Thursday, September 4, 2014

Hidden work or why I can be abnormally stressed

Let's talk about hidden work. When you are in the realms of parenting especially but really any long-term relationship where you are both working toward a common goal, there is the risk of doing hidden work. There isn't any complex definition to hidden work as it's defined in the social science literature beyond "work that goes unrecognized by those who aren't doing it." Usually in parenting hidden work describes all the things that (stereotypically) are done by women that men seem totally surprised need doing.

A good example from my life is scheduling well child visits. I keep track of them for the most part by entering them in my digital calendar and inviting my spouse to them. I have been away from home more or less from May until August and didn't attend Little Monster's 15 month appointment back in May so I didn't schedule her 18 month appointment afterward. With the kid I usually took her to well child visits by myself since usually my spouse was working, and with Little Monster we have gone together up until the 15 month appointment during which I was working (my spouse was very underemployed last year and thus had plenty of time to come with). I had never explicitly stated that at the end of every well child visit, I walked over and scheduled the next well child appointment. I just always did that, and for what is still a majority of the well child visits our girls have attended, I did it with nobody else knowing it's what I always did. It was hidden work from the other person in the relationship who needed to be working on the same parenting project as me. As you might imagine, I mentioned when Little Monster was 17 months old that I was curious about when her 18 month appointment was since I'd be in town then and might be able to attend it if it were in the afternoon... and there was no appointment yet. It meant that she just had that visit this week when she is now 18.75 months old. Is that the end of the world? No. But it's representative of the sort of trouble a lot of couples run into.

For us specifically, playing Chore Wars is a way for us to explore ALL the work and to make it all explicit. We don't have much hidden work but it's important that we keep working at it so we are both aware of the silent contributions the other person is making to keep things going smoothly. The other night, the baby woke up and I slept through it (nights aren't my thing because I get up much earlier than my spouse so I wouldn't have gotten up even if I had known she was up). Without a way to communicate that happened, I would never have known that Little Monster held a baby party from 1am to 1:40am in the living room. We have a weekly family meeting now where we all share something that's going well, something that could go better, and something we personally are going to improve. This week we've split it so I should be emptying the dishwasher and my spouse should be loading it. I actually think we need a white board where we write what everyone is doing to improve this week so we don't lose sight of it.

I have heard from a variety of folks that my spouse and I have such a good relationship. From my seat inside it, I'd say it's pretty typical and nothing especially great. We struggle just like everyone else but in different ways, some of which won't be appearing on this blog, most of which are about our non-traditional division of labor and how weird that is for everyone else. What is different about our relationship compared to those around us is that we have very little hidden work so nobody feels like they get no recognition for the great things they do. When you earn points for doing the dishes, it adds a little oomph to get it done AND your spouse knows you did it, even if there is no evidence. Say I empty the dishwasher and then reload it and then run it again before my spouse gets home from an evening meeting or my spouse does the same while I'm at work one day. Without Chore Wars, it's easy for my spouse to completely miss that I did anything because the dishwasher went from full of clean dishes to... still full of clean dishes! Obviously this means we need to be diligent and add all the parts of the various tasks we work at around the house to Chore Wars so we can record what we do. The reporting aspect keeps us accountable to each other as well.

It's my natural instinct to take on more hidden work than my spouse. I like to organize things and plan and have my living space tidy while my spouse values this much less and would rather relax. I have a hard time relaxing when it's a mess. This means that I have to be diligent about not hoarding that sort of job, that I have to let my spouse do some of it and trust that it will be done adequately even if it gets done totally differently than I had envisioned. We had our office full of boxes, with one wall floor to ceiling boxes from when we moved 2 years ago that was blocking a closet full of MORE boxes. I'd always meant to put shelves into the closet once the boxes were gone or to hold the things that were in the boxes, but my spouse decided to hang some sweater organizers and pile in some totes of stuff, and that's fine. It doesn't matter how that work of organizing the closet happened, just that it happened. PLUS the boxes are out of the office. It's a lovely space now that there's room to move without dodging the boxes. The danger of me taking on all of the work is twofold: if I don't get something done, nobody knows and so whatever it is can get to a critical level of neglect since nobody else is checking in, and I can make sure I never sleep while I get the house organized totally and spotlessly clean. Neither of those is good so it's important that I give up tasks. I explain all the steps I have been taking completely and don't assume my spouse will know one thing about how the job is done (there is much eye rolling usually but sometimes there's a moment of surprise where something I have been doing is explained and my spouse can then more fully do the job), then trust it will be done.

