Your Pharmacy Career: Finding the Creative Corners

Lifelong learning is key for successful niche hunting.

Currently, there are nearly 10,000 different prescription products alone listed in the Orange Book, and over 6600 New Drug Applications. While pharmacy tends to attract the best and brightest, there is no way that any individual pharmacist can know every statistic, side effect, and pharmacokinetic profile of every drug on the market. Nor can a single pharmacist know everything about the profession—like being a strong leader, advocating for the profession, communicating to a wide variety of people, and managing others.

The need to specialize in this area of pharmacy practice isn’t just a luxury anymore—it is a necessity. The good news is that because pharmacy is so vast, it allows pharmacists to find their favorite niches, creative corners, and the areas of practice they are passionate about, which allows for higher job satisfaction and promotes lifelong learning for pharmacists. The challenge becomes the question, “Where can I find my own creative corner of pharmacy practice?”

There are many therapeutic board certifications and advanced degrees a pharmacist may now earn. Equally exciting, specializing in an area of pharmacy or health care practice provides more opportunities for pharmacists to speak, write, teach, and share their knowledge in order to grow and strengthen the profession. This, in turn, demonstrates the value proposition of pharmacy to the health care team, drives the profession forward in new and interesting ways, and ultimately, offers better care for patients.

How does a pharmacist find his or her particular corners of interest within the profession? Here are a few real-world examples from 4 different pharmacists in the trenches who have been lucky enough to discover their own creative corners of practice.

Find Your Niche

, a pharmacist with Walgreens in Indianapolis, found her creative niche by developing Well Babies, a woman and baby wellness service, out of frustration from her own personal experience as a mom.

“After having my first baby, I realized that breastfeeding was not as simple and intuitive as I originally thought. The lactation consultant was excellent, but other health care providers lacked training to provide appropriate advice,” she said. “Even as a pharmacist, there was so much I did not know. Upon returning to work, I provided education to a moms’ group on medication and lactation. My passion was born as I discovered the need for better access to support, better information for moms, and better training for health care professionals.”

, director of pharmacy at Good Samaritan Hospital in Vincennes, Indiana, became a quick study of employee prescription drug formulary management when costs for the self-insured hospital were skyrocketing.

“Employee prescription costs are a significant expenditure for hospitals that are sometimes overlooked, as most pharmacy directors focus primarily on the pharmacy department budget and our inpatient/ambulatory care drug costs,” he said. “We traditionally have done an outstanding job of controlling inpatient costs with strategies, like therapeutic interchanges approved by our P and T Committees, but, at the same time, our hospitals are spending $7 per capsule for proton pump inhibitors for employee prescriptions when similar medications are available for $0.10. There are clearly opportunities for the pharmacy departments to impact hospitals’ health insurance expenses by becoming active in looking at ways to control employee prescription costs.”

Another driver for finding a passion in pharmacy relative to policy at a broader level was discovered by Tricia Lee Wilkins, PharmD, PhD, at the Office of the National Coordinator for Health Information Technology (health IT) at the Department of Health and Human Services.

“This is an exciting time in healthcare. Change is taking place and at a pace like no other time in history, and I want to ensure that our profession has a seat at the table,” she said. Dr. Wilkins earned her PhD in health outcomes research to help patients and the health care system at a broader level.

, also wanted to improve wellness for patients at Butler University. “Every patient during my residency in southcentral Los Angeles had diabetes,” she said. “Coupled with my family experience of watching some diabetic relatives just giving themselves more insulin when they ate cake, I realized that no one was discussing preventive education at all with patients. There had to be a better way.”

The Niche Isn't Always Obvious

When asked if their creative niches were always obvious, a majority of these pharmacists did not think so.

“I would never have guessed this path for me at the time of graduation from pharmacy school,” Dr. Lenell said.

Jim Eskew found his niche in formulary management later in his career.

“As I moved from a large academic medical center to a smaller community hospital, I was challenged by our chief executive officer to look at ways to control and decrease our employee prescription costs, and then became very interested in formulary management.”

Dr. Maffeo cites her residency experience as key to finding her passion in employee and patient wellness programs.

“The residency really sparked it for me, where I had the opportunity to start tobacco cessation and diabetes risk prevention programs.”

Dr. Wilkins knew she had a passion for policy after taking a pharmacoeconomics class in pharmacy school. Working in health IT was not expected, nor does she claim to being an expert in the area. “It’s not about being an expert in the field. It’s understanding the needs of the patients, gaps in care, and then making the connections between desired outcomes and the technology that enables them.” She currently supports meaningful use of health IT in her policy work.

While all professionals ultimately became pharmacists, the niches arrived at various times and places throughout their professional careers.

Sharpening the Niche

If you’re lucky enough to have located your area(s) of pharmacy passion, which may not always be obvious, the next step to take to help you bloom in the niche is to seek extra training, learning, and development. While some can stay within the profession to find quality training, sometimes sharpening the saw of the niche requires seeking training outside of the profession. Both Eskew and Dr. Lenell cite training outside of the profession for their chosen niches.

Dr. Lenell learned more about breastfeeding and maternal and child health outcomes from public health professionals and conferences for lactation consultants, nurses, and pediatricians.

“I am usually the only pharmacist wherever I go, but I see that as an opportunity to show other health care providers how valuable the pharmacist is to the team.”

