Motivational Pep Talk

Regrettably, I must inform you that… The beginning of an email that I intend not to finish reading for at least the next few hours until I calm down and go for a 5 mile run.  No one likes rejection or what is most often considered a failure.  A less than stellar grade on a test you put a lot of time into.  A bad grade on a paper that you think is awesome and the professor just seems to have a different opinion than you.  Losing a scholarship.  It all comes in different forms, but we all experience it one time or another and it’s a bummer. 

BUT, as Winston Churchill said “Success consists of going from failure to failure without loss of enthusiasm.”    Or, for a pictorial summary (courtesy of BU's facebook page today):

It’s not always what you lost, but what you learn from it.  Maybe another opportunity will present itself that was even better than the previous.  So learn from your “failures.”  Continue to make yourself a great pharmacy student.  Go to a different professional pharmacy meeting, email one of the faculty members whose topic you enjoy, try out a new community service project, talk to your mentor.  Success comes in many forms, it doesn't matter how you get there.  Good luck!

Are we here for the wrong reasons? Pharmacy School—for money or for knowledge?

           Flash back to high school, to the fall of your senior year.  We all were busy, not only with classes, but also with extracurricular activities, sports and, most important, a strenuous college application process and SATs that made for stressful Saturdays.  Yet all of us somehow figured out, during those young, busy lives of ours, that pharmacy was the right choice for us.  Was it though?  I ask myself this very question every day.

It is hard to believe that at 17 we all knew we wanted to become pharmacists for the next 50 years of our lives?  After all, most of us had absolutely zero experience as you must be at least 18 to work in a pharmacy (in most states).  So the interesting question is actually quite simple.  What led us to enter the pharmacy field?  Did we really know much about pharmacy coming into our freshman year of college?

              Yes, many of us knew there was retail and hospital, but there are so many other niches in the pharmacy profession.  Besides retail or hospital, we have consulting pharmacy, managed care, government (for example, the U.S. Public Health Service, which includes the FDA and the Indian Health Service, and the Bureau of Prisons), insurance companies, as well as the pharmaceutical industry.  With so many areas of practice within pharmacy, why have so many graduates of MCPHS gone the retail route?  I honestly find it hard to believe that our dream was to work at a job where we could never sit down, slog through insurance issues and get yelled at by customers because their co-pays are too high.
              So again the question remains, why pharmacy?  To be honest, I feel that at 17 we were young and immature.  Heck, we weren’t even legally adults.  The main incentive that I’ve heard from many students about why they chose pharmacy was the money.  To be frank, the allure of a six-figure salary brought many of us to pharmacy school.  Maybe we came because we thought that becoming a pharmacist would lead to a big payday.  So if we came for the wrong reasons, will we leave with the right intentions?
             It seems that to become a successful pharmacist, you need to enjoy at least one of two things.  First, you need to have a passion for the science (the knowledge behind pharmacy such as disease states, pharmacology, kinetics, etc).  However, you must also love the practice, actually being a pharmacist in the real world.  Unfortunately, with the stressful workload and the pressure to do well, the love for the science is lost.  But many of us like at least one aspect and then you have the infinitesimal, exceptional group that enjoys both the science and the practice of pharmacy.  These students are the ones that have a love for pharmacy and are likely to advance the profession.  Unfortunately, those that love neither the science nor the practice may not be in pharmacy school for the right reasons.  Will they make good pharmacists?
             Let’s face it; we all need money and the paycheck that a pharmacy career promises is nothing to scoff at.  However, with so many schools and so many students that are graduating each year, I feel we are obligated to ask ourselves, are we graduating top-caliber pharmacists who truly care about the profession of pharmacy?  Sure, you say that if they pass the NAPLEX, they are qualified, but maybe we merely have learned to be able to study and pass a test without actually learning, because we don’t care about what we are learning.  One cannot look solely at pass rates, but also introspectively for the love for the profession that helps drive an excellent, high-quality, patient-focused pharmacist.