Trust is tricky and building it is still a work in progress (I ask if my spouse can do something, the response is affirmative, the thing is still not done after what I deem to be far too long, I point this out, it either gets done by me or my spouse... or we repeat). I still feel, despite getting let down often, that it's worth it to give up control of some things. We have a much happier relationship if I sleep and if we both pitch in to keep things running smoothly.

Monday, August 11, 2014

Winning and losing all at once

Let's talk Chore Wars! I adore this game.

Here's the very brief version of its rules. Everyone in your "party" creates a character by choosing their skills and a picture. Your party could be your immediate family, your office mates, your neighborhood, or a random bunch of people you meet online. Then the party leaders create Adventures. Every job is an adventure. The adventures are worth experience and earn gold, plus each has attributes that increase your skills (so the stats are strength, constitution, dexterity, charisma, intelligence, and wisdom... every job is high, medium, low or n/a for each stat and doing the job increases your character's stat in that area over time when you gain enough experience). For example, I just created a job for scrubbing a toilet. It's worth 5-10 xp (experience) and requires medium constitution (strength is for physical exertion jobs, constitution for physical jobs that take a long time, dexterity for lighter chores that require precision manual work, charisma for interacting with people outside of the party, intelligence is knowing something specific, wisdom is inventively applying knowledge). When completed it's worth 6-8 gold and there is no chance of a treasure or a wandering monster for this job because I was too lazy to think of something not creepy/gross. Watering the plants in the garden has a chance of finding a treasure like a Leaf of Awesome Proportions or being attacked by a wandering monster Weed of Doom in addition to xp and skill growth.

Then once you earn stuff in the game, you can develop a system to redeem that stuff for real world rewards. We are collecting exercise tokens and can redeem 15 earned in a month for $10 in fun spending money. Soon we're going to set out how game Gold translates into allowance for the kid too.

We started to assign all the work in our house points once before based on how long it took to do the job multiplied by a "everyone hates this" factor (so cleaning the cat box takes 5 minutes a day or 35 minutes a week but we hate it so it's worth 70 minutes' worth of work a week because it's awful, while cooking supper takes 30 minutes a day or 210 minutes a week but we both like it, so it's worth only 105 minutes' worth of work). Then we gave up because it was hard to track and assign and nobody was encouraged to do the really awful stuff despite it meaning less overall work since it included a theoretical rest time.

Why making it a game works: leveling up a character in a game is fun. Haven't tried it? I highly suggest it. It's a very satisfying experience to know you accomplished something. If I spend all day making sure a patient's medications are perfect and appropriate, at the end of the day something changes in the patient's health and all those changes are for nothing. That's frustrating. I love coming home and going on a little ridiculous video game or card game adventure where I know exactly how to succeed and when I have succeeded and all the steps to follow. In a video game I also tend to get visual cues to tell me I'm succeeding like a progress bar that shows me I'm getting close to my next level (in a board game you see your little car advance around the board toward victory).

It's also fun because chores become a competition. I'm totally winning right now in our family Chore Wars game because I am more competitive. I taunt my spouse that I'm going to win, that I'm going to get to some chore first so I get all the points, all in good fun and with a laugh... and yet I am totally winning. I am rarely winning in game stats though. My spouse started playing in June and I didn't join up until July so I have been playing catch-up in overall experience but recently I pulled ahead! When the kid does something that will earn her Chore Wars points, she dances around us until we enter the points in the computer. She isn't reading yet but she inspects her character's numbers after every job she completes (hers are picking up things and doing homework but I think we will add more this week since she has been so excited about it) because she is SO into it.

But even if my character isn't winning by gaining the most experience points or the most gold in a month or a week, I win anyway because THE JOBS GET DONE. The dishes are done more often, the laundry gets put away more often (this is worth double the points of washing and drying because it so seldom happened before). Whether my character wins or loses, I WIN!

