Being an internal medicine pharmacist is a potential career choice for new pharmacists to pursue. To provide insights into this area of practice, an internal medicine pharmacist weighs in on the realities of the job versus the expectations of what she thought it would be like.
Authored By: Desirae Lindquist, Pharm.D., BCPS
[Last updated 7-11-2017]
When people think about practice areas of pharmacy, it is often the really niche specialties, such as infectious diseases, critical care, emergency medicine, cardiology, or oncology, that get a lot of the attention. While these are all very exciting and established areas of practice for clinical pharmacists, internal medicine is quickly gaining ground as a place for pharmacists to become more involved in optimizing patient care by incorporating all of these unique specialties into their practice.
I believe there are often some false expectations about what internal medicine pharmacists do, what we are capable of, and how we can have an impact on patient care outcomes. To address the topic, here I discuss some of the common misconceptions that people have about an internal medicine pharmacy. If you are considering a career as pharmacist, I strongly suggest you consider this specialty as an option and I hope the following perspective assists in understanding this potential path.
Comment #1: “Internal Medicine is not a true specialty”
This is probably one of the largest misconceptions I have encountered throughout my (short) career. I remember being in my 4th year of pharmacy school, and even deep into my first year of pharmacy residency training, when someone asked what my specialty was going to be for my clinical practice. I would tell them internal medicine, and they would quickly proceed to ask me, “and what are you going to do after that?”
Whenever this comment comes up, I bring up a scenario that helps to put my specialty in perspective; for example, many cardiologists are excellent when it comes to heart failure or coronary artery disease management. What these highly trained, highly specialized providers often need help with is management of disease states and illnesses outside of their scope of practice. So when their heart failure patient needs to have their COPD regimen optimized, this is where someone like an internal medicine pharmacist can have an impact.
I like to refer to internal medicine pharmacists as “generalist specialists.” We are highly trained in multiple areas, which gives us the unique opportunity to bring together all aspects of a patient’s care. While many specialties may defer recommendations to other specialists outside their practice area, internal medicine provides clinically trained pharmacists with the knowledge and skill set to be able piece together the big picture and optimize all aspects of a patient’s pharmacotherapy regimen.
A big way we are able to help facilitate this moving puzzle is to be a presence on rounds with physicians and residents. We work with the internal medicine/hospitalist teams to keep up with the recommendations being given to them from multiple different specialties. Since these teams are often ever-changing, with residents and hospitalists rotating on/off of service, the pharmacist on the team plays a big role in promoting continuity of care for the patients.
Comment #2: “You see the same types of patients every single day”
While I will not deny that I often see multiple cases of patients with chronic obstructive pulmonary disease, or heart failure exacerbations, and the ever common pneumonias or urinary tract infections, every single day brings me a new disease state or patient case that stretches me to learn more.
For example, very rarely do patients come in to receive medical treatment of just one single disease state. They initially come in for pneumonia, only to realize they are also experiencing a pulmonary embolism or heart failure exacerbation, in addition to a COPD exacerbation. Did I mention they have a history of significant gastrointestinal bleeding? It takes a skilled and knowledgeable practitioner to be able to optimize a pharmacotherapy regimen that balances benefits and risks with so many moving parts.
When I look back at the decision to become PGY-2 trained in internal medicine, I remember admiring how the preceptors and pharmacists were able to see the patient in one light, and not the silos of each disease state. They were able to recommended antibiotics, anticoagulants, inhalers, and all other medications that would help the patient meet their therapeutic goals. Pharmacy is an art, and internal medicine pharmacists truly are the “renaissance men/women” in the medical world.
Comment #3. “Being trained in Internal Medicine limits my career choices”
Not only are more hospitals seeking generalists for their positions, but having had training in internal medicine allows you to practice in a wide variety of different areas. In my hospital alone, we have PGY-2 trained internal medicine pharmacists working in the areas of pulmonary, gastroenterology, critical care, emergency medicine, nightshift, transitions of care, drug safety, and even informatics!
If you want to stay within the general medicine patient population, there are several areas you can be utilized. Many clinical pharmacists round with house staff medicine teams, family medicine teams, or even hospitalists. Several studies have shown the clinical and economical benefit of adding a pharmacist to these services [1,2].
If academia is a passion you want to pursue, many pharmacists in this specialty take on active roles with teaching at colleges of pharmacy or medicine.
Comment #4. “I will never be able to know everything there is to know for every single disease state…”
I agree! And that is why I decided to go into this specialty.
Every single day, I learn something I did not know before. New medications are developed and guidelines change every other year – and the medical community needs pharmacists that are life-long learners, which are able to adapt their practice when new evidence about medications becomes available.
Training in internal medicine has helped me to understand the pathophysiology of disease states, the pharmacology of treatments, and the ability to incorporate it all together to optimize patient care. It is rewarding to apply my skill set in practice and my training / experience has afforded me the ability to do this with confidence.
Comment #5. “Being an internal medicine pharmacist means I can only work in the realm of ‘clinical pharmacy'”
Outside of clinical practice, an internal medicine residency provides you with the tools to contribute to the administrative side of hospital pharmacy practice. As reimbursements go down, pharmacists are a key resource to pursue cost/resource savings. Each member of the team’s time is increasingly valuable. A policy that gives pharmacists the authority to change a medication based on renal function saves time (aka money!) for the health-system, at the same time allows for pharmacists to positively impact patient care.
Having specialized training in internal medicine enables you to apply the clinical aspects of your pharmacy education to impact the institution as a whole.
Comment #6. “You do not need to be residency trained to practice in Internal Medicine”
While residency training is not required, I believe the American Society of Health-System Pharmacists says it best:
“…residency graduates’ extensive patient care experience, combined with their wealth of knowledge of medical problems and their treatment, provides for pharmacists who can successfully serve health care organizations as an essential information resource to support decisions affecting the care of internal medicine patients.”
Internal medicine training has allowed me to serve my patients to the best of my abilities; I also serve as a reference for all members of the health care team when it comes to clinical decision making and practicing evidence-based medicine. I have been trained to evaluate drug-drug interactions, cost of medications, dosing and adjustments based on hepatic or renal function, in addition to evaluating the overall pharmacotherapy plan. I have built rapport with providers of multiple disciplines, served as a pharmacotherapy expert for medical residents and physicians, as well as preceptor to the next generation of pharmacists.
Becoming an internal medicine pharmacist can be a wonderful career choice that offers benefits not seen at just a glance. For those not hard-set on a specific pharmacy specialty, a career in internal medicine pharmacy may be just what you are looking for.
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