Pharmacist

Too good to be true? An internship program full of a lifetime of learning

After finding out about the RxPharmacist Graduate Transitions Program through my school advisor, I had a strong interest in joining the program. I definitely thought it was too good to be true, to earn income while studying for your boards, but it has truly been a mutually beneficial experience! With a fellowship position already in place, I wanted to join the summer internship to enhance my work experiences and further build my skillset before beginning my fellowship in July. The program is very unique in that it specifically caters to graduating fourth year students and gives them an opportunity to edit or create MPJE/NAPLEX material of the student’s interest. Since I attended pharmacy school in Florida, I had no experience with the Massachusetts MPJE material, but I wanted to be licensed in the state for my fellowship. After editing the Massachusetts guide, I found the whole experience to be very effective and helpful in learning the material. I feel very prepared to take my MPJE exam and pass on the first time easily.

The RxPharmacist Graduate Transitions Program is very flexible and really cares about the success of the intern. I was able to create my own schedule and work on my own time. Throughout the program, I have learned valuable skills through the workshops offered on topics such as LinkedIn and writing effective cover letters through RxPharmacist’s, “How to get a Job Series” program that all interns get free access to. I have also expanded on my previous writing experiences that I know will be very beneficial to my career in the pharmaceutical industry. Another perk of the program is being matched with a mentor to support you through your projects and help you further your professional development. I enjoyed my sessions with my mentor and being connected with other professionals within the pharmaceutical industry. I cannot recommend this program enough, you need to definitely apply!

LeDea B., Florida A&M University

Post-traumatic Stress Disorder: Current and Future Treatment Options for Clinicians

All images in this article pulled from: unsplash.com

PTSD Overview

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that is more common than you might think. It is estimated that at least 60% of men and 50% of women will go through some sort of traumatic experience in their lifetime.1 Also, the one-year prevalence of PTSD in the United States is approximately 3.5 to 4.7 percent.2 PSTD has long been associated with the terms “shell shock,” “post-Vietnam syndrome,” and “combat fatigue” in veterans for years; however, PTSD can occur in all populations regardless of age, gender, race, or socioeconomic status.3 There are many treatments available for PTSD that have been proven effective and in recent years, there have also been innovative yet experimental approaches to treating PTSD.

In summary, PTSD occurs after a traumatic experience (e.g., car collision, sexual assault, witnessing a death, developing a serious medical illness) and can manifest in different ways months to years after the trauma has passed. Although every case of PTSD is unique, many people will experience hallmark symptoms or manifestations such as intrusion, hyperarousal, avoidance,and distortions in thinking. These symptoms must be present for at least a month and cause marked distress that impairs the person’s quality of life.3

PTSD Symptoms/Manifestations3
TermDefinitionExamples
IntrusionUnwanted and intrusive thoughts associated with trauma. This is also known as “re-living” the traumatic experience and can occur with constant flashbacks or nightmares. Certain noises, sights, and smells of a similar manner in which the trauma occurred can trigger strong, spontaneous emotions.A retired veteran wakes up from a recurring nightmare about an airstrike that occurred 30 years agoA woman has an instant flashback of a robbery that happened a year ago while hearing popping of balloons in a department store
HyperarousalThe state of being irritable, easily shaken, hypervigilant, self-destructive, distracted, or unreasonably aggressive after a traumatic experience occurs.A young man becomes overprotective of his 5-year-old daughter around dogs after a he suffered a vicious dog attack last month A woman flinches when people hug her during get-togethers after a close family friend sexually assaulted her years ago
AvoidanceEvading or going out of one’s way to avoid situations, places, discussions, activities, or objects that serve as triggers of past trauma.A man takes a shortcut on his way to work to avoid the construction site where he crashed into another car during a busy intersectionA girl avoids rollercoasters when she goes to amusements parks after her friend was ejected next to her on a ride with faulty safety equipment
Distortions in ThinkingIrrational, distorted, or negative thinking in one’s behavior, feelings or thoughts after experiencing trauma. This can lead to beliefs that oneself or other people are “untrustworthy” or “bad.” Sometimes there is also thinking that oneself or other people do not deserve happiness or the right to lead a normal life.A woman holds anger directed at all of her doctors after learning her primary care physician misdiagnosed her serious heart condition that caused a delay treatmentA man cuts off all communication with his friends and family after he was robbed at knifepoint while walking to the bus stop two years ago

As always, it is important that proper diagnosis from either a psychiatrist, physician assistant, nurse practitioner, or licensed therapist is confirmed before any treatments are started. Related conditions that can highly mimic PTSD are the following3:

  • social anxiety disorder
  • panic disorder
  • agoraphobia
  • separation anxiety disorder
  • social anxiety disorder,
  • acute stress disorder,
  • disinhibited social engagement disorder, adjustment disorder
  • reactive attachment disorder (in children)
Image: unsplash.com

Current Evidenced-based Treatments for PTSD

There are a wide array of treatments for PTSD that are backed by evidence-based science. PTSD patients can choose nonpharmacological, pharmacological, or a combination of both. At times patients can be hesitant to try a new medication and might want to explore other approaches first. Since patient situations and circumstances vary, the provider and patient will come up with a plan for the best course of treatment. Nonpharmacological treatments for PTSD psychotherapies involve cognitive behavioral therapy (CBT). The types of CBT that are promoted by the American Psychological Association (APA) guidelines and the Veterans Health Administration and Department of Defense (VA/DoD) guidelines are4,5:

  • Cognitive Processing Therapy (CPT) – A type of PTSD therapy that focuses on changing internal thoughts and feelings in order to eliminate current and future negative thoughts and actions. CPT encourages the patient to rationalize or “make sense” of the traumatic experience, and how it has changed their perceptions either about themselves or others around them. CPT is typically 12 sessions (once weekly) and the patient will learn tools to help them come to terms with their trauma and how to cope with everyday life.6
  • Prolonged Exposure (PE) – A type of PTSD therapy that involves “rechallenging” or gradual repeated exposure to a situation, place, or activity that was once the source of trauma for the patient. PET helps the patient to incorporate “emotional processing” to slowly process the events related to the trauma that was not processed initially. To help guide this process, in vivo and imagined exposure are incorporated into therapy. In vivo exposure encourages patients to go back to the event, situation, or activity to accomplish a sense of desensitization of the trauma. Imagined exposure helps patients with confronting thoughts, memories and feeling surrounding the traumatic experience.6
Image: unsplash.com

Another psychotherapy treatment for PTSD is Eye Movement Desensitization Reprocessing (EMDR). This involves the patient recalling the trauma and examining the patient’s current emotional state. The patient moves their eyes from side to side during the session and the patient slowly incorporates positive thoughts when the traumatic thoughts subside.6

The APA and the VA/DoD have recommended CPT and PE after extensive systematic and meta-analysis of these evidenced-based treatments.7 It is important to note that the APA guidelines on PTSD are for treating all individuals, while the VA/DoD guidelines are recommendations for providers working for the VA or the DoD.7 Currently the APA guidelines suggests the use of EMDR, however the level of evidence is conditional.4 It is unclear at this time if the level of evidence will be changed to “strong” in the not-too-distant future. This contrasts with the VA/DoD’s strong recommendation for use in patients with PTSD.5 Even though EMDR needs additional exploration to address some limitations (cultural differences, diverse clinical settings), EMDR is still widely used in patients with PTSD.7

Image from unsplash.com

Pharmacotherapy

Currently, only four medications are recommended for the treatment of PTSD: sertraline, paroxetine, fluoxetine, and venlafaxine. While only sertraline and paroxetine are FDA approved for the treatment of PTSD, the APA and the VA/DoD recommend all the aforementioned medications for use.4,5

Medication Recommendations for PTSD4,5,8
Medication/ClassIndicationFDA ApprovalAPA RecommendationsVA/DoD Recommendations
Sertraline (SSRI)PTSDYes  Conditional* GRADE A
Paroxetine (SSRI)PTSDYesConditionalGRADE A
Fluoxetine (SSRI)PTSD (off-label)NoConditionalGRADE A
Venlafaxine SNRI)PTSD (off-label)NoConditionalGRADE A
SSRI = Selective Serotonin Reuptake Inhibitor, SNRI = Serotonin-Norepinephrine Reuptake Inhibitor, * = Conditional recommendation indicates good outcomes, but evidence may not be robust (risks vs benefits may vary from patient to patient), † = The GRADE system examines four domains for strength recommendation: Outcomes (morbidity, mortality, quality of life), Evidence Quality (randomized controlled trials, meta-analysis), Patient Preferences (risks vs benefits for patients, certain beliefs or perspectives in approach to therapy) and Other Implications (resources and/or cost-effectiveness)

In patients with PTSD, the VA/DoD suggests the usage of trazodone (GRADE B evidence for adjunctive treatment) for sleep disturbances and prazosin (GRADE B evidence for adjunctive treatment) for nightmares. Currently, the APA does not have current recommendations for these medications two medications.4,5

As far as benzodiazepines are concerned, the APA does not make mention of any usage of this medication class in their guidelines. The VA/DoD however, strongly recommends (GRADE D) against the usage of benzodiazepines, citing insufficient evidence and adverse side effect profiles5,9

Image: unsplash.com

The Future of PTSD Treatments: Psychedelics

Recently, the use of psychedelic medications has been gaining worldwide attention. In 2019, esketamine, a dissociative hallucinogenic therapy, was approved by the FDA for treatment-resistant depression.10 Other psychedelics such as psilocybin and 3,4-methylenedioxymethamphetamine (MDMA) have also followed suit for future FDA approval.

In 2021, psilocybin was granted FDA breakthrough therapy designation for depression after a phase 2, randomized, double-blind, placebo controlled trial.11 This trial compared baseline depression scale scores in those taking either escitalopram or psilocybin.12 Results showed little difference in the change in scores (2 points difference between both groups) but did implicate some promise for future use. Experts claim that psilocybin will likely gain FDA approval for depression in a couple of years.13 In the PTSD realm, the jury is still out on whether or not psilocybin has its own unique place in therapy.

Similarly, MDMA was granted FDA breakthrough therapy designation for the treatment of PTSD first in 2017 after a phase 2 trial, and more notably in 2021 after a phase 3, randomized, double-blind, placebo controlled trial.14,15 The 2021 phase 3 trial compared the remission rates of PTSD in those taking either MDMA or placebo. After 18 weeks, two-thirds (67%) of the participants taking MDMA demonstrated complete remission of PTSD as opposed to the 32% taking placebo.10 Even though head-to-head studies are needed to demonstrate superiority (sertraline vs MDMA), so far, this novel treatment is making strides on its own.15 FDA approval for the use of MDMA in patients with PTSD could be coming as soon as 2023.13

Possible uses of psilocybin and MDMA does come with its own disadvantages. Both medications do carry the potential for abuse, just like their predecessor esketamine. Another thing to consider is the limitations of the setting in which these psychedelics are taken. In other words, it is highly unlikely that both these medications will be administered in a place other than a controlled environment like a licensed facility.

