In this article a former PGY2 health-system pharmacy administration resident reflects on how his expectations compared to the realities he experienced in completing this type of post-graduate residency training.
Authored By: Jairus K. Mahoe, PharmD, DPLA
[Last updated: 20 October 2018]
We need leaders.
The Bureau of Labor Statistics estimated that in the next 10 years, an additional 17,000 pharmacists will become employed in the United States . Compare that to the reported 14,000+ pharmacy degrees that were handed out in 2017 alone . The future cannot be predicted to a tee, but we may have a potential difference between jobs available and qualified people available – do you know where you will fit in?
Thirty years ago, there were 72 pharmacy schools in the United States. Currently, there are around 150 schools, graduating thousands of pharmacy students each year . Add the expansion of the role of a pharmacist over the past few decades (including the development of pharmacists in specialties such as critical care, oncology, infectious disease, etc.) and what results is quite a dynamic profession with numerous possibilities.
Bottom line – our profession is growing. The good news is we are having a lot people become good pharmacists. The problem is there are less people interested in leadership.
We need leaders.
This was a statement that I have heard multiple times when speaking with pharmacy directors when I was in search for a residency. When asked to elaborate, one director spoke of receiving multiple job offers despite his plans to retire shortly. He felt it was essential to foster in leaders to our profession. That was his motivation to start a PGY2 in Health-System Pharmacy Administration (HSPA) at his hospital.
The purpose of an HSPA residency is to prepare a resident for “a clinical or operational management/supervisory role in a variety of work settings including small to mid-size hospitals, large health systems, and pharmacy benefit management organizations” . It offers a resident the opportunity to become a leader, and what an opportunity it is. For myself, it was an opportunity I could not pass up and an experience like no other.
As a pharmacy student, I was drawn to leadership positions in various student organizations from a desire to serve. I felt grateful to all those who served as role models and guided me into a college of pharmacy and I hoped to one day do same for others. I figured by holding positions (e.g., delegate, president) it would help build my leadership abilities and allow me to better serve my colleagues and our profession. And it did. I learned invaluable lessons from the years spent in those positions, but as with most specialties, there were vast amounts more to learn.
My interests in hospital administration started P4 year and continued throughout my PGY1 residency. Although I have a passion for leadership my goal was not particularly to be a supervisor, manager, or director. Observing the complexities of pharmacy management firsthand, along with the daily challenges (ranging from simple to utterly ridiculous) was what had me fascinated. It is just like playing a game of chess, strategy is everything. But in this case, the goal is not to capture the king, the goal is to provide the best patient care using only what limited resources are available. This new area of pharmacy that was revealed to me was interesting and challenging; I was hooked.
Fast forward some time and an HSPA residency later, I can definitely tell you I have learned far more than I expected. If you are interested in pursuing a career in pharmacy administration, an HSPA residency is a great place to start. In my personal opinion, the leadership experience gained in the past year alone weighs more valuable than that of the previous 5 years combined.
Did I expect it be difficult? Yes. Did I expect it to be rewarding? You bet. Were there some expectations that didn’t really pan out? Well…
Expectation #1: All leaders know exactly what to do
VUCA is an acronym that describes four types of challenges. It stands for volatility, uncertainty, complexity, and ambiguity. These are very much the challenges the world of healthcare faces today. Long story short, when working in pharmacy administration, anything and everything can happen. And if Murphy’s Law (whatever can go wrong, will go wrong) is taken into consideration there can be some extremely challenging times ahead.
Although the majority of tasks and responsibilities can be found in a job description, a significant part of a leader’s job deals with the unpredictable. Unfortunately, the VUCA world presents leaders with challenges they have often never encountered before. Many of which there are no guidelines or standards on how to resolve the matter. For example, when determining a treatment regimen for a patient with a recent heart attack or suboptimal blood sugar levels, there are tons of literature, robust guidelines, and a variety of specialists with information on the relevant topic. But where are the guidelines for…
- “The pneumatic tube system is malfunctioning and sending medications meant for the Emergency Department to the Labor & Delivery Unit?”
- “There’s a high level of suspicion someone is diverting medication”
- “Our organization is changing direction so who do you let go?”
- “The sink upstairs has broken and has now flooded the sterile IV room in the pharmacy”
Highly effective leaders are aware of this unpredictable and almost chaotic world they work in; therefore, they are very adaptive and flexible. Some leaders perform at such high levels that they can tackle a complex problem that they have never encountered before and make it seem like a walk in the park, while other leaders may struggle with the same problem.
The reality is that an HSPA resident will encounter experiences across many disciplines often for the very first time, and it is not unreasonable for other leaders (including preceptors) to be in the same shoes. It is more important to learn and execute during these new challenges than to focus on whether a leader’s initial judgement was the most optimal choice at that time. Keep in mind that it is not just the resident that is the learner. Good leaders habitually acquire knowledge and skills throughout their career. They may not always know exactly what to do in every situation, but they will try their best to get the most favorable outcome.
