Pharmacists: More than Meets the Eye

When people hear the word “pharmacist,” they often picture a genial man or woman in a short white coat behind a counter who counts out medications all day.

The types of pharmacists.

The types of pharmacists.

While this traditional ideation is not necessarily inaccurate, it is most certainly not the entire picture either.

The career of pharmacy is an amazingly broad one that has areas of practice for every type of interest. A single degree in pharmacy can open up an incredible number of doors. In direct contrast to the common image, some pharmacists might never have face-to-face contact with patients. Perhaps most surprising is that many pharmacists never even physically see or handle actual medications. It really is incredible how many different career paths are available to pharmacists.

Whether you are considering going to school for pharmacy, you are about to graduate, you want to change paths in the field of pharmacy, or you are a patient who wants to know more about what your pharmacists can do for you, then take a look below at a few of the many different types of pharmacists that are practicing in today’s health care setting.

Community

This is the prototypical pharmacist working at the drugstore down the street that people associate most with pharmacy. Included are pharmacists that work for  an independent pharmacy, a small business often owned by the pharmacist or pharmacists working there, and retail chains such as Walmart or Walgreens.

In this practice setting, the pharmacist is ultimately responsible for the care that the patient receives. All prescriptions are checked by the pharmacist to ensure that the right patient is receiving the right medication at the right dose. Any patient questions and issues are assessed by the pharmacist who can make recommendations. The operation of the pharmacy and personnel management are usually part of the pharmacist’s responsibilities too.

Some functions that community pharmacists do are a little less known to the public. Many community pharmacists provide health screenings, walk-in immunizations, comprehensive drug reviews, and disease-state management clinics. Though not the only type of pharmacy practice, community pharmacists are still some of the most common positions today.

Health System

Another popular field of pharmacy is working in a hospital or health system setting. These pharmacists may still receive and review prescription orders like a community pharmacist, but there are many other differences. The health system pharmacist usually works within an inpatient pharmacy, managing the prescriptions for treatment of admitted patients. The medications used in a health system setting are usually for much more acute illnesses as opposed to management of long-term disease states, such as various antibiotics and the use of IV fluids. Some hospital pharmacists are in charge of determining dosing of medications (such as vancomycin) and can alter therapy per a protocol without physician intervention. Other tasks include providing input for changes to the hospital formulary, mixing and compounding of preparations, and conducting medicine reconciliation for incoming patients to ensure that records are up-to-date and all of a patient’s drugs are accounted for.

Clinical

A clinical pharmacist is almost like a live drug information resource right at the fingertips of physicians, nurses, and other providers. The primary role of the clinical pharmacist is to provide cognitive functions, such as recommendations to physicians, educating patients on proper therapy, or even making adjustments to drug therapy regimens based on a protocol without having to receive a new prescription from a prescriber. Clinicians often have very in depth knowledge of the medications they most often utilize in their practice, and can tailor medication therapy regimens to specific patients based on their other diseases or conditions.

Most clinical pharmacists complete one or more years of residency after graduation from pharmacy school, though all can become certified after at least 3 years of practice and passing of the Pharmacotherapy Specialty Certification Examination. Clinical pharmacists can specialize in very unique areas of healthcare practice too, such as oncology or critical care.

Nuclear

Nuclear pharmacy is a very unique and specialized area of practice. Nuclear pharmacists prepare radioactive pharmaceuticals that are most often used in radio imaging. Hospitals and clinics order the isotopes and they are prepared the same day by the nuclear pharmacist. Preparation of these isotopes requires usage of specific machines and techniques. Safety is also very important, as long term exposure to the radioactive materials can be detrimental. Special regulations apply to this industry compared to other areas of pharmacy to maintain safety of the pharmacists, patients, and the environment as well.

Consultant

It is well known that the elderly population generally takes a far greater number of medications than younger populations. With more medications comes more risk for interactions, misuse, or duplications. Consultant pharmacists go over patient medication regimens looking for these issues, and can make recommendations to the patients’ caretakers about the most efficient and effective therapy regimens. Based on guidelines and clinical expertise, the goal of consultant pharmacists is to provide truly patient-centered care by optimizing the treatment for each individual patient.