Whether we want to accept it or not, psychedelics might be here to stay for the long haul. What was once viewed by many as dangerous, mind-altering drugs are now seen with gradual acceptance for the future in treating many mental illnesses including PTSD.

About the Author

Dr. Joseph Suarez, Pharm.D. is a Medical Writer at RxPharmacist, LLC who resides in San Antonio, Texas. His interests are in psychopharmacology, psychotherapy, and reconciling healthcare disparities. Dr. Suarez is seeking opportunities to utilize his incredible medical writing talents. If you are looking to hire, you may contact Dr. Suarez via LinkedIn.

References:

  1. How Common is PTSD in Adults? PTSD: National Center for PTSD. https://www.ptsd.va.gov/understand/common/common_adults.asp. Published September 13, 2018. Accessed February 1, 2022. 
  2. Sareen J. Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, assessment, and diagnosis. UpToDate. https://www.uptodate.com/contents/posttraumatic-stress-disorder-in-adults-epidemiology-pathophysiology-clinical-manifestations-course-assessment-and-diagnosis#H1824470698. Published September 20, 2021. Accessed February 1, 2022. 
  3. Torres F. What is posttraumatic stress disorder? What Is PTSD? https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd. Accessed February 1, 2022. 
  4. Clinical Practice Guideline for the Treatment of PTSD. American Psychological Association. https://www.apa.org/ptsd-guideline/ptsd.pdf. Published February 24, 2017. Accessed February 1, 2022. 
  5. VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. U.S. Department of Veteran Affairs. https://www.healthquality.va.gov/guidelines/MH/ptsd/VADoDPTSDCPGFinal012418.pdf. Published 2017. Accessed February 1, 2022. 
  6. Understanding PTSD and PTSD Treatment. PTSD: National Center for PTSD. https://www.ptsd.va.gov/publications/print/understandingptsd_family_booklet.pdf. Published 2019. Accessed February 1, 2022. 
  7. Watkins LE, Sprang KR, Rothbaum BO. Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience. 2018;12(258).doi:10.3389/fnbeh.2018.00258 
  8. Medications for PTSD. American Psychological Association. https://www.apa.org/ptsd-guideline/treatments/medications. Published May 2017. Accessed February 1, 2022. 
  9. Use of Benzodiazepines for PTSD in Veterans Affairs. PTSD: National Center for PTSD. https://www.ptsd.va.gov/professional/treat/txessentials/benzos_va.asp. Published August 23,2018. Accessed February 1, 2022. 
  10. FDA approves new nasal spray medication for treatment-resistant depression; available only at a Certified Doctor’s Office or clinic. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression-available-only-certified. Published March 5, 2019. Accessed February 1, 2022. 
  11. Medications for PTSD. American Psychological Association. https://www.apa.org/ptsdguideline/treatments/medications. Published May 2017. Accessed February 1, 2022. 
  12. Carhart-Harris R, Giribaldi B, Watts R, et al. Trial of psilocybin versus escitalopram for depression. New England Journal of Medicine. 2021;384(15):1402-1411. doi:10.1056/nejmoa2032994 
  13. Expert: MDMA is very likely to be FDA-approved for PTSD by the end of 2023. Pharmacy Times. https://www.pharmacytimes.com/view/expert-mdma-is-very-likely-to-be-fda-approved-for-ptsd-by-the-end-of-2023. Published November 7, 2021. Accessed February 1, 2022. 
  14. Feduccia AA, Jerome L, Yazar-Klosinski B, Emerson A, Mithoefer MC, Doblin R. Breakthrough for trauma treatment: Safety and efficacy of MDMA-assisted psychotherapy compared to Paroxetine and Sertraline. Frontiers in Psychiatry. 2019;10.doi:10.3389/fpsyt.2019.00650 
  15. Mitchell J, Harrison C, Lilienstein A, Bogenschutz M. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine. 2021;27:1025-1033. doi:https://doi.org/10.1038/s41591-021-01336-3 

Pharmacy provider status – Are we there yet?

The advancement of the pharmacy profession has allowed pharmacists to take on various roles and provide services that extend well beyond what people think. Often times, people think the role of a pharmacist may be assumed as the stereotypical 12-hour workday, consisting of only dispensing medications. However, pharmacists have gone to school for much more than to just dispense, and the magnitude of education and training received throughout school is pertinent to providing exceptional patient care throughout all types of pharmacy. As fellow pharmacists and pharmacy students, we all know too well that we have to go through a rigorous 4-year doctorate program. Pharmacists are now involved with advanced patient-centered services that include transitions of care, medication management, medication reviews with thorough monitoring, chronic disease management, disease education, prevention and wellness services, and patient education. To reinforce how essential they are, pharmacists have been amongst the frontline workers who have played a significant role in reducing the spread of the coronavirus disease 2019 (COVID-19). The extent to which accessibility of a pharmacist in one’s community took national stage when the Department of Health and Human Services (HHS) has authorized state-licensed pharmacists to order and administer, and state-licensed or registered pharmacy interns under the supervision of the pharmacist to administer, coronavirus disease 2019 (COVID-19) vaccines to individuals ages 3 or older. Without the efforts of implementing mobile testing facilities, composing response plans, providing curbside delivery, compounding hand sanitizers, and educating the public on methods to prevent spread, the nation’s population may have been much more vulnerable to its virulence. Their highly talented skills, in addition to reasonable accessibility, allows pharmacist to be trusted amongst patients. In fact, pharmacists are rated among the top 5 most trusted professionals year after year by Gallup.