As time goes by, we will add silly conditions to the chores to make it harder to complete the adventures like that something must be done with nobody catching you in the act or on a Thursday (like taking out the trash from all around the house must happen on only a certain day or is worth double experience on a particular day). Goofy conditions keep it fun and challenging to stay ahead in the points.

In the next post, I'm going to touch on "hidden work" and why we count everything (or are trying to) in Chore Wars so it continues to feel equitable.

Monday, July 28, 2014

Fixing reality part 2

Let's talk some more about Game Theory, shall we? This is more of the discussion of the really excellent book Reality is Broken that I started talking about in Part 1.

Game theory! I've studied it mostly in the context of math and education and sociology, but there's obviously the other part that's about designing games people like to play and find valuable. In math, game theory is about the set of equations that can predict outcomes of different games. This gets adopted in education and sociology to be used in discussions of why people play games, how we are fooled into thinking we are more likely to win games of chance than we are (hint: you will never win the lottery or in the casino), and how to best use our human nature to our advantage (ie how to win the Prisoner's Dilemma and what "winning" means, extending into the realms of positive psychology where we try to sneakily make people engage in behavior that makes them happier).

The pieces of Game Theory that I think are most important to consider are: that we have been playing games for probably as long as we have been people and that our societal involvement in playing games as opposed to doing other things follows societal change, that we play games because they fulfill a need we have in our lives and when that need goes away the games likewise disappear, and that the New Games movement of the mid-20th century probably changed those of us who have grown up since then substantially from generations before us.

Playing games: the tidbit I really liked from this book is that in the past, playing games increases as our perceived ability to change our life circumstances and have perceived meaningful input into our own working lives decreases. In other words, when we feel like we have no ability to change our working lives, we play more games because it's a realm in which we have a lot of perceived control. When you consider the stereotypical video gamer, this holds up and that stereotypical guy (isn't it always a guy?) is someone smart who is working in a dead-end job that is really boring. I think it was the 18th century in England (but sorry, no paper copy to double-check this) where card games became wildly popular and at the same time, people were very dissatisfied with their work lives.

Defining games: remember, Game Theory is bigger than just video games, although the author of this book is a game designer who has almost exclusively designed video games (perhaps exclusively even). Games range from the prototypical World of Warcraft or Halo to Farmville  and Words With Friends in the online realm to chess and cribbage or Cards Against Humanity and tic-tac-toe in the purely physical realm.

The New Games movement toward collaborative playful games started in the 1970s and is very widely spread now, which is neat. I just bet you have at some point played a parachute game with a beach ball or one of those "everyone in a circle" sort of games where people take turns. I think the important thing to know is that the idea was that games are an innate part of being human and that we can use the fun of games to help us develop skills and work together better. There's research to back up that theory but I haven't read it in quite a number of years. I do suspect it would be fun to read.

Why Game Theory anyway? This is sort of the convergence of positive psychology that studies what makes people happy (like the opposite of what psychology spent most of the 20th century looking at, the things that make people unhappy and/or mentally unstable) and its practical application: getting people to do things that are beneficial for them or that we want them to do for some reason. The premise of Reality is Broken in particular is that since people as a whole are choosing games as a way to spend free time, we should design games that inspire people to do useful work instead of just leveling up our online avatars or winning at 2048 or whatever. In the US alone there are 183 million people who play an online game for 13 hours a week or more. That's nearly 2.4 billion hours a week that is spent outside of physical reality playing games. If we could harness that time to engage people in something fun but also productive in the real world, wouldn't that be amazing?

Speaking as a new Chore Wars player, I am at least three times more likely to do a job now than I was before. I get excited about increasing my lead in points for the month. We set up a system so if we exercise enough times in a month, we can turn in our Exercise Tokens for our fun spending money. $20 a month doesn't seem like much but since I also get to win (sorry family, I am way too competitive to not win...) and have to keep up my lead by continuing to work on things so there's no resting on my laurels either. Here is a game that I play online and that improves my physical reality at the same time.

Sadly, blog posts don't earn me any points toward my next level so I am off to go empty the dishwasher, walk the dogs (even though they aren't mine, I get points just like if I were cleaning the cat box), and then take a walk.

