Monday, February 2, 2009

Clinical vs. Retail vs. Any Other Area of Pharmacy

I was just reading The Angry Pharmacists most recent post where he puts a douche bag clinical pharmacist in his place. This post got me thinking about what really is the difference between pharmacists who practice in different areas.

Everyone's first instinct is to think that the "clinical" pharmacists are the top-of-the-class, nerdy type and that the retail pharmacists settled on retail because they weren't smart enough for a clinical setting. I think the only thing that separates the two is experience... and it goes both ways. You stick a pharmacist who was doing clinical work for 10 years into a retail pharmacy, and he wouldn't have a fucking clue of what to do. Vice versa, if you took a retail pharmacist and threw him into a hospital, he wouldn't have any idea what to do there either.

It's all just experience. I'm sure all of the interns reading this will agree with me: They teach you everything in pharmacy school except how to be a pharmacist. You learn pharmacology, kinetics, and therapeutics. You learn all the pharmacy-related science you could ever need. However, you don't truly learn how to do ANY pharmacist job.

This is easily seen in the newly licensed pharmacists that only spent the bare minimum time in a pharmacy (hospital, retail, or any other setting) required to be licensed. These new PharmD's can quote you statistics from all the major studies and practically know DiPiro's Pharmacotherapy by heart. However, they cannot perform the simplest of tasks. We think they must be stupid because (like in TAP's case) they can't give a transfer or (in the clinical douche bag's case) they don't know you can't give 40 mEq of Potassium as an IV push (although that one is sort of common sense if you ask me). In reality, they probably are just lacking in experience.

I'm a retail guy. I've been a retail pharmacist for 2.5 years now. I don't have the slightest idea what to do in a hospital environment. The drugs you deal with on a daily basis are different. The rules are different. Your responsibilities are different. I don't know how to use pixis. I don't have a clue as to what a "y-site" is. I'd be completely lost if I had to work in a hospital tomorrow.

I assure you that it has nothing to do with my intelligence or capabilities. I graduated in the top 10 in my class, and I can guarantee you that I did so working half as hard as the other 9 students in that group. My good grades had next to nothing to do with whatever job I was going to take though. Retail pharmacy was not easy for me right away. I was one of those students who didn't spend a lot of time in a pharmacy when I was in school. I only worked about 20 hours per week and only during my semester breaks. When I got my license, I was still struggling to understand insurances. I still didn't have a good grasp of pharmacy laws. I found I had a very hard time making decisions (when I needed to call on interactions, what to do when customers get irritated, etc.). There were even a lot of things about our pharmacy software that I had to learn on the fly because I just never got the experience I needed.

My first few months as a pharmacist were rough, but by continually working 40 hours per week and putting forth an honest effort to improve, I developed into a pretty good pharmacist (I still have much to work on though). It would have been the exact same story had I chosen to work in a hospital instead of retail. All that clinical knowledge isn't much help unless you have the experience to back it. It probably would have taken me 6 months to a year to begin to feel comfortable in a hospital environment.

That's why I will never look down upon pharmacists who practice in other areas. I can't do their jobs. They can't do my job. Give me a few months to learn a clinical job, and I'll quickly learn all the little thing that any hospital pharmacist would need to know. Give them the same amount of time to work my job, and they'll do the same thing. It all comes down to experience. No particular group of pharmacists is any better than any other. They're just more experienced in their particular areas.

***One more thing***

I meant to write this somewhere in the actual post, but I forgot. Since I'm too lazy to go back and work it in so that it flows, you're getting it at the end.

A lot of the my pharmacy classmates went on to do residencies and are now working in highly clinical jobs. Most of these people weren't exactly great students. A few of them, I thought were a little dumb actually (judging by the idiotic questions they always seemed to ask and the way they complained after every single exam that the questions weren't fair). I mean, they used to come to me for answers and pointed me out as one of the smartest students. They did their residencies, and now they can be considered experts and know considerably more than I do about their respective fields. It just goes to show you that it's not really the grades or the intellectual power of the pharmacists in a particular area. Keeping with them theme of the post, it's experience.


Pharmacy Chick said...

Great Post Mike,
so the question that begs to be answered is this?
Why are we retail pharmacists still looked at as the ugly stepsister by the schools when 80% of the jobs and most of the $ is here?
Just thinkin' out loud.

jhartf2 said...

Pharmacy Mike,

It's nice to see you look at both sides of the argument and approach the issue in a calm manner. Very refreshing. I'm a first year pharmacy student, and no matter what field I choose to pursue, I'll give the proper respect to other pharmacists and health care providers.

