Pharmacy Careers in Pharmacy Careers in Academia & Ambulatory Academia & Ambulatory

CareCare

Andrew N. Schmelz, PharmDAndrew N. Schmelz, PharmDPost-Doctoral Teaching FellowPost-Doctoral Teaching Fellow

Dept of Pharmacy Practice, Purdue UniveristyDept of Pharmacy Practice, Purdue UniveristyMarch 30, 2009March 30, 2009

anschmel@purdue.eduanschmel@purdue.edu

Finding the Right CareerFinding the Right Career

PharmD provides many options for PharmD provides many options for careerscareers

Can be tough to choose!Can be tough to choose!– Knowledge of career choices changesKnowledge of career choices changes– New opportunitiesNew opportunities

Need for pharmacy facultyNeed for pharmacy faculty– Change to PharmD as entry level degreeChange to PharmD as entry level degree– Aging population; need for more pharmacistsAging population; need for more pharmacists– New schools of pharmacy; larger, more New schools of pharmacy; larger, more

quality applicant pool of studentsquality applicant pool of students

Traditional Pathways to Faculty Traditional Pathways to Faculty PositionsPositions

Clinical Track

Finish PharmD PGY1 Residency

PGY2 Residency

Faculty Position

Tenure Track

Finish PharmD Grad School (MS) Faculty Position

Grad School (PhD)

Tenure Track FacultyTenure Track Faculty

DiscoveryDiscovery (high expectation for (high expectation for research)research)– 2 active grants2 active grants– 2 refereed publications each year (book 2 refereed publications each year (book

chapters, review articles, primary lit, etc)chapters, review articles, primary lit, etc) LearningLearning (teaching responsibilities) (teaching responsibilities)

– 12 rotation students / year12 rotation students / year– Assigned lectures & coursesAssigned lectures & courses

EngagementEngagement– Committee work, internal/external, volunteerCommittee work, internal/external, volunteer

““Time clock” for promotionTime clock” for promotion

Clinical Track FacultyClinical Track Faculty

Discovery Discovery (lower expectation for (lower expectation for research)research)– 1 active grant / contract (co-funded 1 active grant / contract (co-funded

positions)positions)– 1 refereed publication / year1 refereed publication / year

LearningLearning (teaching responsibilities) (teaching responsibilities)– 16 rotation students / year16 rotation students / year– Assigned lectures & coursesAssigned lectures & courses

Engagement Engagement (clinical responsiblities)(clinical responsiblities)– Per agreement with clinical practice sitePer agreement with clinical practice site– Internal/external, volunteer, etcInternal/external, volunteer, etc

Fellowship v. ResidencyFellowship v. Residency

RESIDENCYRESIDENCY– Usually Usually

accreditedaccredited programsprograms

– PGY1 / PGY2PGY1 / PGY2– Clinical Clinical in focusin focus– Can be Can be

individualizedindividualized– PGY2 – getting PGY2 – getting

extremely extremely specializedspecialized

FELLOWSHIPFELLOWSHIP– Usually Usually

unaccredited unaccredited programsprograms

– 2 years2 years– ResearchResearch in in

focusfocus– Highly Highly

individualizedindividualized

My BackgroundMy Background

Graduated with PharmD in 2008Graduated with PharmD in 2008 Became interested in academia Became interested in academia

immediately before starting rotationsimmediately before starting rotations– PharmD project / Involvement with ELACPharmD project / Involvement with ELAC

Rotations influenced interest in amb Rotations influenced interest in amb carecare– Family Health Center of Floyd CountyFamily Health Center of Floyd County– Interest in pt careInterest in pt care– IndependenceIndependence

My Background (cont.)My Background (cont.)

Decision to pursue academic careerDecision to pursue academic career– Require some form of post-graduate Require some form of post-graduate

trainingtraining– Initial goal to be Experiential Learning Initial goal to be Experiential Learning

DirectorDirector Interviewed with residency programs Interviewed with residency programs

in Spring 2008in Spring 2008– Geographic limitationsGeographic limitations– Results of the MatchResults of the Match

Received offer for Post-Doctoral Received offer for Post-Doctoral Teaching FellowshipTeaching Fellowship

Post-Doctoral Teaching Post-Doctoral Teaching FellowshipFellowship

Started in May 2008Started in May 2008 IndependenceIndependence Responsibilities followed Responsibilities followed

closely with those of closely with those of traditional clinical-track traditional clinical-track facultyfaculty– Clinical practiceClinical practice– Teaching responsibilitiesTeaching responsibilities– Research responsibilitiesResearch responsibilities

Clinical ResponsibilitiesClinical Responsibilities

Interest in ambulatory care drove Interest in ambulatory care drove clinical responsibilitiesclinical responsibilities

Diabetes Medication ManagementDiabetes Medication Management– 2 days/week; Dr. Jasmine Gonzalvo2 days/week; Dr. Jasmine Gonzalvo– North Arlington Clinic, Wishard CHCNorth Arlington Clinic, Wishard CHC– Amb Care for DM, HTN, and lipidsAmb Care for DM, HTN, and lipids

Center for Healthy AgingCenter for Healthy Aging– 0.5 days/week; Dr. Noll Campbell0.5 days/week; Dr. Noll Campbell– Specialty Care Center, WishardSpecialty Care Center, Wishard– Primary Care clinic for elderly patientsPrimary Care clinic for elderly patients

Clinical Responsibilities Clinical Responsibilities (cont.)(cont.)

