Landing your dream job - Canadian Healthcare Network

A supplement from
2013/2014 Student Guide
Landing your
dream job
By Sonya Felix
New numbers show it has indeed gotten tougher out there
for new pharmacy grads. But there are exciting opportunities
for those who know where to look
Contents
Landing your dream job.............................. 1
Critical appraisal......................................... 4
The Pharm D shift....................................... 8
associate editor
Brett Ruffell
editor-in-chief
Vicki Wood
Art Director
Lima Kim
Publisher
Jackie Quemby
Account Managers
Scott Tweed, Pauline Shanks
Rogers Healthcare Group
Executive Publisher
Janet Smith
Editorial Director
Rick Campbell
Rogers Publishing Ltd.
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Steve Maich
Vice-Presidents
Immee Chee Wah, Patrick Renard
Contents copyright 2013 by
Rogers Publishing Ltd. The 2013
Student Career Guide is published
by Rogers Publishing Limited.
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tising anywhere [...] in Canada. You should never settle for a job
you hate just because it is in the right city. That almost never
ends well.”
Jason Perepelkin, assistant professor of social and administrative pharmacy, College of Pharmacy & Nutrition, University
of Saskatchewan, agrees that the ability to secure a job in any of
the 10 cities where schools of pharmacy are located in Canada
is difficult and has always been that way, even during the time
of bonuses and multiple offers.
“[Students] should consider what opportunities are one to
two hours away from their dream location,’” he says. “Many
times a more rural location offers a greater scope-of-practice
for pharmacists and one can learn many invaluable skills and
improve one’s practice expertise that would help them secure
that dream job in the future.”
W
hen Allison Tario enrolled in the pharmacy program
at the University of Waterloo three years ago, she
heard all kinds of horror stories about how hard it
would be to find a decent job at graduation.
“People said ‘Haven’t you heard that staff and salaries are being cut and drugstores are closing?’ and ‘Why would you want
to be a pharmacist?’” says Tario, who has just started her fourth
year and hopes to work at an independent community pharmacy after graduation.
But despite all the worries about how lots of pharmacies
would close as a result of drug policy reforms, she notes that
hasn’t happened. “I think pharmacy has adapted well to the
changes and will continue to evolve as long as we are open to
new ideas and willing to keep learning. I am genuinely excited
about the future.”
Such optimism might be surprising to some, especially to
those who are having trouble landing a job. While more than
92% of registered pharmacists were employed in pharmacy in
2012, more than two-thirds of the remaining 8% were seeking
employment, according to the Canadian Institute for Health
Information (CIHI), Pharmacist Workforce, 2012.
But pharmacy still seems to be a good bet for a well-paid career. “Canada’s Best Jobs 2013,” an annual feature published by
Canadian Business, ranked pharmacist as #27 this year, using
Statistics Canada data to compare wages and employment prospects. Based on a median annual salary of $95,680 in 2012, pharmacist is the fourth highest paid among the top 50 jobs listed,
with wages having increased by 21% between 2006 and 2012.
Still, the projected job openings in 2020 are only 0.71 for
every person looking for a job. That could mean that three in 10
“Students should develop their
own personal brand by thinking about what image they
want to project to colleagues
and future employers”
pharmacists who want a job won’t find one. With that in mind,
we asked experts to share some career advice for tomorrow’s
pharmacists.
Small town advantages
While Tario doesn’t yet have a job lined up, she is well aware that
prospects are better in smaller communities. “I’m open to working in an underserviced area,” she says.
That’s a good idea, according to David Edwards, Hallman
director of the School of Pharmacy and associate dean, Faculty
of Science, University of Waterloo. “The job market is definitely
tighter than it once was. This is especially true in some of the
larger urban centres, and I advise students to be open to prac-
GOOD TIP: THINK ABOUT YOUR DIGITAL FOOTPRINT!
“If something unflattering is posted online, there is a permanent record of
that, even after you personally delete it,” cautions Jason Perepelkin, assistant
professor of social and administrative pharmacy, College of Pharmacy & Nutrition,
University of Saskatchewan. “The vast majority of employers today, before ever
contacting you for an interview, will do a search of your digital footprint, and if
there is something that doesn’t align with that organization’s brand, your chances
of securing an interview are all but gone.”