Anonymous said...

good post mike-

one thing about the economy and clinical pharmacists/residents/etc...a lot of them (some of my former classmates c/o 2007) are getting pinched on their salaries due to the way the economy is. Most of them work for state or government funded hospitals (colleges) and they are getting their salaries cut left and right. Meanwhile, retail chains (namely CVS and WGs) are increasing their RPHs salaries...Not that I care (I'm retail) but just some food for thought.

Anonymous said...

why would you look down on other pharmacists in the first place? you're the one in the shithole environment

Anonymous said...

I really enjoyed your post. Unlike some of the other bloggers who just say something to cover their insecurity, this is actually meaningful. I can not work in a hospital, I cno not be a great pharmacist in a community setting (just not good at it) so I chose academia/clinical. In my classes I stress that community pharmacists probably do the most good since they have the most contact. However, I think clinical pharmacists (we are all clinical pharmacists I just work in a clinic) play a role to and there is no need to compete. I graduated a 101st in my class of 109, but I chose to do a residency that I excelled at and now I am a faculty member.
We need to distance ourselves from blowhards that insult everyone (doc, nurses, other pharmacists) (I think you know the type) and work together, or else pharmacy will die. Too many pharmacy schools opening (USF in Florida just got approved) causing an oversupply. Thank you again for an excellent well thought out post

Anonymous said...

Great post! I'm a new reader, and I really like the way you've presented both sides of the clinical vs retail settings. I work for the VA in an Am Care position, and have only worked briefly in retail. Retail pharmacists have my complete respect. The day to day grind of handling insurance issues, customer complaints, and phones ringing off the hook all the time is something I will never be able to juggle.

The Ole' Apothecary said...

As someone who has worked 15 years in community pharmacy practice and an equal number of years in institutional pharmacy practice, I prefer the unified view: ALL pharmacists have the potential to be clinical pharmacists, and ALL pharmacists, no matter which venue they work in, face clinical problems in practice. What may separate them is experience. To those pharmacists in one type of practice, I have every confidence that you could switch to the other. In each milieu, there are colleagues who will help you get up to speed.

Anonymous said...

From the point of view of being on my rotations right now:
- I get warm fuzzies when I read things on blogs and realize I actually KNOW them (i.e. the Cipro/pna in your post on antibiotics, 40mEq of K, how to give/take a copy)
- I'm not top, I'm not bottom of my class--I'm almost dead middle.

I'm pursuing a residency--because I want to learn more, and I want the chance to see a few more topics before I figure out what the heck I want to do. So, you are right - grades don't mean anything. Nothing says I'll be great or an expert, but I'm realizing that I'm not the best, so I'm taking an extra year to do more learning.

And I'm glad someone finally pointed out that it comes down to the fact that we wouldn't/couldn't thrive in each others arenas.

Anonymous said...

I was a hospital (clinical) pharmacist in an ICU/OR for 20 years. I quit 10 years ago & have been practicing retail (clinical) pharmacy since then.

As the Ole' Apothecary stated, clinical is an adjective to describe what you do when you work. There are hospital & retaill pharmacists who never are clinical by choice. They are pharmacists who you don't want to work with or particularly follow after their shift is over. When I work with or after a clinical retail pharmacist, I know all the bases have been covered in providing care of patients. Since I hire my staff, I only hire those pharmacists with "clinical" capabilities.

Clinical work in pharmacy is found is every setting. I was at the "birth" of this phrase when I was in pharmacy school & it has become a divisive tool betweenn pharmacists. Since I still have students and interns and always have in all my practice settings, I make sure to have them learn exactly what "clinical" means.

I can only hope that at some point, unification of all aspects of our profession will take place. I have my doubts though seeing what takes place in academia!

Anonymous said...

wow mike I had no idea you were a new grad. I've heard from recent grads too that more and more folks are doing residencies; I've heard varying stories from clinical jobs that have great day hours to positions that have you at the hospital 13-14hr days.


Anonymous said...

A pharmacist is a pharmacist regardless of what setting you work in. How intelligent and up-to-date you is not determined by where you work but how you practice. I am a clinical pharmacist with 2 years of specialty residency and now going into a retail setting because of geographic change. I do too, don't look down on anyone regardless of where they practice. School taught us the same basic knowledge, but how smart we are is determined by how we practice and how much we like to keep up to date and use what we know to benefit the public. Retail pharmacists deal with patients/customers to make sure they receive the education they need to take care of their health. Clinical pharmacist deal with the physicians/nurses to make sure the patients get treated for the right condition with the right medication. We all serve the public (our patients, our customers) then why do we delineate ourselves from our profession?