Eileen Koutnik-Fotopoulos

	For many individuals with chronic conditions, pain is a primary symtpom. The National Center for Health Statistics reports that the incidence of pain affects more Americans (76.2 million), compared with diabetes, heart disease, and cancer combined. Pain is classified as acute or chronic, and they are significantly different.

	Acute pain results from disease, inflammation, or injury to tissues. Acute pain is confined to a given period of time and severity. Chronic pain persists over a long period of time, however. More than 50 million Americans experience chronic pain, according to the American Pain Foundation (APF). The most common chronic pain syndromes are back pain, headache, and joint pain caused by osteoarthritis. Furthermore, chronic pain negatively impacts patients’ emotional well-being and quality of life. The burden of pain is also costly, with an estimated $100 billion spent annually in the United States on health care expenses, lost income, and lost productivity, states the APF.

	Chronic diseases associated with inflammation are also on the rise. For example, the number of patients with physician-diagnosed arthritis is projected to increase from the currently estimated 46 million US adults to 67 million by 2030, according to the APF.

	A variety of OTC analgesics are used in the treatment and management of pain and inflammation associated with backache, headache, muscular aches, fever, toothache, menstrual cramps, the common cold, and minor pain of arthritis. The most commonly used oral analgesics to treat these symtpoms are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs; eg, ibuprofen, aspirin, naproxen, and ketoprofen).

	Studies have shown, however, that a majority of patients who use OTC analgesics do not read the product labels, are unaware of the potential risks associated with taking the drugs, and combine these products with other OTC and prescription medicines.

	The proper use of OTC analgesics has come under scrutinty by the FDA. On April 29, 2009, the FDA issued a final ruling that requires manufacturers of OTC pain relievers and fever reducers to revise their labeling to include warnings about potential safety risks (Table). Since 2006, some manufacturers have voluntarily revised their product labeling to highlight these potential safety risks. The voluntary changes to the labeling did not address all of the labeling requirements in the new ruling, however. All OTC manufacturers of NSAID and acetaminophen products had until April of this year to comply with these labeling requirements.

	The new labeling is based, in part, on safety data reported in published litertaure on the use of acetaminophen and NSAIDs. Data indicates that individuals sometimes take more acetaminophen than the labeling recommends. Others unknowingly take multiple products containing acetaminophen at the same time. Exceeding the recommended dose may increase the risk of severe liver damage. Individuals who take NSAIDs who are on warfarin therapy or steroids face an increased risk of stomach bleeding. Stomach bleeding risks also increase for individuals who take multiple NSAIDs at the same time or who take them longer than recommended. The revised labeling also applies to all products that contain an NSAID or acetaminophen, even if combined with other active ingredients, such as cold symptom relievers.

	As one of the most trusted and accessible health care professionals, pharmacists should counsel patients in the proper selection and use of OTC analgesics (Sidebar). Before recommending any products, pharmacists should:

	•         Consider the patient’s medical profile and any history of allergies to prevent possible drug—drug interactions and contraindications.

	•         Check the ingredients of OTC medicines if patients are buying multiple products, and, if duplicate active ingredients are found, make patients aware and recommend alternative products.

	•         Recommend patients with preexisting medical conditions consult their physician before using any of these products.

	•         Encourage patients to ask questions if they are unsure of the proper use of OTC pain relievers.

New Labeling Requirements for OTC Pain Relivers and Fever Reducers

					“Acetaminophen” must be highlighted or in bold type and in a prominent print size on the PDP

					“NSAID” must be highlighted or in bold type and in a prominent print size on the PDP

					Liver warning: Severe liver damage may occur if you take more than the maximum daily dose in 24 hours; take with other drugs containing acetaminophen; and consume 3 or more alcoholic drinks daily while using this product

					Stomach bleeding warning: This product contains an NSAID, which may cause severe stomach bleeding if you are over age 60; have had prior ulcers or bleeding; take a blood thinner or steroid drug, take with other drugs containing NSAIDs (prescription and OTC); have 3 or more alcoholic drinks daily while using this product; and take for longer than recommended

					If unsure whether a drug contains acetaminophen (prescription or OTC) ask a physician or pharmacist,

					Ask a physician before use if you are at an increased risk for stomach bleeding problems

					Ask a physician before use if you have liver disease

					Stop use and ask a physician if you experience the following signs of stomach bleeding: feel faint, vomit blood, have bloody or black stools, and have stomach pain that does not resolve

					Ask a physician or pharmacist before use if you are taking warfarin

Articles

Pain and Inflammation: The Importance of Proper Use of OTC Analgesics

Ms. Koutnik-Fotopoulos is a freelance writer based in Keyport, New Jersey.

The days of cherry-picking jobs are no longer an expectation among graduating pharmacists; 

however, this does not translate into a bleak future for a career in pharmacy. “

	The increasing number of pharmacy schools that have emerged, resulting in more graduating students and the shortage of pharmacists that existed 3 and 4 years ago has shrunk,” explains James A. Owen, BSPharm, PharmD, BCPS, director of professional practice at the American Pharmacists Association (APhA). “This has resulted in more competition instead of just slots to fill jobs.”

