Guide to Career Roundtables Areas of Practice: Defined

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1 Guide to Career Roundtables Areas of Practice: Defined Academia Academic pharmacists have a number of key responsibilities, including training future pharmacists and conducting research. Research may include laboratory studies to evaluate findings with other scientific data. Research is also conducted on patient compliance, medication efficacy, wellness, and other disease-related measurements. In addition to sharing pharmaceutical knowledge and information with other health care professionals and students, academic pharmacists also speak at industry events, contribute to science and education publications, and advise student pharmacists. Pharmacy practice faculty members also have significant responsibility for patient care in addition to their work in teaching and research. These individuals are often are called educator/practitioners, and they serve as role models for pharmacy students and residents in many education and practice settings. Acute Care Acute care pharmacists are health care professionals who specialize in medication in a medical setting where patients are seen over a short period of time, rather than on a longterm basis. These individuals can work in anywhere from poison centers, to urgent-care clinics, to emergency departments. Acute care pharmacists monitor the medication of patients as well as their dosages, the way medications are administered, how long medications should be given, whether the patient has any conditions that may interfere with the way specific medications will work, whether administered medications may interact with one another, and the patient s allergies. Ambulatory Pharmacy -- Ambulatory care pharmacy practice is the provision of integrated, accessible health care services by pharmacists who are accountable for addressing medication needs, developing sustained partnerships with patients, and practicing in the context of family and community. This is accomplished through direct patient care and medication management for ambulatory patients, long-term relationships, coordination of care, patient advocacy, wellness and health promotion, triage and referral, and patient education and selfmanagement. The ambulatory care pharmacists may work in both an institutional and community-based clinic involved in direct care of a diverse patient population.

2 Careers in Industry Pharmaceutical Sales Pharmaceutical sales representatives provide drug information and product samples to physicians. Also, pharmaceutical sales representatives monitor prescribing patterns of physicians in a given geographic territory. Pharmaceutical sales representatives typically represent a particular drug or group of drugs that are typically prescribed to treat certain afflictions or diseases (diabetes, hypertension, eczema, for example). Pharmaceutical sales representatives may work out of home based offices or even their company car, although they may be required to check in at a regional or local office. Generally speaking, however, a pharmaceutical sales representative s time is often spent in the field meeting with physicians, scheduling meetings, attending meetings or in training sessions. Medical Science Liaison (MSL) Medical science liaisons are healthcare consulting professionals who are employed by pharmaceutical, biotechnology, medical device, managed care, and the pharmaceutical industry, at large. Medical science liaisons are responsible for building relationships with key opinion leaders and health care providers. They provide critical windows of insight into the market and help to shed light on the competition. Through such monitoring, MSL s can gain access to key influencers by interacting with national and regional societies and organizations. Furthermore, as MSL s specialize in particular therapeutic areas and have acute scientific knowledge related to their areas, they are often highly involved in activities related to clinical trials. Clinical Pharmacy -- Clinical pharmacists work directly with doctors, other health professionals, and patients to ensure that the medications prescribed for patients contribute to the best possible health outcomes. Clinical pharmacists practice in health care settings where they have frequent and regular interactions with doctors and other health professionals, contributing to better coordination of care. The clinical pharmacist is educated and trained in direct patient care environments, including medical centers, clinics, and a variety of other health care settings. Clinical pharmacists are frequently granted patient care privileges by collaborating doctors and/or health systems that allow them to perform a full range of medication decision-making functions as part of the patient s health care team. These privileges are granted on the basis of the clinical pharmacist s demonstrated knowledge of medication therapy and record of clinical experience.

