By: Dr. Regina Ginzburg
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Regina Ginzburg is an Associate Clinical Professor of St. John’s University College of Pharmacy and Allied Health Professions. Her clinical site is at the Institute for Family Health (IFH) where she is an appointed faculty member for the Beth Israel Residency in Urban Family Health. She and Dr. See oversee the pharmacotherapy curriculum for the family medicine residents. She and her pharmacy students also provide education to patients in the family medicine clinic. Additionally, she is the co-chair of the IFH Pharmacy & Therapeutics committee which oversees medication-related policies for 22 clinics throughout New York.
The profession of pharmacy practice continues to expand, as does the recognition of the vital role of a pharmacist being part of the healthcare team. More than ever, the demand from hospitals, clinics, and community pharmacies to undergo postgraduate clinical training (aka residency) after obtaining a Doctor of Pharmacy degree is abundant.
As a student (years back), I went in to the residency application and interview process somewhat blindly. My preceptors informed me about how important a residency is. Watching how respected my preceptors were by the physicians and nurses surrounding them, I wanted to be a clinical pharmacist and/or teacher just like them (and by teacher I do not just mean teaching students, I did not realize I wanted to do that until later. I wanted to teach patients and healthcare professionals). Therefore, I went to the American Society of Health-System Pharmacist (ASHP) Midyear Clinical Meeting to explore the residency showcase. I was told that it was best to do a residency outside of NY, so I could experience the “real” contribution that a pharmacist could make (as pharmacists had more limitations in NY 10 years back). However, coming from a family that did not want to consider me leaving home before I got married, I felt that I should probably limit myself to a feasible drive distance away (CT, NJ, or PA).
I did not know ambulatory care was my calling yet, and was not familiar with the Veterans Affairs (VA) system or the role of the pharmacist in the VA setting. Therefore, when I went to Midyear, I wandered aimlessly from booth to booth, casually conversing with some of the residents and/or program directors. I spoke with the residents of the AlbertEinsteinMedicalCenter (in Philadelphia, PA), who appeared to be very enthusiastic when speaking about their residency program. I felt compelled to apply there and really only to a few other places that piqued my interest. At my interview there, I was impressed by the number of clinical pharmacists employed by the hospital (not really heard of in NYC at the time, unless you worked for a college of pharmacy), as well as the responsibilities and experiences the pharmacy residents endured. I was hooked. In fact, I was so hooked that I only put Albert Einstein as my choice on the match (by the way, I do not recommend doing this nowadays). However, I feel I should say that I did have an alternative plan should I not get into residency (but it is too long and tangential to mention in this article). Nevertheless, thankfully, I matched!
Because I was so naïve to this process, I was not aware that the program I matched into was a relatively new program that only started three years prior to my being there. ASHP provides somewhat of a guideline on the fundamentals of a residency program and type of rotations that should be included (e.g. core, elective, longitudinal, extended, etc.). This is part of the requirement to be accredited. However, each residency is still unique in the type of rotation and the preceptors’ guidance. For example, residency A and B are both PGY-I hospital-affiliated programs. However, residency A may offer electives in transplant, while residency B tends to specialize more in pain medicine (or endocrine, critical care, infectious disease, etc.). Some residencies are very stringent in their schedules for the year, whereas others are more lax and have the resident seek out electives of their choice. It is important for the applicant to know which type of residency would suit them best. The stringent program works best for those who thrive on structure, organization, and guidance. The lax program would suit someone who is ambitious and can get things done despite the lack of organization surrounding them. Perhaps this person may work better in this setting because they can tweak the program to suit their interests without much opposition from administrators – I matched into this type of residency program.
I have to admit that, as a student, I was not that ambitious. Therefore, when I started the residency program and saw how laid back it could be, I was disheartened. I planned to make a commitment for the year where I would work extremely hard with the payoff of substantial knowledge and experience enhancement. In the first couple of months, as my co-residents and I were wandering around aimlessly, it seemed evident that we did not know what we should be doing or what our priorities were. My program director had the best of intentions, but, sadly, did not follow through on meeting with us or tracking our progression (mainly because he was so busy). I thankfully met a clinical pharmacist at the hospital who started her own Coumadin® (warfarin) clinic. After shadowing her for some time, I saw how beneficial a pharmacist could be in the ambulatory care setting. With her coaching, I introduced myself to the endocrinologists at the diabetes clinic and developed an elective there. I continued to set up more elective rotations in other clinics, as well (pain, HIV, etc.). Hence, I was able to make the best of my situation and feel proficient in ambulatory care. Looking back, I am very grateful for everything that I have learned in my residency program and for the people who guided me and showed me how valuable a pharmacist can be.
This situation, however, could have gone down a different road. There were two other pharmacy residents in my year, and they were as similarly disheartened as I was. One of the residents had a passion for critical care. Therefore, she followed a similar suit where she had to contact numerous attending physicians whom she never met and establish electives in various critical care units throughout the hospital. The other resident just did not have the drive. She just fulfilled her core rotations and spent her elective months dabbling in different floors of the hospital, but never felt that she acquired anything out of her residency experience.
I cannot speak on behalf of my residency program or inform you about how it currently operates. My program director left the hospital a few years after I graduated and all of the pharmacists I worked with back then are currently employed elsewhere. It may very well be a much more structured program or it may still have same the spontaneity as it did then. However, many other programs may be similar in nature. It is very important for the pharmacy student / applicant to research the programs that they are interested in and make a decision about the type of programs that would best suit them.
A PGY-1 residency is a year of dedication equivalent to three years of experience. It is crucial to make the best of it because you only get to experience a PGY-1 residency once.
