One of the most critical decisions a pharmacy student has to make is whether to pursue retail or hospital pharmacy. As the job market for pharmacists becomes increasingly competitive, it is important to understand the difference between the two work settings. In this article, we will analyze the similarities and differences between retail and hospital pharmacy.
Daily Tasks - Retail Pharmacy
As a retail pharmacist, you are in charge of ensuring the safe dispensing of medications to patients pursuant to a prescription. The prescription is either called in verbally, electronically prescribed, or written. The pharmacist is responsible for ensuring that the prescription is accurately transcribed into the pharmacy’s computer system, although the technician may actually complete this function.
The pharmacist must also assess appropriateness of the medication for that patient on the basis of age, sex, and pertinent drug interactions. In addition, the pharmacist is responsible for ensuring that the correct medication is filled and dispensed. Another critical priority for retail pharmacists is patient education.
The pharmacist must act as the “drug expert” in their community and ensure patients understand their medications. Depending on the state’s regulations, pharmacists are responsible for counseling their patients on appropriate use of their medications, including potential side effects, administration and storage tips, and any other outstanding questions that the patient may have. Retail pharmacists also provide valuable advice on self-care treatment via over-the-counter medications.
Other responsibilities for a retail pharmacist include insurance troubleshooting, continuous technician supervision, ensuring compliance with controlled substance regulations, administration of immunizations, medication therapy management (MTM), and general customer service. The expectations for these roles, especially immunizations and MTM, can vary dramatically depending on the culture of the particular organization that the pharmacist works for. These tend to boost profit margins in retail pharmacy and provide an important service to patients in the community.
Unfortunately, many pharmacists feel that they do not have enough time to focus on these functions as pharmacist and technician hours are often tight. One of the most difficult responsibilities for a retail pharmacist, in my opinion, is having to play an integral role in managing our nation’s opioid crisis.
Pharmacists must do their best to inhibit abuse of narcotics and other controlled substances. Pharmacists cannot blindly trust patients or their other healthcare providers. They must do their due diligence to prevent inappropriate use of these medications which may include assessing their state’s controlled substance databases (vary widely by state) to avoid duplication of therapy and pharmacy or prescriber shopping.
At times, difficult conversations with patients and prescribers must be done. Retail pharmacists have opportunities to become promoted into leadership positions such as pharmacist-in-charge which completes store-level administrative functions like scheduling, quality improvement, and regulatory functions.
A layer higher would be the district manager which is responsible for a region of pharmacies within the organization and tends to focus on metrics such as volume of scripts, immunizations, and profitability. District managers may also dictate the amount of labor allocated to each store within their pharmacies. All in all, district managers tend to work with the organization leaders to promote the initiatives that are decided.
Retail pharmacist are uniquely positioned to be an accessible member of the health care team and can provide extremely valuable services to their patients. Being able to create close relationships with patients also allows them to be one of the most trusted professions in the country.
Daily Tasks - Hospital Pharmacy
Hospital pharmacists can perform a variety of tasks depending on the specific setting that they practice in. Generally speaking, in large hospitals there tends to be two types of hospital pharmacists: ones that focus on operations and those that focus on clinical functions.
Operations pharmacists, or staff pharmacists, are responsible for supervising technicians who prepare medications for patients across the hospital, including refilling unit-based automated dispensing cabinets (ADC) and compounding sterile products in a clean room environment.
Operations pharmacists are typically stationed in the Central Pharmacy, IV room compounding areas, or satellite pharmacies. The pharmacist must ensure the right product gets to the patient in a safe, efficient way. Additionally, operations pharmacists usually verify a subset of electronic (and sometimes still paper) orders from across the hospital. For example, operations pharmacists usually cover procedural areas where there are no clinical pharmacists to cover. They are also available as a resource for nurses and physicians and to troubleshoot pharmacy-related issues throughout the hospital.
Clinical pharmacists in large academic hospitals are usually decentralized and unit-based. They are responsible for taking care of all of the pharmacy needs for their patients, nurses, and physicians. Clinical pharmacists may be specialized in areas such as cardiology, internal medicine, ID, pain management, emergency care, or critical care.
These pharmacists may complete rounds with clinical teams that include physicians, nurse practitioners, physician assistants, nurses, dieticians, and respiratory care. They are considered to be the drug expert on the team and often collaborate with physicians to make decisions on the patient’s therapy. In academic settings, clinical pharmacists may have opportunities to be involved in research.
