Discernment

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.