ALBERT EINSTEIN MEDICAL CENTER: EXPLORING PHARMACY SPECIALIZATIONS

Author: Susan Farley

RESIDENTS OF THE GREATER Philadelphia area rely on the Albert Einstein Healthcare Network to provide high-quality care in its fast-paced, urban setting. This private, not-for-profit health system operates 5 major facilities and a variety of outpatient centers, including a behavioral health center, a rehabilitation facility, a subacute care facility, and a teaching hospital—Albert Einstein Medical Center. It is here where Einstein offers its patients advanced health services and its pharmacists an opportunity to carve out rewarding careers in a variety of specializations. Einstein's pharmacy service includes 1 central pharmacy and 5 satellite pharmacies— specializing in critical care, oncology, and neonatal/pediatrics. A dedication to patients and to progressive care led U.S. News & World Report to name Moss Rehabilitation Hospital (part of Albert Einstein Healthcare Network) one of America's best hospitals.

STARTING OUT

Thomas O'Connor, PharmD, MBA, is the clinical coordinator for students in Einstein's pharmacy program. After graduating from the Philadelphia College of Pharmacy, Dr. O'Connor began his career at Jefferson University Hospital in Philadelphia. Years later, while working in Ohio, he decided to return to the "City of Brotherly Love." He soon accepted a position as a pharmacist faculty member, teaching on-site, where he could combine his love of pharmacy and teaching. Every 5 weeks, he greets 12 new students eager to begin a new rotation. These rotations—students must complete 8 in their last year—include drug information, rounds, drug therapy questions, and presentations on drug efficacy. Upon completion of the program, these pharmacists will manage patient disease states and drug therapies, counsel patients and consult with physicians and nurses, as well as serve as a preceptor to new pharmacy students.

In addition, pharmacy residents provide direct patient care at Einstein's Immunodeficiency Clinic. They are also certified smoking cessation counselors and they coordinate the outpatient deep vein thrombosis treatment program. Residents are also in charge of counseling on low-molecular-weight heparin.

BIG-CITY RESPONSIBILITIES

Within the health care system and within the city, Einstein is not only a teaching hospital, but a neighborhood hospital as well. This brings a great sense of pride to the staff and students at the hospital, as they feel that they are making a true difference in their community. Because Einstein is a teaching hospital set in an urban setting, though, it is presented with another set of issues and responsibilities. Einstein's goal is not only to provide patients with exceptional treatment, but also to educate patients on how to alter their lifestyle to prevent diseases and infections once they leave the hospital. "We provide medical support for a lot of preventable diseases. As a result, our challenge is to promote behavior modification to support our therapy," said O'Connor.

THE ROAD LESS TRAVELED

Staying on top of the policies and regulations that allow Einstein to provide care for all of its patients is a vital piece of the puzzle, yet management is an often overlooked component of the pharmacy service. "The management aspect of pharmacy is pretty big in hospital pharmacy," says O'Connor, adding,"You can't be a good manager if you're not first a good pharmacist. Pharmacy schools have not embraced management as its own discipline. Most pharmacists don't even know they want to be managers. They start off grumbling about things like processes, scheduling, and coordination. This aspect of pharmacy takes you away from the warm glow of talking with doctors about drugs and consulting with patients. They think there is a front line that we're supposed to be on that does not include sitting on committees. But there's a real opportunity there to make a difference, and it's a good career, certainly. There are advancements in pay and opportunities to grow in your career. You can spend 4 to 5 years in a pharmacy and then start thinking of management," he suggests.

THE QUIET SIDE

What if management skills are not readily accessible for recent grads? "There are a lot of other opportunities in what I call the ‘quiet side of pharmacy.'That includes investigational drug research, pharmaceutical auditing, managed care, drug utilization review, research, and so on." In fact, Einstein maintains the long-running Clinical Trials Research Program, which serves as a home base for pharmaceutical, biotechnology, and medical device companies interested in conducting their research. More than 200 active clinical trials are going on at Einstein today.

Whatever aspect of pharmacy a resident ends up in, he or she must be adept at communication. While great emphasis is placed on the patient, there is not always an opportunity in hospital pharmacy for face-to-face contact. "That happens on a different level," notes O'Connor. "As much as they want to be patient-oriented, most interactions are with the professional staff. Not too many patients leave the hospital knowing the name of their pharmacist." If interaction with patients is not something a pharmacist strives for, there are many other opportunities to practice the profession—nuclear pharmacy, total parental nutrition, addiction services, compounding, etc.

While O'Connor recognizes the various sides of pharmacy, he sees their inherent conflicts. Between dispensing pharmacists and clinical pharmacists, there is a barrier, he says. "We're trying to combine both clinical services and distributive services. At Einstein, the clinical pharmacists are responsible for putting in an order. Bottom line, we don't have a ‘we're clinical, you're not'problem. Hospitals that integrate the clinical and distributive roles of pharmacy support both the need to be patient-oriented with the need to be competent in the distributive policies and procedures. It's more important to integrate. We need to understand each of the responsibilities and put the pharmacy back together again."

In most programs recent grads will usually begin their clinical practice as a "generalist" in a 6-month training program. Once they show proficiency, they can decide whether or not they would like to pursue a specialization such as acute care, infectious disease pharmacy, or oncology/chemotherapy.

THE PHARMACY OF TOMORROW

Based on his own experiences, O'Connor sees for the future of pharmacy a recentralized pharmacy service with mail orders increasing. He predicts patients will become more and more comfortable with Web services. "You'll continue to see emergency drugs and initial therapy provided locally with centralization of prescription of chronic therapy. Pharmacists will be there for the initial counseling, but the filling will be done elsewhere." That leaves pharmacists working for big organizations rather than small pharmacies, he says. "There will be big banks of pharmacists with headphones taking drug information questions from patients and doctors and nurses—via headphones, e-mail, phones—not in person. Face-to-face counseling is effective but not all patients are ready to learn at the moment they pick up their prescription. Therefore, following up with a phone call, printed material, or e-mails can supplement in-store counseling," says O'Connor. "In the future," he predicts, "there will be more continuity of care."

Ms. Farley is a freelance medical writer based in Wakefield, RI.