Wednesday, July 23, 2014

Fixing reality part 1

I'm listening to a variety of audio books on my commute and my very favorite is Reality is Broken: How Games Make Us Better and How They Can Change The World. The only reason I'm not listening to it right this minute is that I get all excited and inspired listening to it and then I can't sleep (one of the reasons for the audio book indecision, the other being that sometimes a book gets too sad and I just can't listen anymore for a time).

So far, I have learned a whole variety of things about how game theory and game design can be applied to making the real world better and I am super excited to get a physical copy so I can read the bibliography of this and read even more on the subject. BUT today I want to share a little bit about why games are so awesome. This is my very short interpretation of her book and you should just go listen to Jane McGonigal's TED talk and read the book yourself because it's totally worth it.

First is that while we know a bunch of things that make us happier, they seem hokey and we avoid doing them because they make us feel sheepish and silly when we do them alone. BUT when we do them in a group we are willing to be silly and then we are happier as a result! So it is important to get together and be silly by dancing or complementing strangers or whatever. If we need a game to do that, so be it.

Second is the really cool game that helps your household/office/etc group get all the chores done in a fun way. It's called Chore Wars and team leaders set up adventures for team members to complete with experience points and prizes (digital ones) just like in those silly MMORPGs so you get to level up! If you have never leveled a character up, you are missing out. There's a bunch of stuff in this book describing in detail why it is so satisfying to play a video game and have your character earn a new level, but if you haven't ever tried it, you totally should just to see the high the gamers of the world are enjoying. We just started playing but I am competitive enough that I'm doing extra work around here to rack up some points. I even exercised an extra 15 minutes to earn more experience points.

I'm looking forward to going on at great length about this book and how much I adore it but that's coming in part 2. For now I am sure I have homework to finish for next week that I could be working on (organizational skills! I am also practicing those!). Be excellent to each other and know that I'm peeking in to read blogs periodically but mostly am swamped with life and this "in the moment" project of mine.

Monday, June 30, 2014

Side effects

One of the interesting things about being on rotation is the strange things that are happening that are unrelated to my current actual day to day working experiences. In other words, rotations are supposed to teach me pharmacy things and other things I learn or skills I develop are mere side effects.

Since I am clearly procrastinating, here's a short list of my side effect lessons.

1. I do not especially like having a dog. I'm staying in a place with 2 big dumb dogs who are very sweet but also a nuisance. Compared to Fluffinella (our superior resident feline who is probably napping on a pedestal at home right now), these dogs are far too much trouble. One gets so excited to go outside that zie jumps 5 or 6 feet straight into the air. It is ridiculous.

2. Birds are weird. I dodge the chickens leaving my parking space in the very large driveway, then the ducks paddling in the ditch near the road before I leave the driveway, then the pheasant who likes to dart across to the other swamp at the first corner, and THEN there's a family of wild turkies a block away. The tom turkey likes to strut ever so slowly across the road while the hen and chicks just hover in the bushes JUST TO MAKE ME NERVOUS. I also commute passed a pond with 2 pairs of geese nesting in it that take their combined chicks for a stroll along the shoulder of the road every morning JUST as I drive by. Fools are just begging to be smashed and yet they appear to have at least 4 communal chicks. I'm unclear if they are actually aware of which chicks belong to which parents as they even have adjoining nests that I noticed on a walk last week.

3. I still don't like driving in city traffic. It is infuriating to just sit in the car on the road waiting. I don't mind the drive when the traffic moves but gridlock is too much. It is a shame that I can't arrange a carpool or take some kind of transit to this specific rotation.

4. It's very weird being a "grown up." I'm staying with a friend who's in her 50s and there's a resident child of hers who is not that much younger than me, say 5 years or so, yet I'm an "adult" and I feel compelled to do things like empty the dish washer and pretend/avoid knowledge of a variety of things (did I see that when my friend was out of town, there was an extra guest overnight? No, I have no knowledge of that per se because a whole group of folk was here when I went to bed and I saw nothing about any extra cars in the morning, it's a mystery!).

5. I still forget where I put my car all the time. I have learned to accept that I just need to park in the same place every time and not fret about it because I can only remember so many things. When I am in a strange parking ramp, I just take the reminder slip about where I parked with no shame anymore. Getting lost is silly if I can avoid it.