2 pharmacypractice 2013 StudentCareerGuide
CanadianHealthcareNetwork.ca
Focus on acquiring skills
Getting a job isn’t as big a concern as finding one that encourages initiative, innovation and creativity, says Tario. “I realize I
am picky, but I really want a job that is right for me.” To compete
in the job market, she is preparing to differentiate herself. “No
matter what pharmacy program you go through, the knowledge
you acquire is basically the same. So extra skills and any community experience you have is important to show your initiative
and leadership qualities.”
Dr. Wayne Riggs, professor and associate dean, Faculty of
Pharmaceutical Sciences at the University of British Columbia
suggests that students prepare by enhancing their soft skills
such as verbal and written communications, fostering leadership skills and developing their interpersonal skills. As well,
he says that students need to be innovative in developing new
practice models as opposed to fitting into current models that
appear to be largely saturated.
Getting as much experience as possible in a range of different types of pharmacy practice settings is also a good idea, says
Edwards. “This will help identify what areas pharmacy students
are passionate about.” Pharmacy students at UWaterloo have
the advantage of a 16 months of co-op experience that allows
them to make connections with a number of pharmacists and
potential employers and understand what pharmacy practice is
all about in the real world.
The preparations for starting a career as a pharmacist should
really start the day students receive their acceptance letter to
pharmacy school, says Perepelkin. “Networking is a must, especially in a tight job market. Students should develop their
own personal brand by thinking about what image they want to
project to colleagues and future employers. What must not be
lost is the fact that the faculty at your pharmacy school are well
connected throughout the country—don’t burn bridges—this
goes for employers while in school and SPEP preceptors.”
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WATERLOO STUDENTS PRODUCE
DRAKE PARODY VIDEO
The four University of Waterloo pharmacy students behind
last year’s smash hit “Call the Pharmacy” have dropped
their latest single. This time the group, which includes
Danielle Paes, Bhupender Sayain, Kacie Lunn and Jaskiran
Otal, parodied Drake’s “Started from the Bottom” video that
the rapper filmed in an Ontario pharmacy.
The students say their version, “Started from the
Product”, is about pharmacists embracing new opportunities. It’s also about informing both the public and healthcare
professionals about the profession. “At the very least, people can hear a little bit about how pharmacists are making a
difference and see how the profession is evolving to address
challenges within our healthcare system,” says Paes.
Catch “Started from the Product” here, and their previous
hit “Call the Pharmacy” here.
Expect to work hard
As Perepelkin notes, even though demand for pharmacists
may be far greater than supply once the baby boomers retire,
finding a dream job will always be a challenge to secure. “While
building the desired practice many struggles occur, including
failures, but the one thing that [successful] practitioners have in
common is the will to continue on and learn from each experience—good or bad.”
And don’t be afraid to dream big. As a new pharmacy student,
Tario had never considered opening her own pharmacy, but the
idea is growing on her. “Obviously, that won’t happen initially
since I first have to find a job where I can continue learning as
much as I can,” she says.
“Pharmacy is at a delicate point where we are facing numerous budget cuts, changing our compensation model and needing to prove the value of patient-focused care to patients and
government. We have to balance making money with providing
patient services and I think having my own pharmacy could
give me freedom to be as creative and innovative as I want. And
that’s pretty exciting.”
pharmacypractice 2013 StudentCareerGuide 3
In these changing
times, fnding the right
partner is essential
Critical Appraisal
By Bryan Gray
4 pharmacypractice 2013 StudentCareerGuide
A
drug half-life is defined as the
time required for half the quantity of a drug to be metabolized or
eliminated. A longer half-life can impart
a longer duration of action. Now, what is
the half-life of your pharmacy degree?
Four years? Ten years? Twenty years?
Whatever the actual number may be,
it’s guaranteed that much of what you
are learning now will drastically change
over the span of your pharmacy career.
