The senior care market is exploding, as 10,000 people turn 65 every day in the United States and the first baby boomers are projected to turn 85 in 2031. Pharmacy students considering a career in a nontraditional pharmacy field should know that there are many opportunities to serve this unique and growing population.

During the 2018 American Society of Consultant Pharmacists (ASCP) Annual Meeting in National Harbor, Maryland, 4 amazing pharmacists working in senior care shared their career stories with a handful of pharmacy students. As a new employee of ASCP, I had the opportunity to be a fly on the wall and hear these pharmacists speak, and what struck me was realizing that although they all served senior patients in pharmacy, their experiences were radically different.

Throughout all issues of Pharmacy Careers® in 2019, I’ll explore each pharmacist’s story in-depth to provide students with a glimpse into the dynamic and diverse field of senior care pharmacy. Our first featured senior care pharmacist is Dee Antimisiaris, PharmD, CGP, FASCP, an associate professor in the University of Louisville Department of Pharmacology and Toxicology.

Dr. Antimisiaris grew up in Hawaii Kai, Hawaii, and Monterey Park, California, where she enjoyed biking, swimming and surfing. She had a passion for math and science, which led her father to influence her to go to pharmacy school.

“He told me that ‘pharmacy is a great profession for women,’ and he didn’t mean it in a biased way,” Dr. Antimisiaris said. “My mom was a judge, and observing her career and that of a physician, I found them to be options that would be difficult to keep in practice by working part time, especially with young children.”

After pharmacy school, Dr. Antimisiaris completed a clinical residency in geriatric pharmacy at the VA-Sepulveda Geriatric Pharmacy Residency Program in Los Angeles, during which she worked with innovators and leaders in senior care. After her residency, she returned to Hawaii and, inspired by her experience, decided to work in long-term care.

“Long-term care duty in Hawaii is an experience in rural health. The care homes do much with little, and as such, when the pharmacist [comes] in every month, sometimes they wanted me to help assess a patient or they would want me to help figure out what to use instead of another drug not easily available, since the pharmacy only delivered once daily,” Dr. Antimisiaris explained. “But, most of all, the rural care homes taught me the special meaning of caring for elders and those who can’t care for themselves in a tight knit community.”

ONE PHARMACIST IN SENIOR CARE: MULTIPLE GIGS

Dr. Antimisiaris currently leads the Fraizer Polypharmacy and Medication Management Program at the University of Louisville School of Medicine, where she educates students on polypharmacy-related topics, conducts research on polypharmacy and medication use, and performs outreach to nonacademic stake holders regarding polypharmacy.

“With the departmental shift to pharmacology and toxicology, my day-to-day has shifted from clinical care and the education of postgraduate learners to primarily research, with the same ongoing effort to collaborate outside of academia with other stakeholders,” she stated. “I always make sure to stay up-to-date with senior care practice. I provide case consults at our medication management clinic once a month, and I fill in for long-term care consulting pharmacists when they go on vacation.”

In addition to feeling grateful for the opportunity to work with and learn from her colleagues, Dr. Antimisiaris views serving seniors as a privilege and points to her patients as what she loves most about senior care.

“[I like] protecting older adults from the lack of appropriate oversight that the complex health care system of today offers,” she said. “Caring for older adults is a very meaningful practice, and it seems that there isn’t a day that goes by when I don’t feel like I’ve made a difference.”

All professions and areas of pharmacy practice have their challenges, and senior care is no exception. Dr. Antimisiaris cited legal regulations over medication, access, and affordability, as well the complexity of care, as some of the biggest challenges faced by pharmacists in the senior care setting. “Anything from formulary choices to long-term care regulations and lack of access to care are so frustrating for the senior care pharmacist,” she stated. “The subjectivity and complexity of regulations often result in barriers to adequate and appropriate care.”

A related frustration highlighted by Dr. Antimisiaris is the inability to influence those regulations, formularies, and access.

“At the level of the individual long-term care facility, we can help correct issues due to our face-to-face interaction with the staff and residents, but our successful collaborations and interventions cannot go beyond the care facility to impact broader and more permanent improvement,” she explained. “This illustrates the importance of your professional organizations and why we should support them. They do take the fixes we find in day-to-day practice, as well as the problems we identify, and give us a voice that can reach the outside stakeholders that adversely impact care.”