	As of July 2009, there were 111 United States— based colleges and schools of pharmacy with accredited professional degree programs and 5 schools with precandidate status, according to the American Association of Colleges of Pharmacy (AACP) Web site. The number of schools of pharmacy has gradually increased in recent years, though—the Accreditation Council for Pharmacy Education’s Web site stated that there were 99 programs with accredited status in 2006&mdash;an increase of 12 programs in just 3 years.

	“Major metropolitan markets are becoming saturated,” says Jennifer Athay, director of student affairs at AACP. “However, it does not mean that jobs are not available. The job prospects are expected to be good. Deans are telling us that students are finding jobs, but they may not have gotten the exact job they wanted.”

	“Students are going to have to put a lot more effort into finding a job,” she adds.

	The current economic climate is a major factor in the number of jobs available. Industry experts are reporting that the days of retail pharmacy chains recruiting student pharmacists with sign-on bonus incentives have fallen by the wayside. Preliminary data from the not yet released 2009 National Pharmacist Workforce Survey (results will be released at the 2010 APhA annual meeting) found that 27% of respondents reported the restructuring of pharmacist work schedules at their place of employment to save labor costs, followed by mandatory reductions in pharmacists’ hours (15%), layoffs (6%), and early retirement incentives (3%). In both urban and rural areas, pharmacists working in chain and hospital pharmacies were more likely to report “mandatory reduction in pharmacists’ hours” and “restructuring of pharmacist work schedules to save labor costs.” 

What does the current economic recession mean for graduating pharmacists? Students are pursuing careers in academia, postgraduate studies, and residency programs. The AACP reports that in 2008, there were 4957 full-time and 525 part-time faculty members at 111 schools of pharmacy.

	The increasing number of pharmacy schools has helped fuel the growth of careers in academia. Owen says that opportunities in academia have expanded over the last 2 decades. “We are seeing an increase in applicants for our AACP—Wal-Mart Scholars Program,” says Athay.

	AACP and Wal-Mart share the commitment to help colleges and schools of pharmacy ensure that there is an adequate number of well-prepared individuals who aspire to join the faculties at the growing number of institutions across the country. The goal of the program is to strengthen the students’ skills and commitment to a career in academic pharmacy through their participation at the AACP Annual Meeting and Seminars. Funded by Wal- Mart, the program provides $1000 scholarships to 65 student-faculty pairs from AACP member institutions to attend 2 AACP seminars.

	Dachelle Johnson, PharmD, 2009 graduate from the Medical University of South Carolina, is currently a postgraduate year-1 (PGY-1) pharmacy practice resident at the Johns Hopkins Hospital, and will continue on to do a PGY-2 specialty residency in critical care. She chose this particular career for the multiple opportunities to which it lends itself in pharmacy. “Ultimately, I plan to be a clinical specialist in an ICU [intensive care unit] setting, conduct research, and precept students,” she said.

	“A residency program gives me the tools to accomplish these short-term goals while allowing me the flexibility to pursue other opportunities, should they present,” Johnson explains. “There is a lot of competition for residency positions. Unfortunately, the amount of individuals applying for residency positions is increasing at a much greater rate than the amount of available positions.”

	Kyleigh Estler, PharmD Candidate 2010, attending the Ernest Mario School of Pharmacy at Rutgers University, is in the process of joining the Navy Medical Service Corps as a pharmacist. Having lived in New Jersey her entire life, Estler sees a pharmacy career in the military as a way to see other parts of the country and the world.

	“The military provides a lot of benefits for a recent graduate, including loan repayment, which will allow me to pursue life experiences without worrying about financial problems. I have nothing but respect for the members of our military, and being able to give back to my country is something that has always appealed to me,” says Estler.

	“The competition is really for the scholarship program, which is a great program. You are commissioned in your third year of school and have your last 2 years paid for. It is a very competitive scholarship to get. The Navy, and the military in general, has the most up-to-date facilities that a new graduate could hope for, which makes it an attractive position to have,” she explains. 

Future pharmacists need to start thinking about their career track in their third and fourth years of pharmacy school.

	Johnson started looking into specific residency programs during her fourth year of school. “I spoke to current residents and professors for their advice and used the ASHP [American Society of Health-System Pharmacists] Web site to narrow my search.” Attending ASHP’s midyear clinical meeting is also useful. Johnson said it “was a major factor in the process. It allowed me to meet with different program directors and ask questions that could not be answered by just looking at their respective Web sites.”

	The idea of joining the military first presented itself in Estler’s third year of pharmacy school. “It seemed like something different that would open up a lot of opportunities for me in the future. After speaking with a Navy recruiter, I knew it was what I wanted to do. The process has been long, but is up to the individual. There are many steps along the way and lots and lots of paperwork to fill out.”