New waves of research trials, guidelines,
meta-analysis are being published at an
unprecedented rate. At graduation, your
CanadianHealthcareNetwork.ca
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CA0113GEN005E
How to extend the half-life of your education
so that you’re always on the crest of the latest
evidence-based practice wave
FIgure 1
Intensive case/care management
Level 3
Complex co-morbidity 3-5 %
In person
Disease/care management
Level 2
Poorly controlled single condition 15-20 %
phone
Self management
Level 1
Self-management 70-80 % of LTC
fax
Inequalities
targeted high
risk primary
prevention
Level 0
Population Wide Prevention, Health Improvement & Health Promotion
The Kaiser Permanente Pyramid: When collaborating with prescribers, consider the urgency of the recommendation and best approach.
For more minor recommendations, faxing is usually appropriate. For more urgent matters, a phone call is more effective. And if you have
the luxury of working in close proximity to prescribers, nothing will get a problem solved faster than walking down the hallway! Modified
from www.scotland.gov.uk/Publications/2009/12/03112054/4
clinical knowledge will be at the crest of the evidence wave and
you are likely to be the most up-to-date you will ever be.
After that…well, it’s up to you. So what’s the solution to extending the half-life of your education and riding that evidence wave
for longer? The answer is critical appraisal skills—tools that enable you to assess the trustworthiness and relevance of evidence.
Making the tough decision
What is each day but a series of conflicts between the right
way and the easy way? It takes less effort to swim downstream,
taking the path of least resistance. Sure, you could let that prescription for atenolol be dispensed again. Hopefully the aspirin
and warfarin will behave themselves and not interact. Perhaps
StaYIng uP-to-date WIth evIdenCe
Make Sure to SIgn uP For:
dynaMed - dynamed.ebscohost.com/about/weekly-update
BMJ Best Practice - bestpractice.bmj.com/best-practice/welcome.html
MedScape - www.medscape.com/pharmacists
BS Medicine podcast - therapeuticseducation.org
Mental health - www.morethanmeds.com/more-than-meds-news.html
Medication InfoShare - medicationinfoshare.com
6 pharmacypractice 2013 StudentCareerGuide
this one time the ezetimibe will actually prevent heart disease.
The thing is, you should be headed upstream. When you
decide to turn your back on what’s comfortable, routine and
what some would call common sense…well, that’s just the
beginning of experiencing the challenges and rewards of
evidence-based practice.
It can be difficult explaining to patients that the diclofenac
they’ve taken for years may cause a stomach ulcer or increase
their risk for heart disease. It’s tough sharing with a woman
that the hormone replacement therapy she’s taken for 10-plus
years may increase the risk for breast cancer.
From there it only gets tougher. So make sure you’re ready,
because the easy way out will always be there, ready to wash
you away. Stand true to your anchor of critical appraisal: relative vs. absolute risk reduction; NNTs and NNHs; surrogate vs. clinical
outcomes. These are the tools you’ll require
to ride the wave of evidence-based clinical
practice.
Patient-Centered Care:
A paradigm shift
The term patient-centered care will take on a
new meaning. By helping patients make evidence-based decisions regarding their own
CanadianHealthcareNetwork.ca
health, they will in turn become their own biggest advocates.
In using the best available evidence to facilitate patient education and self-management, you support enhanced health
literacy and better health outcomes.
In my experience, one of the most impactful moments is the
completion of a Framingham risk score. The patient’s surrogate outcomes (age, gender, blood pressure, cholesterol) are
entered into a risk calculator, which generates a meaningful
number for their personal risk of developing heart disease—a
clinical outcome. Here is when the patient will usually pause
and think, and then look up to me and ask what they should
do. This is a teachable moment.
I then provide the relative risk reductions for each intervention—quitting smoking, reducing blood pressure, taking lipidlowering therapy—and let the patient decide where they want
to focus.
Offering recommendations to prescribers
You’ve just written a comprehensive, thorough and accurate
list of recommendations to the prescriber. As you dial the fated
seven-digit number, the fax machine swallows your recommendation. Did it make it? Did the prescriber read it? Days later, your response curls out of the fax machine like a tidal wave.
“No,” is the only response to your three-paragraph, 250-word
recommendation with an attached reference. No explanation,
no rationale, no nothing—just a “No”.
