I've written about how I chose retail and how, against all odds, I actually like my job. I don't think I ever mentioned just how close to doing a residency I was though.
My first 3 rotations in my 6th year were highly clinical. I did a rotation in a cardiac ICU, a geriatrics rotation, then a general medicine rotation where I rounded with doctors and medical students on hospital floors. Going into my rotations, I knew I was book smart. I breezed through pharmacy school. I only studied for a couple hours before each exam, paid attention in class only half the time, and still managed to make Rho Chi (the "pharmacy national honors society," which basically means you were in the top 10% of the class).
I attributed my success in school to an innate ability to do well on tests. I'm a good test taker. I don't get nervous before exams, which is pretty amazing because I get nervous before doing just about anything else. I swear that sometimes I don't understand the material until the test is put in front of me. Then, suddenly, everything becomes very clear. I can focus completely on each answer, and I even amaze myself sometimes with the little details I can recall from the very back of my mind.
However, acing tests and actually applying that knowledge in a clinical setting are two entirely different things. Before starting my rotations, I worried that I would be one of those A students that struggled with rotations because I couldn't put it all together. To my surprise, this wasn't the case at all. In fact, I was very good in rotations. Moreover, the seemingly disparate pharmacy knowledge that I had acquired started to come together. All of a sudden, all the P450 inhibitors that I had trouble keeping straight weren't hard to remember. Suddenly, with some help from my incredible cardiology preceptor, I could go into detail on the pathophysiology of heart failure, A-fib, myocardial infarctions, etc. Suddenly, I could quote statistics from specific clinical trials, and in doing so, I knew (for example) that adding eplerenone to a post-MI patient with a LVEF of less than 35% could decrease mortality up to 25% (It's been a while, so I'm not sure of those percentages are 100% accurate).
This cardiology knowledge carried over into my geriatrics and general medicine rotations. I found myself really drawn to clnical pharmacy. I was good at it. I was good at dealing with patients (though I admitedly was still pretty intimidated by the medical staff). At this point, I decided that I did not want to waste my "talent" for clinical pharmacy by going into retail. Therefore, I planned to do a residency after graduating.
This wasn't a half-hearted plan. I fully expected to do it. I started getting my applications together. I got letters of recommendation. I attended residency showcases. I pretty much abandoned the idea of continuing on with retail (I still was an intern at a retail pharmacy at the time).
Since, I'm now a retail pharmacist, obviously, something changed my mind. Actually, there were a couple factors....
First... I was still dating my ex at the time, and after over 5 years together, we started having relationship problems. I attributed all our problems to the fact that I was absolutely broke and still in school. I had less than $500 in my account during my last year of school. I was only working every 3rd weekend because I wanted to make sure I had free time to spend with my girlfriend. In addition, working every weekend probably would have driven me insane. I was already working 40+ hours per week for free (rotations), so I couldn't imagine spending my 2 off-days at work at the pharmacy.
Without a lot of money, I couldn't afford to do very much with my girlfriend. We'd go out to eat or to the movies from time to time, but I couldn't afford to go away for a weekend with her. I couldn't afford to take her to a show. Our time spent together was mostly just watching TV in her tiny apartment. It was driving me mad, and it was making her even more mad because she started to complain that I never take her anywhere. It's not like she was asking for a lot. She was always dying to take a vacation with just the two of us, but I just never had enough money.
In addition, she was in her second year of law school, and when I was on rotations all week, she was hanging out with her law school crowd, which contained a bunch of guys that wanted her. For most of our relationship, I was never a jealous guy, but when she started blowing me off to go hang out with her law school friends, I got a bit jealous. In fact, I tried to discourage her from spending so much time with them. It wasn't necessarily the time she spent that bothered me. It was what she did. She went to a ton of law school socials, parties, out to the city bars for drinks, etc. She was basically acting like a single girl. I went to one of her law school semi-formal dances with her, and she ignored me the entire night.
During all this time, I kept thinking to myself, "we just have to make it through a few more months. Just wait a few more months, and I'll have a job with some money, and everything will be OK." That's when I began to do the math regarding residents' salaries. They were pathetic. $35,000/year tops. I had school loans. I had a girlfriend of nearly 6 years that I wanted to live with and eventually propose to. I started thinking that if I did a residency, it might set me up to pursue a clinical job that I desired, but it would just be another hard year on our relationship.
The second factor that pushed me towards retail was my schools "interview day." All the chain pharmacies were represented there, and they were all just dying to tell us how much they wanted to pay us. Here's me, $500 to my name, and the first chain I talked to wanted to pay me well over $100,000/yr to work for them. Those dollar signs looked really really good. I always knew retail pharmacists made good money, but you don't truly comprehend it until you get that salary offer.
I thought all that green would be the solution to all my problems. I could move us out of that crappy apartment. I could finally take my girlfriend on vacation and to all the other nice places that she had been dying to go, but I always refused. Moreover, I could finally afford to put a ring on her finger, which was something that I had wanted to do for a couple years. It was something we talked about for quite some time.
I ended up abandoning the residency. I never completed the applications. Then, a few months later, she broke up with me. I kept telling her just to wait a few more months, but she said she was too unhappy to hold out any longer. I had abandoned my career aspirations in order to make my personal life better. In the end, that sacrifice was for nothing.
That's the story of how I ended up in retail pharmacy. As I've stated numerous times, over my first year as a pharmacist, I suffered through some of the harshest working conditions you can imagine, but I survived them, and now my job has become so much better than I thought it would be. In addition, I've become a better pharmacist because of those initial hard times. I like my job. I feel appreciated. Perhaps, I don't make a great difference in anyone's healthcare outcomes, but you know what?... I feel like I can make a greater impact on a person's life being a friendly community pharmacist than by working side by side with a medical team.
It's annoying, but at the same time, it makes you smile a bit when you work at a 4 pharmacist store, and you have customers who trust you so much that they'll only talk to you and not any other pharmacist when they have a question. It's nice to have customers that just drop by to say hi or to wish me a Happy New Year.
Yes, my clinical knowledge is going to waste. Yes, I'm forgetting a lot of the things I learned in school and on rotations. However, if I had to go back and make the decision between residency and retail again (this time knowing that my relationship wasn't going to work out anyway), I'd still choose retail, and this time it wouldn't be just for the money.
Another thing I've learned about myself is that I'll always put career aspirations secondary to my personal life. I will never live for my job. It will never be my source of happiness, nor will it ever be a great source of discontent for me. Being a clinical pharmacist takes a committment to the job that I'm incapable of making. I continually write about how I lack any semblance of a social life (although things are looking up in that department recently), but despite what I lack in that department, I'll just never throw myself into my job.
Perhaps that's the best part of community pharmacy. When I close that gate at 9:00 PM, my day is over. I don't have to be on call. There are no real emergency situations. I don't have to pull any nightshifts, nor do I have to be at the pharmacy by 7:00 AM five days per week. It's just a good situation for me.
Alright... this is probably the longest post I've ever written (maybe second longest to me "Peak Oil" post). I haven't written in a few days, and I felt the need to write about something. I guess I also wanted to clarify my entire decision making process when it came down to choosing what area of pharmacy to practice in.