	Athay points out that securing a job after graduation takes more than just getting good grades. “Students need to take advantage of leadership roles within professional organizations, do more volunteer work, and consider residency programs to help differentiate themselves from their peers.” 

Pharmacy schools and professional associations offer resources to help students find employment. Both Johnson and Estler took advantage of these opportunities.

	The Medical University of South Carolina hosted a career day, where different retail chains visited the school on designated days to set up interviews or answer questions. The school also had a seminar that offered help with CV [curriculum vitae] and an elective for individuals interested in residency training. “This elective, called the clinical track, allowed me to pick up an extra rotation to make me a more competitive candidate, offered insight into the National Matching Service, expanded upon benefits of pursuing postgraduate training, and gave many helpful tips about applying for residency,” says Johnson.

	“Throughout our fourth year, especially, there have been networking events, interview days, and showcases,” says Estler. “There were opportunities to check out almost any area of pharmacy that may interest you. The resources are definitely there; the students just have to use them.”

	“If they do not choose to engage, they will not be able to take advantage,” concurs Owen. “The resources are there if they want them.” 

The APhA Annual Meeting and Exposition, scheduled for March 12-15, 2010, is well-attended by pharmacy students. During the 3-day meeting each year, students can attend the APhA Career Connection. The career exposition will expose pharmacists and student pharmacists to career opportunities by connecting them with employers as well as representatives from advanced education programs. In addition, students can register for the Student Information Showcase. This showcase provides an opportunity for community pharmacy residency programs and other postgraduate training programs to exhibit program materials and to interact with students.

	The APhA Web site also has a careers link offering helpful tools from choosing the right employer to networking to job interviewing tips.

	In addition to the Residency Showcase at ASHP’s Midyear Clinical Meeting, the December 2009 meeting offered student programming with workshops and roundtables geared toward helping students hone their skills for finding a job. The meeting also staged CareerPharm’s Personnel Placement Service—a national pharmacy recruitment event. 

Networking is becoming an increasingly popular and important component for seeking employment, and it is a job skill that students need to hone.

	“Networking is huge, especially in the profession of pharmacy where everyone seems to know everyone,” comments Johnson. “Keep in touch with your contacts—send them an e-mail every now and then to see how they are doing or just to update them on what you are doing. This way, when you contact them to write a recommendation letter on your behalf, you are memorable and they can write a meaningful letter, rather than inserting your name into a template.”

	“Networking helps to get you in the door for interviews, but it will not do the job for you,” cautions Estler. “The best way to network is to just take part in the events that are offered to you.” 

Aside from having an up-to-date CV, Estler adds, “Do not be afraid to say what you did. As students, we have the tendency to downplay our roles, and that is reflected in how we describe them on our CVs. It is basically an advertisement of yourself, and you have to make yourself look good.”

	Job interviews can be stressful. “Be yourself—just a more professional and well-spoken version of yourself,” advises Estler. “You cannot sell something you are not, and you should not try&mdash;it will only make you nervous. Remember that the person sitting in front of you has been in your seat and knows what it is like.” 

Research the institution and the people you will be interviewing with before the interview. 

Never speak badly about another institution while on an interview. 

Make business cards and send thank you cards. 

Practice good dinner etiquette for dinner interviews. 

As competition increases in the pharmacy job market, graduating pharmacy students should look for a job early and take advantage of career and networking resources.

Job Search Navigation Skills: Understanding Today's Economic Lay of the Land

Ms. Koutnik-Fotopoulos is a freelance writer based in Keyport, New Jersey.  

It is the final year of pharmacy school, and it is decision time. While in school, students have spent years taking classes, getting involved in pharmacy advocacy, doing an internship or clerkship rotation, and countless other requirements in preparation for becoming a pharmacist. Now it is time to take all the knowledge and experience and apply it to a career in pharmacy.

Career options in the ever-changing pharmacy profession offer students numerous avenues to pursue. Graduating pharmacy students need to consider all their options and determine if they want direct patient care opportunities, conduct research in the pharmaceutical industry, or go into academia. If they choose direct patient care opportunities in community pharmacy, they need to factor in the practice setting and size of pharmacy.

Many future pharmacists are choosing to work in smaller regional chains. As the most accessible health care provider, pharmacists play an active role in patient counseling and medication therapy management (MTM) as the number of Americans taking more medications grows. Regional drug chains are known for their personal care and patient service. A career in this practice setting affords graduating pharmacists the opportunity to assist patients with their health care needs and form relationships with people in the community.

Headquartered in Omaha, Nebraska, Pamida is one regional chain that offers an exciting, rewarding career. The company operates 142 pharmacies in 15 states, employs 1092 pharmacists, and dispenses, on average, 500,000 prescriptions per month.

