Monday, January 26, 2009

My Everyman's Guide to the Basics of Hospital vs. Retail Pharmacy

I thought it would put in my 2 cents on the comparisons of working hospital vs. retail pharmacy, as I have done both, each for a significant period of time. Let me say first, I am not a high-powered 'clinical pharmacist' -- my first years in hospital were pretty much in the basement processing orders and doing a lot of troubleshooting by phone. As the job evolved and I changed employers, I also spent time as a decentralized pharmacist, responsible for an area of the hospital where I would process orders on the nursing unit, resolve any issues with those orders, do MAR reviews, carry a pager so the nurses/ward clerks could contact me, and do some aminoglycoside and vancomycin dosing and be available for any other problems that came up. My rundown, on a personal level, of hospital vs. retail:

Using Your Knowledge --
Whether you're in hospital or retail, it's what you make it. Hospital has just as many routine and repetitive tasks as retail, and hospital pharmacists deal with an array of drugs (especially injectables) that retail pharmacists never see. But in hospital you don't see a lot of the drugs that are widely used in the community (Tri-Sprintec? Propecia? What the heck is that?) Any 'good' pharmacist will be on their game wherever they are practicing. When I worked hospital (before retail) I always envied my retail colleagues as seeming to possess a lot of practical, nuts-and-bolts knowledge that I didn't because they dealt more directly with the consumer of the medication and knew far more about down 'n dirty cost issues.

But for some, these are the very reasons they want out of retail. Either way, I've seen supremely talented retail pharmacists who have a knack for dealing with the public, and I've seen the same in hospital who love what they're doing. One environment isn't any more prestigious than the other, they're just focused differently. In hospital you may get into one very specialized area, get good at it and pretty much 'forget' everything else - in retail, you've got the chance to maintain a little broader knowledge base. It all depends on the job.

Who You Work With --
In retail, you're in contact with the public and generally work with a small group of people behind the counter. In a hospital of any size, you're likely working with a larger pharmacy staff and instead of the public, you have a lot of contact with other health professionals; physicians, yes, but far more often with nursing staff (RN or LPN), ward clerks ("health unit coordinators") and occasionally a dietician or respiratory therapist. These individuals can vary widely in their experience and general competence. You've got to be able to adapt and work and play well with others. You won't always get your way. There are significant turf wars between these groups and you have to be comfortable asserting yourself without being an a-hole (a mistake I've seen many a pharmacist make.)

Physician contact can be very satisfying. Some will be receptive and some won't, and you have to be comfortable enough with your abilities to know how to approach them. If you're in a teaching hospital the med students, interns and residents present lots of opportunities for education, although I often found them to be so bombarded with learning how to 'diagnose' that the prescribing part just wasn't on the radar yet and they looked at me a little wild-eyed when I tried to explain how to write an order. (!)

I worked with some purely 'clinical' pharmacists who complained that all they did was chase after doctors to correct things they were doing --- in a few months, a new crop would come through and they had to start all over again. Some were burned out by it.

Nurses are the key, though. You've got to be nice to the nurses. If they learn to like you and trust you they will ask a ton of questions and you will learn a lot from that too.

The Boss ---
You may have a manager in retail who's always looking over your shoulder, or you may have a manager who leaves you alone. In retail, I kind of enjoy the autonomy. When I'm with a patient it's just me and them -- I'm the pharmacist and they're not. Of course some customers respect you and some don't, but you're calling the shots. In hospital, you'll often have the 'multiple boss' situation. You might have an area supervisor, several middle managers, a clinical supervisor and a director of pharmacy. This can present the obvious difficulties (see any "Dilbert" comic strip). You have these hierarchies in retail too, but you generally don't see those people every day.

Patient Contact --
This depends a lot on what job responsibilities you have in hospital. Generally, patient contact is less than retail of course. If your hospital requires pharmacist discharge counseling you'll have patient contact. For in-patients, you are generally not wandering in and out of rooms chatting with people and you'll probably be too busy anyway. There can certainly be opportunites for patient contact when medication questions arise, but generally it's less.

Routine Work --
Every job has its routine duties, hospital as much as retail. I couldn't begin to count the number of IV solutions, TPNs, crash carts and unit dose carts I checked over my hospital days. Unit dosing in hospitals is very labor intensive. When I left hospital there was talk of some 'checking' duties being taken over by certified techs, but I don't know if that is a reality or if it should be.

