	Since the introduction of the Affordable Care Act in 2010, the landscape of health care has changed dramatically, resulting in greater emphasis on key issues such as expanding access to care, lowering costs, and improving overall health—particularly through better management of chronic disease.

	The New England Healthcare Institute estimates that $290 billion per year in health care costs result from failure to properly take medications for conditions such as diabetes, asthma, and heart disease. According to a study from the US Department of Health and Human Services, chronic disease management accounts for more than 75 cents of every health care dollar spent.

	Costs have spiraled out of control, and as providers struggle to adjust to changes in the way that care is delivered and reimbursed, a need has emerged for pharmacists to take on a greater role.

	“There’s such a focus right now within the health care system as well as the government in trying to curb these costs and trying to figure out solutions for being able to afford care,” said Edith Rosato, RPh, IOM, senior vice president of pharmacy affairs at the National Association of Chain Drug Stores (NACDS) and president of the NACDS Foundation. “This is a fantastic opportunity for pharmacists, who are so welltrained in the appropriate use of medications, to be able to step up to the plate and really develop a specialized niche to help contribute to lowering overall health care costs in the US, and also enhancing the quality of care.”

	Pharmacists can help shift the landscape of health care to a more patient-centric model by providing medication therapy management (MTM), increasing medication adherence, and promoting and increasing the use of generic medications—services that are all a high priority for national retail pharmacy chains such as Walgreens, CVS, and Rite Aid.

	Some of the programs aimed at improving both medication adherence and overall health include the following:

	• Walgreens is collaborating with Johns Hopkins Medicine (JHM) on a population-based research initiative to develop protocols to improve outcomes for patients with chronic diseases. By partnering, Walgreens and JHM hope to develop new ideas for research in disease management, screening, and prevention; develop and review clinical protocols; provide training for pharmacists and other care providers through onsite and distance training; and work to develop lifestyle, chronic care, and disease-specific programs.

	• Walgreens is also partnering with Northwestern Memorial Physicians Group of Chicago on a coordinated care program through which it will share the results of pharmacist clinical interventions with primary care physicians to improve the care of individual patients.

	• CVS Caremark Special Pharmacy’s Hep C CareTeam—a group composed of pharmacists, nurses, and pharmacy service representatives&mdash; aims to improve the treatment of patients with hepatitis C by providing training and education related to the disease and its available therapies. The Hep C Care- Team works to ensure that patients safely and effectively take prescribed medications and proactively communicate with their physician to address any treatment-related issues or complications that may arise. • Through its Care 1on1 program, CVS/pharmacy offers patients one-on-one time with a pharmacist during which they can discuss cost issues, safety, and side effects when a prescription is transferred or filled for the first time.

	• Rite Aid Pharmacy has partnered with the American Diabetes Association to educate patients and their loved ones about how to effectively manage the condition and take on a more active role in their health. Through Rite Aid’s Web site, patients can download a list to track their current medication regimen, calculate their estimated average glucose, watch educational videos, and use the My Food advisor to plan healthy meals and track calories and carbohydrates.

	In addition, all 3 national retail chains offer interactive weight loss programs and immunization programs to help protect against conditions such as influenza, human papillomavirus, shingles, and pertussis.

	Through these initiatives, community pharmacists can establish strong relationships with patients and help them to better manage chronic conditions, according to Jay Nadas, PharmD, director of retail clinical pharmacy programs at Walgreens.

	“All of these services provide the ability to offer the assistance patients need in a way that lets us form lasting relationships with our patient base,” he said. “These relationships are absolutely crucial as we move into a performance-based paradigm within health care.”

	By interacting with patients on a daily basis, pharmacists are able to build and maintain a level of trust that is more difficult for physicians— who see patients less frequently&mdash;to establish, according to Rosato.

	“That’s the beauty of community pharmacy,” she noted. “Pharmacists are moving from a dispensing role to one where they are face-toface with patients, providing important services. Pharmacists are positioning themselves as the new patient advocate for care and act as a patient’s coach.”

	In addition to offering testing services for blood pressure, blood glucose, A1C, and total cholesterol, Walgreens features centers of excellence focused on compounding, HIV, and other disease states at selected stores.

	“In any long-term behavioral change, ongoing encouragement from a reputable source is crucial,” said Dr. Nadas. “We, as pharmacists, who see the patient more than any other clinician, are in the best position to provide regular and constructive feedback.”