What is provider status?

According to the Social Security Act (SSA), obtaining provider status means pharmacists can participate in Medicare Part B programs and bill Medicare for services under their scope of practice. However, at this time, and despite all their expertise, pharmacists are omitted from this status as the federal government does not consider these health care professionals as medical providers. Currently, those with provider status are professionals employed as physicians, physician’s assistants, certified nurse practitioners, qualified psychologists, clinical social workers, certified nurse midwives, and certified registered nurse anesthetists.

While a large component of this battle surrounds pharmacists fighting to gain provider status under Medicare Part B, reimbursement from Part D also appears to be controversial. Although Medicare Part D reimburses pharmacies for providing medication therapy management to select patients, the program includes only a small set of services that pharmacists are capable of supplying.

What barriers hold pharmacists from reaching this level of authority?

  • Congress members deliberately direct their focus towards the nation’s spending and other issues, including immigration.
    • Due to financial pressures, those making decisions are more focused on reducing health care expenditure, rather than adding new spending costs.
  • Congress equates provider status with the “fee-for-service” (FFS) payment model.
    • FFS is a model in which payment is contingent to the quantity of care, over quality.
    • Legislators may be unwilling to pursue old payment reform as newer payment models evolve.
  • Health care professionals with provider status who bill Medicare through the fee-for-service payment model are in a position of strength, both politically and financially.
    • These individuals may oppose the pharmacy provider status initiative.

While these barriers may impede the ultimate goal of gaining provider status, the American Pharmacist Association (APhA) is taking initiative by contacting health care providers, consumer organizations, payers, and policy makers, all in an effort to educate on the health and economic benefits a pharmacist provides.

What does this mean?

“Provider status is shorthand for ensuring that patients can get access to the clinical services that pharmacists provide and that pharmacists get reimbursed for providing those services” noted vice president of policy for the National Alliance of State Pharmacy Associations, Krystalyn K. Weaver, PharmD. Therefore, this exclusion limits Medicare beneficiaries from accessing pharmacist services.

Tom Menighan, EVP and CEO of APhA, also addressed this concern by stating: “Beyond being unfair to our profession, this lack of federal recognition restricts the contributions pharmacists can make to improving patient care.”

Why is this important?

There is an absolute need to improve health outcomes. In 2016, a released report revealed that the United States spends approximately $1.1 trillion annually on treatment for chronic health conditions, equivalent to almost 6% of the country’s GDP. Additional statistics include the following:

  • 1.5 million cases of preventable medication related side effects
  • $290 billion spent annually to treat preventable medication related side effects
  • $100 billion spent annually towards hospitalizations

Improvements in disease state management through proper medication use would not only go a long way in reducing these costs but will also advance patient quality of life in a cost-efficient manner. Who can serve this role and provide comprehensive education to help treat, manage, and prevent diseases? Pharmacists. All evidence through studies and practice-based experience has shown that pharmacists have all the tools to improve health outcomes and reduce health care costs; however, the absence of provider status and proper payment models have obstructed patients and health care providers from accessing full benefits received through pharmacist services. Provided below are opportunities that pharmacists have taken upon to increase health outcomes:

So, is now the time to gain provider status?

Amidst the ongoing global pandemic we face in today’s world, now is certainly the best time to gain full provider status. Currently, as of October 2020, there are only 37 states that have pharmacists classified as “medical providers” under the provisions of Medicare Part B, resulting in a lack of reimbursement for the clinical services provided. Being such an integral part of health care, pharmacists are well-equipped to take on much healthcare challenges, and COVID-19 is reassuring that certainty.

**October 2020 Legislation Update**

The Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592/ S. 109) is a bipartisan bill that will recognize pharmacists as providers under Medicare Part B. Furthermore, this bill will:

  • Allow Medicare beneficiaries to access the services provided by a pharmacist
  • Focus on providing pharmacist care and services to Medicare beneficiaries in medically underserved communities
  • Provide Medicare reimbursement for pharmacist services in medically underserved communities

Be a patron, support the cause, because now is the time to reward pharmacists for their purposeful work.

Best,

Sam Tamjidi

RxPharmacist Team

References:

  1. Gebhart, F. (2019, June 13). On the Road to Provider Status. Retrieved October 08, 2020, from https://www.drugtopics.com/view/road-provider-status
  2. Provider Status for Pharmacists. (2017, March). Retrieved October 10, 2020, from https://www.amcp.org/policy-advocacy/policy-advocacy-focus-areas/where-we-stand-position-statements/provider-status-for-pharmacists
  3. Provider status: What pharmacists need to know now. (2013, August). Retrieved October 07, 2020, from https://www.pharmacist.com/provider-status-what-pharmacists-need-know-now
  4. The Costs of Chronic Disease in the U.S. (2020, September 02). Retrieved October 07, 2020, from https://milkeninstitute.org/reports/costs-chronic-disease-us
  5. Weitzman, D. (2020, October 07). Provider Status for Pharmacists: It’s About Time. Retrieved October 08, 2020, from https://www.pharmacytimes.com/news/provider-status-for-pharmacists-its-about-time

Review of new and unique pharmacy careers

Review of new and unique pharmacy careers

It is undeniable that the role of a pharmacist has advanced from the traditional “pill counter” to trusted health care professionals who contribute to patient outcomes through extensive management of drug therapy. According to a published study by the American Association of Colleges of Pharmacy (AACP), the primary practice that PharmD graduates wish to pursue upon graduation is community pharmacy. To outline why this is relevant, the Bureau of Labor Statistics (BLS) anticipates a decline in employment for pharmacists within a traditional retail environment, thus posing a threat to many who wish to follow this route (our full post entitled, “Pharmacist market saturation and career outlook“ can be found here). While all of this may be concerning, pharmacists are fortunately well-equipped with suitable skills that allow them to rise above orthodox practice and pursue nontraditional opportunities while maintaining impactful frontline care. Favorably, the American Society of Health-System Pharmacists (ASHP) has acknowledged this matter and launched its Practice Advancement Initiative (PAI), providing pharmacists with future practice models that may act as an option for those exploring alternative career paths. The campaign advocates for advancing the role of a pharmacist by establishing changes to current pharmacy resources, ultimately promoting career opportunities and patient care simultaneously.