THE FUTURE LOOKS BRIGHT FOR SENIOR CARE PHARMACY

In spite of these concerns, Dr. Antimisiaris sees global opportunities to improve senior health.

“In addition to the aging of our population in the United States, the population is aging globally,” she said. “There are opportunities to collaborate internationally in order to share skills and solve ideas, as well as provide education, and there is always more research and collaborative work to do with the interprofessional health care team.”

ADVICE FOR STUDENTS INTERESTED IN SENIOR CARE PHARMACY PRACTICE

Dr. Antimisiaris recommended that students interested in pursuing a career in senior care first gain exposure to caring for older adults.

“Make sure that working with older adults is for you. Students can get this experience by working in the retail setting, a longterm care facility, or senior centers. Keep in mind that senior care is not limited to long-term care facilities and that senior care skills translate to just about any practice setting,” she advised. “Additionally, consider completing a residency in geriatrics and identify a mentor who works with older adults.” Dr. Antimisiaris concluded by sharing the best career advice she had ever received.

“Learn to appreciate the mundanity of excellence,” she said. “There is value in slowing down and doing the seemingly mundane tasks so you can truly digest topics and develop habits that lead to excellence or innovation.”

Senior care pharmacy offers many amazing career choices for the pharmacy student or practicing pharmacist who wants something different. As you can witness from Dr. Antimisiaris’ story alone, the sky is the only limit! ®

, is a writer, pharmacist, attorney, and former professor. Follow her on Twitter (@ErinLAlbert) or at her website (erinalbert.com).

Articles

Feature Focus

Pharmacy students considering a career in a nontraditional pharmacy field should know that there are many opportunities to serve this unique and growing population.

Senior Care Pharmacy: One Exploding Population, Many Career Paths (Part 1)

There is a moment when the great roots of a tree finally bellow their last breath and relinquish their hold on the moist undercarriage of soil. The forest watches as their elder slowly leans over and drops to its knees as the sheer mass of decaying cellulose crashes into the leaves and brush scattered across the ground. Cacophonic vibrations rip through the air, but no one is there to listen. Did it make a sound?

If we want our research to have an impact, it must have observers, it must have listeners, and it must be heard. A vast quantity of science is lost year after year in the annals of journals andcitations without ever reaching the public. This is wasteful at best and immoral at worst; scientific research elucidates insights that can improve the quality of day-to-day life, relieve the pain and anguish of disease and affliction, and even save lives. For this positive impact to be made, the results of our research must be accessible to those who stand to benefit from it. It is important to put as much effort into distributing our research as we do into conducting it.

I am becoming a pharmacist because I want to help make pharmacy more equitable, accessible, and effective. Throughout my first year as a pharmacy student, I wondered why my textbooks, slides, and lectures kept referring to concepts like patient outcomes, disease prevention, and overall health as if they were a novelty. I was surprised to learn that these common sense measures had only recently become the focus of health care. Quality is important not just to my career as a pharmacist; it also is part of why I applied to pharmacy school in the first place. Quality focuses on effective health care—not just on managing disease but also on building a society that gets less sick, less often. Patient-centered care should be the minimum, and education and empowerment should be a priority.

I want to challenge my fellow pharmacists and student researchers to do more than research. I call upon my peers to build new, creative, and innovative ways to bring our research to a public that deserves to learn from our work. Medicine does not exist within the papers of a results section; rather, it provides benefit when it coexists with well-informed doctors, pharmacists, and patients. Too often, standard practices are not updated, new information is not distributed, and positive life benefits are not conferred because our research is not heard. We must challenge ourselves to build public awareness when we make discoveries. Public health may begin in laboratories, but it ends in the minds and bodies of the population.