6. It will be important in the future to remember to keep a change of clothes either in the car or in the office in case of coffee-related difficulties that necessitate a change of attire.

7. I am pretty happy with my "right sized" lunches and I may translate that into unit dosing my dinners as well. (Aside: "unit dosing" is something that happens often in a hospital pharmacy, where a large bottle gets purchased and then each dose gets put into its own packaging so it is ready to be given OR where a special single dose package gets purchased.) Once a week or so I make something for lunches and portion it out into 400-600 calorie servings in a variety of jars. I'm finding that now that I'm a few weeks in, I am happy enough and survive the commute home with my stomach rumbling. I keep reminding myself that being hungry isn't a bad thing, just a part of life, and that I should adapt and that I WILL adapt in time. I haven't ventured onto the scale yet but I think I've lost maybe an inch at my waist thus far so that's something.

8. I am really lazy after work and will need to plan my daily exercise to happen BEFORE work if it is going to happen at all.

9. Sleeping remains crucial and I am going to go attempt to do some more of it. I still fail miserably at a sensible bed time but I am doing all right at getting up on time despite not enough sleep.

Monday, June 23, 2014

Living the lies

So let's talk about the truth. Clearly there are lots of truths and lots of levels of truth, and since we are here on my blog, you're stuck with the truth that matters to me right now, as much of it as I've figured out.

The obsession (or whatever it is) that I have with figuring out what truths I'm hiding and from whom is over a decade old now and in all honesty, it started with a crazy guy asking me a question that I had never considered before. What's something you think about but don't tell anyone else?

So here and now, the levels of lies in my life are multiple. I don't find this necessarily all bad but mostly a part of being a person. If we were capable of being totally honest the world would be remarkably different. All people can't handle the whole truth, whatever that might be. I think we catch glimpses of the truth about ourselves and about the world and maybe about divinity but we are incapable of grasping the whole truth.

Right now there are a few levels of lies that are playing out sharply in my life: the lies of omission where I fail to correct people's assumptions about me and the lies I tell myself that materialize as excuses are most notable. There's also the obvious set of lies that underpin this blog, the ones that hide my identity, obscure my location and my spouse's identity, the pictures I'm not posting, the significant but identifying things in my life I'm omitting, but I feel like these are among the lesser sins at the moment.

So the lies of omission. What's the first thing every single person in a pharmacy asks a pharmacy student they've just met? "What do you want to do when you graduate? Do you want to work in a hospital or...?" I'm still working on a good answer beyond "well, I don't really know." I have some ideas but I'm not sure enough to narrow it down to one of three very different paths. Later on, maybe a half hour into the conversation at most but sometimes less if the other person is lobbying for a residency as the best way to go, we come to the "oh I' sure you'll match somewhere" point. (Aside: pharmacy residencies are the hot new thing what with the crunch in the market where there are not nearly enough hospital jobs to go around for new grads who want them so extra credentials are required to get those entry-level jobs. There's an application process in the fall, interviews lasting a day in January and February, and the Match happens afterward. Last year 2/3 of people who applied actually matched and a small chunk of residencies didn't match so some of those who didn't match likely scrambled to get those spots filled.) The problem is much more complex than that of course. While technically I have limitless options to apply to the perfect residency anywhere, I am cautious and want to avoid moving if it's at all possible. It might be possible but it would mean a long commute and maybe taking a less than perfect residency position (if I could get it at all). I'm then at the corner where I could mention that I'm not applying everywhere or just anywhere because of my family and omitting it.

The assumption made by everyone in the pharmacy is that, like most pharmacy students, I have no children and probably no spouse either. Furthermore the assumption is that I'm young and immature and pretty innocent. For the most part I let this slide because I am pretty private and would prefer to be remembered for my work and not for my non-traditional student status. I have been joking about how I appreciate being called a kid and could my superiors please try to work that in a few more times, especially when giving me verbal feedback so I can bask in being a kid just a tiny bit longer? It's only a little bit of a joke though. I  am reveling in the last bit of youth I have left before being a professional. There is also a little bit of ribbing of my superiors who are only a year or two older than me to remind them that not all pharmacy students are such babes in the woods. Obviously many are lost little sheep but not everyone and perhaps they should watch the lumping of us all into the "silly little kids who know nothing" heap.

