Exploring Hospital and Health-System Pharmacy Careers

Narrator: Welcome to We’re Your Pharmacist, a new monthly podcast featuring ASHP members and colleagues sharing their stories and discussing the essential contributions pharmacists make as part of the patient care team.

Ashley Boedecker: Hello everyone, and welcome to We’re Your Pharmacist, where we sit down with healthcare team members to share stories of the incredible impact pharmacists have on patient care. I’m Ashley Boedecker, Director of Member Relations for the Section of Ambulatory Care Practitioners at ASHP. Today I’m joined by Justin Moore, a practice coordinator for antimicrobial and diagnostic stewardship at Northwestern Medicine in Chicago, Lucas Schulz, a medical science liaison at Cepheid, and Liz Wade, system director of medication safety, quality, and compliance at Dartmouth Health. In your own words, what does a hospital pharmacist do?

Lucas Schulz: Well, what does a hospital pharmacist do is a pretty complex question. I’ll start with a more of a walking you through a process of what a pharmacist does because the health system is very complex. So think about a time when you or your family member maybe have been in a hospital and what those experiences have been. It’s likely that a pharmacist has been part of that. So think of an emergency department. You come in, you’re admitted to the emergency department. You’re getting acute care. Somebody’s trying to take care of you in a very fast fashion. A pharmacist is probably there checking to make sure all the medications are right for you and are going to help you give the best chance to succeed. You might get admitted and then you go to hospital floor. Could be in an intensive care unit or a general ward floor. Pharmacist is there, again, checking to make sure the medication, the dose is right, the medication is right, there’s no drug interactions. And then you think about you transition and you’re going to leave the hospital and you’ve got a pharmacist there that’s going to make sure you’ve got all of the knowledge and education that you need to be successful as a patient when you leave the hospital. That’s just a little bit of the work that goes on in the hospital. that directly interacts with you as the patient, but there’s a whole group of pharmacists that are supporting those pharmacist roles as well. So I don’t know if Liz, if you want to talk about maybe some of those operations pharmacists, safety pharmacists.

Elizabeth Wade: Yeah, absolutely. So when you go to a hospital, there are so many different types of medications that you might see as a patient in the hospital compared to what you would see at home from a community pharmacy. So for example, not only would you have pills, right, and medications that you take orally, but you might also have medications that are infused intravenously directly into your vein. And so there’s a lot of different complex therapies that pharmacists in the hospital manage. And behind the scenes, right, there’s pharmacists who are not only preparing and helping to check the preparations to make sure those medications are safe, they’re also checking for drug interactions and making sure everything looks good for the whole course of your stay, that you’re getting those medications on time, that those medications are frankly just these days, right? Because sometimes there might not always be the medications available with shortages and different things like that are happening. But behind the scenes, there’s pharmacists who then ensure that all those processes from when that doctor makes the decision, I want to put you on this medication to when a nurse gives you that medication and makes sure that it’s working for you. There’s a pharmacist that’s making sure that all of that happens safely and that there aren’t any errors that happen. There are studies that show now that every hospitalized patient experiences at least one medication error per day. And so that is when something doesn’t go right in the process. And so it could be It might not reach you, but it might be that the medication wasn’t intended as the doctor intended to give you. So there’s a team of pharmacists who just look into those. I sometimes like to call it investigation. And so whenever there is something that goes wrong, of course we want to make sure it doesn’t happen again. And so the pharmacist team is basically being like an investigator. They’re interviewing people. They are looking at the process and saying, hey, can you tell me a little bit more about what might have happened? And they’re really recreating how that medication went through all the way to you as a patient so they can make sure we’re making that process foolproof. We’re going to make sure that nothing goes wrong so that patients can feel safe when they come into the hospital. And so it’s a huge responsibility. There’s a lot of different. places we have to be to make sure that goes well. But overall, I think we support a team that, we practice in a variety of care settings. And so we have to be there to support all the pharmacists on the front lines, taking care of patients in the different roles that we have. So there are a lot of different pharmacists who work in different roles across the hospital. And Justin, do you want to talk a little bit more about that?