	One of the key components of pharmacist training at Walgreens focuses on the patientcentered consultation, which involves using open-ended questions to help patients identify their needs. “It is much easier to align services to a patient’s needs when we’ve worked together to determine what those needs may be,” he added.

	For both pharmacists and pharmacy students, there are a number of options that can lead to a fulfilling and successful career. Working as a community pharmacist in retail affords individuals the opportunity to interact with patients in an intimate setting while benefiting from the resources and reach of a larger company.

	It also offers a career setting that is extremely versatile, according to Dr. Nadas. “For those looking to specialize and target complex disease states, there are community-based centers of excellence. For those looking at more in-depth relationships with patients, there are worksite pharmacies that focus on particular employer groups and allow deep-rooted relationships over time.”

	Additionally, there is a great deal of variance within freestanding pharmacies based on their geographic location. For example, those that are within close proximity of a children’s hospital may offer more of a pediatric focus, whereas pharmacies that are located near senior communities may focus more on geriatric care.

	“There is so much for our industry to offer patients,” he said, emphasizing pharmacists’ increasing role in “improving engagement and overall health outcomes. Community-based pharmacy is on the front lines of this powerful movement.”

	One of the keys to further advancing the profession, according to Rosato, is in changing the perception that many patients have of pharmacists, and helping them to understand the role pharmacists can play in improving a patient’s overall health.

	“Patients should view the pharmacy as a health care destination,” she noted. “Pharmacists can be a sounding board and help triage patient conditions and determine the next step, whether that is recommending over-the-counter medications, or advising a patient to go see a physician to get a prescription medication, or go to the emergency room or an urgent care facility.”

	As MTM and other services continue to expand, particularly in community pharmacies, Rosato believes that more patients will take advantage of the high level of care offered by pharmacists.

	“In the next 10 years, there’s going to be a sea change in the way health care is delivered,” she said. “We’re going to see more focus on looking at patients in a holistic way. This is an exciting time for pharmacy as a career.” %u25CF

Articles

Careers

Rise of the Community Pharmacist

This semester, hit the books—and have more fun&mdash;with help from these handy gadgets. 

	If you’re not in the market for a smartphone, but find yourself sneaking off to check e-mail on your roommate’s iPad, the Nook Color is your gadget. Not just an eReader, the full-featured tablet boasts a slick 7-inch touchscreen, 8GB internal memory, and built-in WiFi with full e-mail and Web-browsing capabilities, including images and video via Adobe Flash Player. In addition to displaying books, newspapers, and magazines in full color, Nook supports Word docs and PDFs—ensuring a seamless switch from lazy beach reads to assigned readings. 

	When your schedule is tight, it’s easy to let fitness goals slide. Whether you’re aiming to lose fat, gain muscle, or maintain your weight, the Withings body scale helps you stay motivated and keep tabs on your progress. Each time you step on the scale, it wirelessly transmits data to a designated smartphone or computer. Results are displayed in graphs detailing changes in weight, muscle mass, and body mass index over time. For an extra dose of moral support, you can share your stats with friends on Facebook or Twitter. 

	Roku’s newest line of compact set-top media boxes make it easy to cut the cord on cable TV. Whereas a cable subscription delivers a fixed, standard selection of channels for a high monthly price, the Roku set-top box offers viewers an “a la carte” selection of streaming media from more than 300 sources. Choose movies from Netflix, entire seasons of current shows from Hulu Plus, sports programming from national sports leagues such as UFC and NHL, or music from Pandora. Angry Birds addicts can get their fix with the Roku 2 XS, which comes standard with a motion-sensing remote and a free version of the game. 

	Never leave your phone in a public bathroom again—unless you forget your keys too. Designed to hang from a keyring, the ZOMM wireless leash for mobile phones connects to your cell phone via Bluetooth and springs into action when you leave the phone behind by accident. The gadget flashes its lights, vibrates, and sounds an alarm when the user carrying it walks outside the Bluetooth technology’s 30-foot range. It also doubles as a hands-free speakerphone with one-touch answering. 

	A dying battery can bring your impromptu outdoor study session to a grinding halt. Enter the Coffee Cup Power Inverter, a quirky cup that turns your car’s cigarette lighter and cupholder into a power station for laptops, smartphones, MP3 players, and other portable devices. Equipped with 2 standard plugs and a USB port, it can power up to 3 gadgets at once. 

This semester, hit the books and have more fun with help from these handy gadgets. 