I plan to bring the results of my research on treating childhood schizophrenia to the neighborhood of Harlem, New York, by distributing free pamphlets that will contain accessible information and resources that can be understood by anyone willing to read them. My research shows the potential importance of considering first-generation antipsychotic medications for treating schizophrenic children and adolescents and will be a part of a wider campaign to raise awareness that all potential drugs should be considered for the best possible health outcomes. The goal is to put psychiatrists and physicians in the best position to treat childhood- and early-onset schizophrenia by arming them with information about all medication options, along with their benefits and adverse effects.

Educational outreach will also target patients and their families to inform and empower them to take a more active role in their treatment and health care. It will require innovation and courage to transform the results of research into essential and actionable advice that patients can use to make decisions as soon as they close the pamphlet. Meta research on making the research accessible must be performed.

This is where surveys and user experience testing come into play. Let us learn from the industries around us that use these tools to market their value and their products to the public. Strategies that prove effective to advertise and market products can do the same for life-improving research; in light of this, I plan to test the effectiveness of a variety of pamphlets and actively respond to user feedback to improve the efficiency and clarity of the presentation. Information cannot just be distributed; it needs to be distributed effectively.

We must become leaders in an era of quality care by taking it upon ourselves to teach our fellow professionals and the public. Providing the highest level of service and care to the population necessitates an informed population. It is not enough to discover lifesaving results; we must use those results to save lives.

 is a 2020 PharmD candidate at the Touro College of Pharmacy. As a participant in the Pharmacy Quality Alliance—CVS Health Foundation Scholars

Program, she is researching antipsychotic medication used for children and adolescents with schizophrenia.

Careers

For a positive impact to be made, the results of our research must be accessible to those who stand to benefit from it.

Did It Make a Sound? Becoming Leaders in an Era of Quality Care

In an article published in the fall 2018 issue of 

®, we explored perceptions of women in pharmacy and their leadership opportunities.

After more than 30 interviews with women in pharmacy at a variety of career points, we found that women early in their careers had mixed feelings and perceptions about leadership roles within the profession, midcareer women generally felt more disparity between genders and leadership opportunities, and women later in their careers felt most optimistic about options for women leaders.

Due to a serious lack of women at the helms of health care and pharmacy organizations, it is now important to discuss actual methods for getting more women at the heads of organizations. Based on research and strategies that have worked for other industries, here are some suggestions for how we might gain more women in leadership in health care and pharmacy.

Create continuous discussions on career trajectory.

 Retired pharmacist Marianne F. Ivey, PharmD, suggests that collegial conversations about career options need to occur in all stages of one’s career. Dr. Ivey noted that although these conversations were not as prevalent when she started her own career, they are now more frequent.

This falls on managers, as well: Dare to have collegial conversations with your direct reports. Great managers and leaders are always assessing the positions and responsibilities of employees and whether all parties would benefit from changes.

Buy from businesses owned and managed by women.

 If women are making the majority of purchase decisions in the United States, they can support other women with their wallets.

Provide more flexible work arrangements and paid time off. 

The more flexibility and paid time off that employees have, the more likely they are to remain engaged and loyal to the pharmacy or health care organization. We should be aware that stress in the workplace can lead to a lot of detrimental issues for women, including burnout, career dissatisfaction, and fewer opportunities for leadership.

We need managers and executives to step up and not only mentor women but sponsor them as well. Sponsorship happens when a senior member of a leadership team fights for a junior employee’s growth. In particular, women in senior positions need to mentor other women.

I have witnessed women who pull each other down rather than supporting, mentoring, and sponsoring one another; this must stop if we want more women at the helms of organizations. Women in junior-level positions also need to be given opportunities to “grow” into positions rather than being thrust into managerial positions without experience.

Promote quotas and diversity on boards and in senior leadership.

 California appears to be the first state to require gender balances or gender quotas on boards for companies. This may be controversial to some, but it has been documented repeatedly, including in a 2017 report by the Credit Suisse Research Institute, that boards with more diversity and women are more profitable. Therefore, capitalists should be on board with this idea, and savvy corporations should put quotas in place long before states or jurisdictions require them.

Initiate more pharmacy leadership postgraduate training programs.