Hospital pharmacists also tend to have scope of practice to manage drug therapy in many policy driven situations including pharmacokinetics (vancomycin and aminoglycosides are most common), IV-PO conversion, renal dosing, warfarin dosing, parenteral nutrition, and therapeutic interchange. Additionally, hospital pharmacists are often involved in hospital and pharmacy committees, resident and student precepting, and quality improvement projects.
Leadership opportunities within hospital pharmacy include positions involved with managing operations, the clinical program, drug formulary, inventory management, controlled substances, education, research, and medication safety. The director of pharmacy is the head of the department and works closely with hospital leadership. Hospital pharmacy leadership is responsible for managing difficult situations like drug shortages, drug budget, HR responsibilities, and even disasters like mass casualties or hurricanes.
All in all, hospital pharmacists tend to work with different customers than retail pharmacists. While the patient is at the center of all that they do, pharmacists are a crucial part of the health care team and are a valuable resource for nurses, doctors, dieticians, and other healthcare providers. In addition, working on a diverse team that includes a variety of specialized pharmacists promotes teamwork and collaboration in the hospital setting.
As a budding pharmacist, it is important to understand the differences in training requirements for pharmacists in the retail and hospital settings prior to deciding on a desired career path. Retail pharmacists are more likely to be hired directly out of pharmacy school based on the sheer number of jobs in the market.
It is uncommon for retail pharmacists to be required to have residency training, however, there are community pharmacy residency programs per the ASHP Residency Directory. Retail pharmacists may be required to become immunization certified and trained in MTM services.
Hospital pharmacists tend to have varying levels of training post-graduate school. Completing a residency program makes a candidate more competitive in the job market, however, it is not unheard of to be hired as a hospital pharmacist directly from pharmacy school.
Operations pharmacists are less likely to be residency trained as compared to clinical pharmacists. Clinical pharmacists in large academic health systems are usually required to be residency trained for 1 to 2 years.
Residency programs provide general clinical training in the first post-graduate year, also known as a PGY-1. Most programs provide diverse experiences depending on the hospital specialties available and usually offer rotations in cardiology, internal medicine, critical care, and administration, for example. The first year essentially trains you to become a competent hospital pharmacist—skills that aren’t necessarily taught in pharmacy school. Also, research and student precepting are emphasized to give the opportunity to gain experience in these areas.
Second post-graduate year programs, known as PGY-2s, allow for further training to become a specialist in areas like critical care, administration, and infectious disease. These programs allow you to focus on your area of interest and are often completed at the same institution as your PGY-1. Some programs even offer combined PGY-1/PGY-2 programs or early commit processes to enhance continuity.
Salary and benefits are similar among retail and hospital, but vary significantly depending on the particular role and setting. Retail pharmacists tend to make slightly more than hospital pharmacists on a salary basis. It is also important to note the lost salary during residency training.
Residents average less than half the salary of other pharmacists and therefore lose income upfront relative to pharmacists who forego residency.
Pharmacists in the hospital setting are more likely to be needed during over nights, holidays, and even natural disasters due to the 24/7 nature of the hospital. Hospitals tend to down staff during these times and often minimize clinical services.
During natural disasters, such as hurricanes, pharmacists may have to stay for 48-72 hours to ensure coverage during crucial times of need. Both retail and hospital shifts vary depending on the particular setting, but both tend to work 8-12 hours per day and approximately 40 hours per week—though overtime opportunities may exist.
Both retail and hospital pharmacists are valuable members of the health care team and provide important services to patients in a variety of ways. Both are experts in their field and one of the most well-respected professions in the country.
While retail pharmacists work more directly with patients, hospital pharmacists tend to work behind the scenes and in collaboration with the health care team. A variety of differences exist between the two settings including daily activities, training requirements, salary, and staffing situations.
It is Important to realize that there is no right or wrong answer when pursuing a particular path as a pharmacist. Reflect on your particular values, strengths, and situation to determine the best path for you. Also understand that this a general assessment of retail and hospital pharmacy—every work setting is unique!
Finally, although retail and hospital are the primary work settings for pharmacists, there are many more opportunities that exist including nuclear, academia, industry, research, MTM, managed care, and ambulatory care. The sky is the limit and it never hurts to get experience in a variety of settings!