Expectation #2: You are a resident and that is your role
Like all residencies, an HSPA residency has objectives, goals, and evaluations. There are assigned tasks, staffing days, and a variety of learning experiences. But unlike most residencies, an HSPA resident has quite a few hats to wear, and being a resident is not your only role.
The general role of being a resident is very familiar to anyone who has completed a PGY1 residency. One of the hardest challenges PGY1 residents come across is the transition from being a student to becoming a provider. The HSPA resident faces a similar challenge, making the transition from being a provider to becoming a leader, and that is more complicated than it sounds.
To be an HSPA resident is to be in a perpetual identity crisis. How so? The number of roles far exceed that of just a resident, and here are some examples:
- Orientating or working unfamiliar shifts – the resident is a learner
- Working with pharmacy students (and PGY1 residents) – the resident is a teacher and preceptor
- Staffing in the pharmacy – the resident is a pharmacist, provider, and peer of the staff
- Administrative projects and duties create additional roles: working alongside managers and supervisors – the resident is seen as a leader, generating protocols, policies, and education
- Participating and assisting with interdepartmental committees – the resident is a representative, designee, and advocate of pharmacy
- Working with third-party entities and regulatory bodies – the resident is a representative of the hospital system
The reality is that although the HSPA resident is very much a resident, the position requires a substantial amount of responsibilities spread over various specialties. It is crucial to acknowledge and identify these roles early on in the residency. Increased success and efficiency will come to those who are aware of when to step in and out of these roles.
As an HSPA resident, do not be surprised if you are tasked to educate not only the pharmacy staff, but leaders throughout the hospital. I have heard the saying “I’m just a resident” one too many times, and it is not a mentality that will fly in an HSPA residency. You could be filling a docusate order one moment and writing policies that will affect the entire health-system the next. You are a resident, and so much more.
Expectation #3: It’s all about the deadlines, deadlines, deadlines
From applying to pharmacy school to turning in group projects, deadlines have always been crucial to being successful. Did not turn in your PhORCAS application on time? Better luck next year. Now although deadlines are still very important as an HSPA resident, they may not be as dreadful as the ones that haunted your past.
Great communication has always been a fundamental trait to great leadership. An HSPA residency will reinforce this over and over again. One of the things that great communication helps facilitate is the negotiation of deadlines.
Wait, what? Deadlines are not set in stone?
When stepping into a leadership position, one of the most unsettling challenges is not being able to have a fully completed To-Do List (spoiler alert: more to come in Expectation #4). Now it is crucial to come to terms with this, because in order to be an effective HSPA resident and leader, one must understand that time is always limited. There will never be enough time to complete all tasks and projects; there will always be more to do. Why is this important? Because this is how to master prioritization.
The reality is such that deadlines are fundamental to have, but they are not the be all and end all. It is vital to understand the differences between hard and soft deadlines, and the significance of the task itself. For example, imagine that you start work on Monday morning by prioritizing your week. One report is needed by tomorrow for a hospital-wide committee meeting and another report is needed by the end of the week for a departmental meeting. The answer seems pretty clear to prioritize completing the report that is due tomorrow, right? Let’s take it a step further – add in all your meetings for the week. Insert your daily, weekly, and monthly tasks as well. Now add all adjunctive tasks from preceptors, rotation duties, committees, etc. How does your week look now? What are your top priorities? Will you be able to complete all your tasks? How do those reports compare to the bigger picture? It might be a good time to start negotiating some of those deadlines.
Not convinced? *BONUS* You just found out regulatory surveyors have arrived unannounced at your hospital for the week and you will be following them for the duration of their visit… still think you will be able to complete all of your tasks? Negotiate those deadlines of less significant tasks and prioritize those with the most importance.
Expectation #4: If you want to be successful, you have to complete everything
When we are students we are taught that the more we complete, the higher our grade. Complete 75% of the coursework and you get an C for the course, 85% is a B and 95% is an A. Higher completion is equal to higher success, right? Well, there are always exceptions.
Is it better to complete 100% of all predetermined tasks even though less than half of those tasks ended up being of no benefit? Or is better to constantly evaluate tasks and focus efforts on what is the most beneficial and relevant at the time?
Say goodbye to the simple times of just ticking boxes, to be a HSPA resident you must be able to continuously re-evaluate your priorities. Checking off a task on your To-Do List just for the sake of completing it may have worked in the past but not here. You should be investing in your skills, experiences, and value, and not focusing on getting the 100%.