This process is fraught with challenges. While many providers are eager to access the knowledge, skill and judgment of
the pharmacist, others are less receptive. Issues of territory,
hierarchy and politics are often front and centre. At times you
may feel as if you are engaged in a battle to ensure that optimal medication management is provided. It can seem a little
claustrophobic and scary. That’s just you—your fears; your
doubts; your insecurities.
It can be tough when your recommendations get shot down.
Though you may have the most up-to-date evidence available,
my suggestion is to tailor your approach based upon the level
of urgency (please see the Kaiser Permanente Pyramid, fig. 1).
Staying up-to-date
Staying afloat with all the new evidence will be tough. Attend
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Student leader honoured
You’ve likely heard about her vocal stylings (if not, see page
3). But the university of Waterloo’s danielle Paes, the 2013
Commitment to Care and Service award winner for Student
leadership, has much more to offer than her mic skills.
Paes belongs to a long list of professional associations
(six at last count). Since her first year in the program, she’s
also been active in the Canadian association of Pharmacy
Students and Interns (CaPSI) and helped coordinate the
ontario Pharmacy Students Integrative Summit. In 2012 she
was vice president of the university of Waterloo Society of
Pharmacy Students, welcomed new pharmacy students as
orientation committee chair, and edited the school yearbook.
this past year she sat on the pharmacy admissions interview panel at the university, was her student council’s member rep for the Canadian Society of hospital Pharmacists,
and was elected to the CaPSI executive, where she is editor
of the national newsletter. She takes her love of learning on
the road, regularly attending national conferences and local
interdisciplinary events.
and in her spare time she volunteers with Community
action now, helping with the soup kitchen and food drives.
Paes is clearly driven by a passion for helping those in need.
“I want to be someone who makes a difference in a stranger’s life,” the fourth-year student says on her nomination
form. “Pharmacy has given me the opportunity to do this.”
conferences, talks, lectures and presentations. Sign up for
email updates from evidence databases. Talk with your peers,
colleagues and other healthcare professionals. In the not-sodistance future when you eventually have your own pharmacy students working with you, ask them what they have just
learned in school!
As Theodore Roosevelt once said, “Believe you can and
you’re halfway there”.
So remember these tips when you get “no” for an answer:
• Stay true to the anchor of critical appraisal.
• Hone your collaborative relations.
• Stay up-to-date.
These approaches will help extend the half-life of your education so you can continue to provide the best level of care for
your patients.
pharmacypractice 2013 StudentCareerGuide 7
The
PharmD
Shift
PHARMACY IS
OPPORTUNITY
AT SHOPPERS
As schools upgrade to
entry-level doctor of
pharmacy programs, what
will change and what will
the move mean to you?
By Joe McAllister
S
tudents Sumaira Hasan and Danielle Paes are happy
with the way the University of Waterloo is instituting
its new entry-level doctor of pharmacy (ELPD) degree.
Although they’re still waiting for details of how they will transition into the program.
The two pharmacy students are part of Waterloo’s existing
bachelor of pharmacy program. But this January the school
enrolled its first ELPD class.
In December, Hasan finished a co-op turn at the Canadian
Pharmacists Association in Ottawa. She hopes to transition
to the PharmD program and is awaiting details on entrance
requirements.
“I am very happy with the curriculum changes being considered,” she wrote in an e-mail. “At the University of Waterloo,
students are consulted at the end of every school year for their
feedback regarding coursework, course load, and course con-
tent … They take student consultations very seriously.”
Fellow student Paes says she expects to graduate with a
bachelor of pharmacy (BScPhm) degree, but is considering upgrading to PharmD status in the future. After the faculty held
a number of town hall meetings about the change, she thinks
about 90% of current Waterloo BScPhm students will upgrade.
“I am thrilled that this option will be available to me.”
Waterloo, like most of Canada’s faculties of pharmacy, seems
to be ahead of the PharmD game. Canadian pharmacy faculties
pledged two years ago to upgrade their curriculums to ELPDs
by 2020. It looks like most will achieve their goal by enrolling
their first ELPD classes three or four years before the deadline.
