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Q&A: Establishing a new clinical pharmacy practice

Written by: Elena (You Jung) Ko, Pharm.D., BCPS
Published on: Jan 6, 2021

New Practice Site

Q: What factors should I, a recent residency graduate, consider when accepting a job charged with establishing a new clinical pharmacy practice?

The task of establishing a new clinical pharmacy practice often seems daunting, especially for a pharmacy resident who has not yet completed training. I remember how intimidating it was when I was offered the position of first emergency medicine clinical pharmacist for my institution fresh out of residency. This article shares some important factors to consider before accepting a position responsible for establishing a new pharmacy practice immediately postresidency.

YOU Know Your Limits – Beyond Clinical Knowledge

Residents are accustomed to receiving continuous feedback from established and experienced preceptors on their clinical knowledge and other relevant skills. However, when it’s time to decide to accept a job charged with establishing a new clinical pharmacy practice right after residency, however, you must do some significant self-assessment.

First, assess your natural and acquired abilities. Accurately evaluate and reflect on your abilities as you transition from a learner to an independent practitioner. Then, assess your interpersonal communication skills. Establishing a new pharmacy practice requires not only clinical knowledge, but also good interpersonal skills to build rapport with the providers and staff. Preceptors may not always get to witness and provide feedback on your interpersonal communication skills. Preceptors primarily observe the learner and public presenter, with limited access to their direct communication with others on the team. As a preceptor, I had learners who built an incredible rapport with nurses, medical residents, and attendings, but many times, I was informed of this after the rotation had been completed. I also cannot evaluate the interaction between patients and my learners during private counseling sessions. Even if a learner has all the characteristics to help build trust and rapport quickly in the new job, preceptors may not witness this to the full extent. Only you know how well you will perform the task of building a new pharmacy practice. Trust yourself, and assess your abilities HONESTLY.

Create Your Own Mold

The need for a new clinical pharmacy practice typically means you will be entering one of the following environments:

  1. An institution that has never worked with a clinical pharmacist.
  2. An institution with staff who have trained with clinical pharmacists (during medical residency, previous hospitals, etc.) but that is currently without a clinical pharmacist on staff.
  3. An institution with a sizable clinical pharmacy presence, but a specific department has not had a clinical pharmacist.

Regardless of the category in which the job in question belongs, all such jobs require you to design your clinical pharmacist position and practice. If you do not want to be the first to shape the clinical pharmacist’s role, this type of position is not a good fit for you. Although you may have support from other members of the pharmacy department or the medical staff in your service, establishing this specific job description can only be done on your own. Unlike institutions with an existing, robust clinical pharmacy department, institutions that are building a brand new clinical pharmacy service will require you to be the leader in establishing pharmacy protocols from the start. For example, a simple task of implementing a clinical pharmacist–driven IV-to-PO antibiotic conversion protocol may entail meeting with the infectious diseases leadership, assessing the ability of clinical pharmacists with pharmacy department leaders, educating all the involved clinical pharmacists, and constantly discussing why this will benefit the institution. As a leader, you will be expected to explain and prove the worth of implementing a brand new protocol (“It is widely implemented at other institutions” will not suffice). Does process of creating of your own mold seem daunting to you, or does it excite and motivate you? Consider the answer to this question carefully before accepting the position.

Ask Whether the Right People Are on Board

When offered a job that consists of establishing a new clinical pharmacy service, confirm that your future colleagues believe in the benefits of having a clinical pharmacist on board, even if it means changing their existing practice. No matter how many groundbreaking ideas you bring to the institution, without several open minds to your clinical role, these ideas will not gain traction.

During my interview for the position of first emergency medicine clinical pharmacist fresh out of residency, I was reassured that the institution was open to having an emergency medicine clinical pharmacist because pharmacy, nursing, and physician leaders were present. Although they all acknowledged their uncertainty regarding the detailed role of an emergency medicine clinical pharmacist, they supported the idea of having one. I still remember the chief medical information officer at my institution, who is also an attending physician in the emergency department, saying, “We are ready for an emergency medicine pharmacist.” Patient care does not involve just one department. Make sure your role is supported by all of them.

Find a Mentor

When I told my residency director that I was taking my current job, her first advice was to “find a mentor.” Many colleagues may not at first understand your abilities or clinical value because they lack experience with your “kind.” Therefore, within the institution, find a person (may not be a pharmacist) who believes in you and envisions progressing the clinical practice with you in it. I have gained immense personal support and wisdom from my mentor at my institution. I can talk openly about my struggles, mindset, and vision. It may take time to build the mentor-mentee relationship, but choose someone you feel comfortable with discussing your goals and expectations.

It is also important to have mentors outside your institution. There are clinical pharmacists who are at the forefront of their specialty and are innovating new clinical paths at other institutions. Reach out to them and ask for ideas and practical advice on some of the struggles at your current institution. Most likely, they have already gone through many of the same struggles. Having mentors will alleviate some of the exhaustion and pressure of handling everything on your own.

Keep Doing Your Thing

Building a new clinical practice from nothing is sometimes met with resistance. People may not understand your intentions for improving patient care, communication lines may break down, and unprofessional behavior may surface. Therefore, having support from pharmacy, provider, and nursing leadership is extremely important, as previously mentioned. It is okay if you are misunderstood for trying to improve patient care. Changes are difficult for many. Remember that although a few negative voices may be loud at times, they will not last if you truly benefit the patients. It is extremely important to avoid feeling defeated or discouraged. In fact, when resistance is at its highest, it signifies the turning point, and whether it is for the better or worse is up to you and how you handle the noise. Keep pursuing what’s best for the patients, and other people will see the benefit and support you. The best course of action is to remember that you are there to improve patient care.

Additional Resources

Research additional resources available to you through state or national pharmacy organizations and colleges or schools of pharmacy. Many offer live or online programming that addresses the specific needs of those establishing a new practice. Also, look to your professional network, like an ACCP Practice and Research Network (PRN), to see if others have insight and experience to share.

Last Remarks

New challenges arise daily for clinical pharmacists establishing a brand new practice or service. I have shared some guidance, support, and lessons I acquired from my experience. And although each pharmacist and potential position are unique, I hope my experiences will help you decide whether to accept a job of building a new clinical pharmacy service fresh out of residency.

Elena (You Jung) Ko, Pharm.D., BCPS
Emergency Medicine Clinical Pharmacy Specialist
Hurley Medical Center, Flint, Michigan