Justin Moore: Yeah, sure. You know, healthcare is a team sport, like Liz mentioned. You have a bunch of different physicians, nurses, prescribers, pharmacists, social workers, physical therapists, respiratory therapists that are part of that team that make sure that your or your family member is well taken care of and safe throughout the hospitalization and you’re able to go home healthy. So like you may go to a different type of specialist, so say a dermatologist or an allergist or a primary care physician, we have those same variations across the pharmacy specialty within the health system lens. So like I said, I’m an infectious diseases pharmacist. We have specialties including cardiology, solid organ transplant, hematology and oncology, or cancer-related medications. internal medicine, the list goes on and on. So I think what I didn’t recognize when I first got into pharmacy was just how many opportunities there are. So a lot of the maybe science nerds in the crowd really gravitate towards that field and you’re able to focus and really get into it at a much deeper level. So maybe you like a mystery. So for me, I love the puzzle of ID. I love seeing a bacteria or a bug and being able to recognize I know an antibiotic that can treat that and make that patient better. Sometimes I don’t always have the right answer. So for my job, it’s really figuring that out and being that detective or investigator throughout. And a lot of other pharmacists in that acute care setting or health system setting get to do that as well. So I think that’s something that’s just really cool about our profession. You don’t get that variety. I again didn’t recognize it early on. It also allows us to be flexible and adaptable. So within that, say you start out as an internal medicine pharmacist, you’re taking care of patients’ diabetes or high blood pressure, and maybe you want more advanced training, there are opportunities for you to really go in, do some additional years of training, which is called residency for us. A lot of us have completed that and that allows you to go into these specialty care areas. Again, creating more job flexibility, job satisfaction, and I think longevity within the career.

Lucas Schulz: Health system pharmacists can play a lot of different roles. We’ve all heard of different types of physicians, right? There’s emergency department physicians and ICU physicians and surgeons. Just like that, there’s a lot of different roles for pharmacists. There are emergency department pharmacists who care for you in that very time of urgent need, who are there at the bedside helping making decisions about what medication is best for your grandma when they’re having a stroke. There are surgery pharmacists. So they are there to make sure that after your surgery, your pain is well controlled and that if you need blood thinning medications, that it’s titrated just to the right amount so that you’re getting the maximum benefit. Like Justin, I’m also an infectious disease pharmacist. We find lots of opportunities in infectious disease to pair a bacteria and an antibiotic and then make sure that you’re not having any drug interactions or adverse reactions to that medication. There’s a whole group of different types of pharmacists and the roles that they play. And that can go from oncology and cancer all the way to infusion center, ones who work on just making sure that IV medications are prepared and administered appropriately in the outpatient setting. So you come into a clinic, you get an IV medication that might be treating a very specific type of disease state. and they are there to make sure that all of that runs smoothly. And as Liz mentioned before, there’s a whole group of pharmacists that do what we call operations. They are the ones that are making sure that when that order is sent downstairs after the physician and the pharmacist and the nurse have talked to you as the patient and evaluated and made a decision that We need this medication. There’s an order that’s sent usually downstairs. There’s a team of pharmacists and pharmacy technicians that are preparing those medications. IV medications, medications that are administered right directly into the vein. It’s absolutely necessary that those are sterile, that they have no bacteria, fungus, viruses in the preparation, and they’re specially trained to make sure that they can prepare those medications safely and appropriately, and then send them upstairs to the floor so that the nurse has them at the right time to administer to you as the patient. So there’s so many different specialties in health system pharmacy.

Justin Moore: And I think, if you haven’t had a healthcare experience, hopefully you haven’t, or you’re coming into the hospital or had a loved one come into the hospital, think of some of your favorite television shows, Grey’s Anatomy, The Pit, those team-based situations where, you know, they’re being rushed through the emergency department, they’re headed to the intensive care unit. There’s a pharmacist there at every step to make sure that you’re being well taken care of, your medications are safe, they’re dosed appropriately. And it’s really exciting for us to be able to contribute to that excellent patient care and enhance that safety. So we don’t always get the glamour that a lot of the other healthcare roles get in the public media. But knowing that a pharmacist is there taking care of you every step of the way is really exciting for us.

Ashley Boedecker: What’s the difference between a pharmacist and a pharmacy technician and the work that they do in the hospital setting?