I also am wary of making plans because I know exactly how well my plans have worked in the past: hahahahahahahahahahah no. My plans were wrong, sometimes exactly opposite of what has turned out to be the right direction.

One of the books I have been assigned to read so far (aside from a vast swath of things on a certain pharmacy association's website, to the tune of 175 printed pages of very dense text) is about adapting to constant change and being ready to change when the time comes (and it was pretty hokey and I don't even know how to make sense of its combination of hokey and useful). One of the main characters reluctantly and eventually changes to take a new path and starts writing messages on the wall for the other anti-change character in the hopes he'll follow, and one of the things shocked me.

"What would you do if you weren't afraid?"

I realized that maybe my hemming and hawing and not committing to applying for a residency might be because I'm afraid I'll fail. Then I had this moment of clarity where I realized I have already failed so spectacularly that there is no failure that will top that. If I apply for residencies and I get zero interviews, there is no public failure at all unless I let on that I applied. If I apply and interview for a residency but don't get it, that's not a failure. Getting the interview is huge! If I manage to interview and then match, that's a few levels of spectacular. There is no failure at all except if I fail to try. If I weren't afraid, I would go for it with no hesitation at all. I would dig in, research thoroughly and find a good fit and then apply.

So now that I recognize the lie that's been playing out in my life, I will squash it.

The other big omission that keeps playing out is mentioning my family. They aren't around right now so it feels monumental to me to avoid talking about them because I've already set up a situation where I am away, probably for the best but it's HARD to be away. I sat in on an interview and one of the candidate's reasons for wanting the new job is to have a shorter commute and therefore more time with the kids. At the time, I sort of went, "Aww how sweet, more time with kids..." and didn't look further. Then I considered what would happen if I was the person being interviewed looking for a change for that reason. Would I be that candid? Would I have a different answer? What would my response have been if the candidate looked different (more masculine, more feminine or pregnant)? And what does it say about me that I don't know for sure if I would treat a job candidate of a different gender identity the same when exactly the same words were spoken? Big questions that I'm sure I will consider at more length later.

So this brings me to the second significant category of lies that's been influencing my life lately: the lies I tell myself. I turn these lies into excuses and the excuses fuel my laziness. Example: I am tired after I get home from rotation, the traffic psyches me out, I really just want to eat pizza and relax afterward. I use being tired as an excuse to avoid a whole host of things, from eating healthier (takes more time) to exercising (too tired and sore) to being social (too tired, too hungry to wait to see if anyone else is around for dinner, etc). Sometimes I make excuses for why I can't get groceries after work so I can justify getting a fast food breakfast.

Today I did pretty well for the first part of the day. I was tired when I got home and hungry on the way but I resisted getting a snack and then went for a walk after dinner. Then I walked an extra 5 minutes beyond my goal (one way, I'm just timing the walk out for now and hoping to make it back in rather than timing the whole walk) and made it back. Of course then I had an ice cream bar while surveying the freezer for tomorrow's lunch prospects, but up to that point I was really good! I squashed all my excuses and did it anyway. I chose to think about the things I don't have to do (have a second ice cream bar, eat a snack before dinner, take a nap or watch TV ) and to skip the excuses and get to doing what needs to happen.

The lie I tell myself the most often is "tomorrow things will be different" and a close second is "just this one (or once) won't hurt that much so it isn't a big deal." But I know that now and today I have the chance to change things. I will not change my rocking out to a song from a musical in the car reminding myself "there's only this, forget regret, for life is yours to miss... there's no day but today." I can change things now, today. I can stop buying the lie that tomorrow will cure everything and that once is harmless. Once is only in the moment - in retrospect, all those "just once" events pile up.

Today I get to choose to keep living the lies or to move beyond the lies I've discovered into uncharted territory, and I get to keep making that choice all day long and I get to start over again when I inevitably am human and imperfect.

Tuesday, June 10, 2014


Now that I'm on rotations, I imagine I will either post more because it's lonely or less because it's exhausting and busy. Or maybe more in conjunction with this next thing I'm up to.