While the number of PharmD graduates continue to increase and advancement of traditional pharmacy begins to slow, you may be asking yourself “what other roles can be filled by pharmacists?” This article will dive into more nontraditional and innovative roles that remain both unique and effective in our dynamic health care world today.

Non-traditional career opportunities:


TypeDescriptionWhere to find information
Nuclear Pharmacy  Nuclear pharmacists focus on the preparation, monitoring, drug information, storage, and handling of radioactive medications. In addition to this, pharmacists in this role provide quality control, patient safety, and counseling to those who require a more unique class of medications. The need for a pharmacist within a nuclear medicine team is impeccable as it allows for a boost in pharmaceutical care to patients.  National Association of Nuclear Pharmacies (NANP)
Specialty PharmacySpecialty medications are typically referred to as high cost medications that focus more on intricate disease states such as cancer, transplant, hepatitis, HIV, and multiple sclerosis. The prevalence of patients who require specialty medication is increasing, thus necessitating an increased demand for specialty pharmacists who can provide comprehensive care and close management.   Due to the increased complexity in the delivery of specialty pharmaceuticals, many health plans have established approaches to help with the obstacles associated with the distribution of these drugs to patients (classified as insourcing and outsourcing):

Insourcing: Staff are hired to manage the high demand and cost of these medications. These pharmacists are responsible for purchasing, handling, educating physicians and patients, and monitoring patient outcomes.

Outsourcing: Contracting with pharmacies that have established specialty pharmaceutical services to access its expertise, technologies, and resources.   Regardless of the approach a managed care organization wishes to pursue, both insourcing and outsourcing have identical requirements that include: Negotiating discounted pricesEmploying staff with specific expertise (with respect to administration, utilization, and monitoring of specialty medications)Accessing centralized distribution points for specialty pharmaceutical manufacturers  
Academy of Managed Care Pharmacy (AMCP)
Veterinary Pharmacy  While veterinary pharmacy is not a new area of pharmacy practice, it is expected to expand each year and become classified as a more unique career opportunity. Veterinary pharmacists may establish a career with veterinary schools, pharmaceutical companies, manufacturers, and a variety of regulatory agencies (including the FDA through the Center of Veterinary Medicine). An individual interested in working with animals may make this a suitable option; however, additional education and training through residency is required and opportunities are limited usually to academic institutions or professional organizations.  Veterinary Pharmacy Association
Compounding Pharmacy  What originally began as physicians taking on both the prescribing and compounding role of patient medication has now evolved to become the responsibility of a pharmacist since the late 19th century. At one point, during the early progression of the 20th century, the manufacturing of mass medications monopolized the service of compounding pharmacies. Today due to the increased need to formulate patient-specific drugs to tailor drug therapy, there appears to be a resurgence in the demand for compounding pharmacists. Compounding services allow pharmacists to prepare medications that target pain management, dermatology, pediatrics, geriatrics, and hormone replacement therapy.  Alliance for Compounding Pharmacy  

APhA   National Community Pharmacists Association
Toxicology  Pharmacists in this role can serve as toxicology specialists within poison control centers. In these centers, they facilitate patients who have ingested or otherwise have been exposed to medications or household chemicals. Pharmacists will direct patients to the proper course of action and will subsequently follow-up with them depending on the severity of the situation.  American Association of Poison Control Centers
   TelepharmacyTelepharmacy aims to meet the needs of today’s healthcare consumers through the use of telecommunication. The application of this tool covers a wide and diverse scope, including drug review and monitoring, dispensing, sterile and non-sterile compounding verification, medication therapy management, patient assessment, patient counseling, clinical consultation, outcomes assessment, decision support, effective drug information, and electronic prescription filling. Telepharmacy technology allows pharmacists to provide communication and remote care delivery. It significantly improves quality of patient care and medication process and safety by increasing accessibility and efficiency through reducing the need to travel. Especially during the ongoing pandemic, telepharmacy has established itself as an attractive tool to positively impact patient outcomes. Individuals who have been tested for COVID-19 could have a consultation with the pharmacist on the phone or video conferencing platforms such as Skype or zoom for follow-up care. Telepharmacy aims to improve U.S. economy and healthcare efficiency.  ASHP’s Statement on Telepharmacy  
2019 NIH Study on Telepharmacy
Regulatory Sciences  Pharmacists also play a huge role in regulatory drug and biologic development at the Food and Drug Administration (FDA). Many pharmacists work at the FDA and if you are lucky, you may score a rotation site at the FDA to learn more what they do from drug labels, to drug reviews and ensuring regulations are met.  FDA Regulatory Fellowships  

Regulatory Affairs Professionals Society (RAPS)  

While additional opportunities may require fellowship training, pharmacists can also be involved within the pharmaceutical industry and strive in research and development, quality assurance, marketing, and regulatory affairs. There are still many other pockets of careers we did not dive into such as medication therapy management (MTM), pharmaceutical industry, consulting, and data analytics, the PharmD degree is versatile and allows the flexibility of pharmacists to create their own unique careers outside the ‘box’ of retail and hospital pharmacy. As health care transforms, pharmacy roles will also grow, allowing pharmacists to take on new and unique roles.