 Although pharmacy schools are increasingly providing students with leadership opportunities, there remains a need for more postgraduate leadership programs. Such programs are provided by the American Society of Health-System Pharmacists and the American Association of Colleges of Pharmacy, but they tend to require significant investments in time and money, and extensive applications and sponsorship from organizations and executives, as well as take only a handful of applicants each year. Every school of pharmacy should consider providing some type of postgraduate leadership program for their alumni. We, as a profession, do a good job of requiring continuing education in areas such as pharmacotherapy, so why do we not do the same for leadership training?

Employers can also develop their own internal leadership programs for pharmacists and other health care professionals. Companies who identify their own senior women leaders and put them in front of the next generation of leaders can also benefit, as early-career professionals “can be what they can see.”

Provide equity and creativity in company family care policies.

 Men and women need equal access to family leave for children and elderly parental care. If we continue to punish women who choose to have children or take care of their families, they will continue to be held back from career development opportunities. As care tends to fall on women in families, we have to level the playing field and create opportunities for them to remain in the workforce part-time, whether this be through job sharing or creative and flexible workforce options so they are not penalized for caring for or raising a family. Companies can also provide day care for children or senior care for older adult parents so that the sandwich generations can better help their families.

We have a long way to go to achieve gender parity in C-suites of health care and pharmacy organizations. However, employing the strategies above may help all of us attain a path forward and see more women become leaders over time. Like anything in pharmacy, change is evolutionary, not revolutionary. And of course, to all the women who have gone before us and led in pharmacy: Thank you for your contributions!

, is a writer, pharmacist, attorney, and former professor. Follow her on Twitter (@ErinLAlbert) or at her website, www.erinalbert.com.

Due to a serious lack of women at the helms of health care and pharmacy organizations, it is now important to discuss actual methods for getting more women at the heads of organizations.

Empowering Women Into Pharmacy and Health Care C-Suites

For many pharmacy students, the North American Pharmacist Licensure Examination (NAPLEX) is the final challenge standing between them and their careers as pharmacists. Although it may seem overwhelming to review all the material you have learned over the past few years at pharmacy school for 1 exam, it is important to focus on key learning points. Creating an effective studying plan early on to reinforce your strong subjects and brushing up on your weaker ones can make the difference in overcoming this last obstacle.

Before you start preparing for NAPLEX, familiarize yourself with what to expect for the exam. The National Association of Boards of Pharmacy website provides information on what you can and cannot bring to the exam and details the structure of the exam itself. NAPLEX contains 250 questions; 200 are operational and count toward your score, whereas the remaining 50 are being evaluated as potential operations questions for future exams.

You will have 6 hours to complete the exam, so it is important to track how much time you have left as you are working. If you do not finish the exam, any unanswered questions will be scored as incorrect. Therefore, try not to waste too much time on 1 question if you are stumped, and make sure to provide an answer for all questions. However, do not rush either, because once you submit your answer, you will not be able to go back to it.

The scoring for the exam is on a scale of 0 to 150, with 75 being passing. It is based on a complex “item response theory” model that evaluates patterns of correct and incorrect answers and weighs scoring based on the content of the question. This scoring model makes it very difficult to predict your score, but you should still try your best. Completing practice exams, such as thePre-NAPLEX, can be a useful way to familiarize yourself with the types of questions that may appear on the exam.

There are various types of questions, including multiple choice, multiple response, fill in the blank, constructed response, ordered response, and hot spot. Calculation questions can be free throws, so be sure to specifically practice statistical questions and know your formulas. Another recommendation is to think through casebased questions that may provide you with unnecessary details as distractions.

Ensure you have an ample amount of time to review material at a speed at which you are comfortable. This is a comprehensive exam, and cramming all the material in over a few days would be tough for anyone. Consider identifying which therapeutic areas you feel are your weakest and tailoring your studying as appropriate. As with any exam, make sure you get plenty of sleep and eat nutritious meals; avoid too much caffeine and sugar.

These tips will also be invaluable when studying for your state’s Multistate Pharmacy Jurisprudence Examination. This exam is shorter than NAPLEX, but it is still just as important for you to have a grasp of both federal and state laws. The exam questions may not specify which laws you should consider when answering the question, but it is important to always remember that the more stringent law prevails.