Pamida is looking for prospective pharmacy graduates who have “strong pharmaceutical care skills, including customer service ability, business acumen, and willingness to differentiate Pamida from the industry via specialized services such as [MTM], immunizations, diabetes counseling, etc,” explains Tony Schmid, director of pharmacy operations.

Internships with Pamida are beneficial for pharmacy students considering a career with a regional drug chain. Schmid says that quite a few students who do internships with the company decide to stay on after graduating. Students who choose to pursue a career elsewhere are “generally looking for a bigger city to settle in.”

In addition to a competitive salary with the industry and a benefits package that includes medical, dental, and vision; 401(k) plus company match after 1 year; and 2 weeks’ vacation and 3 personal days, Pamida offers a lot more that is attractive to future pharmacists.

“Being that Pamida pharmacies are in small communities, our pharmacists are leaders and important members of their communities,” says Schmid. “They are able to work in a pharmacy that is oftentimes closed by dinnertime, and they never work Sundays or holidays. Our company is on goal to increase the percentage of nationally certified technicians, which we believe will aid in our pharmacists’ ability to interact even more with their customers.”

In its ongoing efforts to better serve patients, Pamida’s biggest incentive for its patients “is our service; it is what we stand behind,” comments Schmid. Services offered include free prescription mail-out service and intown delivery, private one-on-one consultations with a pharmacist, MTM and immunization services in certain locations, electronic prescribing capabilities, convenient drivethru in some locations, assisted living and nursing prescription service, and hospice service.

Pharmacists are facing more adversity as the pharmacy industry, particularly with small regional chains, continues to change. Schmid attributes it to “increased competition both for sales and recruiting. Sales and margins are being squeezed due to lowered reimbursements and competitive cash pricing on generics. The recruitment of pharmacists is becoming more difficult due to longer life cycles of pharmacists and higher wages of pharmacists keeping retirement-aged pharmacists in the game longer.”

Built around the vision of pharmacist James Ruben, Shopko opened its first location in 1962 in Green Bay, Wisconsin (its headquarters). Shopko has 2 divisions: 136 Shopko stores and 6 Shopko Express Rx stores in 13 states throughout the Midwest, Mountain, and Pacific Northwest regions. The pharmacy fills approximately 12 million prescriptions per year.

Because pharmacy service is the cornerstone of the company’s business, Shopko offers future pharmacists an environment they can thrive in. Students looking for a pharmacy career with Shopko will need to have “exemplary patient care and customer service skills, communication skills, leadership potential, and the ability to understand business,” explains Shantell Nelson, corporate and retail health recruiting manager.

Pharmacy students can get a firsthand look at a Shopko pharmacy by doing an internship. “Pharmacy interns benefit from the same work culture that our pharmacists enjoy: strong mentoring relationships, development and leadership opportunities, and time and resources to focus on patient care and practice the profession,” says Nelson.

In addition to internships, the company implemented a pharmacy Student Loan Program to continue to promote the profession more than a decade ago. Eligible students can qualify for up to $33,000 in student loans. Students accepted into pharmacy school and remain in good standing can be recommended by a Shopko pharmacy manager for the program.

“At Shopko, development of future pharmacists is crucial to our success. Pharmacy accounts for more than 30% of our profit,” says Nelson. “We were founded by a pharmacist and have had pharmacists as senior leaders throughout our history, so it is important to help future pharmacist education.”

Nelson believes, for students who enjoy the community setting, “regional retailers can provide a unique balance between retail pharmacy with corporate resources and the feel of working for an independent pharmacy.”

In addition to a competitive salary with industry and comparable benefits to pharmacists who work a minimum of 20 hours per week, the benefit package includes medical, dental, and vision coverage; paid vacation and holidays; 401(k) after 90 days plus company match after 1 year; flexible spending account, employee assistance programs; and teammate appreciation sales. Perhaps what makes a pharmacy career with Shopko attractive is “access to senior leadership with a short chain of command. Shopko pharmacists have ownership of their impact on the community. They have access to corporate resources, yet are able to control scheduling, workflow design, work environment, community program offerings, and more,” notes Nelson.

The various Shopko pharmacy initiatives allow pharmacists to continue to practice pharmacy by doing what they do best—serving the patients in the community. For example, the pharmacies provide a range of disease state management programs as needed by an individual community. Some pharmacists also have built partnerships with assisted living facilities to provide special services, according to Nelson.

Shopko continues to succeed as the pharmacy industry changes. “Our focus has always been on patient interaction and education. As prescription volumes increase, we want to maintain the customer focus that differentiates us and provides value to our customers. We are always balancing profitability/volume with quality service,” says Nelson.

One thing is certain—graduating pharmacists will have many opportunities as they start their careers to make a difference in the health of the patients they serve.

Pharmacists Thrive at Regional Chains

The Mayo Clinic is world-renownedfor itspatient care, integrated clinical practice, education, andresearch. For graduating pharmacy students, the MayoClinic can lead to a rewarding career as part of a healthcare team that is focused on putting the patients' needsfirst.