Elizabeth Wade: So pharmacy technicians play a critical role in the hospital setting. You might see in the community pharmacy that there are pharmacy technicians that you work with. You walk up to the counter, right, and present a prescription, and that technician’s there to make sure that they asked about the right questions and that you have allergies, are you on any other medications that we don’t know about? In the hospital setting, it’s really similar. They are there to keep you safe as well. And so you might see a pharmacy technician talk to your loved one or new while you’re in the hospital to ask you about what medications you’re taking at home. Those pharmacy technicians are also critical to supporting the pharmacist. So if you think about in like a doctor’s office, physicians might have a physician assistant. For pharmacists, pharmacy technicians are also that vital team member to ensure that the pharmacy world goes round, right? And so without our technicians, we wouldn’t be where we are to get the medications to patients in a timely manner. So they are key to making sure those medications are available in the hospital, that the nurse is able to go and get the medications in a timely manner with whatever the patient needs.

Ashley Boedecker: Are there non-patient care activities in the hospital that you can participate in as well?

Justin Moore: So like I said, I’m an ID pharmacist, and so what I do is kind of behind the scenes work to make sure that your or your loved one is on the right medication for a particular infection. And ultimately, we’re trying to put you on the right antibiotic to prevent resistance. These bacteria over time get smarter and smarter, and then the agents or antibiotics that we use become less effective, and then we won’t be able to treat common infection types. So this is something that’s really scary. It’s a global problem. You’ll be hearing about it. It’s expected to outpace cancer deaths, Rd. accidents. So while it may seem theoretical and far away, it’s something that could impact you or a loved one. So that’s why my job is so critically important because I’m preventing both harm to you, but harm to future patients as well or your loved ones. And that’s something that we want to prioritize as health system pharmacists, again, to deliver that excellent care, to make sure that patients feel better and get out of the hospital sooner.

Lucas Schulz: If I can add to that, I think pharmacists trained in health systems play a critically important role about thinking about societal health. And infectious disease is typically the place where that comes to fruition. But when you think about emergency preparedness, our emergency departments are critically important about being prepared for traumas and major car accidents. You think of things like that. So there is a very important role that pharmacists play in administrative leadership and thinking about how does the health system serve the community as a whole and society as a whole. So there’s administrative roles that we haven’t yet talked about that pharmacists play to really support both the health system but the community at large. So There’s roles from an infectious disease standpoint where we participate in our infection control committee. This is a group of individuals that discuss emerging outbreaks when COVID came. Justin and I and Liz were at the front lines of those discussions about how do we make rooms available for when patients get sick? How do we make sure patients get the right medications and have nursing that are available to administer those? but we also participate in those emergency preparedness drills. What’s going to happen when 25 patients all come to the hospital and need our care right away? So those administrative roles also roll into really medication safety. That’s the role of the pharmacist. And there’s a whole group of pharmacists called medication safety experts that help frontline pharmacists and physicians and nurses provide the safest most efficient care possible. You want to talk about medication safety?

Elizabeth Wade: Yeah, absolutely. From a public health standpoint, we also, I mean, I think it was still overshadowed by COVID, but the opioid epidemic was a huge component where pharmacists and health systems played a key role. So pharmacists are at the forefront of ensuring that when patients get opioid prescriptions, when patients receive opioids in the hospital, that they’re safe, that they’re not getting doses too high, and that those medications are disposed of safely. So pharmacists and hospitals also played a key role in advocating to legislators about making sure that we’re able to put measures in place to ensure that those opioid medications are being used safely at home. So we’re at the forefront of a lot of that work to keep patients safe, not only in the hospital, but at home too, because we’re responsible for the care of the whole patient, not just while they’re in the hospital.

Ashley Boedecker: Are there leadership roles for pharmacy in a hospital setting?