Pharmacists will always be required to perform many of these duties -- advanced degree or not.
Retail pharmacists should not feel any inferiority complexes about using their 'clinical' skills. Again, it's what you want to put into it. In fact, retail pharmacists need to be more diligent in some ways -- when a hospital patient crashes, there's a whole army of people there to respond. When your retail customer crashes at home at midnight due to a drug interaction they're in much more danger.

Pay --
If you go from retail to hospital you will almost certainly take a pay cut, the extent of which can vary based on where you live and the job climate.

The Hours --
In hospital, 24/7, weekends, holidays. Of course this goes for some retail outlets too. I never had to work graveyard shift, but I worked a lot of 2-10pm and 3-11pm's. I never really liked evenings and if you've got family responsibilities it's a hell of a long day. Evening shift was always understaffed for the amount of work we had, and often times I felt dumped on by the day shift. However, it can also work to your advantage if you're sharing child-care responsibilites or just aren't a morning person. Flexible hours and scheduling can be nice, no question. It may be more of a factor at different times in your life, ie. if you're married/single/children or no children, etc.

The Working Conditions --
Hospitals can be depressing. Reading the charts of sick people can be depressing. You do need to have some detachment and that was sometimes hard. I avoided being scheduled in the ICU (and especially, the pediatric ICU) because I felt uncomfortable and untrained for that. If your hospital employer is going to put you in those types of areas and require you to attend 'Code Blues' for example, insist that you be thoroughly trained and feel comfortable doing it. Again, there are some pharmacists who will gladly take it on and that's fine too. Maybe you have completed a specialized residency. I took it very seriously, and it bothered me to observe pharmacists with an over-blown sense of their own importance who walked into some of these areas with little background.

The 'Little' Things --
When I started in retail, I was actually excited by some little things, like not being charged for parking! To pull into a surface lot and walk into the front door was well, damn nice. In hospital I had to allow an extra 10-15 minutes to circle the parking ramp for a spot and get myself into the department. Also, I cannot overstate the delight of being at work and seeing DAYLIGHT out the window!! I honestly felt like I was back in the land of the living, out in the world!

In comparing hospital vs. retail, I don't mean to favor one over the other. I enjoyed hospital while I did it and learned a lot -- it just ran its course for me. I had a chance to work fewer evenings and weekends and I took it, and I also got tired of the top-heavy bureaucracy of hospital life. My transition to retail was made easier by working with some very knowledgable technicians who really helped me till I got the hang of things. If I had gone to a retail store with high turnover and inexperience, it would have been much harder.


Akmar Anuar said...

hi Frantic Pharmacsit!

i learn a lot about pharmacy world from your blog. someday i may become a pharmacist, so your blog really help me a lot. thank you!

keep on writing, ok? and hey, i have linked you at my blog.

Pharmacist Erin said...

I'm so glad I read this. Most days I wonder, "What the heck am I doing in retail?!" I've never worked in hospital pharmacy, and have wondered what a day there would be like. It's good to hear that hospital has its monotony, too. Your post made me feel better about my job. So thanks for the pick-me-up!

RxMomma said...

You forgot to mention one big perk that most hospital pharmacists get which is LUNCH breaks and bathroom breaks! I've worked both retail and hospital and have vowed to NEVER go back to retail because of this very reason. That and the fact that the general public is just amazingly stupid and I'm tired of dealing with them........

wallzen said...

I've been wondering what the heck I'm doing in retail too. My only hospital experience was 6 weeks spent during my rotations in a small hospital pharmacy in the basement with 2 bitter, egotistical old pharmacists ie. they didn't get paid enough, and their pearl of advice to me was "just remember, nurses are stupid". The crushing boredom and isolation I felt and the impression these guys left on me made me pick retail where it is true you don't always get lunch breaks, and where I steal my bathroom breaks! The people seem to get EVEN dumber and yet more shrill and demanding every day and DRIVE THRU makes me want to wear a button that says 'Do you want FRIES with THAT?' instead of the one that says "Ask me about a FLU SHOT" The Corporate people come in and give us pointers about how to work smarter NOT harder. They point out the inefficient location of the pen holders and how dusty the shelves are and how work flow should be more efficient... by people doing less not more and staying in their stations, and we should have the warehouse order put up within one day. But I guess it is probably just some variation of this bureaucrasy in hospital pharmacy. If I had it to do over I would have gone to med school, but the MDs don't seem all that happy either.