Known as the first and largest integrated, not-for-profitgroup practice in the world, the Mayo Clinic was named"Best Hospital" for the 19th consecutive year in the 

 America'sBest Hospitals issue. The publicationalso again named the health systemto its honor roll of top hospitals. Tomake the honor roll, a medical centerhas to rank at or near the top in at least6 of the 16 specialties included in therankings. The Mayo Clinic scored inthe top 5 in 12 specialties and rankedfirst or second in 7 specialties.

The Mayo Clinic has 3 locations inRochester, Minnesota; Scottsdale, Arizona;and Jacksonville, Florida, as wellas 17 hospitals in the Mayo HealthSystem in Iowa, Minnesota, andWisconsin.

Pharmacists can choose a career ininpatient or outpatient pharmacy&#8212;both areas offer opportunities for advancement withinthe Mayo family. The outpatient pharmacy in Rochesterfills 20,000 prescriptions a week and has 150 employees,explained Harlan Langstraat, RPh, vice chair, MedicalProducts, Mayo Clinic Health Solutions. Langstraat hasworked in the Rochester location for 9 years.

The outpatient pharmacy hires a significant numberof new pharmacists eachyear. In addition to atraditionalpharmacistposition,pharmacists canwork in medicationtherapymanagement (MTM),specialty pharmacy services,and research. Pharmacists also can work in 2 pharmaciesthat do not stock medications or fill prescriptions.Instead, the pharmacist's primary role is counselingpatients, according to Langstraat.

"It is a wonderful place for young pharmacists, becauseit offers such diverse practices and so many areas they cangravitate toward," he said.

In his experience, Langstraat is seeing incoming pharmacistsfocused on clinical pharmacy services, which isa reflection of the education they arereceiving today. Graduating pharmacistsare doing more with MTM, clinical,and specialty pharmacy services."We are fortunate in that we can offerthese services," he said.

The advantages of working at theMayo Clinic are numerous. Langstraatgoes back again to diversity of practice."A pharmacist over time can work inmany different positions. It is a wonderfulenvironment with true collaborationwith clinical departments. TheMayo Clinic also has world-class facilities,focuses on the needs of patients,and is on the cutting edge with itsinvolvement in clinical trials."

In terms of employment, Langstraatsaid that, because of the shortage of pharmacists, "we canbe selective with the candidates we hire." The criteria theylook for in potential pharmacy graduates include high-qualityclerkships and their experience during summerswith advancing their knowledge of pharmacy. He pointsout that Mayo hires from different pharmacy schools.Every year, the Mayo Clinic recruits at 15 pharmacyschools with a number inthe Midwest. New pharmacistsare trained in a traditionalpharmacy setting,and the remaining trainingis in areas in which they aregoing to work.

The Mayo Clinic Pharmacy offers a variety of 5-weekclerkship programs to students in their final year ofpharmacy school. Individuals completing the ambulatorycare rotation will further develop their skills in providingMTM to a variety of patients. The pharmacy managementrotation is designed to expose the student to issues affectingpharmacy management, and the pharmacy researchrotation allows the student to explore the pharmacist'srole in outpatient dispensing of investigational medication.

In terms of internships, "We focus on getting studentsfrom different colleges of pharmacy. The experience is notonly valuable to them, but valuable to our staff. Internscome from across the country and a high percentagemove on to residency programs," explained Langstraat.The internship is a salaried 12-week program. Pharmacistexperiences will include patient counseling, compounding,interacting with health care practitioners, and minirotations to acquaint pharmacists with specialty practiceswithin the pharmacy.

He said that a misconception about the Mayo Clinic isthat many pharmacists think they need a residency programfor employment consideration. Although the MayoClinic likes to hire individuals with a residency, it is nota requirement.

The Mayo Clinic offers opportunities for advancement.Langstraat said pharmacists interested in moving up theranks need to endorse the philosophy of the Mayo Clinic,exert and assert themselves&#8212;for example, take internaleducation classes offered and demonstrate leadershipthrough active involvement in state and local pharmacistassociations.

Langstraat has advice for graduating pharmacists."They need to think real hard about what they want fromthe practice of pharmacy. They need to ask themselveswhat they would like to be doing in 5 or 6 years. Manywill respond that they do not know until they gain moreexperience. I tell them to consider a career at the MayoClinic because of the diversity of pharmacy practice."

Pharmacists interested in pursuing a career in the inpatientpharmacy will not find a shortage of opportunities.

"I enjoy the challenges of the position and strategicallypositioning pharmacists so the pharmacy department isstructured to meet the Mayo Clinic mission," said KevinDillon, PharmD, director of pharmacy services in Rochester,on why he loves his job.

For Lance Oyen, PharmD, assistant director of pharmacyservices in Rochester, "It is the bright, innovativepeople you work with throughout the hospital. It is ateam atmosphere."