Lucas Schulz: A health system pharmacist role is not the same throughout your career. I think that’s very clear. Justin alluded to the role that a residency training program has. You finish undergrad and you go to pharmacy school and you get your doctor to pharmacy degree. Then you might go into residency training and you can specialize into a field like emergency medicine or critical care or ID, medication safety. And you start your career. You’re caring for patients, right? You’re on a patient care team working with physicians and nurses. You might care for 15 or 20 patients and make an impact on those 15 or 20 patients A day. As your career evolves and you become more skilled and your value to the health system increases, you might step into a leadership role. This can be an example from infectious diseases, stepping into an antimicrobial stewardship coordinator role. Antimicrobial stewardship is a fancy word for overseeing all antibiotic use at a hospital. So you’re making sure that it’s not just 15 or 20 patients that get the right antibiotic, but 100, 300, 500, 700 patients a day are getting the right medication. And now you can’t obviously do that by going and seeing 500 patients a day, but you work behind the scenes, you work with the electronic health record, You work in committees and work with physicians and nurses to make sure that all of the other physicians and nurses are doing the right thing. And your career might continue to grow. And now it’s not just you that’s doing that one responsibility, but maybe there’s a team of pharmacists. And that team can be junior pharmacists, new early ones, they might be resident pharmacists. that all participate in that job to make sure that all patients are getting the right antimicrobial. So now you’ve moved into more of a manager level role. And there’s future roles beyond that into directors, senior directors, vice presidents. The skills that you learn as a pharmacist translate from being a one-on-one with a patient in front of you all the way to looking at large populations of patients that need your help. And the skills that you develop are very broad with regards to the types of work you do, whether it’s overseeing people and working with a team, or if it’s. writing manuscripts and doing publications and leading research. So the skills that you develop as a pharmacist, very broad and lead a lot of opportunities for you as a pharmacist to grow and have a very long, fruitful and happy career.

Justin Moore: Yeah, as a clinical pharmacist, you’re rounding at the bedside, deciding which medications to give, what’s the right dose, again, treating the patient as best as possible with that team-based approach. So multidisciplinary teams weighing And we’re always looked to as the medication expert to ensure, again, that patient safety and quality of care. So that’s at the local patient level. And then over time throughout your career, maybe you find that you want to have a bigger impact on a broader population. So kind of zooming out a little bit. And that’s really, I think, a cool opportunity in pharmacy because you can play a much larger role, especially in these health system positions, to impact maybe an entire community or an entire practice. So there are things that pharmacists do that advance health care. allow us to provide that higher level of care, ensure that safety, and you’re making your mark on such a bigger level. So whether it’s a national guideline, international practice change, there are things that we can contribute to the healthcare space that I think are unique to pharmacy, given our hat as that medication expert.

Elizabeth Wade: Yeah, it’s not uncommon to see pharmacists involved in not only reporting issues locally and working with local groups, but also bringing things directly to manufacturers. So government agencies like the Food and Drug Administration and bringing things to their attention so we can actually have an impact nationally to improve safety. So for example, we had a situation in which there was a patient who had experienced a drug interaction, unfortunately, and the computer software that we were using did not alert the healthcare team to that. the pharmacist recognized that right away. And we were able to report that up through the vendor and national groups, and they were able to fix it not only for that hospital, for that patient, but for patients all over the country. And that’s the kind of impact that you can have as a pharmacist.

Ashley Boedecker: For someone who’s considering working in a hospital, what skills and mindset tend to thrive here?

Justin Moore: So we’ve been there. You’ve been a high school student. You don’t exactly know what you want to do. You’ve got a ton of opportunities. There’s so many different fields that you can get into. For pharmacists, I think it’s really important to focus on the maths and science, but also look at the soft skills. So maybe your English, communication, those literature skills are really going to help you throughout as you transition to undergrad and then pharmacy school to really refine some of the specific things that we look at. So we’re obviously very nitpicky and making sure that it’s the right dose, it’s the right medication, it’s tailored to all the needs of the patient. And those skills are really going to help you going into it. So especially the sciences and the maths, if you find that you gravitate towards those subjects in school, consider a career in pharmacy. It’s really broad in terms of what you can do and the impact that you can make. I think it allows for us to be able to translate some of those hard sciences and talk to people. So we’re able to take that knowledge and expertise that we we have and communicate effectively to patients to explain to them in a very simple way, this is the medication that we’re giving you. This is why, and this is how it will work to make you feel better. And so I love our career just because it allows us again to kind of make sense of the science and really translate from maybe a clinical setting to a patient setting or to the bedside and make people feel safe, secure, and comfortable. And so I would say, yeah, really lean into those things as you maybe pursue career opportunities in the future.