Gadget Guide 

Make your mobile device work for you with these practical tools for research, patient counseling, and professional development.

 iPad edition to swipe and tap your way through insightful columns from the print issue, including OTC and Rx Focus, Pharmacy Law, Drug Diversion and Abuse, Continuing Education, and more. Each article is enhanced for the iPad with bonus links to video, podcasts, and other multimedia resources selected to help you explore the issues impacting your profession. Reader favorites Case Studies and Can You Read These Rxs? are also included in every edition, with an interactive spin that lets you test your skills. Downloaded issues are archived in the app, helping you build a library of resources to turn to as you launch your pharmacy career.

	Boost your pharmacy IQ with the Pharmacy CPE app, a convenient source of mobile CE from the 

Office of Continuing Professional Education. Free for registered users, the app brings Pharmacy Times’ robust catalog of CE activities to the palm of your hand. Browse within the app for Webinars, case studies, and lessons that pique your interest, then complete courses for credit directly on your mobile device and print certificates on the go. Pharmacy CPE also connects you to PharmacyTimes.com for upto-date information on pharmacy news and trends.

	Pharmacists practicing in diverse communities face language barriers on a regular basis. MediBabble is a free, easy-to-use medical translation tool designed to bridge the gaps and improve care for non—English speaking patients. It includes thousands of simple clinical questions and instructions written and reviewed by a panel of physicians, with a special focus on evaluating the patient’s medical history. Tapping a question or instruction in English plays the question out loud in the patient’s language. For noisy environments or to communicate with hearing-impaired patients, phrases can also be displayed in large text. MediBabble is currently available in 5 languages, including Spanish, and requires no 3G or Internet connection to run.

	Research more efficiently with Citelighter, a free toolbar for Mozilla Firefox that helps you keep track of every scrap of information you find online. As you cruise PubMed, read journal articles in Google Books, or look up drug information, use Citelighter to highlight quotes and capture citation information. Log in to Citelighter’s dashboard from any computer to organize saved clips, print your research, or start building an outline or bibliography for your next project.

	Adherence coaching is about empowering patients to take charge of their medication regimen, and Dosecast is a user-friendly app that can help. Patients enter basic information about drugs they take—including the name, dosage, scheduling, and special instructions&mdash;and set up reminders to sound on a daily, weekly, or monthly basis. Reminders can also be set to sound within a specific time frame, for example, 4 hours after a dose is taken. These and other basic features are included in the free version; for an additional $3.99, the app sends reminders without an Internet connection, tracks a wider variety of dosage forms, and enables dose history logging and refill alerts.

 Free (basic version); $3.99 (full version)

	Brush up on your pharmacology knowledge with this practical study aid. Launched by the makers of Davis’s Drug Guide for Nurses, Mobile Pharm Phlash! includes key facts on 389 of the most frequently prescribed generic drugs. Each flash card highlights relevant drug features, including trade names, phonetic spelling, indications, off-label uses, mechanisms of action, side effects, safety information, and patient counseling points. Users can also tap an audio link to hear the drug’s name pronounced—good preparation for those moments when patients and physicians expect you to be a walking drug encyclopedia.

iPhone, iPod touch, and iPad; Android devices

	Prescription orders that include the patient’s diagnosis can help you deliver better education and counseling, but not if you’re forced to spend inordinate amounts of time looking up a diagnosis code. ICD9 On the Go is a simple app that makes searching for ICD9-CM codes a snap. Updated to 2011, the mobile database lets users search for a specific code, browse groups of codes by disorder, keep a list of favorites, and share codes by e-mail.

	Powered by LinkedIn, CardMunch helps you turn opportunities into real connections by capturing business cards you collect through internships, classes, conferences, and other events where pharmacists congregate. When someone hands you a business card, snap a picture on your phone and CardMunch adds the information to your mobile Rolodex for future reference. You can also immediately invite your new contact to connect with you on LinkedIn, ensuring that your name is fresh in their minds when the perfect job or internship opportunity becomes available.

iPhone, iPod touch, and iPad; coming soon to BlackBerry

Here are the latest apps that can make your life easier, provide great resources for your pharmacy career, and offer practical tools.

App Wrap: 8 Great Apps for Pharmacists

American Pharmacists Association: Careers 

	The American Pharmacists Association (APhA) was the first established national professional society of pharmacists and remains the largest association of pharmacists in the United States.

	Through its Careers section, APhA offers resources to help students learn more about opportunities available in the pharmacy profession.