You might walk out of either exam feeling as if you failed; and many of your peers will likely share this sentiment. Don’t let this discourage you. As long as you properly prepare for the exam, you will likely do better than you think.

Remember, getting through pharmacy school was the tough part. If you’ve made it this far, you can conquer this exam! 

, is the senior director of scientific affairs for Pharmacy Times Continuing Education™ and a graduate of the Rutgers Ernest Mario School of Pharmacy.

, is a director of scientific affairs for Pharmacy Times Continuing Education™ and a graduate of the Rutgers Ernest Mario School of Pharmacy.

 is a manager of education for Pharmacy Times Continuing Education™ and a graduate of the Southern Illinois University Edwardsville School of Pharmacy.

Before you start preparing for NAPLEX, familiarize yourself with what to expect for the exam.

NAPLEX Preparation: Tips for the Most Important Exam of Your Career

The Ohio Northern University (ONU) Raabe College of Pharmacy prepares pharmacists who improve health, serve others, lead change, and advance the profession.

Although located on a small, primarily undergraduate, liberal arts campus, Raabe College is one of the largest pharmacy programs in the country, Dean Steven J. Martin, PharmD, BCPS, FCCP, FCCM, said in an exclusive interview with 

®. The college is also among the oldest in the country and has nearly 7500 alumni across the globe.

Raabe is also 1 of just 8 schools to offer direct entry into the professional PharmD program, offering a 0-6 pharmacy experience, with no Pharmacy College Admission Test and no pharmacy-related prerequisites for admission. The Class of 2018 saw a pass rate of 95% on the North American Pharmacist Licensure Examination. In addition, 40% of the graduates went on to residencies (81% match rate), and 93% were employed full time or enrolled in graduate or professional school within 6 months after graduation.

The pharmacy program at Ohio Northern University (ONU) teaches students to focus on improving health in the underserved community of Harden County, Ohio by pairing the 6-year curriculum with patient care experiences. 

Q: What is unique about your school or program?

A: ONU is a unique setting to begin a career in pharmacy. The scenic, safe, and modern campus rests on nearly 342 acres in the heartland of America. Its location in Ada, Ohio, provides a quaint, small-town atmosphere that complements the friendly campus environment. Five years on campus allows for a rich undergraduate experience while students are prepared for roles as health care providers and patient advocates. More than 40% of students on campus are enrolled in a health professions major, making ONU a premier institution for health sciences and interprofessional education.

All pharmacy students participate in patient care services, including health-risk screenigns, during their time at ONU. 

Q: What is the teaching style or philosophy?

A: The pharmacy program prepares students to be practice ready, incorporating extensive patient care experiences throughout the 6-year curriculum. Students learn to be primary care providers through a focus on improving health in the underserved community of Hardin County, Ohio.

The Raabe College clinical practice group includes a health and wellness program, a community pharmacy on campus, a drug and health information center, a pharmacy services center that provides a variety of patient services via telecommunication, and a mobile health clinic.

ONU students are immersed in an integrated educational style that brings pharmaceutical sciences, clinical sciences, and social and administrative sciences together. Students learn to practice health care delivery with interprofessional teams in a variety of settings.

The colleges clinical practice group includes a community pharmacy on campus, a drug and information center, and a variety of other patient services. 

Q: What are some community outreach activities or programs the school participates in?

A: All students participate in health-risk screenings, wellness and health education programs, immunization events, medication education and therapy management sessions, and other direct patient care services throughout their time in the program. Student-led and student-directed health outreach activities occur daily, such as cancer awareness programs, childhood obesity intervention, drug-abuse prevention programs, and national events such as the Script Your Future Medication Adherence Challenge; Generation Rx; and Operations Diabetes, Heart, and Immunization. More than 15 student organizations also compete regionally and nationally. ONU’s National Community Pharmacy Association (NCPA) chapter was the first runner-up for 2018 Chapter of the Year, as well as the winner of the NCPA Legislative Advocacy Challenge. The ONU NCPA Business Plan Team was selected as 1 of 3 teams in the nation to present at the national convention in 2018. Raabe College students also produce and edit 

Immersion in the profession of pharmacy for 6 years allows students to develop key leadership skills, which have been recognized by students’ selection to national offices in professional organizations, such as president of the Student National Pharmacists Association, Student Leadership Council members for NCPA, and regional leadership in the American Pharmacists Association Academy of Students of Pharmacy.