The content of this particular blog entry does not represent the official views of the Massachusetts College of Pharmacy and Health Sciences (MCPHS) nor of The Rho Chi Society or the Psi Chapter of the Rho Chi Society at MCPHS. The content represents solely the view of the author

Increased opportunity to obtain the entry-level PharmD over the last decade: an overview and a student’s perspective

The content of this particular blog entry does not represent the official views of the Massachusetts College of Pharmacy and Health Sciences (MCPHS) nor of The Rho Chi Society or the Psi Chapter of the Rho Chi Society at MCPHS. The content represents solely the view of the author.

As recently as 2000, the Department of Health and Human Services (HHS) released a white paper documenting evidence of an emergence of a pharmacist shortage, which was attributed both to an increase in the demand for pharmacists and limits in the ability to increase pharmacist supply to meet that demand. Many institutions of higher education addressed the latter through the establishment of new PharmD programs, the creation of satellite campuses for existing programs, and expansion of class sizes, thereby expanding opportunities for pharmacy education.

Today, according to the American Association of Colleges of Pharmacy, there are now 123 distinct colleges and schools in the continental U.S. that will offer a PharmD as a first professional (entry-level) degree for fall 2012, and this figure does not include any institutions that are seeking accreditation status from the Accreditation Council for Pharmacy Education (ACPE) or those that are not accepting applicants for fall 2012. In contrast, there were about 80 schools or colleges of pharmacy in the U.S. as of 2000. In New England alone, at least 5 new schools and colleges of pharmacy or satellite campuses have opened within the last 4 years (one in Connecticut, one in Massachusetts, two in Maine, and one in Vermont). This expansion of pharmacy education has occurred despite a downward trend in the demand of pharmacists nationwide based on survey data collected by the Pharmacy Manpower Project.

The extent and rate of the increase of PharmD programs has not escaped the attention of pharmacists and pharmacy graduates facing a tight job market. The blog of Fred Eckel, a professor at the University of North Carolina Eshelman School of Pharmacy and the Editor-in-Chief of Pharmacy Times, provides one perspective regarding the struggles of those seeking employment (“Do We Need More Pharmacy Schools?” and “Will the Pharmacy Job Market Self-Correct?” among Mr. Eckel’s entries). Nor has the pharmacy academe failed to note a scarcity of potential IPPE and APPE sites accompanying the rapid increase in new pharmacy schools and an emerging disconnect between the number of future graduates and the number of vacant positions in the near future, with 7 new colleges or schools of pharmacy graduating their inaugural class in 2010, 3 in 2011, 9 in 2012, 5 in 2013, and 6 in 2014.

And in November 2010 the American Pharmacists Association (APhA) and the American Society of Health-System Pharmacists (ASHP) jointly released a white paper discussing concerns about the expansion of pharmacy education, including a shortage of faculty in colleges and schools of pharmacy, an inability of programs to comply with ACPE standards for experiential education, and a decrease in the collective quality of pharmacy applicants, all of which could affect adversely the quality of pharmacy education.

What does the expansion of pharmacy education, in conjunction with current trends in the job market, augur for current pharmacy students and potential future applicants? It may be instructive to note difficulties for graduates of other professional or doctoral degree programs, where the grass is not necessarily greener.

In April 2011 the journal Nature published a series of articles on “the future of the PhD,” highlighting a dissonance between the traditional expectation that science PhDs pursue a career in tenure-track academia and the low proportion of those PhD graduates who actually achieve it. Similarly, current and prospective pharmacy students aware of increased competitiveness in the job market could benefit from an increased awareness of niches in areas of pharmacy beyond the traditional modalities of community and institutional pharmacy practice (e.g., clinical research, regulatory affairs) and actively tailor their career development according to their interests. Accompanying this awareness could also be a recalibration of expectations regarding the necessity of pursuit of a residency or fellowship.