Discussing the importance and priority of tasks with your bosses (i.e., preceptors, supervisors, managers, program director) is as vital, if not more vital, as negotiating deadlines. To determine when a task should be completed is one thing, but to determine if a task should even be completed is a step above. For example, renegotiating the deadline for a report that is due this Friday to next Friday could help you allocate resources to more significant projects and be very helpful. But what if instead you analyzed its benefits, discussed its significance with your bosses, and find out that this report is actually no longer necessary. Not only do you recover the resources you would have spent working on those reports throughout the year, you also recover all the resources your bosses and your department would have used reviewing those reports. Yes, you could have easily completed 100% of those reports, but little benefit would have been gained for you and the department.
In reality, it is okay not to complete everything that you originally set out to do. In some instances, when it is identified that efforts could be allocated better somewhere else, it is actually better. This does not mean that you should dispute every task assigned just because it may not interest you. This means critical thinking and situational awareness is crucial to be a successful HSPA resident. If tasks are blindly accepted and completed just to get that 100%, it will lead down a very dangerous and short path to burnout. It is better to work smart than to work blind.
Expectation #5: All HSPA residencies are the same… or at least similar
Okay, perhaps you already know this is not a realistic expectation, but it is worth reiterating. If you are considering a residency, you are currently a resident, or you have completed a residency, you have realized that no two residencies are the same. The differences between residencies depend on the type of hospital, location, state laws, size, community, and much more.
Like any program or service, a HSPA residency needs to be of benefit to the hospital or it would get discontinued. This means the HSPA resident will be contributing to very real tasks aligning with the pharmacy department goals. Why is this significant? Because if you are a resident in a pharmacy whose strategic plan is focusing on medication safety, you will be focused on medication safety. If your hospital is planning on rolling out a new electronic health record (EHR) system, you will be rolling out a new EHR system. There is good and not-so-good in this. It is good because it gives you real world experience. You will receive in-depth training in everything that coincides with the pharmacy department’s goals for the year. It’s not-so-good because there’s a chance that your goals don’t coincide with the pharmacy’s goals. For example, you may have a passion for learning about pharmacy informatics but if your pharmacy department lacks a relationship with the informatics team or your hospital is still utilizing paper charts, you may have a difficult time pursuing that passion.
The reality is no two residencies are the same and even any one residency can vary from year to year. It is very difficult to predict what the near future can bring. This is especially important when dealing with HSPA residencies because this is a VUCA world.
Prepare yourself by talking to key individuals at an HSPA program, such as pharmacy directors, managers, and previous residents, to see what was historically done and what may be in store. Maybe a goal for next year will be starting a new type of medication delivery system, implementing a new pharmacy initiative system wide, or remodeling an IV cleanroom to meet regulations. Maybe the hospital just signed a partnership bringing in new services. Maybe regulatory findings have prioritized a transformation of pharmacy services. Maybe a new pharmacy will be opening requiring the transfer of all equipment and personnel. These are all very real possibilities that would have a profound influence on an HSPA resident’s experience. Each HSPA residency will have something unique to offer, it is up to the individual resident to embrace and make the best of it.
Our profession is growing and we need leaders who are motivated to lead. If you are interested in health-systems and feel like pharmacy administration is a potential career choice, I highly recommend pursuing a HSPA residency. It is a great opportunity that will further enhance your leadership abilities and provide numerous learning experiences. There is no debating that the challenges to overcome are substantial, but each challenge comes with its own reward. Sure, there may be some experiences that won’t meet your expectations, but that is part of being a leader.
Ultimately, completing a HSPA residency is just one means to an end, and it does not necessarily make you a leader solely by finishing it. There are a variety of other ways to grow and develop professionally, however, embracing the opportunities provided by a HSPA residency can be a great investment in your career.
Even if you decide that pursuing a PGY2 may not be in your best interests, I hope that you decide to continue to contribute to our profession. With more pharmacists entering our profession each year, the future of pharmacy is in our hands. Whether you decide to pursue leadership yourself or help foster in leaders, it is up to us how our profession advances.
The question is, if you are interested in being a leader, are you willing to take the path of health-system pharmacy administration?… Well… are you?
Want to get a feel for or a jumpstart on HSPA? Consider having a read through the following…
- The 7 Habits of Highly Effective People by Stephen R. Covey
- Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference by Quint Studer
- Harvey A.K. Whitney Lecture Award (series)
P.S. – Are you interested in pursuing additional leadership training?
Check out the ASHP’s The Pharmacy Leadership Academy that includes 7 courses focused on various topics surrounding pharmacy leadership. Several PGY2 HSPA residency programs offer enrollment to supplement learning experiences. Read more about The Academy here.
1. Occupational Outlook Handbook, Healthcare, Pharmacists. S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics. Last updated: 13 Apr. 2018.
2. Academic Pharmacy’s Vital Statistics. AACP.
3. School Directory – PharmCAS. PharmCAS RSS.
4. Educational Outcomes, Goals, and Objectives for Postgraduate Year Two (PGY2) Health-System Pharmacy Administration Residency Programs. American Society of Health-System Pharmacists, Inc. 18 Apr. 2007.
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