3 This specialized knowledge and clinical experience is usually gained through residency training and specialist board certification. Community Pharmacy Community pharmacy is a pharmacy that deals directly with the people in the area in which it is located. A community pharmacist has the responsibility of compounding, counseling, checking and dispensing prescription drugs to patients with care, accuracy, and legality. Community pharmacists are the health professionals most accessible to the public. They are also responsible for maintaining links with other health professionals in primary health care. Geriatric Pharmacist Geriatric pharmacists (sometimes referred to as consultant pharmacists) specialize in dispensing medication and counseling older patients. Like all pharmacists, they label medications and dispense them as prescribed by a physician or other health professional. Geriatric pharmacists tend to take extra time to speak with their patients to explain when and how to take a medication, describe any potential side effects and possible adverse reactions, ensure that medications won t interact with any other prescriptions, nutritional supplements, or over-the-counter medications the patient may be taking, make adjustments in the dosage or recommend changes in medications to alleviate unwanted side effects, perform routine tests, such as blood-sugar and blood-pressure monitoring, answer questions about medication management and other health concerns, and help patients, especially those who may be on fixed-incomes save money by recommending generics or special insurance programs. Some geriatric pharmacists don t dispense at all, but work solely in the consultant role as part of the health care team taking care of older adults. This may take place in long-term care facilities, assisted living facilities, hospice facilities, and numerous other care sites. Preventing adverse reactions and ensuring that patients take their medications correctly and consistently are also key goals of a geriatric pharmacist. Hospital Pharmacy -- Hospital pharmacists are responsible for the supply of medications to inpatients as well as ambulatory patients who receive healthcare in clinics. An administrative team in the pharmacy includes the director of pharmacy and generally a team of managers. Hospital pharmacists may work directly on the hospital units, working directly with patients and members of the healthcare team as they review and dispense drugs. They also can work from the central pharmacy, or be engaged in preparing compounded or intravenous admixtures. Hospital pharmacists also assist in the procurement, distribution and control of all pharmaceuticals used within the facility. They are important members of Quality Committees, the Pharmacy and Therapeutics Committee that develops the formulary for the hospital.

4 Adult Internal Medicine Careers in internal medicine typically require the completion of a PGY1 and a PGY2 residency in internal medicine. Internal medicine pharmacists are quipped to participate as integral members of interdisciplinary teams caring for internal medicine patients, and assuming responsibility for the patient s medication-related care. IN their role, they provide a patients team with evidence-based, medication-related information and formulate that information into expert recommendations to the team for the use of medications and other therapeutic approaches. Critical Care Pharmacy -- Critical care pharmacy practice specializes in the delivery of patient care services by pharmacists, as integral members of interprofessional teams, working to ensure the safe and effective use of medications in critically ill patients. The practice requires informed, rapid assessment of clinical data for patients whose pharmacokinetic and pharmacodynamic parameters differ substantially from the non-critically ill patient. Pharmacists in this practice are required to review, analyze, and frequently reassess multifaceted clinical and technological information to make reasoned decisions for highly dynamic patients with life-threatening conditions and complex medication regimens. Hospital Operations Management/Administrative Pharmacy -- The goal of a Hospital Operations Manager is to provide leadership and vision for pharmacy operations, clinical services and research across the inpatient and outpatient care settings. Hospital Operations managers ensure excellence and innovation in the care provided to patients, the training opportunities provided to students and residents and the clinical research that is often conducted and supported in a hospital setting. Operations managers are also responsible for medication management and the delivery of care. They advance the profession of pharmacy through innovative practice models that allow for comprehensive medication management through clinical consultation. Alternatively, pharmacy administrators may be responsible for organizing office records, managing administrative staff, and ensuring the overall quality of pharmacy services for a variety of health care sites.