Gradual acceptance
Less than 10 years ago many in the pharmacy community were
opposed to the upgrade. But the profession eventually under-
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8 pharmacypractice 2013 StudentCareerGuide
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stood the need to change to meet the challenges pharmacists
will face in the future, as front-line professionals dealing more
directly with patient’s needs.
“I’m all for it,” says David Hill, Dean of Pharmacy and
Nutrition at the University of Saskatchewan. Hill also chaired
the Blueprint for Pharmacy Task Force , a collaboration of national and provincial pharmacy organizations. The task force
reported in 2009 and, among other groups, lent its support to
the move to PharmD.
“It is a move that had to take place. I spent a number of
years at the University of Colorado where the first professional
degree is a PharmD. The idea of going back to a baccalaureate
program makes little sense. The complexity of the healthcare
system, drug therapy and patient management problems are
such we can no longer pack all of that in a four-year baccalaureate program.”
The first class of PharmD students at the University of
Saskatchewan will be enrolled in 2016. “We are like most of the
other schools right now, engaged in specific curriculum redesign processes that will lead
to new curriculums (and)
new doctor of pharmacy
programs. Apart from the
programs already there—
Toronto,
Montreal
and
Laval—the rest of us have committees in place that are actively
engaged in the redesign process.
“Our target date is 2016 … and the other universities all
seem to be converging around 2015 or 2016 for the start of new
programs.”
The two Quebec universities are ahead of other schools; the
University of Montreal has already graduated its first PharmD
class, while Laval enrolled its first PharmD students two years
ago. The University of Toronto enrolled its first class of PharmD
student in September, 2013, and has now had its program approved by accrediting agencies. U of T and UBC’s existing postgrad PharmD will continue.
The University of Waterloo, which operates on a semester
system, was able to enroll its first PharmD class in January, 2014.
AlbertA hAs other plAns
students in the first years, says Dr. David Edwards, dean of the
faculty of pharmacy at the University of Waterloo. “The classroom component won’t be changing too dramatically. (We) only
started our pharmacy program in 2008, so it didn’t require drastic change. The most substantial change is the change in clerical
experience our students will get,”
The four BScPhm co-op placements, which were part of
Waterloo’s curriculum, will be reduced to three, and a sixmonth clinical rotation focused on direct patient care added.
“At Waterloo, co-op is the strength of the university, and we’ve
applied that to pharmacy program. We have been met with a
lot of success and enthusiasm. We’ve had a focus on the business aspect of pharmacy and
I’m sure other programs will
put their own unique twist
on the program as well,” says
Edwards.
Despite Waterloo’s emphasis on co-op, he thinks Canadian pharmacy programs will all be
similar. “They won’t be wildly different. We all have to meet the
same accreditation standards.”
As pharmacists’ scope of practice
has expanded, we need to ensure
the curriculum reflects that
What change will look like
Although entrance requirements will probably include more
foundation courses in science and other subjects before acceptance, ELDP students won’t find a huge difference from BScPhm
10 pharmacypractice 2013 StudentCareerGuide
The U.S. example
The Canadian programs will be similar to the established
American PharmD programs, familiar for many in Canada’s
pharmacy faculties. Many, like Hill and Edwards, have taken
advanced degrees, or taught, in the U.S.
Neil MacKinnon, a Canadian, has crossed the border more
than once. He earned his doctorate at a U.S. university, returned
to Dalhousie for 12 years in the pharmacy faculty, served as
president of the Canadian Society of Hospital Pharmacists, and
was appointed dean of the University of Cincinnati this past
year (2013) after a stint teaching at the University of Arizona.
“It’s an interesting dynamic in that the U.S. made the move 10
or 15 years ago, so it is all entry-level PharmD here.
“It’s a very large change in Canada … I think there is a sense
in the profession that it is a good thing. As pharmacists’ scope
of practice has expanded, we need to ensure the curriculum
reflects that.”
But he adds a word of warning for students enthusiastic
about the change: “Putting my scientist, evidence-based hat on
and asking where is the evidence that pharmacists graduating
with a PharmD do better than those with a bachelor’s degree?
There really is none as far as I know.”
