Pharmacy Residents Gain Advanced Job Skills to Succeed in Evolving Health Care Practice

March 20, 2015

An increasing number of new graduates of the University of Iowa College of Pharmacy are entering into pharmacy residency training programs. These residents are not only getting a leg up on the competition through specialized on-the-job training, but are also preparing to become future leaders in the profession.

A pharmacy residency is an organized, directed training program in a defined area of pharmacy practice for Doctor of Pharmacy (PharmD) graduates. Preceptors — skilled practitioners in a graduate’s interest area — mentor residents at their workplaces. Residents gain confidence and practical experience working with patients. Residencies generally last a year, and residents complete a Postgraduate Year One (PGY1) program, before potentially moving on to a PGY2 program.

Residency training helps new pharmacy graduates transition from school — and the entry-level job market they would otherwise encounter — into a more specialized area heavily involving clinical practice. You can find residents working to improve patient care at community pharmacies, as a vital member of a hospital health care team, or even on Capitol Hill bringing grassroots pharmacists’ messages to the legislature.

For many pharmacy school graduates, snatching up a residency position or two after graduation is getting to be a better and better idea.

“Residencies are not necessarily intended for every pharmacy school graduate,” said Dean Donald Letendre. “But for the pharmacy school graduate that believes that he or she needs to hone their skillset to pursue a position in health systems pharmacy, clinical academia, or clinical science, then I would argue that a residency is fundamentally important to enhance their skillset so that they can function in those arenas.”

“When you’re in pharmacy school it’s just impossible for you to gain all the knowledge and skills that you really need to practice at a high level,” he added. “Postgraduate residency training helps you enhance your critical thinking, problem-solving, interpersonal, and clinical skills. A residency provides you with a broad range of experiences that permit you to really decide for yourself if there is a particular niche that you might like to pursue.”

Pay for a resident is less than a pharmacy graduate would likely make in their first year in the workforce. The payoff, for many, is that either they gain the equivalent of 3-5 years of job experience per residency year; find their niche if they haven’t already; and/or come out specialists.

After Wendy Lantaff graduated with her PharmD from the University of Colorado in 2013, she accepted a residency position with the College of Pharmacy at Towncrest Pharmacy in Iowa City.

She worked closely with Randy McDonough (’87 BSPh, ’97 MS, ’00 PharmD), co-owner and director of clinical services, and other pharmacists there.

“I tell Randy all the time that I consider this year my eighty thousand dollar investment year, because of what I could be making as a pharmacist, versus what I’m making now,” said Lantaff, during the residency. “I do think that this residency is fulfilling this investment.”

Many things attracted Lantaff to the Towncrest site in the college residency program. “I’m proud to be a part of one of the most respected community residency programs in the country,” she said.

She has gained clinical skills, competence, and confidence. She liked the fact that the required Pharmacy Educator Preparation Program for Residents (PEPPR) program has prepared her for a faculty position if she goes that route.

Mostly, the interview sold Lantaff, because she was encouraged to bring ideas and implement her own clinical programs.

Last winter, Lantaff did just that. She launched a service at Towncrest to coordinate patients’ refills. The service, based on the National Community Pharmacists Association (NCPA)’s Simplify My Meds model, targets patients who visit the pharmacy often for various medications due to staggered prescription dates.

“We get them all lined up so they’re coming in once a month to get their medications,” explained Lantaff. “Knowing a patient will be coming in also gives me a chance to be proactive; I can review their medications ahead of time and foster a better relationship with him or her.”

Lantaff said the residency has prepared her well for many possible futures: as an independent pharmacy owner, running clinical pharmacy programs in a community setting, teaching and precepting students, or a combination thereof.

“The residency opened up options, so that’s really good,” said Lantaff.

The Towncrest program is one of seven sites in the college-administered PGY1 community pharmacy residency program. The community residency program was the nation’s first accredited, multi-site community residency program. It is also the longest running continually APhA/ASHP accredited U.S. community pharmacy-based program, according to Jay Currie (’80 BSPh, ’84 PharmD), clinical professor and chair of the Department of Pharmacy Practice and Science, who developed it in 1997. Currie served as program director until 2012. Stevie Veach, (’06 PharmD), clinical assistant professor, is the current program director and site coordinator.

As early as 1949, the University of Iowa Hospitals and Clinics (UIHC) began offering pharmacy residencies.

The UI — between the College of Pharmacy and UIHC’s Department of Pharmaceutical Care — currently offers the already-mentioned PGY1 in Community Pharmacy Practice; the UIHC’s PGY1 Pharmacy Practice Residency Program (which was part of the first cohort of 32 hospital residency programs ever accredited by ASHP in 1963); PGY2 Specialty Residency in Pediatrics; PGY1/2 in Health-System Pharmacy Administration (with MPH or MHA degrees); PGY2 Specialty Residency in Critical Care; and PGY1/2 Specialty Residency in Ambulatory Care.

In addition, many of the pharmacy residencies across the state of Iowa are UI-affiliated.

There are more than 1,762 ASHP-accredited pharmacy residency programs in the nation. In 2014, 5 percent more candidates applied for PGY1 residencies, and 18 percent more sought PGY2 residencies than in the previous year.

Jordan Schultz, ‘13 PharmD, is working on a two-year UIHC residency that will earn him the title Clinical Pharmacy Specialist. He is specializing in ambulatory care.

Schultz did a five-week rotation in that area while he was a fourth-year pharmacy student.