5 Long-Term Care and Consulting Pharmacy Long term pharmacists provide medication to residents in senior care facilities including nursing homes, assisted living facilities, and personal care homes. Several forms of drug distribution including automated pouch packaging, blister cards, and traditional vials are provided. Long term pharmacies also prepare IV medication and compounded medications. A clinical consultant pharmacist reviews the drug regimen of each nursing home resident monthly making recommendations to the physician and nursing staff. Managed Care Pharmacy Managed care is an organized health care delivery system designed to improve both the quality and the accessibility of health care, including pharmaceutical care, while containing costs. Much of the work is focused on health of a population of patients. Managed care pharmacy works to forge innovative, comprehensive programs that deliver effective pharmaceutical care and improves outcomes and overall quality of life for patients. Managed care pharmacists are intimately involved in the care and course of pharmaceutical treatment. They play a vital role in contributing to positive outcomes. Medication Therapy Management (MTM) Medication Therapy Management is medical care provided by pharmacists whose aim is to optimize drug therapy and improve therapeutic outcome for patients. Medication therapy management (MTM) includes a broad range of professional activities, including but not limited to performing patient assessment and/or a comprehensive medication review, formulating a medication treatment plan, monitoring efficacy and safety of medication therapy, enhancing medication adherence through patient empowerment and education, and documenting and communicating MTM services to prescribers in order to maintain comprehensive patient care. MTM includes five core components: a medication therapy review, personal medication record, medication-related action plan, intervention and/or referral and documentation and follow up. Nuclear Pharmacy -- Nuclear Pharmacy is a specialty area of pharmacy practice dedicated to the compounding and dispensing of radioactive materials for use in nuclear medicine procedures. Nuclear pharmacy is a patient-oriented service that embodies the scientific knowledge and professional judgment required to improve and promote health through the safe and efficacious use of radioactive drugs for diagnosis and therapy. Outcomes Research/Big Data Outcomes research is a branch of public health research, which studies the end results of the structure and processes of the health care system on the health and well-being of patients and populations. Big data is commonly associated with outcomes research due to the extremely large data sets that may be analyzed computationally to reveal patterns, trends, and associations, especially relation to human behavior and interactions.

6 Pharmacogenetics/Genomics Pharmacogenetics is the study of inherited genetic differences in drug metabolic pathways which can affect individual responses to drugs, both in terms of therapeutic effect, as well as adverse effects. Pharmacogenomics is a broader term and is the study of how genes affect a person s response to drugs. This relatively new field combines pharmacology and genomics to develop effective, safe medications and doses that are essentially tailored to an individual s personal genetic makeup. Pharmacy and Innovations As biology and technology become more intertwined, new opportunities in healthcare are emerging. Pharmaceutical innovators are being called upon to explore complex drug combinations, create cutting edge technology that can streamline pharmacy operations, or even shape state and federal policy to incorporate creative models of care into the health care delivery system. Post Graduate Education Upon completion of a pharmacy degree, graduates can pursue further training with either a clinical focus, (i.e. residency programs) or a research focus (i.e. fellowship programs). Residency training is divided into two postgraduate years. Postgraduate year one (PGY-1) offers more generalized training, providing residents exposure to a broad range of clinical scenarios. Postgraduate year two (PGY-2) emphasizes a specific area of interest and helps lead to specialization in that field. In order to complete a PGY-2 residency, a PGY-1 program must be completed. After residency training, many practitioners choose to further distinguish themselves through board certification. PGY-1 -- Postgraduate year one of pharmacy residency training is an organized, directed, accredited program that builds upon knowledge, skills, attitudes, and abilities gained from an accredited professional pharmacy degree program. The first-year residency program enhances general competencies in managing medication-use systems and supports optimal medication therapy outcomes for patients with a broad range of disease states. PGY-2 -- Postgraduate year two of pharmacy residency training is an organized, directed, accredited program that builds upon the competencies established in postgraduate year one of residency training. The second-year residency program is focused on a specific area of practice. The PGY-2 program increases the resident s depth of knowledge, skills, attitudes, and abilities to raise the resident s level of expertise in medication therapy management and clinical

7 leadership in the area of focus. In practice areas where board certification exists, graduates are prepared to pursue such certification. PGY-2 specialties include: ambulatory care, cardiology, critical care, drug information, emergency medication, geriatrics, infectious diseases, informatics, internal medicine, managed care pharmacy systems, medication-use safety, nuclear pharmacy, nutrition support, oncology, pediatrics, pharmacotherapy, health-system pharmacy administration, psychiatric, and solid organ transplant. Post-Graduate Fellowships A fellowship is a form of postgraduate training that is usually more research based and less clinical. Fellowships are a directed, highly individualized program designed to prepare the participant to become an independent researcher. An individual may choose to a fellowship in a specialty field after completing a residency so that he/she may get additional training in research in that area. Fellowships are designed to develop competency in the scientific research process, including conceptualizing, planning. Conducting, and reporting research. Under the close direction and instruction of a qualified researcher/preceptor, the fellow receives a highly individualized learning experience that utilizes research interests and knowledge needs as a focus for his or her education and training. A fellowship graduate should be capable of conducting collaborative research or functioning as a principal investigator. Fellowships are typically offered through colleges of pharmacy, academic health centers, or specialized health-care institutions. Fellowships are often offered for predetermined periods of time, often exceeding 12 or even 24 months. Psychiatric Pharmacy Psychiatric pharmacists apply the principles of evidence-based pharmacotherapy and the knowledge of biophysical, administrative, regulatory, and clinical sciences, and serve as an interface helping to move translational research to clinical practice. The core responsibilities of a psychiatric pharmacist include: working collaboratively with interprofessional teams to optimize drug therapy, providing direct patient care, including treatment assessment and medication management activities, monitoring for potential adverse drug reactions and interactions, evaluating and educating others on medical literature, conducting medication education groups for patients and their families, educating patients and families on psychiatric medications, as well as psychiatric disorders and other related conditions, engaging in patient advocacy efforts both independently and with consumer

