Oh, The Places You’ll Go!

The following is a post of mine in response to a post on ASHP Connect regarding residencies, pharmacy, and finding your path when setting out after finishing pharmacy school.

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Elva, you bring up some very important points, and I want to add my experience for any of those looking at “residency vs. retail”. My story is proof that you never know where you are going to end up, and that sometimes the unknown is better.

I was set on completing an inpatient pharmacy residency. I believed hospital was for me and also did not want to do “retail” pharmacy. In 2010, I was one of the 1100 or so Match applicants that did not match, and suddenly I was left trying to find a job in a local hospital where experience or a residency was required. I applied to 30 positions in all aspects of pharmacy, received two call backs, and did not get a job.

I was lucky enough to have a mentor from my 4th year, Bill Jones, who believed in me. He was hired to help set up a new residency on Maui and suggested me for the residency. How could I say no to living in paradise? (It isn’t all paradise, as moving out here and living here are both prohibitively expensive, but it’s worth it)

Originally, this was supposed to be a hospital residency. With only one hospital on the island, we had a tremendous opportunity to focus in on local needs and continuity of care. The hospital fell through, and so the residency was changed very suddenly to a community pharmacy residency. At this point, I was about two months away from moving, had not been able to find a job in the 3 months post-graduation, and decided I would go for it and make the best of it. I started in October of last year and have 9 days left in my residency. Little did I know  last October what an amazing experience I would have!

Setting up a new residency is never easy, and this past year has certainly had its ups and downs, but the end result is amazing. From the community setting, we are able to affect change on so many levels. Working out of an independent pharmacy, I have the freedom and capability to start up just about any type of clinic I want (assuming it is feasible and warranted in our community). I was able to branch out of the hospital and look at the COMMUNITY we live in. This included working in long-term care, going on home visits with a public health nurse, and giving presentations on the pharmacist’s role in continuity of care to the local medical society, to critical access hospital administrators, and to rural healthcare providers. Through a USDA grant, I was flown to neighbor islands to present to elderly about high risk medications. My co-resident and I started both an MTM service and an immunization clinic that are both picking up speed, and the incoming residents already have a business plan and are advertising their new Cardiovascular Risk Reduction Clinic. I am currently working with a physician in her office, completing chart reviews and looking at implementing a CDTM protocol with her. The next step is branching out to other independent physicians and group practices to see how far I can take my practice. I want to increase continuity of care and focus on transitions of care.

Through a community pharmacy residency, I have been able to see the WHOLE community aspect of transitions of care. Having seen the gaps, I can do something about them! I have a more global view of healthcare on the island than I would have only working in the hospital.

I think community pharmacy is redefining itself, and much of the work is started in community pharmacy residencies. What a great opportunity for a self-starter and innovative thinker! I challenge people who are only considering hospital pharmacy residencies to talk with some community pharmacy residency programs and see all the innovative services they are providing. It is mind-boggling and exciting, to say the least!  Imagine if a community pharmacy residency partnered with an inpatient pharmacy residency. What a great model for continuity of care they could create!

Why is continuity of care so important? If you have been paying attention to all the buzz, you know about ACOs and the new Comprehensive Primary Care Initiative, among other new and exciting opportunities aimed at coordinating care across the continuum of healthcare. These initiatives present amazing opportunities for pharmacists to become involved and tie together some of the major gaps in healthcare, many of which cause costly medication errors and involve transitions of care between the hospital, rehabilitation facility, long-term care facility, primary care and the community pharmacy. We have an opportunity here, and I think that if students looking at the future can see beyond what they believe to be pharmacy, they will see that we are at a turning point. Pharmacy is at a place where we  can create the practice we want. It will not be easy, and reimbursement issues are huge, but I believe that we can create programs through residencies that will demonstrate value and support our case for provider status.

Think outside the box, don’t limit yourself, and find a way to create the practice you know your community wants and needs.

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