, and research.”³

In addition to postgraduate year 1 (PGY1) pharmacy practice (hospital) residencies and PGY1 community residencies, there are PGY1 managed care residences, a wide variety of PGY2 residencies that focus on a certain specialty, and combined PGY1/PGY2 residencies in pharmacy administration, informatics, and other areas.⁴ In 2016, there were 2092 programs offering 4309 residency positions across all types of residencies.⁴ There were 5438 participants in the National Matching Service, which uses a computer algorithm to match candidates and programs.⁵

Of the 4309 residency positions offered in 2016, only 228 were PGY1 community pharmacy residency positions.⁴ It is estimated that there are 10 or fewer specialty pharmacy—focused PGY1 community pharmacy residencies in the United States, according to the ASHP residency listing, or approximately 4% of all PGY1 community pharmacy residencies. Specialty pharmacy residency programs are recent developments, beginning within the past few years as the specialty pharmacy landscape rapidly expanded.^6,7

Rationale for Specialty Pharmacy Residencies

Specialty pharmacy revenue accounts for approximately 30% of all pharmacy revenue per year in the United States⁸ and is estimated to grow to 42% in the next 5 years.⁸ The increase in specialty medications approved by the FDA is an important reason why specialty pharmacy residency programs need to be developed. Certainly, the complexity and the high-risk nature of these medications require the competence and expertise of pharmacists to ensure safety and efficacy for patients. Residency programs provide the additional training necessary to ensure specialty pharmacists are competent and confident in their ability to provide care for patients using a specialty medication.

Besides the benefits provided by residency-trained pharmacists, specialty pharmacies will find value in offering residency programs for several other reasons. Inserting enthusiastic learners into the pharmacy provides precepting experiences for current specialty pharmacists. Many pharmacists not only enjoy precepting but also find that it motivates them to practice at a higher level in order to be a role model for their learner.

Residents also bring in fresh ideas about improving patient care and pharmacy workflow, providing energy and motivation to investigate, analyze, and complete valuable projects. The drive and passion of a new practicing pharmacist resident can be contagious and inspire others. By incorporating new ideas for patient care and completing a wide variety of projects, the specialty pharmacy can grow and improve its services.

The addition of a resident to a specialty pharmacy is a symbiotic relationship. It benefits both the pharmacy and the resident. First and foremost, the resident gains exposure to a new field of pharmacy and is able to become competent in providing specialty pharmacy services. The resident is also provided with an abundance of opportunities that would not otherwise be available, such as practicing in multiple settings through different rotations; learning management, leadership, and project management skills; improving presentation and public speaking abilities; and fine-tuning communication with a diverse group of patients and providers. Of course, this list is not all-inclusive and may vary among programs. It is, however, safe to say that pharmacy residents are provided a wealth of opportunities to advance their pharmacy practice that are not typically available through their formal education.

The rationale discussed here is a brief summary of why specialty pharmacy residency programs provide value and should be offered to graduating pharmacists, but there is unlimited potential for specialty pharmacies to initiate high-quality residency programs within their organizations.

Developing a Pharmacy Residency Program

For specialty pharmacies considering implementing a residency program, it is critical to understand that a great deal of work is required before the first resident even starts and on an ongoing basis thereafter. An excellent starting point of reference is at the ASHP website, where a number of publications are available, beginning with How to Start a Residency Program. Comprehensive information on factors to consider during the residency process is included in this and other publications.

Essentials to consider include budgeting for the resident salary, ensuring adequate workspace, determining a practice leader to serve as the residency director, and having a plan for the development of meaningful practice rotations that provide the resident with the ability to provide care to a diverse set of patients throughout the experience.

It is imperative to gain the support of pharmacy leadership before proceeding too far in the process. Of equal importance is gaining the strong support of those pharmacists who will become preceptors to the future resident. Pharmacists with past residency experience are invaluable in the planning process. All pharmacists participating in the program should be willing to sharpen their precepting skills and be prepared to share their time with the resident to provide direction and feedback.

ASHP provides resources to assist in the processes of recruitment, program design, and accreditation. Again, any pharmacy considering a residency will be well served to tap into these resources early in the process. Networking to learn best practices from other pharmacies and health systems with established residency programs provides another invaluable source of useful information.