After "what's your name?" and "where do you go to school?" the next question every person I've met so far on rotations asks is "what do you want to do when you graduate?" I know I've written about this before but I'm too lazy at the moment to go hunt up old posts. If you're a long-time reader or have bothered with my archive, this is not new ground just a new time.

There are three major pathways to very different sorts of careers after pharmacy school. One is a community pharmacist job, at one of those chain pharmacies would be typical. The upside is lots of interacting with patients and caregivers. The downside is lots of standing all day long and night and weekend shifts. The other most common is a hospital pharmacist job. It's rare that anyone in public sees a hospital pharmacist but every patient in a hospital who gets a medication has it double checked by a pharmacist. Instead of interacting with patients, most hospital pharmacists interact with doctors and nurses. The third route is what I'll describe as "other" and it includes managed care pharmacists who work for insurers or other entities that manage healthcare somehow, nuclear pharmacists who prepare the medications used to do radioactive imaging among other things, and ambulatory care pharmacists who operate in a clinic setting. When I started pharmacy school I had no idea what an ambulatory care pharmacist did and here's how I understand it now in a little example. Say Harry Potter goes to see his doctor and discovers he has diabetes and high blood pressure. His doctor orders some labs, schedules him an appointment to see a dietician, and a follow up visit in a few weeks after he sees the diabetes educator. In some practices (say that national one that's had long wait times in the news recently) at that follow-up visit, Mr. Potter would see a pharmacist to talk about his medications first and then the doctor after that, both in the clinic, often in the very same exam room with a hand-off between providers or sometimes (rarely) both with some overlap. Then the pharmacist would schedule a follow up visit sooner or later than the next doctor visit. In some practices, patients see the doctor once a year and the pharmacist changes medications at any point in between those annual visits with follow ups based on patient needs.

The job market for pharmacists is tight. After finishing a PharmD there is the option to do a year or two of residency. These are competitive to get (mostly) and are almost all focused on hospital pharmacy. Most people who do a year of residency stop there but a few go on to the second year or do two year combined programs. Jobs are split 60-65% community, 20-30% hospital, 5-10% other. In cities with a population over 200,000 people a residency is required to be considered for a hospital job in most cases and depending on the area it may be required in smaller cities too.

Of course it isn't so bleak as "there are no jobs unless you do a residency and only 75% of people who apply get one" overall. There are jobs in community pharmacies but not always immediately nice positions with a fixed home store or not without willingness to relocate. Ambulatory care is expanding as medical homes start to be a thing. Managing healthcare costs is similarly a growing area where more and more pharmacists are employed.

The areas I feel I have the most skills in are informatics and patient care of the sort that happens in an ambulatory setting. Informatics is the computer stuff that happens to make a pharmacy work so there are informatics pharmacists in all realms of pharmacy but mostly in hospitals since it's so complex to manage the wide range of patients in a hospital. To work in a hospital in particular would require both a first year general residency and a second year informatics residency (probably). Similarly ambulatory care would require either a residency for a year or two, or waiting a few years to start applying for jobs in that specialty area.

So then there's the residency debate. If my life were different and there were zero children involved, we would find the best residency program and move wherever to complete it. I think that if I had the whole nation to search and apply, I could find a program that would be a good fit and that I might match with (or be able to scramble for). But that isn't my life and I don't have unlimited flexibility. Given the kid's very poor adjustment the last time we moved, I think we can move one more time to a new school and that's it. So that doesn't exactly prevent me from looking at residencies outside driving distance of where I live now but it does mean we would need to be really sure about accepting a position that requires moving.

At the moment I'm getting ready to structure a period of discernment for myself so I can consider the options and figure out what's the right or most right path for now. The cool thing about pharmacy is that it's very possible to change specialties if you want at any point. Although it's rare for a community pharmacist to switch to being a hospital pharmacist, it happens occasionally. Discernment is something I've done before and I'm looking forward to planning it out. I'm going to do more prayer and meditation, read some sacred texts and some sacrilegious ones and probably some self-help books too, and make some lists. Then I will deliberate and consider the merits of each path and then reflect on them. At the end is some prayerful consideration and listening for cues and clues to point me in the right direction and then accepting whatever my heart and gut point me to.