And the plight of newly minted law school graduates, saddled with onerous debt and facing a dismal job market despite an increase in tuition, existing class sizes, and the number of new schools, has received much attention in the New York Times (“Job Market Weakens, Tuition Rises,” “For Law School Graduates, Debts if Not Job Offers”) and elsewhere in the media. While pharmacy education differs from law education in many important aspects (barriers to increasing pharmacy student enrollment such as the limited availability of rotation sites, for example), the APhA/ASHP report has noted that the majority of new PharmD programs have been established in private institutions and even for-profit institutions, a trend mirroring that in law school expansion.

Prospective pharmacy students might be advised to weigh carefully the opportunity costs of pursing a pharmacy education against future earning potential and the availability and quality of rotation sites available to newer programs. Pharmacist graduates with high debt levels are also likely to suffer from market corrections in response to any pharmacist oversupply and may have to re-evaluate any personal constraints to labor mobility given regional variability in the demand for pharmacists.

Paul Le is a doctor of pharmacy candidate at the Massachusetts College of Pharmacy and Health Sciences in Boston, MA.

Suggestions from a Resident

I'm totally terrified about my future.  Not only am I not sure about what type of pharmacist I want to be, but I am nervous that I will not get a residency and that it will limit my options.  Approximately 10% of graduates from each pharmacy school in the country get a residency (not on purpose, purely by chance) and it has been recently stressed by Dean Pisano and Assistant Dean DiFrancesco that not getting a residency now will not mean that you won't get a great pharmacy job and there is no reason for one if you are going into community pharmacy.  There is also the option that I could go back in 2 or 3 years, after some experience, and apply for a residency.  But, might as well get my CV up-to-snuff in the mean time.


My facilitator for Therapeutics Seminar in the fall was at PGY-1 resident at Harvard Vanguard and a 2011 graduate of URI College of Pharmacy.  In preparing for a Resident Discussion, he gave us some tips about applying for a residency.  I'm going to relay this information on to you, we all need as much info as we can get!



As 5th years, it is difficult to add more extracurricular activities and leadership roles to your CV. Things you could add to boost it are:

• Present a poster at a national meeting such as APhA or ASHP. There are many ways to present a poster without having done original research. Speak with a faculty member for some ideas.
• Be a delegate for your school at a national meeting
• Submit a case report or submit a review article for publication. It is unlikely that it will be accepted by the time you're interviewing for residencies, but it is a great conversation piece. Case reports are the simplest way to publish. They often involve a unique side effect to a drug not previously described in literature. Keep an open mind to unique experiences on rotations, as they may lead to publishing opportunities.

Seek rotations in areas you are interested in, not just those that are easy. If you are seeking an inpatient residency, having some more experience in critical/acute care may help.

Document key experiences while on rotations. These may be interventions or presentations. Interviewers are going to ask about these and having them fresh in your mind will be great during the interview.

Start researching programs early and keeping a folder with information.

Attend the ASHP Mid-Year meeting.

Polish up your CV.

Large residency programs affiliated with Schools of Pharmacy and in big cities are the most popular programs and are likely the most difficult to get into.

Lastly, the best piece of advice is to be prepared for the interview, look professional, and to act enthusiastic about the opportunities available. All students who get an onsite interview are fully qualified. Make a great impression! Little things like a smile and some positive small talk go a long way. They help loosen the mood. Interviews are full day events and you often have to present a 15 minute presentation of something you have done. Remember you are always being interviewed with every person you meet. Above all, residency programs are looking for students that fit into their programs, not necessarily the ones with the most polished CVs.


Hope this helps! And don't forget to join us on Tuesday the 24th to meet 3 more residents all with very different experiences as to how they got there.

What is Missing on Pharmacy Shelves?

There is a new problem plaguing hospitals nationwide.  No, it’s not a new superbug, or an outbreak of a new disease.  It is what is lacking that is the problem: drugs.  The number of drugs in short supply has tripled since 2005, and currently over 200 drugs are listed as in short supply on the FDA website.  These drugs range from commonly used drugs, to chemotherapy, anesthetics, and critical care medicines.  Many are generics.