Graduating pharmacists will start in the central pharmacy,which provides a strong foundation to help pharmacistsbuild their pharmacy practice. Dr. Oyen said theyconsider candidates new to hospital pharmacy and pharmacygraduates with or without residency experience.

"I was a new graduate without residency experience,"explained Dr. Oyen. He completed a residency programafter 5 years with the Mayo Clinic. In his 16 years with themedical center, he has held 7 positions. "I have not eventouched upon all the opportunities."

The Mayo Clinic offers residency programs in pharmacotherapy,ambulatory care, critical care, infectiousdisease, oncology, and pediatrics. It also offers a HospitalPharmacy Internship and Clinic Outpatient PharmacyClerkship. The 12-week salaried internship programprovides in-depth exposure to inpatient pharmaceuticalservices to help pharmacists explore hospital pharmacyas a career. Pharmacist experiences include unit dosing,intravenous dispensing, and several mini rotations toacquaint pharmacists with specialty practices within ahospital pharmacy. The clerkship program runs 10 to 15weeks and will help pharmacy students further developtheir skills with a variety of patients.

A career in inpatient pharmacy offers opportunities foradvancement. "We encourage pharmacists to apply foreligible positions. The qualities we look for are pharmacists'personal goals, ability to work well with others, andinterest in management-type tracts," said Dr. Dillon.

Drs. Dillon and Oyen agree that the role of an inpatienthospital pharmacist has changed. "There is growingresponsibility to make sure patient care is safe, and pharmacistsare becoming more actively engaged in patientcare," said Dr. Dillon. Dr. Oyen sees a "pull toward thenondispensing aspect of pharmacy. The pharmacy professionhas moved toward comprehensive clinical care incollaboration with physicians and nurses."

In their combined years of experience, Drs. Dillon andOyen's advice for graduating pharmacy students is plentiful."Look at a place where you would want care or afamily member to receive care," said Dr. Oyen.

"Do not forget why you became a pharmacist," said Dr.Dillon. "Seek out a high-quality organization that is consistentwith your philosophy, and seek out a pharmacydepartment that is progressive and centered."

Mayo's Diversity of Practice Appealing to Pharmacists

Students have many opportunities upongraduation from pharmacy school. Choosing the rightcareer path can be overwhelming. Pharmacists need toconsider the practice setting, size of the pharmacy, andmost important, what they hope to achieve in their profession.Oftentimes, pharmacists who have an internshipwith a smaller chain discover that this practice setting fitstheir ideal pharmacy job.

Many pharmacists are opting to practice in smaller,regional chains, because they want more opportunities toserve patients in the community and more involvement inthe business of running a pharmacy. The relationships theybuild with patients through daily interaction help fostertrust between patients and the pharmacists who provide theservice. As the most accessible health care providers, pharmacistsare in a unique position to educate patients on theirmedications and other health-related issues.

A career in a smaller chain offers many unique benefits.In addition to providing one-on-one counselingto patients, pharmacists are part of a health care teamthat works collaboratively with physicians to managepatients' drug therapy. Pharmacists in this practice settingmay find opportunities to gain more patient interactionthrough various pharmacy programs such as diseasestate management, immunization services, medicationtherapy management, and clinic services.

Here is a brief summary of facts about some of the topchains:

Headquartered in Sioux Falls, South Dakota

Operates 30 pharmacies in southeastern South Dakota, northwestern Iowa, and southwestern Minnesota

Dispenses an average of 200,000 prescriptions per month

Employees: approximately 300 full- and part-time pharmacy employees, including pharmacists, technicians, and clerks

Offers competitive starting salary with industry

Benefit package includes health insurance, dental insurance, short- and long-term disability insurance; 401(k) plan; and paid time off

Headquartered in Gouverneur, New York, with a regional office in Syracuse, New York

Operates 87 retail stores and 4 institutional pharmacies; retail locations throughout upstate New York and northern Vermont; and Health Direct Institutional pharmacies in Gouverneur, Syracuse, Canandaigua, and Burlington. ProAct pharmacy benefits management and Health Direct mail-order pharmacy both located in Gouverneur.

Benefit package includes health insurance, vacation and sick time, store discount, reimbursement of professional licensing fees, employee stock ownership plan contribution, profit sharing, and company-sponsored continuing education programs

Headquartered in Green Bay, Wisconsin, with 2 divisions: Shopko and Shopko Express Rx

Operates 136 Shopko stores, 6 Shopko Express stores, and 3 Shopko Express Rx stores in 13 states

Offers competitive salary with industry and comparable benefits to pharmacists who work a minimum of 20 hours per week

Benefit package includes medical, dental, and vision coverage; paid vacation and holidays; flexible spending account; 401(k) plus company match; employee assistance programs; service recognition awards; teammate appreciation sales; and teammate retail discount.

