Today’s student earning a Doctor of Pharmacy degree (PharmD) has a multitude of career paths from which to choose. While many think only of PharmD’s as the pleasant person filling prescriptions and counseling patients at the local retail pharmacy, today’s PharmD is trained to perform many roles and to succeed in multiple and diverse settings. Roseman University started the first school of pharmacy in Nevada—in order to respond to a demand for more pharmacists—and today remains the only school of pharmacy in the state. Roseman has trained thousands of healthcare professionals as nurses, healthcare MBAs, dentists, and orthodontists and has cumu-latively graduated over 2,400 pharmacists since its inception in 1999. Roseman’s PharmD program is accelerated, compressing a four-year doctoral program into three years. Within the curriculum is ample clinical exposure to a variety of settings, helping to prepare students to identify their career path upon graduation. Student pharmacists are exposed to various practice settings within the first month of the program, and in their final year of the program which consists of varied clinical experiences, each six weeks long.

Today’s pharmacist has far more opportunity to specialize than in years past, and with this focused training comes unique work environments. With residency and fellowship training, PharmD’s function now in settings once held exclusively by other health professions or in patient settings that did not exist previously. Paths to pursue range from academia, ambulatory care, nuclear, oncology, pediatric, or long-term care pharmacists, industry positions such as drug discovery, drug development and regulatory affairs, owner, or telepharmacist. Choosing a path does not mean that it is the only path in a career. Many PharmD’s are continually learning and as such, desire to work in different settings to continue to round out their experience. According to Dr. Mark Decerbo, a high degree of specialization and training will continue to be the norm as the complexity of disease states, medications, and patient populations shift and grow. With that, there will be less opportunity to move into new areas without needing additional training. The following are some of the most common paths for PharmD graduates:

THE RETAIL PHARMACISTA retail pharmacist transitions from their program of choice directly into the pharmacy once they have successfully passed both their na-tional board examinations, the NAPLEX, as well as their respective state law exam. With market shifts, there are fewer positions today within the independent pharmacy, as conglomerates and big box retailers have taken ahold of the market. According to Dr. Leiana Oswald, the retail pharmacy environment is fast-moving, intense and requires the pharmacist to multi-task.

The retail pharmacist may work an eight-hour shift, but they typi-cally do additional tasks before and after their shift to insure the pharmacy runs smoothly. These include transcribing physician prescriptions, printing refills, doing inventory counts, completing daily reports, checking refrigerator temperatures, and taking out the trash. In one day’s work, they may counsel over 100 patients, answer on average eight physician calls, transfer medications, provide immunizations, counsel on OTC medications and over-see technician work. Among the most highly compensated in the profession of pharmacy ($120,000-$160,000), the work is physically demanding and at times, lacks flexibility in scheduling.

This role is evolving as focus on “provider status” becomes more important. Pharmacists and pharmacists’ patient care services are not included in key sections of the Social Security Act (SSA), which determines eligibility for healthcare programs such as Medicare Part B. As such, the pharmacist role can be limited even though

Growth And Expertise Create New Paths Of Opportunity

THE CAREERBy Vanessa Maniago, Special Advisor to the President, Roseman University of Health Sciences Contributing Authors: Mark Decerbo, PharmD, Associate Professor of Pharmacy Practice, Roseman College of Pharmacy; David Rawlins, PhD, Assistant Professor of Pharmaceutical Sciences, Roseman College of Pharmacy; Catherine Leiana Oswald, PharmD, Assistant Professor and Introductory Experience Coordinator, Roseman College of Pharmacy

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studies and practice-based experience have shown that when pharmacists are involved as members of the healthcare team, patient outcomes improve, patients report higher rates of satisfaction, and overall health-care costs are reduced. Without the proper “provider status” recognition and payment models in place, patients and healthcare providers are often blocked from accessing the benefits achievable through pharmacists’ services. According to Dr. Oswald, as pro-vider status evolves and the role of the retail pharmacist grows, pharmacists may become more focused on counseling and less so on verifying prescriptions and paperwork. The person best suited to this role should have a strong desire to help the general public, work well with other staff members, possess strong communication skills, and function well under pressure.

THE CLINICAL PHARMACISTSpecialization has driven the pharmacist into a variety of settings within various areas of the hospital or clinic. Graduates wishing to pursue this path will advance to a one- to two-year residency, depending upon their area of expertise. Areas of specialty include nuclear pharmacy, oncology, pediatrics, and infectious diseases, among many others. De-spite this advanced training, in comparison, hospital pharmacists typically earn less than retail pharmacists.

Record numbers of graduates now seek post-graduate residency training, and the number of residency positions is growing, but only six or seven of every 10 applicants is successful in securing a spot. In Nevada, Roseman graduates often need to go out-of-state to secure a residency position, which can create challenges. While the number of pharmacists has grown significantly since the 1990’s due to the number of pharmacy programs, the challenge is preparing stu-dents to be preferentially sought in a high supply environment.

This is a notable trend however, and one that may come to impact licensure in the future. “The importance of residency training as a mechanism for further skills development will continue, perhaps even becoming a requirement for practice in the future,” says Dr. Decerbo, who also notes that pharma-cists with MBAs offer a powerful skill set, allowing them into the C-Suite and upper level management positions, which is criti-cal in today’s climate of corporate mergers.