Aurora Specialty Pharmacy Residency Program

Wisconsin’s largest nonprofit health care system, Aurora Health Care, has been training pharmacy residents for more than 20 years. The system will be training 35 residents across all pharmacy residency programs during the 2017-2018 year.

As part of Aurora Health Care, Aurora Specialty Pharmacy began a specialty pharmacy program in 2013. The program has since become accredited by URAC and the Accreditation Commission for Health Care. Aurora Specialty Pharmacy began offering its PGY1 Community-Based Specialty Pharmacy Residency program in 2016 with 1 resident.

The program is conducted through several rotations, typically longitudinal-style rotations lasting several months, although there are block-style rotations as well. During the first half of the year, each resident spends 2 days per week in the practice management rotation learning what it takes to manage a specialty pharmacy. This is altered to 1 day per week in the second half of the year to accommodate spending 1 day per week in an ambulatory care clinic rotation. The ambulatory care clinic was established during the first resident’s program year, within an outpatient neurology clinic. Also, throughout the year, each resident spends 3 days per week at the specialty pharmacy providing patient consultations, monitoring, and refilling assessments on specialty medications.

Two other rotations are completed in a block fashion in the middle of the year: drug policy and medication safety, and pharmacy logistics. During these, each resident completes a medication use evaluation and/or drug monograph, medication safety projects, and pharmacy logistics projects to gain exposure to drug acquisition channels, inventory management, reporting, and more.

Finally, each resident completes 3 additional rotations to meet the residency requirements, as well as staffing 3 shifts every third weekend at one of Aurora’s clinic-based community pharmacies. This enables the residents to be confident and well rounded in counseling on any medication, along with providing leadership development. They then provide an accredited 1-hour presentation for house staff, which gives the opportunity to become an expert in the chosen topic area and practice public speaking. Lastly, each resident completes a yearlong project with an emphasis on services provided to patients of a specialty pharmacy.

Conclusion

Pharmacy students and new graduates have expressed strong interest in specialty pharmacy residencies. Pharmacy leaders should investigate and take action to increase the availability of community pharmacy residencies, with a focus on specialty pharmacy practice. There is a real need to increase the number of specialty pharmacy residencies being offered, as these programs are beneficial to both graduating pharmacists and specialty pharmacies.

Marisa Goninen, PharmD, is the first graduate of the PGY1 community-based residency at Aurora Specialty Pharmacy in Menomonee Falls, Wisconsin. Jim Motz, RPh, is the manager of Aurora Specialty Pharmacy and the residency program director of the PGY1 community-based pharmacy residency at Aurora Specialty Pharmacy.

References

• Stolpe SF, Adams AJ, Bradley-Baker LR, Burns AL, Owen JA. Historical development and emerging trends of community pharmacy residencies. Am J Pharm Educ. 2011;75(8):160. doi: 10.5688/ajpe758160.
• Sasich LD. A proposal for a community pharmacy practice residency program. Am Pharm. 1983;NS23(5):25-28.
• Groves RE. Community residency: a student perspective. Am Pharm. 1983;NS23(5):24-25.
• Summary of programs and positions offered and filled in phase 1 of the 2016 match. National Matching Services Inc website. natmatch.com/ashprmp/stats/2016summpos1.html. Accessed March 8, 2017.
• Summary results of the phase 1 match for positions beginning in 2016. National Matching Services Inc website. natmatch.com/ashprmp/stats/2016applstats1.html. Accessed March 8, 2017.
• Koerner PH, Miller RT, Higginbotham S. Development of a community residency program with a focus on specialty pharmacy. Am J Health Syst Pharm. 2014;71(23):2067-2072. doi: 10.2146/ajhp130732.
• ABD, UNE launch specialty pharmacy residency. Special Pharmacy Times^®. specialtypharmacytimes.com/market-news/abd-une-launch-specialty-pharmacy-residency. Published December 5, 2016. Accessed March 8, 2017.
• Sederstrom J. Considering specialty pharmacy? Make your move. Drug Topics. drugtopics.modernmedicine.com/drug-topics/news/considering-specialty-pharmacy-make-your-move. Published February 16, 2017. Accessed March 15, 2017.