	The APhA Career Pathway Evaluation Program for Pharmacy Professionals offers a live workshop to help guide students in their decision making and develop “a clearer understanding of how to choose a career path in pharmacy that is appropriate for you.” The site also features listings of jobs in all facets of pharmacy, from academics to managed care; information on the community pharmacy residence program; and career development tools, including tips for choosing the right employer, a listing of typical job interview questions, and practical advice on evaluating job offers, negotiating with employers, and networking with peers.

www.pharmacist.com/AM/Template.cfm?Section=Careers1&Template=/TaggedPage/ TaggedPageDisplay.cfm&TPLID=75&ContentID=6329 

	Founded in 1898, the National Community Pharmacists Association (NCPA) represents the pharmacist owners, managers, and employees of independent community pharmacies across the United States and is “dedicated to the continuing growth and prosperity of independent community pharmacy.” NCPA’s Web site provides information on NCPA Student Chapter activities and community service projects, promoting independent pharmacy, advocating legislative action, creating new members, fund-raising, pharmacy ownership, and more.

	Also featured on the site are important dates for students, including NCPA conferences and deadlines for summer internship and residency applications, scholarships, student loans, and award nominations; Pharmacist e-Link, providing news, continuing education courses, and business management tools; links to schools of pharmacy; information on the NCPA MTM Challenge and the NCPA Legislative Activity Challenge; and a link to the Independent Pharmacy Career Guide, a publication providing insights into independent practice.

www.ncpanet.org/index.php/students/student-resources 

	The National Association of Chain Drug Stores (NACDS) represents traditional drugstores, supermarkets, and mass merchants with pharmacies, from regional chains with 4 stores to national companies. The organization’s goal is to “advance the interests and objectives of the chain community pharmacy industry, by fostering its growth and promoting its role as a provider of healthcare services and consumer products.”

	On the “Careers in Pharmacy” page, students can find the help they need to succeed in “one of the hottest fields in the health industry.” Here, students can access listings and resources for chain pharmacy internships and residencies; learn about the NACDS Foundation Student Scholarship and other scholarship opportunities; access a listing of college of pharmacy career and interview days for the 2011-2012 school year plus contact information; and search for jobs by state or by chain in the Rx Career Center.

	The American Society of Health-System Pharmacists (ASHP) is a national professional association that represents pharmacists who practice in hospitals, health maintenance organizations, long-term care facilities, home care, and other components of health care systems. One of the organization’s offerings, the ASHP Pharmacy Student Forum, is designed to “help prepare ASHP student members for successful careers in hospital and health-system practice, equipped with the skills to lead our profession into the future.”

	At this site, students can obtain information on starting, changing, or modifying a residency program; learn about the benefits of doing a residency; and access resources such as application forms for accreditation, residency accreditation regulations and standards, and an online residency directory. Students can also view a Webinar series to learn how to navigate the residency process, and watch a video about residency training, including opportunities, benefits, settings, finding the right program, and when to start thinking about a residency.

	Information on advocacy opportunities can be accessed at the site as well, along with links to networking opportunities, a career center, and a student calendar with upcoming meetings, events, programs, and activities.

www.ashp.org/menu/MemberCenter/SectionsForums/PSF.aspx 

Pharmacy Associations: Student Career Resources

	The pharmacy job market is tightening, and it takes extra effort to stand out from the crowd of applicants. You need to pay attention to the traditional resume details, but also be alert to how social media now plays a role in how a potential employer views and evaluates candidates. It is more important than ever before to research each position thoroughly, monitor your online presence, and always offer a professional appearance. Here are some important navigation skills that will help you conquer today’s pharmacy job market. 

		Join professional pharmacy associations and stay active

		Ask advice from practicing pharmacists in a variety of settings

		Network with all of your contacts in the field 

		Utilize the career services and counseling at your pharmacy school

		Write a clear, concise career objective

		Highlight the pharmacy internships you have held to focus on your real-world experience

		Stress health care—related extracurricular activities

		Do arrive early for your interview and always confirm the appointment

		Don’t forget to bring extra copies of your resume and samples of your work

		Do detailed research on the position and company

		Don’t forget to send a follow-up communication after the interview

		Get regular exercise while job hunting and take care of your health

		Set realistic goals for each day and follow through

		Keep good records of contacts, conversations, and leads 

		Keep in touch with family and friends during the job hunt 

Navigation Skills 

Pharmacy job market information is critical as students prepare themselves for the changing demands of today's workplace.

	Pharmacy is a field in flux. The basic responsibilities and public perception of the pharmacist are evolving. At the same time, the pharmacy job market is undergoing important changes in supply and demand.