A mobile health clinic is one of the ways that Raabe School of Pharmacy Students are provided opportunities to become immersed in the profession and their community. 

Q: What opportunities do students have for internships or co-ops?

A: Many ONU pharmacy students engage in paid internships in a variety of pharmacy care settings throughout the program. In addition, students take advantage of the pharmacy practice opportunities on campus, providing patient care in a rural, medically underserved community and engaging in patient care experiences built into the program to help close the health care gap in the region.

Q: What advice do you have for students who will graduate this year?

A: For our 2019 graduates, I have 3 streams of advice. Employers want pharmacists who communicate well, are self-directed and self-aware, are problem solvers, demonstrate strong personal leadership skills, and can function well on teams. Drug and disease knowledge is expected, but these other characteristics are what make our graduates stand out from the crowd.

Create a broad foundation for your career by getting as much training, as many credentials, and as much distinction as possible.Your career should span 40 years or more, and now is the time to prepare for the future.

And help everyone you can, including patients, friends, family, students, and strangers. There is no greater reward than helping someone who needs what you can do.

Although located on a small, primarily undergraduate, liberal arts campus, Raabe College is one of the largest pharmacy programs in the country.

Q&A: Ohio Northern University Raabe College of Pharmacy

Giang Ho is a 2019 PharmD candidate at the University of Iowa College of Pharmacy. She grew up in Vietnam before traveling to the United States to study pharmacy. More of her comics can be read at garuscaselogs.wordpress.com or on social media under #graphicpharmacy.

Graphic Pharmacy: A Student's Journey in Comics (Winter 2019)

Pharmacists are again among the most highly trusted people in their occupations, according to a recent Gallup poll.

The poll ranked pharmacists third among professionals in the United States for honesty and ethical standards, with 66% of respondents rating their trustworthiness as “very high” or “high.”

Pharmacists ranked behind nurses (84% rated “very high” or “high”), who held the top spot for the 17th consecutive year, and medical doctors (67%). High school teachers (60%) and police officers (54%) rounded out the top 5 most trusted professionals.

Poll responses were collected in telephone interviews conducted by Gallup from December 3 to 12, 2018, with a random sample of 1025 US adults 18 years and older. Respondents resided in all 50 states and the District of Columbia. Landline and cellular telephone numbers were selected using random-digit-dial methods, according to Gallup.

At the bottom of the 2018 ranking for trustworthiness were members of Congress and car salespeople, both of whom earned an 8% rating of “very high” or “high” for honesty and ethical standards. Telemarketers (9%) were third from the bottom.

Many other occupations, including accountants, funeral directors, clergy, journalists, building contractors, bankers, and real estate agents, had more “average” levels of trust from poll respondents.

Pharmacists’ ranking in the 2018 Gallup poll is an improvement over their place in the previous year’s Gallup poll, which placed these professionals fifth among occupations included in the survey. Previously, 62% of respondents rated the honesty and ethical standards of pharmacists as “high” or “very high.”

In 2017, military officers and grade school teachers ranked in the top 5 for trusted professionals in the Gallup poll. However, neither of those occupations was included in the 2018 poll.

Gallup has measured the public’s views of various occupations’ honesty and ethics since 1976. Although the rankings and the list of included occupations change each year, the latest poll’s results revealed that health care workers are consistently rated highly for their trustworthiness.

Brenan M. Nurses again outpace other professions for honesty, ethics. Gallup website. news.gallup.com/poll/245597/nurses-again-outpace-professions-honesty -ethics.aspx. Published December 20, 2018. Accessed February 26, 2019.

Brenan M. Nurses keep healthy lead as most honest, ethical profession. Gallup website.news.gallup.com/poll/224639/nurses-keep-healthy-lead-honest-ethical-profession.aspx. Published December 26, 2017. Accessed February 26, 2019.