VA RotationVA Rotation– 1 month/year; Dr. Susan Bex1 month/year; Dr. Susan Bex– Rotated through several clinicsRotated through several clinics

Primary CarePrimary Care AnticoagulationAnticoagulation Cardiology clinicCardiology clinic Lipid clinicLipid clinic

– Attended topic discussions with studentsAttended topic discussions with students– Presented to clinical pharmacistsPresented to clinical pharmacists

Teaching ResponsibilitiesTeaching Responsibilities

Course CoordinationCourse Coordination– CLPH 49000-007 Clerkship BootcampCLPH 49000-007 Clerkship Bootcamp– CLPH 49000-00X Diabetes ElectiveCLPH 49000-00X Diabetes Elective

Didactic LecturesDidactic Lectures– PHPR 20200 (Nursing Pharmacology)PHPR 20200 (Nursing Pharmacology)– P 570 (Pharmacology for PT) – IUPUIP 570 (Pharmacology for PT) – IUPUI– Adult Med RotationAdult Med Rotation– RoundtablesRoundtables

Teaching Responsibilities Teaching Responsibilities (cont.)(cont.)

Integrated LabIntegrated Lab– Evaluate oral presentationsEvaluate oral presentations– Facilitate small group activitiesFacilitate small group activities– Diabetes lab - facilitated 1 station for weekDiabetes lab - facilitated 1 station for week

Other Teaching ExperienceOther Teaching Experience– Invited presentationsInvited presentations– Co-precepting students; leading topic Co-precepting students; leading topic

discussionsdiscussions– Development of “In Their Shoes” Development of “In Their Shoes”

experienceexperience

Research ResponsibilitiesResearch Responsibilities

Submission of Submission of THREETHREE primary primary literature articles for publication literature articles for publication during fellowshipduring fellowship– IPPE Programs survey (published!)IPPE Programs survey (published!)– Roundtable evaluations (submitted Roundtable evaluations (submitted

abstract for poster at AACP)abstract for poster at AACP)– Spanish-Speaking Pharmacists needs Spanish-Speaking Pharmacists needs

assessment (in data collection)assessment (in data collection)

What is Amb Care?What is Amb Care?

Ambulatory care:Ambulatory care:– Provision of care for outpatientsProvision of care for outpatients

Primary care:Primary care:– See patients for chronic/acute conditionsSee patients for chronic/acute conditions– Serve as “gatekeepers” for access to Serve as “gatekeepers” for access to

healthcarehealthcare Family Practice:Family Practice:

– Working with physician with board Working with physician with board certificationcertification

– Usually private practice model in natureUsually private practice model in nature

Pharmacists’ Roles in Amb Pharmacists’ Roles in Amb CareCare

Working with physiciansWorking with physicians– Obtain medication historiesObtain medication histories– Identify any medication-related problemsIdentify any medication-related problems– Provide recommendations to physiciansProvide recommendations to physicians– Provide patient education on medicationsProvide patient education on medications

Working “independently”Working “independently”– SEE patients independently of physiciansSEE patients independently of physicians– Manage specific disease statesManage specific disease states– Under “scope of practice”Under “scope of practice”

Amb Care Pharmacist SkillsAmb Care Pharmacist Skills

Patient history / interviewingPatient history / interviewing– Thorough history of diseases and medicationsThorough history of diseases and medications– Ability to efficiently gather patient informationAbility to efficiently gather patient information

Physical assessmentPhysical assessment– BP, PulseBP, Pulse– Breath soundsBreath sounds– Diabetic foot examDiabetic foot exam

Pharmacotherapy knowledgePharmacotherapy knowledge Clinical decision-making & critical thinkingClinical decision-making & critical thinking

Benefits of Amb Care CareerBenefits of Amb Care Career

Patient interactionPatient interaction Specific hoursSpecific hours Potential for impactPotential for impact ““Cutting edge” of practiceCutting edge” of practice

My Advice to YouMy Advice to You

Find mentors!Find mentors!– Guide you to that perfect positionGuide you to that perfect position– NetworkingNetworking– Potential for research experiencePotential for research experience

Start preparing now for your future Start preparing now for your future careercareer– Involvement in extracurricular activitiesInvolvement in extracurricular activities– Discover your passion (practice area!)Discover your passion (practice area!)

Carefully evaluate residency options if Carefully evaluate residency options if desireddesired

Advice (cont.)Advice (cont.)

Be willing to step outside of your boxBe willing to step outside of your box– GeographicallyGeographically– EmotionallyEmotionally

““Only those who dare to fail greatly Only those who dare to fail greatly can ever achieve greatly.” - JFKcan ever achieve greatly.” - JFK