I Want to be a Pharmacist When I Grow Up

I am a preceptor for 2 colleges of pharmacy in the area. Today, I had my very first student. He is a first-year pharmacy student. He has to do two four-hour “shadow” rotations this quarter, one in a retail pharmacy and one in a hospital pharmacy. This student has never worked in a pharmacy before, but spent 4 hours with me today behind the counter.

I think that is kind of nuts.
I started as a clerk in an independent pharmacy at the age of 15. It was an after school job. I would put away the drug order, file prescriptions, answer the phone, and run the cash register. Before working in a pharmacy, I wanted to be a journalist when I grew up. I was on the newspaper staff and was the yearbook editor. But after working in a pharmacy for a few years, I fell in love with it and decided that pharmacy is what I would do.

Granted, pharmacy was a different thing then than it is now. I worked in an independent pharmacy. We were open 8-6:30 Monday through Friday, 10-2 on Saturdays, and closed on Sundays. The pharmacy filled about 1000 prescriptions a week, and did it with 3 full-time pharmacists, 3 full-time technicians, and me (the clerk). There was plenty of staff to get our jobs done, interact with our customers, and have fun at the same time.

The pharmacists that worked there were great. They had positive relationships with their patients; and taught me a lot about pharmacy. It was interesting to me, and I had lots of questions. “Why this drug? Why do these smell funny? What’s this medicine for?”

They would draw me chemical structures, explain a drug’s mechanism of action, and quiz me on my brand-generic names. One pharmacist would send me home with a list of drug brand and generic names to memorize in the evenings. He would usually do it by class; one evening I would have ACE inhibitors, the next it would be beta-blockers, etc. The pharmacists also taught me how to compound medications, I distinctly remember spending hours making diethylstilbesterol capsules (for canine incontinence) and a cocaine-based oral gel. I also used to “compound” my own flavored lip glosses that we sold at the counter.

I remember at that pharmacy the first brand-generic combo that I memorized was Sinemet. The pharmacist told me that she remembered the generic name by doing the “Sinemet cheer.”

Carbi-dopa levo-dopa RAH RAH RAH!

When I moved away to college, I got a job in a different pharmacy. This time my job title was actually “technician.” It was another independent with a closed-door operation (for nursing home prescriptions, we did lots of blister packing) as well as a retail operation. I started in the closed-door portion; I was responsible for all of the medications for a local convalescent center. They had weekly blister packs; I prepared the weekly packs and kept up-to-date charts to record medication changes. I also delivered to the center once daily to take them new orders. After a couple months, I transitioned that convalescent center to monthly blister packs instead of the weekly ones and moved to work in the retail operation.

The good part about working in an independent is that I always had a lot of responsibility. My pharmacy manager had me prepare the contract that the pharmacy made with the local women’s prison (we supplied their medications). They also sent me through a compounding training program (I made lots of ketamine PLO gels and hydrocodone lollipops) and taught me how to work under a laminar flow hood (mixing IVs).

When I got into pharmacy school, I moved again. This time, no jobs at independent pharmacies were available. I went to work as a pharmacy intern for a department store. This was my first experience working for a corporation. I took all the knowledge and experience that I had gained at independents and applied it to my new job. When the pharmacy’s technician hours were going to be cut because of decreased volume, I talked the pharmacy manager into letting me “detail” local nursing homes to see if they needed pharmacy services. I ordered blister packs and started medication filling and management for two nursing homes in the area, increasing our monthly prescription count by several hundred Rxs.

By the time I graduated from pharmacy school I had 7 or 8 years of experience under my belt, in several different practice settings. I knew what I was getting into. I can’t imagine graduating from school and getting a job, never having done it (except on rotations). I would have been scared shitless. As it was, I was pretty confident when I first got licensed, thanks to all my previous experience.

My student today didn’t know much of anything about pharmacy. I was explaining rejected claims and about prior authorizations. I told him that patients expect me to be an expert on their insurance but not on their drugs. The only “clinical” thing that I did was compound some testosterone vaginal cream.

I feel bad; he isn’t going to have nearly the experience I had going into pharmacy. Pretty much the only experience he will have will be his six-week retail pharmacy rotation. He is probably going to just end up working for CVS or Walgreens and never know all that pharmacy has to offer as a profession. It is truly amazing how much the practice of pharmacy has changed in a decade.

How does one decide to be a pharmacist without ever having worked in a pharmacy? What would be the appeal for someone who hadn’t ever done it? And how is this student going to fare his first year practicing as a pharmacist when his school teaches him virtually no “practical” knowledge that he needs to be a retail pharmacist?