Best of luck in your career searches!

Sam Tamjidi

RxPharmacist Team

References:

  1. 6 Things to Know About Telepharmacy During COVID-19. (n.d.). Retrieved September 26 2020, from https://blog.cureatr.com/6-things-to-know-about-telepharmacy-during-covid-19
  2. ASHP Statement on Telepharmacy. (n.d.). Retrieved September 26 2020, from https://www.ashp.org/-/media/assets/pharmacy-informaticist/docs/sopit-bp-telepharmacy-statement.ashx
  3. Bai, S., Hertig, J. B., & Weber, R. J. (2016). Nontraditional Career Opportunities for Pharmacists. Hospital pharmacy, 51(11), 944–949. https://doi.org/10.1310/hpj5111-944
  4. Kramer, M.H. (2019, January 14). Retrieved September 22, 2020, from https://www.thebalancecareers.com/veterinary-pharmacist-125836
  5. Specialty Pharmaceuticals. (July 18, 2019). Retrieved September 27 2020, from https://www.amcp.org/about/managed-care-pharmacy-101/concepts-managed-care-pharmacy/specialty-pharmaceuticals
  6. What is compounding? (n.d.). Retrieved September 22, 2020, from https://www.medisca.com/compounding/what-is-compounding

Career advancement opportunities – Residency or fellowship?

Over the last decade, the profession of pharmacy and the capabilities of a pharmacist has advanced immensely with respect to broader clinical responsibilities and logistical needs in the Pharma industry. We previously lived in a time where a bachelor’s degree in pharmacy sufficed for a career in pharmacy practice. Since 2003; however, the Doctor of Pharmacy (PharmD) degree has superseded previous qualifications to become a licensed pharmacist and has provided pharmacists more holistic roles as a healthcare provider. To dive deeper, the role of a pharmacist now extends from the initial introduction of a chemical molecule for drug therapy all the way to managing a patient’s regimen post dispensing. Based on the competitiveness and saturation of the workforce, in addition to employment projections showing decreased future demand for retail pharmacists (as previously mentioned in our Pharmacist market saturation and career outlook blog here), it is presumed by many that a PharmD will simply be a stepping stone within the realm of pharmacy practice. Therefore, the well-rounded ability needed for our future pharmacists will strongly build through residencies and fellowship.

What are some opportunities to differentiate yourself as a newly graduate? Let’s take a look at the following main categories of post-graduate training programs:

Residencies:

  • Focus primarily on direct patient care
  • Within a clinical, hospital, or community setting
  • Collaborate with pharmacists, nurses, and other healthcare professionals
  • Duration: 1 year each – Postgraduate Year One and Two (PGY1 and PGY2)
    • PGY1 – General medicine
    • PGY2 – Specialized therapeutics
      • Specific areas of focus include: Ambulatory care, cardiology, critical care, geriatric, pediatric, oncology, pain management, and more. For a more complete list of options, be sure to check out American Society of Health-System Pharmacists’ (ASHP) website.
    • Interestingly enough, the perception of a PGY3 residency has been viewed negatively by many pharmacists. Based on a distributed survey, residents, preceptors, coordinators, and other pharmacists believe that PGY3 training offers limited benefits in professional development.
  • Career after completion: Hospital or clinical pharmacist

While clinical and hospital settings are more predominate, many also choose to pursue community-based residency programs. This path allows residents to remain within the community setting while taking on critical education and training to provide increased care and improve patient outcomes.

Another popular residency of interest is managed care. Managed care residencies heavily focus on evidence-based clinical decision-making and comparative research, medication therapy management, clinical drug evaluation, formulary management, quality assurance, and drug utilization review. A pharmacist within these roles is responsible for performing any analysis, for example, drug utilization data to identify trends and then implement new strategies to improve patient outcomes. Additionally these roles may also require on-going knowledge of all heath plan pharmacy benefits. Beyond the logistical aspects of analyses, clinical knowledge is key for a successful career in managed care. Managed care pharmacists are also part of multidisciplinary teams during rounds in which they serve as the primary drug information resource, provide pharmaceutical interventions, facilitate prior authorizations, and develop educational materials for patients and providers.

What’s the likelihood of matching?

Below is a graphical representation of the match statistics between 2013-2020. Figure 1 illustrates the amount of applicants participating in the match, positions offered, matches/positions filled, unmatched applicants, and unfilled positions. Based on the trend, it’s easy to interpret that residency is playing an expanding role as more programs are being introduced each year. While this appears to be beneficial, it’s also important to address the increasing applicant pool, making it a challenging to gain acceptance in the program of your choice.

A close up of a map

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Figure 1. Complete match statistics between 2013-2020.

Fellowships:

  • More research and data-based
  • Within the pharmaceutical industry, academia, nontraditional pharmacy or healthcare setting
  • Collaborate with professionals, both in and out of healthcare
  • Duration: Ranges between 1-3 years depending on the program
  • Career after completion: Pharmaceutical industry or academia

It is very clear that these two main options provide two distinct pathways. The direction you wish to pursue will strictly depend on your interests. If you thoroughly enjoyed classes that focused on therapeutics, pharmacology, and kinetics throughout pharmacy school then a residency may be the best option for you. Conversely, if you were more engaged on the economics, research, and administrative science side of pharmacy, then a fellowship would be better suited for you. Whether you wish to enhance your clinical knowledge or look for professional advancement, a residency or fellowship will provide a firm foundation and present you with many unique career opportunities down the road.