The pharmacist’s work day can vary, but will generally begin with updates on patient medications and clinical condition over-night. Patient profiles will be reviewed for drug interactions, lab results analyzed, and other tests reviewed before joining the medical team for rounds. On rounds, the pharmacist serves as the drug therapy expert to the physicians with whom they work, making recommendations, providing teaching and answering drug information questions in real time. In the afternoon, the pharmacist ensures medication orders are carried out, engages in clinical teaching of pharmacy residents, and works on other projects and protocols.

THE TEACHING PHARMACISTA faculty pharmacist’s work day mirrors that of students in the university setting. Days run, on average, from 8-5 with evening grading, communication and committee work several nights per week for several hours. “In a typical day, I will meet with two to six students, speak with one to three preceptors, prepare lectures, work on research and grants in-progress, attend college, university or national-level commit-tee meetings, and work collegially with my peers, “ says Dr. Oswald. According to Dr. David Rawlins, ample preparation is neces-sary in order to successfully walk into the classroom. While the faculty day is long and

requires constant interaction with students, as well as physical endurance from standing and moving throughout the room, this can be the most rewarding time for faculty. “It is a wonderful feeling to be working with a student and see their eyes light up as they get a concept,” says Dr. Rawlins.

Teaching faculty earn less than retail pharmacists, but the job is more flexible and requires less physical fortitude than the retail setting. Dr. Oswald agrees with Dr. Rawlins about the impact felt with working with students every day. “Working one-to-one with students to help them achieve their dreams…is something very rewarding to me,” notes Dr. Oswald. Even within this role, faculty may pursue different paths. Some may be drawn to ad-ministrative functions like directors, assis-tant deans, deans, or even presidents of their academic institutions. Additionally, gaps in teaching time offer faculty the opportunity to do research or clinical work. According to Dr. Rawlins, research involves the opportu-nity to work on one's own ideas in educa-tional techniques, laboratory or community research and to ultimately involve students in research if they desire. Because of the teaching aspect, the approach to research in this setting is markedly different from that in a pharmaceutical company.

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CORPORATE PHARMAEmployees working for a pharmaceutical company might work in drug discovery or in clinical development performing tasks such as basic research, designing new clinical trials, analyzing the data of a past trial, or recruiting physicians to participate in trials. In drug discovery, employees will spend the majority of their time in the re-search lab trying to find new agents that might be a pharmaceutical. When not in the lab, they attend team meetings where they present their results and discuss with the team other ways of approaching problems. They will also attend seminars and company meetings. Salaries in the pharmaceutical industry are generally higher than those either in academia, the hospital, clinic or pharmacy—some-times twice as high—but that comes at a cost.

Compared to academia, there isn’t as much freedom, and projects which may have required a great deal of time and investment may be eliminated at any time with very little explanation. Dr. Rawlins says, “You work on projects that are important to the company, and ultimately to the shareholders.” As a veteran pharmaceutical employee who has moved into academia, Dr. Rawlins explains that, “In academia, you are more in control of what you are working on, which requires you to be more self-motivated, however the resourc-es for accomplishing research are more abundant in the industrial setting.” Those pursuing leadership positions within the industry might go on to earn a PhD, adds Dr. Rawlins.

Most important is the ability to work in a team setting. “The ability to work for the good of the team is critical, and the ability to take criti-cism is valuable. In the industry, being flexible is important as you may be switched from project to project,” says Dr. Rawlins. And given the stress, it isn’t uncommon for someone in the industry to switch paths mid-career; this is a normal part of the journey of the PharmD.

ADDITIONAL TRAINING OPPORTUNITIESPost-graduate fellowship training is yet another path for the PharmD, and that can be achieved in either a traditional aca-demic fellowship or an industry fellowship. An academic fellow-ship provided by a university are training programs focused on a specific clinical area such as oncology or infectious diseases. Typically two years in duration, this prepares the PharmD for independent research or as a clinical research scientist for faculty positions in academic settings or research in the private sector. The industry fellowship allows the fellow to gain experience in various departments within a pharmaceutical company in areas such as regulatory compliance, medical information, pharmaco-economics, and pharmacovigilance.

MORE ALIKE THAN DIFFERENTWhile the various training opportunities and career paths diverge, most agree that there are commonalities that exist among this pro-fession. According to Dr. Decerbo, the importance and commitment to lifelong learning is a given. The pursuit of knowledge does not end the day a diploma is awarded. Reading and ongoing dedication to professional practice is part of a continuum of learning. Com-munication skills are paramount to success, as one needs to work alongside physicians, nurses and other healthcare professionals, work with patients, and communicate clearly, concisely, and com-passionately. Understanding and knowledge of the other professions with which one is interacting allows for greater understanding and collegiality. Empathy and the ability to listen to the patient is crucial, and having the ability to deliver information in a way that empow-ers is important. Accuracy and attention to detail are paramount in reducing potential medical errors. Finally, being a natural advocate for patients is a must for any PharmD.

The profession of pharmacy is widely diverse and rich with opportu-nity and change. The changes seen in the last 10 years of the profes-sion will undoubtedly be eclipsed by new changes in the future. While there are many paths to pursue now--far more than most people understand--technology, advances in education, specializa-tion and future healthcare shifts will undoubtedly lead to new career paths and environments suited to the PharmD.

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