Elizabeth Wade: Yeah, I think having open-mindedness is key. I remember when I was in high school, I thought I wanted to be an eye doctor. I thought I wanted to go into ophthalmology. I knew I wanted to do something in healthcare, but I wasn’t sure exactly what that was. I knew I wanted to make a difference, make people feel better, but I wasn’t sure in what way. And so what drew me to pharmacy was just the fact that, hey, we all have taken medications or we all know somebody who’s taken medications. And it’s a miracle. How did I take that medication and suddenly my pain goes away or suddenly I feel better and I recover from that horrible cold or cough or flu that I had? It’s just amazing. And so I thought that as a high school student, there might be something there. I was fascinated with how medications work in the body, but I was also fascinated with just how much is out there that still hasn’t been cured. There’s so many cancers and disease states that are out there. There’s so, much we can do to help patients and to make patients better. And so I just thought, hey, you know what? Pharmacy is a great place where I love science and really make a difference as a pharmacist and finding the right medications, but also thinking about how we can come up with new medications in the future and make therapy better for patients overall.

Lucas Schulz: I think the skills that you need to be a successful pharmacist in a healthcare setting One, being a member of a team. Healthcare is super, super complex. Nobody does it alone. We work as a team, everybody with their different expertise and bringing different skills to improving patient care. So be ready to work as a team member. I think be ready to ask lots of questions, be inquisitive. It’s important that pharmacists are a member on the team that’s asking questions of Are we sure this is the right diagnosis? Are we sure this is the right medication we can use? Rarely is there a single answer. So we have to factor in all the different things with a patient. And it’s not just their age and weight, but it’s also their socioeconomic status. Can they get to the medication when they’re in outpatient and actually take it? There’s a final skill that I think you would need is just compassion. You’ve got to put the patient first. So there’s a selflessness that comes with being a hospital and a health system pharmacist that you really do try to serve others and go out of your way to help people. Oftentimes in one of the most trying times that they are experiencing, that time you’re admitted to the hospital, when you think about a loved one that’s been admitted to the hospital, if you’re fortunate enough to be very healthy, Those are scary times when you have a heart attack or you’re diagnosed with cancer and you need to go into a hospital or health system and who’s going to be there for you? It’s going to be a pharmacist and they’re going to be the ones that are going to help make sure you are safe, that the care you’re being provided is as absolutely safe as possible and it’s the most effective as possible. We’re going to give you every chance possible to be successful and choose the right antibiotic for your infection. Choose the right chemotherapy for your cancer, or make sure that the pain medication is dialed in just right so that your pain is controlled, but that you’re not asleep all day. As much as my 14 year old son would love to sleep all day. So we understand where you’re coming from, but take every opportunity you can to ask questions, be a team member, and you’ll be a very successful health system pharmacist.

Justin Moore: Yeah, I totally agree. I think if you’re one of those folks who’s curious and always asking why, and or that person that your friends are coming to you, they want some help or they need advice, pharmacists are curious and we’re problem solvers. So if that’s up your alley, I think it’s a great career for you. In addition, just again, the flexibility and diversity in terms of the job types that you can have, be it in a clinic setting, in a hospital, in a retail pharmacy. These are things within the community that you can really contribute to help solve some of those problems for folks. So if you want to get to the bottom of things, I think pharmacy is a great career for you.

Elizabeth Wade: One thing that we haven’t quite touched on is also just the role that pharmacists play with development of technology and automation in the health system space. And so there’s a lot that we do to make sure that the systems that we use are safe, right? And so from the time you get into the hospital, anytime you go into the doctor’s office, there’s not a time you don’t see someone on a computer doing something. And if you’re ever wondering, well, what are they doing? How are they ordering my medication? How are they prescribing that medication? How does that all happen? There’s a lot of pharmacists behind the scenes who are working on that to make sure that computer software works safely for you. So I think if you’re interested in technology, there’s a lot of development, especially now is an exciting time because artificial intelligence is being introduced into healthcare space. Pharmacists are playing a pivotal role in making sure that that’s developed safely so that we can optimize patient care.