As implied above, the patients of consultant pharmacists are most often senior citizens of nursing homes, skilled nursing facilities, or other types of long-term care facilities. Medicare requires that the regimen of all residents be reviewed by a consultant pharmacist at least once per month. Working with other providers of care for the residents, consultant pharmacists can ensure that their patients receive the best health outcomes possible.

Academic

It is exciting to learn that there are so many avenues for a pharmacist to practice, but who teaches all these individuals studying to become pharmacists? Other pharmacists of course! There are over 130 pharmacy schools throughout the United States, and many of the faculty, professor, and administration positions are held by pharmacists. Academic pharmacists are in a unique position to impact the field of pharmacy, as they are responsible for teaching, mentoring, and inspiring the next generation of pharmacists, directly shaping the future of the profession.

Most academic pharmacists are involved not only with teaching, but with research and public service as well. State and national organizations will regularly consult academic pharmacists for guidance on pharmacy related topics. A post-graduate degree or other training such as a residency or fellowship is often required for a full time or advanced position, but adjunct professors can teach certain classes while practicing in their field full time. As one can see, the next generation of pharmacists relies heavily on academic pharmacists.

Public Health/Commissioned

Public health pharmacists are in a particularly unique area of pharmacy. In the US, most public health pharmacists are actually commissioned officers of the US Public Health Service (USPHS). As a commissioned officer, the public health pharmacist is part of the seven uniformed services, such as the Army, Navy, or Coast Guard. Along with this, the pharmacist is a federal employee and receives the same pay scale and benefits as other members of uniformed services.

Public health pharmacists provide direct, hands-on patient care much like other types of pharmacists, but the setting and the patient populations can be very unique. Some of these include Native American reservations, prison systems, and other underserved rural areas of the country. Also, commissioned pharmacists are mobilized for disaster relief work, such as events like Hurricane Katrina or the 2010 Haiti Earthquake. Working as a commissioned public health pharmacist can provide some truly one of a kind practice opportunities.

Inspector

Inspectors work for the state boards of pharmacy to ensure that pharmacies are maintaining compliance with the law. The primary goal of the state board of pharmacy is to protect the public, and one way of doing so is by performing inspections. Inspectors will look at things such as record keeping, privacy of health information, control substance use, and ensure that all licenses and certificates are up to date.

The inspector usually has an area within the state that he or she is in charge of. In the case of Missouri, there are currently eight inspectors who are in charge of different regions of the state. Per Missouri law, each pharmacy must be inspected at least once per year; this can keep inspectors very busy! For pharmacists who have an interest in pharmacy law and seeing a variety of different pharmacy practices, becoming an inspector is an appealing option.

This list is by no means all-inclusive, as there are many other types of pharmacists not mentioned above. Pharmacists work for the FDA to guide healthcare in the US and assist with the new drug approval process, deciding which drugs should and shouldn’t be allowed to go to the market. Drug companies employ pharmacists for research of new medications and to act as drug information liaisons for their drug portfolio to help healthcare providers make the most informed decisions possible for patients. Pharmacy associations have high-ranking pharmacists that head the association as a full-time job, and sometimes employ pharmacists as lobbyists too, making great opportunities for pharmacists who enjoy politics and advocating. Compounding pharmacists still make tailor-made medications the old-fashioned way, when patient-specific illnesses require the use of something not normally made.

Even the above types of pharmacists often do not stop there, and instead have nearly unlimited advancement opportunities. Community pharmacists in a retail setting can move on to managing districts and even move further up in the corporation to help shape the direction and practice of the company. Academic pharmacists who teach and perform research can work their way up to become a dean, leading the school and determining its course. Many pharmacists start in one field and change or advance to another area. Even our 38th Vice President Hubert Humphrey was a pharmacist! As one can see, pharmacy is so much more than counting pills, as there are many different career paths within the field of pharmacy.

John Oechsner
UMKC School of Pharmacy at MU
Pharm.D. Candidate, Class of 2014

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