When I Grow Up...

About a week ago all of the Johns Hopkins interns made a trip to ASHP headquarters located in Bethesda, Md. It was a great experience and a rare occasion, having all of the interns together at once. We were also accompanied by JH pharmacy residents and pharmacy students from all around the country. It was great to hear the differing perspectives and experiences from those assembled in the room. There were really three discussions/arguments that I was involved in during my time at ASHP. No need to comment about how often I was in the middle of these discussions/arguments.

The issues? First, there is a new ASHP guideline that by the year 2020, all graduates of pharmacy schools will be required to have a one-year residency if they are involved in direct patient care. I strongly disagree with this guideline, yet I can see both sides of this issue have valid points. The first problem with implementing this plan is the limited availability of pharmacy residencies. Last year, for example, there were about 11,000 PharmD graduates while there were about 2,000 available residencies. This doesn't add up. With more pharmacy schools opening and programs expanding (including our own), how will health systems fill the widening gap? Also what does the term "direct patient care" actually mean? Does that mean I have to do a residency if I want to work at Walmart?

Secondly, residencies are one strategy new PharmD graduates use to bolster their career credentials in order to make themselves stand out from their peers. That will disappear when every applicant has to have a residency on his/her resume.

These are my opinions, and, to be sure, there are some compelling arguments in support of this guideline. As I generally oppose this guideline, I'll let someone who agrees with it argue in favor of it.

Contentious issue number two came from a question I asked; namely: Why are so many pharmacy schools opening, and should this trend be curtailed? I perceive this trend as a serious problem for a variety of reasons. Until fairly recently, there was a genuine shortage of pharmacists which benefited our profession because: 1) it allowed pharmacists greater career mobility, and 2) it gave us greater leverage when negotiating salaries, fringes, and career options. (Think supply and demand.)

Now, we are starting to see a systemic decline in job availability and flat or declining salaries. I believe that our profession needs to regulate the growth of pharmacy schools. (ACPE regulates this to some degree through accreditation, but this doesn't address the broader issue of what constitutes too many players in a competitive market.) Because supply-and-demand forces dictate how many pharmacy schools are enough, those of us who have benefited from a seller's market need to deal with it until the balance is restored in our favor.

The final issue of disagreement centered on advocacy. This question I asked the vice president of ASHP and senior director for pharmacy advocacy was what their organization contributed on behalf of pharmacy to the debate on health care reform -- and what they would say to practitioners and students who feel a lack of representation in health care reform. I was informed ASHP apparently fought long and hard to have pharmacy mentioned and represented in the reform. The fact that MTM and tuition forgiveness are now on the table for pharmacy are two areas they are particularly proud of and they have a right to be. Without advocacy there a chance that our profession could have been overlooked entirely.

Now to the title of this blog. For the last 3-4 years my professional goal was to be a director of pharmacy. No one could tell me any different. That's all I ever wanted to be and I felt that it was a great life goal, offering the right level of challenges and perks to keep my satisfied in life.

It took one day at ASHP to change my perspective on things. I realized there was a place in pharmacy that would offer me a greater challenge and reward than I thought possible. Upon leaving ASHP both the vice president and director of advocacy gave me their personal contact information and a book. That's one of the things I love about this profession: There is always more to experience as long as we take the opportunities presented to us.