Lucas Schulz: Health systems and medicine are as complex of systems as you can get. When you think about a future career, one that’s going to be meaningful and provide a service to others and to the communities that you live in, health system is really a place that you can find a place to thrive in. It’s exceptionally challenging. Oftentimes people talk about how complex law is or aerospace engineering and health systems are equally as complex. And the skills that you develop growing up in a health system, going from a student in pharmacy school to a resident to an early pharmacist, to a pharmacist that’s taking over and leading teams, those skills are going to translate into any other thing you want to do. Many of us stay absolutely in the health system because it’s so rewarding to care for others and to see patients when they’re at their sickest, all the way to the time when they’re discharged and they’re transitioning them over to your coworkers that are in the outpatient setting. But all of the skills that you develop are valuable and they really expand your opportunities. We talked about moving into leadership roles. Pharmacists are seen as highly valued members at the administrative level. If you want to go and pursue a business degree and combine that with your pharmacy experience, you become a very valuable member to the health system because you can open up new clinics, you can open up infusion centers, you can do a wealth of non-pharmacy related activities, but because of your role in the center of that team and being part of those healthcare teams and understanding everybody else’s role because you’ve trained with them and you’ve worked and understood how other professions think and interact with each other, those skills are invaluable and will translate to leadership roles in business and even outside of health systems. You can move into business or industry and be a valuable contributor to making sure that people who have never had that experience in a health system really understand what patients are going through, but also understand what the clinicians, those physicians, nurses, pharmacists, respiratory therapists, occupational therapists, you gave a wonderful list earlier of what they’re thinking, what they’re going through, what they’re experiencing. There’s so much important information that comes out of health systems that is applicable beyond the direct patient care aspect. And that’s something that you should consider as well because your career path can change. There are times when you’ll stay in healthcare and you might deviate out for a while and you’ll come back and the world changes quickly and health system sets you up for success no matter what is next in your career.

Justin Moore: I feel like we got most of it. Is there anything else that you think a high schooler would want to know? The only thing that I talked about earlier is maybe, a lot of times we do things because we see other people do them in the world or, you have a family member. For me, it was a sibling. So my sister is a pharmacist. She was four years older than me. And so I was able to see kind of her go through this, find, you know, healthcare field, a science that she loved, patient care. And that motivated me, I think, to realize how valuable of a career it was. And so I think if you don’t have maybe a health system pharmacist accessible, go to a health system near you and start asking questions. Again, community pharmacies as well. There’s plenty of expertise and really clinical knowledge in any space with the role of a clinical pharmacist. So I would say just start asking people why they chose this career. For me, it was seeing that example in my sister who’s a clinical pharmacist and how amazing her opportunities were and how much she enjoyed giving back to patients and the community. And so that motivated me to really pursue this career in health system pharmacy. And so I would challenge you, maybe let us be that person for you to say, health systems and a career as a clinical pharmacist has been very successful for us and we love it. So hopefully there’s an opportunity for you in the future.

Elizabeth Wade: I will add to that to say, when I was undecided about my career path, I knew I wanted to go somewhere in healthcare. What absolutely sealed the deal for me when going to hospital pharmacy was having the chance to shadow a pharmacist in a hospital. And I remember going on to a critical care unit and being so surprised that the pharmacist was the one making the recommendations, calling the shots on the medications. And I had just had no idea that that’s what they do. And so that was exciting to see. And it was exciting to see, hey, wait, so I can take care of patients, but not have to actually touch them. And so for me, I wanted to do healthcare, but I couldn’t see myself being a doctor. I couldn’t see myself being a nurse. And I thought being a pharmacist in a hospital was the right way to go.

Ashley Boedecker: That’s all the time we have for today. I want to thank Justin Moore, Lucas Schulz, and Liz Wade for their time, and thank our listeners for joining us on the We’re Your Pharmacist podcast series. We hope today’s conversation gave you a new perspective on the invaluable role of pharmacists. Don’t forget to subscribe and tune in for our next episode, where we’ll continue to explore the many ways pharmacists make a difference.

Narrator: Thank you for listening. Be sure to visit yourpharmacist.org to learn more about how pharmacists provide essential patient care. For more podcasts from ASHP, visit ashp.org/podcast. If you loved the episode. And want to hear more? Be sure to subscribe, rate, or leave a review.