Clinician to manager: How pharmacists can best make the transition

April 1, 2009

For some pharmacists, the road from clinical practice to management is unexpected - and inevitable.

Key Points

John D. Pastor III, PharmD, never imagined he would trade his daily patient-care duties for financial, regulatory, and personnel management.

Yet, the path taken by Pastor's career is probably similar to what many other pharmacists experience. As his career progressed, Pastor began seeking out opportunities for closer involvement in hospital-wide initiatives. He discovered he enjoyed working with various management teams within the organization and being a part of the decision-making process. Soon a management-level position became available. "I saw that as an opportunity to do something different and further my career in another way," said Pastor, assistant director of clinical pharmacy services at the University of Minnesota Medical Center in Minneapolis.

Making the leap from clinician to manager may not be the desire of every pharmacist. But for many, it is a career path that is destined. For individuals equipped with the right tools, the transition does not have to be daunting. Those tools include finding mentors, learning financial management, being aware of regulatory issues, and learning human resources skills.

Correna Pfeiffer, PharmD, is a pharmacy manager for Med-Fast Pharmacy, a 25-store chain in Pittsburgh. She was promoted to oversee the company's long-term care division after being with the company for less than two years. Today, with almost four years on the job and a staff of 13 reporting to her, Pfeiffer said her goal was always to go into management. "I went from filling scripts all day to being in charge of the technicians and ensuring they are doing their jobs, making sure the inventory is adequate and overseeing the finances," she said.

Pharmacists are natural leaders

Cindi Brennan, PharmD, MHA, director of clinical excellence at the University of Washington in Seattle, said most pharmacists, by the nature of their jobs, are intuitive people and are actually already serving in management roles. "They are out on the floors and are the frontline leaders in making things happen,"she said.

Nonetheless, with no formal business training, many pharmacists often find themselves ill-prepared to handle a job that, in some cases, is quickly thrust upon them.

"When we attend pharmacy school, there is no business training, no HR training, and nothing even related to management provided," said Med-Fast CEO Doug Kaleugher, RPh.

Kaleugher went to school to work on his MBA and ultimately underwent a lot of trial-and-error and on-the-job-training when he went into management. Adding to his difficulties, he openly admitted, was his "micromanager" mentality. To succeed, "I had to change my entire mindset," he said.

Rafael Saenz, PharmD, MS, pharmacy operations manager at the University of Pittsburgh Medical Center, understands Kaleugher's earlier predicament. He helped develop and moderate a new-manager session at the December Midyear Clinical Meeting of the American Society of Health-System Pharmacists (ASHP) in Orlando. The session was led by Pastor, Brennan, and Jill M. Strykowski, MS, RPh, director of pharmacy at Mercy Hospital and Unity Hospital in Minneapolis.

To succeed in a management role, "you have to change your whole focus. In school they teach us to focus on taking care of the patient. Of course, you want to have patient-care programs in place, but [as a manager] you also have to look for revenue streams to pay for them," Kaleugher said.

The skills and knowledge needed to make the transition include:

1. Learning and employing human resource skills. There is a misconception, common among nonmanagers, that managing people is easy - simply "tell people what to do and they will do it," Saenz said. "But we have seen pharmacists get promoted and all of a sudden start dictating and wielding the sword. As a result, they end up falling on that sword, because you are never going to motivate people by threatening them. New managers do not know that right away." Indeed, the HR skills needed in a management position are underrated, Kaleugher said, adding that upon entering management, figuring out how to effectively direct other people was "one of my biggest hurdles."

In addition, knowing how and when to provide feedback to staff is a critical component to success, Saenz said. "Pharmacists are accustomed to receiving feedback, but not good at giving it. As a new manager, you tend not to give feedback because you're not used to it or don't know how, and as a result, your [feedback] is not constructive. It all goes back to the need to communicate with people in a way that helps to motivate them and coach them, as opposed to beating them down."

2. Staying on top of regulatory issues. Keeping abreast of all the wide-ranging areas that fall under regulatory management can be a bit like swimming upstream, Saenz said, "because as a pharmacist, you are used to other people putting these policies in place for you and then working within those confines. But once you become the manager, you are in charge of setting [the boundaries] and if something goes wrong, your name is attached to it."

Although this component of the job can appear overwhelming, much of the fear stems from pharmacists not being aware of all the resources available to them, Saenz said. A considerable variety of this information can be found online and through various organizations and networking groups.

3. Taking a class in financial management. Although one of the basic requirements for acceptance into pharmacy school is the completion of either an economics or an accounting class, that won't cover the essentials needed to manage the finances of a busy pharmacy department or store. "Clearly the need to understand how a pharmacy department is run financially is vitally important for a new manager," Pastor said. Strategies may vary somewhat, depending upon your environment: inpatient pharmacies are considered cost centers, while outpatient pharmacies are typically considered generators of revenue.

Yet, many financial-management concepts are universal. Understanding labor allowances, for example, is one of the first keys to effective financial management, Pastor said. Knowing what shared labor costs are, understanding how to use full-time equivalents (FTEs) to adequately cover shifts, calculating sick and vacation time, managing productivity, billing, and purchasing are all areas to be understood and executed under the umbrella of financial management.

"I highly recommend some basic accounting classes," Kaleugher said. "Know what a [profit and loss statement] is."

Pastor recommends new managers also understand how to limit unnecessary drug spending. "The biggest part of a pharmacy's expenses is supply cost or drug expense," he said.

Balancing the need to manage costs with inventory control is perhaps the first big challenge a new manager will have to combat, said Bruce Kneeland, a pharmacy industry consultant in Royersford, Pa. "There is always that fine line between ideal patient care and economics."

A recent initiative Pastor implemented in his own pharmacy was a strategy to reduce waste and better control costs by instituting a "cut-off" dollar amount for certain products. At his facility, a large cancer and transplant center, a number of expensive products must be prepared regularly. For example, "if we are preparing an item that costs more than $1,000, we verify that the dose is going to be administered before we perform the final mixing, so that we're not admixing a product, sending it to the patient's room, and then discovering that the provider decided ten minutes earlier not to administer the drug.

4. Finding mentors and developing a network. Creating a network of colleagues and professional contacts is critical, Brennan said. You can start within your organization, but often your network will expand beyond your own walls. Where possible, strong partnerships with your quality department, nursing leadership, and, from a regulatory standpoint, risk management, will prove to be valuable alliances as you evolve in the management role, Strykowski said.

Professional associations provide resources, as well. ASHP, for example, sponsors a mentoring exchange program. The whole concept of mentoring is "huge," Strykowski said. She advises new managers to make this step a top priority. Pastor agreed, adding that this may be the best single piece of advice for a new pharmacy manager. "I can pick up the phone and call another manager and ask them what they are doing about XYZ problem, whether it is a regulatory, financial, or formulary issue. I can do that with several dozen people across the country and very quickly get some feedback." Kaleugher warned that managers cannot lose touch with their patients. "If you are going to step into a manager role, make sure you stay in direct contact with people at the store/hospital level," he said. "You'd better still know how to fill prescriptions and interact with patients. Otherwise, you'll quickly lose sight of what the real problems are at the counter, because pharmacy changes very rapidly."

LEAH PERRYis a writer based in Atlanta.