What can you do now and what are some additional resources to find out more?

  • Take a moment to fill out the APhA Career Pathway Evaluation Program for Pharmacy Professionals survey. This quiz will aim to assess your goals, values, strengths, likes, and dislikes.
  • Maximize your potential and showcase your academic achievements while demonstrating your leadership qualities outside of the classroom.
  • Check out the ASHP and ACCP directories to get a better idea of the many residency and fellowship opportunities out there and which institute may best suit you.

Whatever you wish to do is ultimately your decision. All we recommend from our end is to be the best version of yourself and manifest all your skills in an effort provide to the pharmacy profession.

Good luck!

Sam Tamjidi

RxPharmacist Team

References:

  1. Dang, Y. H., To-Lui, K. P. (2020). Pharmacist perceptions of and views on postgraduate year 3 training. American Journal of Health-System Pharmacy, 77(18), 1488-1496. doi:10.1093/ajhp/zxaa198
  2. Doctor of Pharmacy. (n.d.). Retrieved September 19, 2020, from https://en.wikipedia.org/wiki/Doctor_of_Pharmacy
  3. Goode, J. R., Owen, J. A., Bennett, M. S., & Burns, A. L. (2019). A marathon, not a sprint: Growth and evolution of community-based pharmacy residency education and training. Journal of the American College of Clinical Pharmacy, 2(4), 402-413. doi:10.1002/jac5.1140
  4. Postgraduate Education Frequently Asked Questions: Residencies and Research Fellowships. (n.d.). Retrieved September 17, 2020, from https://www.pharmacist.com/sites/default/files/files/10-417postgraduate.pdf
  5. Tips on Applying for a Residency or Fellowship. Academy of Managed Care Pharmacy. (n.d.). Retrieved September 19, 2020, from https://www.amcp.org/resource-center/group-resources/residents-fellows/tips-on-applying-residency-fellowship

Pharmacist market saturation and career outlook – An overview

One of the main obstacles that recent PharmD graduates face is the challenge of finding a job right out of school. Whether it is due to saturation or a lack of experience, the dynamic field of pharmacy appears to raise concern for many, and statistics appear to support this concern. According to the U.S. Bureau of Labor Statistics (BLS), which is responsible for publishing employment trends and projections, there is an estimated 3% decline in pharmacist employment between 2019 and 2029. While the career outlook of a pharmacist may vary by industry, it is quite evident that most of this decline comes from chain and independent pharmacies (Table 1).

Table 1. Employment projections for pharmacists in a retail versus non-retail setting.

Table 1 above accounts for 81% (or 259,000 of 321,700) of jobs that pharmacists have held in 2019, while the remaining 19% come from other industries that have a positive effect on the pharmaceutical workforce. A more detailed look at employment projections can be found here.

What can we take home from observing these statistics? The demand for pharmacists who work in non-retail settings, such as hospitals and ambulatory care facilities, is set to increase over the next decade as the number of jobs are expected to grow. Alternatively, all retail positions, which make up over half of all pharmacy jobs, is projected to take a significant hit and decline over the next 10 years. Why might this be the case? This branch of pharmacy is expected to expand the role of pharmacy technicians and transition to greater use of mail order and online pharmacies. For example, marketed as “a better, simpler pharmacy”, Amazon has expanded pharmacy by introducing their PillPack and in September 2020, launched its online pharmacy in India. This online service is free and allows patients to receive free delivery on their prescriptions and over-the-counter medications monthly, reducing the need to sort their meds, wait in line, or chase refills.

How could you respond and move forward?

  • Build connections: Use platforms such as LinkedIn to expand your social network and connect and communicate with those in the same profession. Reach out to your school’s alumni network as you already have a shared connection of your alma mater to start off the conversation.
  • Be comfortable with being uncomfortable: Often you may find more opportunities outside of your city or state of preference. While this may seem unfavorable to begin with, coming out of you comfort zone will always pay off.
  • Be innovative and embrace change: Demonstrate your passion for excelling the pharmacy profession and show your willingness to flourish. Opportunities will come by with the right mindset.

As always, best of luck!

Sam Tamjidi

RxPharmacist Team

References: Pharmacists: Occupational Outlook Handbook. (n.d.). Retrieved September 09, 2020, from https://www.bls.gov/ooh/healthcare/pharmacists.htm

What is the MPJE and What do I Need to Know?

WHAT IS THE MPJE?

The Multi-Prudence Jurisdiction Examination (MPJE) is a 120-question computer-based exam that uses adaptive testing response questions. For example, if you keep getting questions wrong then the computer will provide you questions that are statistically deemed “easier.”  It’s important to note that of the 120 questions on this exam, only 100 are used to calculate your final score. The remaining 20 questions are pretest questions that will not count into your MPJE score, but you won’t be able to tell which ones are pretest questions and which ones are not. The total testing time is two hours with NO breaks during the testing session so it’s important to take note of time. 

WHAT IS THE PASSING SCORE?

The passing scaled score is 75 with the minimum score being zero and maximum 100. The exam is divided into three major sections:

  • Pharmacy Practice- 83%
  • Licensure, registration, certification, operational requirements- 15%
  • General Regulatory Processes- 2%

WHAT HAPPENS IF I FAIL?