Regional Chains Are Ideal Practice Setting for Some

The Centers for Disease Controland Prevention (CDC) estimatesthat every year in the UnitedStates, on average, 5% to 20% of thepopulation is infected with the influenzavirus; >200,000 individuals arehospitalized from flu complications;and 36,000 patients die from the flu.The CDC has designated the weekof December 8 to 14 as NationalInfluenza Vaccination Week to highlightthe importance of continuing theflu vaccine.

For the 2008-2009 flu season, vaccinemanufacturers project that between 143million to 146 million doses of the influenzavaccine will be available. The FDArecently approved 6 flu vaccines forthis influenza season. The flu vaccine isrecommended for individuals aged 50and over, pregnant women, individualswith chronic medical conditions, nursinghome or long-term care residents,and individuals who live or care forthose at high risk for complicationsfrom the flu. The 2008-2009 flu season marks the firsttime all healthy children aged6 months up to their 19th birthdayare recommended to getthe vaccine.

The CDC also recommendsthat adults aged 60 and olderbe vaccinated with Zostavax(Zoster Vaccine Live [Oka/Merck & Company Inc]) to preventherpes zoster, commonlyknown as shingles. Zostavaxis the only vaccine to preventherpes zoster.

As the most accessiblehealth care providers, pharmacistsare in a unique positionto advocate the importanceof vaccinations. In addition,many independent and chainpharmacies offer vaccinationservices and annual flu programs.

The National Community PharmacistsAssociation's (NCPA) 2007 

 found that 43% of independentcommunity pharmacists offer immunizations.The association expects thatnumber to hold steady as it collects datafor the 2008 publication.

Katterman's Sand Point Pharmacy inSeattle, Waghington, is an "immunizationdestination," according to co-ownerBeverly Schaefer, RPh. The pharmacyprovides all vaccines available, includingseasonal flu, FluMist, and pneumoniaimmunizations.

Shaefer explained that the pharmacyhas a year-round immunization businessthat includes routine immunizations,such as hepatitis A, hepatitis B, polio,human papillomavirus (HPV), meningococcal,chickenpox, and shingles. Inaddition, it offers travel immunizationslike typhoid, yellow fever, and Japaneseencephalitis.

"All immunizations are administeredby a pharmacist and all are available ona walk-in basis without an appointmentand without a doctor's prescription.Washington State allows us to have acollaborative practice agreement with alocal physician that gives us prescriptiveauthority for all vaccines," she said.

When the pharmacy administers thevaccine, with the exception of the flu,it sends a fax to the patient's primarycare physician, so immunizations canbe recorded in the patient's medicalrecord. It also serves as a reminderfor physicians on where they can referpatients for immunizations not routinelyoffered in doctor's offices.

Katterman's does about 3000 flu shotsannually and offers the service fromOctober through May. No appointmentis necessary, walk-ins are welcome, noprescription is required, and shots areavailable when the pharmacyis open. When the pharmacybegan offering the flu vaccinein 1996, it was one of the firstpharmacies to offer large-scaleimmunizations. "We did 1200flu shots our first year. Wewere successful and profitablebeyond our wildest expectations,"said Shaefer.

The pharmacy also offersthe Zostavaxvaccine. The vaccinehas been offered since itreceived FDA approval in May2006, and the pharmacy hasdone >500 immunizations. Thepharmacy can administer boththe flu and Zostavax vaccinesat the same time if they areavailable.

"In addition to increasingaccess to medical services,offering immunizations is profitable for pharmacies. Immunizationsare now more than 10% of our pharmacybusiness," she said. "It takes about thesame amount of time as filling a newprescription. It increases foot trafficin the pharmacy. Many people seekingimmunizations buy other products orprescriptions (often in the case of travelimmunizations). It allows the pharmacistto be a source of health informationfor both patients and physicians year-round."

In 2000, the SUPERVALU Adult Immunizationprogram was established to helpprovide the communities the storeserves with convenient access to preventivehealth care. Specially trainedand certified SUPERVALU pharmacistscan administer the Zostavax vaccine byappointment in many of the pharmaciesyear-round, reported Jeff Bregar, RPh,manager of the Adult ImmunizationProgram. To date, the pharmacies have"administered >15,000 doses and educatedthousands of patients about theZostavax immunization, as well as availableinsurance options to help themmake wise and healthy choices," he said.The vaccine is covered by Medicare PartD, Medicare Advantage, and other insuranceproviders. The pharmacy also providesa range of adult vaccines.

SUPERVALU has been offering fluclinics for >10 years. Immunizing pharmacistswill provide traditional flu shotsand the no-needle FluMist nasal sprayvaccine by appointment or on a walkinbasis at in-store pharmacies throughFebruary. Both vaccines also will beoffered at special, in-store flu vaccineclinics through December. In addition toproviding flu vaccines at each of its 920in-store pharmacies, it will offer nearly3000 flu clinics nationwide, said Bregar.