CanadianHealthcareNetwork.ca
And he doesn’t believe all of Canada’s new PharmD graduates
will end up utilizing their advanced skill set. “There is considerable variation between jurisdictions, provincial or state, with a
very wide variation of what pharmacists are doing. Some community pharmacists are still more traditional dispensing and
a bit of counselling. In others they are doing disease management. In the U.S. there is something called Medication Therapy
Management (MTM), while in Canada there are obviously
medication reviews, among other things.
“In the hospital setting there is a similar dynamic. Some hospital pharmacists are still doing distributive functions, maybe
not seeing patients at all, where others are using very, very advanced skills.”
More real world experience
At his school, fourth-year students spend the entire year in
clinical placements, which is part of the reason tuition is about
$17,000 a year. That figure is low for U.S. pharmacy schools.
Yearly tuition can be $40,000-plus at U.S. private, as opposed to
state-run, universities.
“Part of it is additional costs for preceptors. That is a challenge every pharmacy school in Canada is going to have to face
in the first years,” he says. Canadian students may not find the
additional clinic work is as valuable as they hoped.
“As we move into PharmD will schools have bachelor-trained
pharmacists precept PharmD students? That is an interesting
question. Until there are a large number of PharmD preceptors,
that is a challenge the schools will face.”
In the sparsely populated Prairies, the University of
Saskatchewan does not have access to the many sites for clinical experience available in population centres like Southern
Ontario, admits Hill, but he doesn’t foresee problems. “We do
know this is going to be a major undertaking for our college, as it
will be for all the other programs ... We know getting the clinical
sites are going to be a challenge for all of us.
“We’ll probably have a broader range of clinical placements
than we have ever had before. We will be innovative and creative about the type of practice sites we have available. I expect
international placements will be part of our plan.
“Saskatchewan’s healthcare system has developed a number
of primary-care centres new to the province, and these have
great environments to place students to train in a professional
environment with physicians and nurses.”
At Waterloo, Edwards says, “We’ve been going out around
CanadianHealthcareNetwork.ca
the University of Alberta is not going to an entry-level to
pharmacy doctorate route. this past fall the faculty enrolled
its first dozen bscphm graduates into its inaugural pharmD
course, a 14-month program that will concentrate on patient
care. the bachelor’s program will still lead to professional
accreditation. In future years, the pharmD program is
expected to attract practising pharmacists who wish to
upgrade their qualifications.
the U of A has also introduced Canada’s first MbA/
bscphm program in pharmacy, a 12-month course-intensive
business program taken before the fourth year of a bscphm
program. students completing the requirements graduate
with a dual MbA/bscphm degree.
the province talking to hospital and community pharmacists
and pharmacists in family health teams. I think there is a lot
of enthusiasm, and I’m optimistic we will have enough clinical
training sites.
“Because we are in a smaller urban setting without teaching
hospitals, we needed to reach out to the pharmacy practice
community in the province.”
What about my bachelor’s degree?
Another problem most schools will face is how to handle existing BScPhm students or recent graduates. At Waterloo, Hasan
will probably be allowed to transition into the PharmD program
with an extra year of schooling, while Paes will have the opportunity to upgrade her degree after graduation. At Saskatchewan,
the school will offer distance learning courses allowing present
BScPhm grads to earn their PharmD designation.
Hasan says she understands at Waterloo that the 2016 graduating class will be the first to have the opportunity to transition
from BScPhm to PharmD. “Being a young pharmacy school,
Waterloo has taken advantage of the feedback that students
provide, and they actively incorporate all comments and concerns into the curriculum.”
No one expects the quality of students or number of applicants to change greatly. At most schools up to 50% of students
already hold a BScPhm before being admitted to pharmacy.
Most schools already have admittance criteria placing emphasis on a candidate’s personal and community interaction, and
not just academic marks.
“Personally, I am quite happy and encouraged to see our curriculum transform to meet the educational needs for our evolving pharmacy practice. As a result of the modifications made to
our training, I believe pharmacy students graduating today will
be well equipped to take on the expanding scope of pharmacists within Canada’s healthcare system,” agrees Paes.
pharmacypractice 2013 StudentCareerGuide 11