“What drew me to ambulatory care was the idea of building those one-on-one, long-term relationships with patients,” said Schultz. “We see the same group of patients very regularly.”

In this program, ambulatory care pharmacy specialists work in various outpatient clinics with patients who require long-term or ongoing anticoagulation therapy or have chronic diseases such as Type 2 Diabetes, high cholesterol, or hypertension, and sometimes heart failure.

Pharmacists in ambulatory settings often partner with primary care physicians and adjust a patient’s medicines after he or she has been stabilized and discharged from the hospital. Their goal is to optimize outcomes of drug therapy, prevent adverse events and prevent unnecessary office visits or rehospitalization.

For certain clinics and disease states, the ambulatory care pharmacy team may adjust medicines and run lab tests under a collaborative practice agreement with physicians.

Schultz precepts PharmD students as part of the residency, and is working on a research project related to gastrointestinal bleeds suffered by a small percentage of patients with heart-related devices.

“Ultimately, I’d like to be in an academic institution with ties to a college of pharmacy so that I can still pursue my ambulatory care interests and be a clinical pharmacy specialist in that area, but also precept students,” said Schultz.

“Plenty of people go into a clinical role without doing a residency first,” Schultz said. “But a residency exposes you to a lot of things you might never be exposed to otherwise. Preceptors help you develop your clinical skills, and I am working with some of the most fantastic preceptors in the nation. If you just jumped into a hospital job out of pharmacy school, you might feel less prepared.”

“The number of graduates from pharmacy schools is exploding, so competition for a lot of these jobs is becoming a lot stiffer,” added Schultz. “If you want to be in more of a hospital setting, it helps to differentiate yourself.”

The career path and work of Sarah Tierney, ’07 PharmD, demonstrates how, as pharmacy specialties grow, so does the importance of associated residencies.

After graduation, Tierney was a PGY1 pharmacy practice resident at UIHC. She focused her residency rotations in pediatrics, when possible, due to her strong interest in this patient population.

However, like an animal lover flirting with the possibility of becoming a veterinarian, Tierney had her doubts about the emotional toll a pediatrics specialty might take on her.

“Every rotation I did, I thought, ‘This will be the rotation that tells me pediatrics is not the fit for me.’ However, the opposite became true. With every pediatric rotation I did it became very clear that pediatrics was the place for me as I witnessed the impact pharmacists in pediatrics have on the outcomes of these kids when they are part of the health care team.”

In 2008, Tierney became the first clinical pharmacy specialist in the Neonatal Intensive Care Unit (NICU) at the UIHC, and she still holds that position. Tierney rounds with the rest of the health care team, ensuring medications are used safely.

Although Tierney developed highly-specialized skills through a one-year residency and job experience, it is unlikely that a current PharmD graduate would be able to get into a job like Tierney’s without an additional residency year.

“If somebody wants to work in a specialized area of pediatrics in a hospital, then they definitely need a PGY2 residency like this,” said Tierney.

She, herself, created and directs a PGY2 specialty pediatric residency which began in July 2012 and was accredited in 2014. Applicants must have completed an accredited PGY1 program to be considered.

More specialized training is needed for positions such as Tierney’s in part because the importance of specialty pediatrics pharmacists is being underscored nationally.

Last year, pediatric pharmacy was recognized as a specialty by the Board of Pharmaceutical Specialties of the American Pharmacists Association (APhA). Starting in fall of 2015, there will be an exam to become board certified.

The pediatrics PGY2 residency has graduated two specialty residents so far, but the program seemingly cannot grow quickly enough: When the new children’s hospital opens in a couple of years, there will be an estimated 20 percent more pediatric beds.

It is expected that 18 or more pharmacists will be hired to care for the additional pediatric patients.

“We need to have highly-qualified, top-notch pharmacists to meet the current and growing need of our specialized pediatrics population,” said Tierney.

For another Iowa graduate — Farah Towfic, ’11 PharmD — a residency gave her a birds-eye view of the profession that left her longing to be practicing at the ground level.

Towfic completed a one-year residency at the American Pharmacists Association Foundation in Washington, D.C. There, she learned association management and leadership through rotations in the nonprofit affiliate of the APhA and the association itself.

“In the association, I saw a great passion for advocating for pharmacy, and how pharmacists’ grassroots messages are unified into one voice and shared at the national level. It really inspired me to push the profession at the grassroots level by making myself a more effective advocate through direct, in the field experience,” Towfic said.

Towfic remembered hearing Tom Menighan, BSPh, MBA, Executive Vice President and CEO of APhA, saying repeatedly during her residency: “Pharmacists are the most accessible health care professional. We increase access to health care and reduce cost.”

“I think that is tattooed in my mind,” added Towfic. “We are the most accessible health care provider. You can walk into any pharmacy in the United States, ask to speak to the pharmacist, and you will talk to them. You may have to wait a little bit, but you will get to them. That’s how we can promote the pharmacist’s role.”

Upon completing her residency, Towfic began a position as pharmacy services manager at Boscobel Pharmacy, where she lead efforts to streamline workflow processes to drive patient-care based services– a career passion that one of her APhA preceptors helped her find.

“Pharmacists are succeeding in delivering direct patient care clinical services,” Towfic said. “I want to be part of the pharmacy success story, when it’s a no-brainer to say pharmacists need reimbursement for direct patient care, non-dispensing services, because look at what they did in Wisconsin.”