The cost for the flu shot is $24.99, andMedicare Part B, Medicare Advantage,and other insurance plans are accepted.To minimize wait times, individuals areencouraged to make an appointment.Appointments are not required for thewalk-in flu clinics, where patients areseen on a first-come, first-served basis.For more information, patients cancall 800-783-0458 (Jewel Osco patientscan call 866-388-1805) to schedule anappointment and find a nearby location;visit the in-store pharmacy to makean appointment or ask questions; orvisit 

 and click on the "Health ProgramsLocator."

Publix offers the Zostavax vaccine in itsAlabama, Tennessee, South Carolina,and Georgia locations with a prescription.Patients should contact their Publixpharmacist for the schedule. Publix alsooffers the pneumococcal, tetanus anddiphtheria (TD), and tetanus, diphtheria,and pertussis (TDaP) vaccines.

For >6 years, Publix has been offeringthe flu shot program, which runs throughDecember 15. The cost for the flu shot is$30, and Medicare Part B is accepted forthe influenza and pneumococcal shots.The other immunizations are cash only.Many locations will offer walk-ins orappointments. Patients can find moreinformation by visiting 

, by calling 877-629-3580, or by speakingwith a Publix pharmacist.

Rite has been offering the Zostavax vaccinefor 4 years. The vaccine is administeredby pharmacists in states wherepermitted and according to state regulations.Cost varies depending on insurance.Normally appointments are notneeded, but since this vaccine in is highdemand and orders take a few weeks,appointments are recommended. Othervaccination services include pneumococcal,meningococcal, hepatitis A, hepatitisB, HPV, and TDaP.

The pharmacy chain will host a 3-dayflu and pneumonia shot clinic this month.Patients also can receive flu shots fromany of its 1200 immunizing pharmaciststhrough the season by appointment. Inaddition, the flu shot will be available atRite Aid stores that host in-store clinicsfrom its clinic partners. Nearly 2600 flushot clinic events will be held this fall at1300 stores.

The cost for the flu shot is $30, free forpatients with Medicare Part B, and someprivate insurance plans are accepted.The vaccine will be administered on afirst-come, first-served basis at the fluclinics. At locations with an immunizingpharmacist, patients will need tomake an appointment. Patients can findout more information by visiting 

, speaking with a pharmacist,or calling 866-751-1494.

CVS does not administer the Zostavaxvaccine. If a patient has a prescriptionfor the vaccine, the pharmacy will transferthe prescription to its specialty mail-orderunit, which will coordinate scheduleswith the patient and the physicianand ship the drug directly to the physicianfor administration of the vaccineto the patient. Additional vaccinationservices administered by nurse practitionersat CVS MinuteClinics includeTD, pneumococcal, and polio.

CVS, which has been offering flu clinicsfor >10 years, will have store clinicsoperating until the end of this month.Flu shots at MinuteClinics will be availablethe entire flu season. A total of 7500flu clinics will be held in CVS/pharmacylocations. Scheduled clinics will operateon a first-come, first-served basis. Inaddition, flu shots will be available ona walk-in basis, no appointment necessary,at CVS/pharmacy's 540 in-storeMinuteClinic locations.

Each flu shot is $30. Medicare PartB recipients who have not reassignedtheir prescription coverage benefits toan HMO may get the flu shot at nocost when they present their MedicarePart B card. Patients can find out moreinformation by calling 888-FLU-SHOTor visiting 

 and clickingon the store finder link. All stores hostingclinics also will have flu clinic schedulesposted.

Walgreens has been offering flu shotclinics for >12 years. For the first time,most Walgreens locations also will offerthe FluMist nasal spray as an alternativeto the shot. In addition to Walgreenspharmacies, patients can receive theflu vaccine at all 237 Take Care Clinics.Board-certified nurse practitioners andphysician assistants will administer theshots and nasal spray.

The cost for the flu shot is $24.99at most Walgreens locations, andthe nasal spray is $29.99. MedicarePart B is accepted, and the vaccinationsmay be covered by insuranceplans. Patients are encouraged tocheck with their insuranceprovider.Appointments are recommended atWalgreens pharmacies. Take CareClinicswill offer the vaccine 7 days aweek with no appointmentrequired.Patients can find additional informationby calling 800-FLU-9950 or visiting

Kmart Pharmacy will operate flu clinicsthrough November 13. The vaccine willbe offered at >900 pharmacist-based and400 nurse-based clinics and nonpharmacylocations throughout the country.Flu shots at the pharmacy are $25 andpneumonia shots are $50. Patients canfind out more information by visiting

, calling 800-822-8345,or asking a Kmart pharmacist.

Whereas Wal-Mart pharmacists willnot administer the flu immunization,nurses will be available to administerthe vaccine in some pharmacies andSam's Clubs. The flu shot program runsthrough November 8.

The cost for the flu shot is $29 and willbe conducted on a first-come, first-servedbasis. Patients can find more informationfrom in-store signage or by visiting 

The 2008-2009 flu season marks the first season where healthy children aged 6 months up to their 19th birthday are recommended to get the vaccine.