The shortages put patient lives in danger and raise health care costs.  Drug shortages have allowed the “gray market” to flourish.  These secondary suppliers are able to search the FDA’s shortage website to determine which drugs are in short supply, stockpile the medications, and try to sell them to hospitals at exorbitant markups- on average 650%.  Notably, the heart medication Labetolol was listed at a 13,000% markup from one supplier.  Not only is this unethical behavior that drives up health care costs, but it is unsafe.  Hospitals cannot determine the source of the medication, whether it was stored correctly, or whether it really is what the label claims it to be.

As an intern in both the community and hospital setting, I’ve witnessed these shortages firsthand.  An ongoing shortage that has recently been brought to the forefront of the media is ADHD medications, particularly generics.  Because of the potential for abuse, the DEA strictly regulates the production of this medication, setting quotas on how much can be produced to prevent diversion and illicit use.  Due to the current shortage the DEA has increased the quotas to help alleviate the problem.  In the hospital setting, one example of shortages is chemotherapy.  Heartbreaking stories of patients who rely on Doxil, a chemotherapy agent with less toxicity than other medications in its class have been published in the media.  Manufacturing problems halted the production of Doxil, and because it is only produced at one plant, shortages quickly followed.  At my workplace there is a strictly controlled supply of Doxil, split up by patient.  Patients now must add availability of their medication to the list of worries concerning their survival.

So what is the problem?  The pharmaceutical industry has consolidated recently, and as a result only a few manufacturers make certain drugs.  When one plant fails, the effect quickly snowballs.  The effects can be potentially catastrophic for both individual patients and public health. 

At the end of October 2011, President Obama signed an Executive Order that supports requiring drug companies to report drug shortages.  Currently, drug companies are only required to report discontinuation of drugs when they are the sole manufacturer of the drug.  Reporting drug shortages is voluntary.  The Executive Order also supports preventing illegal price gouging and stockpiling of medications. 

Unfortunately, there is no quick fix.  For now hospitals are left dealing with shortages by using more expensive substitutes including brand name drugs and drugs that are potentially more toxic.  It also increases the risk of medical errors, as medical staff must be educated to use and administer unfamiliar drugs.  

So, what can patients do to navigate this crisis?  First, they need to have a discussion with their doctor about the supply of the medications they are prescribed, and inquire if a waiting list for a particular drug exists.  It is extremely important that patients are frank and complete about their medical history and medication use so that the most appropriate alternative drug can be chosen when necessary.   Also, patients should refrain from purchasing drugs from the internet or unconfirmed sources, as the safety, efficacy, and identity of the drugs cannot be ascertained. 

Since President Obama’s Executive Order, the FDA has prevented over 100 shortages.  Hopefully we can continue on this path to recovery, and in the meantime, work together as a healthcare team to ensure optimal outcomes for patients using available drugs.  What drug shortages have been huge issues where you work?  Are you concerned that there won’t be a fix?  We’d love to hear from you!

Additional Reading & Videos

http://abcnews.go.com/blogs/health/2012/01/03/adderall-drug-shortage-will-continue-in-2012-government-officials-say/

http://www.cbsnews.com/8301-31727_162-20120140-10391695.html

http://www.cbsnews.com/video/watch/?id=7381127n

http://www.fda.gov/Drugs/DrugSafety/DrugShortages/default.htm

http://www.huffingtonpost.com/2012/01/03/medication-shortages-2011_n_1182128.html

http://www.nytimes.com/2011/12/13/health/policy/the-personal-price-paid-for-shortages-of-doxil-and-other-drugs.html?_r=1&scp=3&sq=drug%20shortage&st=cse

http://onpoint.wbur.org/2011/10/04/prescription-drugs

http://thechart.blogs.cnn.com/2011/12/16/drug-shortages-hit-an-all-time-high/

http://www.webmd.com/add-adhd/news/20120103/adhd-drug-shortages-why

http://well.blogs.nytimes.com/2011/12/31/a-d-h-d-drug-shortage-has-patients-scrambling/?scp=1&sq=drug%20shortage&st=cse

http://www.whitehouse.gov/the-press-office/2011/10/31/we-can-t-wait-obama-administration-takes-action-reduce-prescription-drug