If you don’t pass the first time you still have 4 more attempts to pass you’re MPJE exam. A maximum of 5 tries per state to pass the MPJE is allowed. Hopefully you won’t fail the first time you take your MPJE but if you do, you need to wait 30 days per state until you can sit for the exam again to re-take. For the NAPLEX, it is a period of 45 days to wait before you can retake the exam again. 

Note that if your eligibility to sit for the NAPLEX or MPJE is going to expire within 10 business days then you won’t be able to pay and sit for the exam so make sure as soon as you get your authorization to test (ATT) letter that you book your appointment as soon as possible. 

IMPORTANT 2019-2020 UPDATES TO MPJE AND NAPLEX

The re-sit fees for the NAPLEX and MPJE are bumped up to $475 and $150 (YIKES that hurts!). If you miss your exam due to an emergency (whatever that means), then you can ask if you can re-sit to take your exam for a reduced fee of $170 for the NAPLEX or $100 for the MPJE. 

SOME MAJOR POINTS TO REMEMBER:

  • All questions are answered in order so there’s no going back
  • Lots of situational questions
  • Online registration costs $250.00 per examination
  • You will need to bring two forms of ID at Pearson Vue
  • At least one picture ID with signature (i.e. Driver’s License)
  • Other can be credit card with signature
  • 120 questions, 100 count towards your score
  • MUST complete 107 questions for examination to be scored
  • If you fail, you must wait 30 days to retake for the MPJE and 45 days for the NAPLEX
  • The MPJE doesn’t distinguish between state and federal laws, but answer each question based on state law
  • Any misconduct or inkling of misconduct is grounds for failure
  • Arrive at least 30 minutes early
  • Ensure to read EVERY SINGLE WORD!
    • They will try to trick you so make sure to answer the question they ask, and lookout for unusual words as triggers. 

BREAKDOWN OF FEES:

Total if you passed the first time: 

$250 MPJE ($150 + $100 application fee)

$575 NAPLEX ($475 + $100 application fee)

$825

Total if you failed but passed the second time: 

$500 MPJE ($250 x 2)

$1,150 NAPLEX ($575 x 2)

$1,650

As you can see, it really adds up if you don’t pass the first time so we hope that you pass the first time! This does not include the stress and wasted time either since you can’t start working until your licensed. We highly recommend reviewing the https://nabp.pharmacy/programs/mpje/ site and reading over the NAPLEX/MPJE registration bulletin. They provide a more specific overview of the exam, scheduling requirements, and a list of core competencies for you to understand. Don’t spend too much time on the core competencies, but more on understanding the laws, as there are many situational type questions.

About RxPharmacist 

RxPharmacist got created out of a calling to help a fellow classmate who failed his board exams, lost his job offer, and almost went homeless in not being able to gain employment as he had to wait 45 days before being able to sit and retake his board exams. Frustrated over the high cost of expensive study guides that were outdated, heavy in content, and weren’t focused on getting to the information needed to pass was the call to action that RxPharmacist has answered.

We are a group of volunteer pharmacists, paid pharmacy students, and mentors to our pharmacy profession driven by fellow pharmacy graduates and pharmacists just like you. We want to make a positive difference and disrupt the pharmacy test-prep industry but we need your help.

If you think you can help join our cause, feel free to shoot us over an email on how we can improve our services and products to help you. Even though this starter guide is basic in nature, we hope it can get you pointed in the right direction so you can start your journey in passing your MPJE board exams. Whether you are a fresh pharmacy graduate or a seasoned pharmacist getting licensed in another state, we’re excited you started your journey with us although it will be short-lived as we hope you will pass the first time! 

We all understand board studying for gaining your pharmacist licensure is not easy. We don’t want the stress and headaches of potential failing you’re MPJE get in the way of the career you want.

The Creation of RxPharmacist

Getting through pharmacy school is not easy. Second year was the worst and finally when you get to your fourth year you need to focus on getting a residency or fellowship program. The obstacles don’t stop there, you then need to finally graduate and take your licensure board examinations, mainly the NAPLEX and state specific MPJE exam. Those few months in between graduating and starting your residency, fellowship, or first job out of school are tough transition periods for pharmacy graduates as they need to pass their boards in order to start their first paid income job.

I’ll tell you how RxPharmacist got created. One of my pharmacy school classmates, Mike, received an offer and moved his family of three little boys from Florida to Tennessee contingent upon him passing his board exams. He called me sobbing at 2am in the morning, I could hear the desperation in his voice. Knowing Mike for the past 4-years during pharmacy school, I never saw him this low and said I will do everything in my power to help him. That same morning, I started creating study guides and working with my fellow classmates. After using them, he passed and said how this will help so many people who are struggling. That is how RxPharmacist got created out of a call of service that helps pharmacy graduates and pharmacists nationally as being one of the only companies to offer this service and helping over a thousand students pass their board licensure exams the first time. 

A key signature among all of our services and products are serving and giving back to our pharmacy profession. We offer a unique, one-of-a-kind pharmacy graduate transition program to assist students during that time period between graduation and starting their first job and connecting them to preceptors and mentors to ensure they are successful in this saturated pharmacy market. Check out our internship page for more information. We create a symbiotic relationship with students ensuring everything we do, we put them first. Even with our customers, we ensure to reach out and follow up with them as we enjoy seeing the success of our students, and we take down our guides if they need to be updated even though we lose potential funds to help sponsor future pharmacy graduates. Think about this. Many companies don’t do this, they just reuse their content over and over, without updating or tweaking. We understand why, it’s extremely time consuming but someone has to do the right, good work that needs to be done.

We hope to continue RxPharmacist to continue to serve our pharmacy profession and disrupt the test-prep industry in creating affordable, high quality, and up to date guides.

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