Eskew learned a lot about formulary management and employer-managed pharmacy benefit managers (PBMs) by working with the hospital’s consulting agency for health care insurance. “The consultants are very knowledgeable, and as pharmacists we can certainly learn a number of concepts related to overall employer health care costs from these organizations.”

Dr. Wilkins learns from everyone around her, especially in health IT, and was excited to find a PhD program within a school of pharmacy for policy. However, she also cites that there is value in learning from other professions.

“When you have a team to enlist, no one person walks around knowing everything. You learn together—from other agencies, other stakeholders, listening to those in the field and outside the field, then thinking about how all those inputs can come together to improve health care. It is a lot of learning as you go.”

“What we do for our patients is reduce barriers to wellness in our program,” Dr. Maffeo said when discussing the employee wellness program she built at Butler University. “Technology is great, but if we can, for example, produce lab results for employees before they go see their doctors, that reduces a barrier—both in cost and in outcomes—for the patient. We research and find evidence-based tools and technology to help reduce barriers for our patients.”

Recommendations on Niche Hunting

If you don’t know your own personal niche yet in pharmacy, here are suggestions from the experts. Eskew recommends hunting for areas of pharmacy practice in which you can make a difference: “With health care reform, there are going to be many new opportunities for pharmacists. I would recommend studying the Affordable Care Act (ACA) in some detail and examine how the ACA is going to drive pharmacy practice, then develop an expertise related to that opportunity.”

Dr. Wilkins agrees. “Technology is not new to pharmacy. We’ve been using sophisticated systems for decades. The question now is, how do we take the traditional dispensing role and merge it with other skills we have—clinical knowledge, medication management, etc—and integrate ourselves as members of the health care team to better manage health care and outcomes for our patients?

“Be open and willing to try new things. Also, if you find a niche, make it known,” Dr. Wilkins suggested.

Dr. Maffeo cites passion as a hallmark for finding your niche. “When I teach the immunization elective, a few students ‘geek out on vaccines’ every year. That is, they tell me they go out and find learning beyond the class to know more about a subject—like watching CDC videos or asking how to build a business plan around a service. Follow your passions and your gut.”

Dr. Lenell recommends having an open mind to new opportunities. “Loving what you do is so important. Sometimes work and your life outside of work will intersect, and that’s OK. Also, it is helpful to have a plan, but sometimes more helpful to have an open mind. You never know what opportunities will come up.”

Niche Hunting: A Lifetime Skill

Last but certainly not least, all of the pharmacists interviewed cite lifelong learning as a key for niche hunting. Jim Eskew is very focused on discovering how pharmacists may fit into new policies around the ACA, but this interest found him later in his career.

Dr. Lenell is now pursuing a passion around public health, based on her work with Well Babies. “Low breastfeeding rates and barriers to breastfeeding are public health issues, so at meetings for these topics I have encountered information on other public health concerns, such as obesity, that I’m interested in pursuing. I am contemplating more training in public health in my spare time.”

Dr. Wilkins loves the idea of anticipating and preventing health care challenges in patients of the future with data collected from electronic medical records. “We’ll have freeflowing data—what can we do with it? I see a world where we will do predictive analytics and stay one step ahead of problems like medication nonadherence and proactively identifying risk factors in patients to optimize care.”

Dr. Maffeo cites lowering barriers and her passion for public health. “Right now, I’m asking our point-ofcare lab testing manufacturer when the B12, TSH, and other tests are going to be made available for our point-of-care testing machines, so I can lower the barriers to care even further for our patients.

“Ultimately, in our practice setting, we are teaching what’s next in pharmacy. We always ask—are we in a good position to provide a new service? Why can’t we do it for our patients? It all comes down to identifying needs, turning them into opportunities, asking whether pharmacists are wellpositioned to perform those services or needs, identifying the resources necessary to make it happen, building a plan, and then implementing,” Maffeo explains. “This could be true for any creative niche in pharmacy practice, and any profession.”

No Endings, Only Beginnings

Creative corners and niches in pharmacy practice are necessary to expand the profession and move it forward. Although niches are not always top of mind and easily identifiable according to our experts in pharmacy practice, they are not only important but also critical to improve the profession, deliver better care to patients, and evolve the health care system itself. Each professional can also attest to life-long learning and a constant search for new niches and creative corners not once, but over one’s entire career in pharmacy practice. Happy hunting for your niche(s)!

Pharmacy Expert Profiles

Jim Eskew, RPh, MBA—Director of pharmacy, Good Samaritan Hospital, Vincennes, Indiana

Niche: Saving money and increasing medication adherence by managing a self-insured employer PBM

Carrie Maffeo, PharmD, BCPS, CDE—Associate professor and director, Health Education Center, Butler University, Indianapolis, Indiana

Niche: Employee wellness program management

Amy Lenell, PharmD, CLC—Pharmacy manager, Walgreens, Indianapolis, Indiana

Niche: Developer of Well Babies program, use of drugs in pregnancy and lactation

Tricia Lee Wilkins, PharmD, PhD—Policy analyst, Office of the National Coordinator for Health IT, Washington, DC

Niche: Passion for blending policy and health IT

Erin Albert is a pharmacist, author, entrepreneur, lawyer, and associate professor at Butler University College of Pharmacy and Health Sciences. For more of her writing, go to www .erinalbert.com.