The Pros and Cons of Switching to a Health System

March 15, 2019

Health systems offer a wider use of pharmacy training, but more readily succumb to drug shortages and frequent formulary changes. 

Working at a health system pharmacy has its perks when compared to working in a community setting. For one, health systems are where pharmacists tend to make the most money, according to the Drug Topics 2018 Salary and Job Satisfaction Study. The survey found that 82% of hospital pharmacists make more than $120,000 annually compared to 71% of all pharmacists, and 25% make at least $150,000. This means health system pharmacists are almost twice as likely to earn salaries in the top range for the profession than pharmacists as a whole.

But it is health system pharmacists’ responsibilities and opportunities that make their jobs most rewarding. In fact, the annual salary survey reported that only 15% of health system pharmacists were dissatisfied in their work compared to 27% of all pharmacists.

Health system pharmacists cite a variety of reasons for making the switch from community pharmacy. Emily Griesbach, PharmD, BCPS, at University of Wisconsin Health, Madison, Wisconsin, decided to pursue being a health systems pharmacist to grow her clinical knowledge and become involved with managing more acute disease states. “I can use what I learned in pharmacy school more fully,” she says.

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“A huge benefit of working as a health systems pharmacist is being directly involved in the patient’s healthcare team,” Griesbach says. “I work alongside physicians and advanced practice providers to develop care plans and make medication recommendations during daily rounds. Being visible to these providers helps foster relationships, which in turn leads to clinicians asking pharmacists for their opinions and recommendations.” 

Besides having more time to spend with patients, Panteha Kelly, RPh, BCACP, CDE, clinical pharmacist specialist and assistant clinical professor of pharmacy, University of California San Diego Health, La Jolla, says her work hours are also better. “At the community pharmacy, I worked until 9 or 10 p.m. some nights and every other weekend. Now, as I gain seniority, I can choose from variable shifts and transition to shifts that are more desirable.” 

And with more technicians and clerks assisting with prescription processing, Kelly has more time to focus on patient care rather than being more involved in the business side of the practice and completing tasks such as prior authorization approvals from insurance companies or prescription order entry. 

When she worked as a community pharmacist, Susan Alsaras, PharmD, pharmacist at the Hospital for Special Surgery in Manhattan, says the focus was entirely on selling prescriptions, refills, offering 90-day prescriptions, and verifying orders fast enough to keep up with demands of statistical requirements.

Working as a health system pharmacist differs from community pharmacy in other ways, according to pharmacists who made the change.

Patient interaction and counseling: 

In a community pharmacy, patient interaction was abundant, but rushed, Alsaras says. “Patients didn’t want to be bothered with discussing their new medications,” she says. “And they often targeted me for insurance mishaps. Patients at HSS usually listen, ask questions, and seem satisfied with pharmacist responses when counseled.”

Developing care plans: 

With access to each patient’s electronic medical record at a health system, it is much easier to determine if the selected therapy is appropriate for the patient, Kelly says. At a community pharmacy, this access is not always readily available.

Consulting with physicians, nurses, and other professionals: 

Health system pharmacists work more frequently with other care team members, says Ryan Foster, PharmD, MBA, senior director of pharmacy at Spectrum Health, Grand Rapids, MI. They bring a specialized set of skills and knowledge to the team and can integrate it into decision making much earlier in the process.

Griesbach says it’s easier to consult and work with other healthcare providers, especially physicians, when working as a health systems pharmacist because they often work with the same people each day and can build rapport.

Providing specialized services: 

In community pharmacy, you are a “jack of all trades,” you know a little bit about a lot of medications, Griesbach says. As a health systems pharmacist, you can carve out a niche in an area of great interest. However, additional training may be required such as a second or third year of residency.

Kelly says a health system offers the opportunity to work in a variety of specialties such as geriatrics, internal medicine, oncology, diabetes, and administration, and provides many career opportunities. “At UC San Diego Health, my interest in diabetes led me to start a diabetes self-management program, which the pharmacy department supported,” Kelly says. “Our accredited program allows us to bill for services and not only garner additional revenue but also practice at the top of my pharmacy license. Our organization has employed numerous clinical pharmacists who are involved in different specialties and work side by side with other healthcare providers.”

By working at a hospital that deals solely with surgery and orthopedics, anti-coagulation and infectious disease are topics that Alsaras largely provides information on to physicians, prescribers, and nurses. In addition, she compounds medications, often for intravenous use, which she rarely did as a community pharmacist.

Involvement in research: 

Health system pharmacists have many opportunities to participate in research as well as quality improvement, especially at larger academic institutions, says Griesbach, who championed a bariatric quality improvement project.

Tips for Success

For pharmacists considering which path to take, Foster recommends they reflect on whether they prefer to work with patients more longitudinally, which community pharmacists do, or if they would rather be more involved with acute episodic care, which health system pharmacists do.

In order to build a successful career in health system pharmacy, pharmacists need to first establish a high degree of trust with their pharmacy peers and other members of the healthcare team, Foster says.

Along these lines Alsaras adds, “Work together with your colleagues, ask each other for advice and maintain a cordial, professional relationship.”

Pharmacists who are interested in a career change should research their path of interest, learn what it takes to get there, and not be afraid to take risks to make a change, Kelly says.

Griesbach says it’s critical to know your resources. “Not a day goes by without being asked a question for which I don’t have the answer,” she says. “It’s fine to say, ‘I don’t know the answer,’ but then I go and find it in a timely manner.”

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When offering a recommendation to a physician, word it thoughtfully and concisely. “Physicians are constantly busy and are appreciative (and will more likely listen) if you’re short and to the point,” Griesbach says. “Also, don’t be discouraged or take it personally if your recommendation isn’t accepted.” 

Flexibility is another key. “Drug shortages, clinical guideline changes, and formulary changes are just a few challenges that you encounter every day as a health system pharmacist,” Griesbach says. 

When reflecting on making the change, Alsaras says, “Learning something new each day, working together with a team to provide the best possible care for patients, and being someone who everyone relies on for drug information gives me a sense of pride and success that I never felt when working in community pharmacy. Although I enjoyed the frequent interaction with patients that was prevalent in community pharmacy, I had much more to offer patients and physicians. Switching to a health system pharmacy was one of the best decisions I have made.”

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