8 groups, teaching other health care students, residents, and practitioners, and conducting original research and/or publishing in peer-reviewed journals and texts. Psychiatric pharmacists often find themselves serving people in areas such as chemical dependency, developmental disabilities, long-term care facilities, adherence clinics, mental health clinics, and within prison systems. Public Health Service USPHS Pharmacy officers work throughout the U.S. Department of Health & Human Services and in other Federal agencies and programs caring for patients; reviewing, approving, and monitoring new drugs; conducting research; and assisting in public health emergencies. USPHS pharmacists work as part of a team of health care professionals in order to improve and advance the health of the Nation. FDA Pharmacist Pharmacists at FDA can use their knowledge and skills to perform a wide array of duties. A pharmacist at FDA may compound prescriptions of physicians, dentists, or other licensed practitioners, formulate, prepare, select, dispense, preserve and bulk compound drugs, medicines, research and investigate the development of original techniques for compounding for the use of new investigational drugs, advise on drug therapy and use, evaluate drug proposals submitted by private industry, survey marketed drugs for safety and efficacy, properly interpret prescriptions and the dispensing of products, or even advise on significant new drugs and developments in the pharmaceutical, chemical, and medical fields. Institutional Pharmacy (ex. Bureau of Prisons) Pharmaceutical services in correctional facilities encompass many aspects of community, hospital, and consultant pharmacy practice. A pharmacist working in or for a correctional facility could work in numerous aspects of the field ranging from administration, policies and procedures, medication administration, therapeutic policies, documentation, quality improvement, emergency services, or drug information and research. For example, pharmacists working for the Bureau of Prisons work as part of an interdisciplinary team with other healthcare professionals. Their responsibilities include: adjudication of the medication order, dispensing, counseling, educating (staff & patients), and monitoring the safe and appropriate use of medications while following BOP Clinical Practice Guidelines and the national formulary. Viewed as healthcare providers and equal partners in health, pharmacists routinely enter into collaborative practice agreements with physicians in order to

9 manage a variety of disease states, medications, and preventative health services. The areas of physician-pharmacist collaborations continue to expand, thereby increasing access to care and improving overall clinical outcomes. These collaborations typically include but are not limited to: anticoagulation, immunizations, diabetes mellitus, HIV, and hepatitis. Research Pharmacy Individuals involved in pharmaceutical research can conduct research in a wide array of fields. They can use their knowledge of science to develop new chemicals, study the bio-mechanical processes of the human body, study plants or animals for insights regarding drug efficacy, or study the physical reactions of processes at the atomic level. Pharmaceutical researchers can design and carry out laboratory experiments, study natural events in the field, or supervise animal and human testing. Manufacturing drugs and medicines is often the last stage in the pharmaceutical research process. Much of the work that goes into that process is basic research based on the body s function and how illnesses can be treated. Specialty Pharmacy Specialty pharmacy is a category of pharmacy practice that incorporates a comprehensive and coordinated model of care for patients with chronic illnesses and complex medical conditions. Specialty pharmacies dispense and distribute FDA approved medications, coupled with integrated therapy management services, patient education, and counseling. Integrated standard-of-care services expedite the start of therapy, drive adherence, compliance and persistence, monitor and manage patient dosing, and drug effectiveness and appropriateness. Specialty pharmacies fill prescriptions for specialty drugs. These types of drugs may be injected, infused or taken by mouth. Typically, specialty drugs are not available at local retail pharmacies.