	Pharmacy job market information can be confusing. Some sources say that a pharmacist shortage still exists, whereas others warn that the recent expansion and opening of pharmacy schools will lead to a large surplus in the near future.

	A recent discussion paper by the American Pharmacists Association (APhA) and the American Society of Health-System Pharmacists (ASHP), entitled “Concerns about the Accelerating Expansion of Pharmacy Education: Time for Reconsideration,” sheds some light on this important issue. These observations can give pharmacy graduates a new perspective on the job market they face.

	In 2001, the Pharmacy Manpower Project—a nonprofit group that monitors data on the supply of and demand for pharmacists&mdash;suggested that the United States would be short 157,000 pharmacists by the year 2020.

	Although there had been pharmacist shortages in the past, the aging of the US population and the resulting need for medication experts made a potential lack of qualified pharmacists particularly critical. The decline in the number of primary care physicians means that pharmacists, as the most accessible health care providers, are now needed more than ever.

	The pharmacy education community responded by opening new pharmacy schools and expanding existing programs. The APhA-ASHP paper notes that as of July 2010, 115 schools of pharmacy were open with full accreditation or candidate status, with 5 more schools in the precandidate stage of accreditation. This is a stark contrast to just decades ago—before 1987, there were only 72 US pharmacy schools.

	The APhA-ASHP discussion paper also describes a critical change in the role of pharmacists. It states that pharmacists are increasingly overseeing the dispensing of medications, rather than personally “doing” the work of medication distribution.

	In the wake of this change, pharmacists are also assuming more patient care responsibilities, including medication therapy management, patient counseling, health screenings, and immunizations. In response, the authors write, “New pharmacy graduates will need to perform both the traditional work of the profession and the work that is linked to the future.”

	Today’s pharmacists rely on technology and support staff to allow them to assume time-consuming patient care responsibilities. Without automation and the support of pharmacy technicians, many pharmacists would find it difficult to embrace this change in the profession.

	The APhA and ASHP warn that the rapid expansion of pharmacy education programs will cause growing pains that, if not addressed, could negatively impact pharmacy students and the profession as a whole.

	They raise concerns that the increase in pharmacy programs is causing a shortage of quality faculty to teach and mentor the current crop of pharmacy students. In the 2008-2009 academic year, a survey revealed that there were 396 vacant or lost faculty positions at schools of pharmacy. Nearly half of these positions remained unfilled due to a lack of qualified candidates.

	The increase in pharmacy school enrollments also means that there are often not enough experiential rotations available to meet the demand. In a survey of 43 experiential directors at pharmacy schools, 81% of respondents said that it is “extremely difficult” or “somewhat difficult” to find quality hospital and health-systems placements for their students. For community pharmacy placements, 51% of directors said finding a placement was “extremely difficult” or “somewhat difficult.”

	The American Association of Colleges of Pharmacy, APhA, and ASHP are all taking steps to provide resources for finding experiential learning placements and recruit quality preceptors for students. More information can be found on the associations’ Web sites (see page 25 for more information).

	What can current pharmacy students do to prepare themselves for the changing demands of the modern workplace? Pharmacy students, especially those who are interested in the health-systems practice setting, might consider postgraduate residency training. Residencies can be a valuable tool to develop one’s skills and specialize in specific areas of interest.

	Patient care experience is also key. Pharmacy students can hone their patient care skills outside the classroom by volunteering their time in the community. The special skills of pharmacy students are needed at health fairs and screenings, where patient counseling and disease state management is the central focus.

	Pharmacy students might also consider more nontraditional career choices, such as specialty pharmacy, managed care, and long-term care positions.

	Although the competition might be a bit stiffer, the increase in pharmacy education programs and enrollment does not mean that good positions will be impossible to find. To supplement their education, pharmacy students should seek opportunities to hone their current knowledge and develop new skills that will set them apart from other pharmacy job seekers.

Pharmacy Workforce Trends 

Social media can be messy, whether you are seasoned veteran or a newcomer. Here are some guidelines to help you navigate the perils of your online activities and build a positive presence.

	When Facebook launched, it was easy to imagine that trivial conversations exchanges on the site would eventually disappear into the ether of the Internet. Today, we know that couldn't be further from the truth.

	A recent study found that 20% of pharmacy residency program directors look up candidates and current pharmacy residents on social media sites. A vast majority (89%) consider the public content “fair game” for judging an applicant’s character.

	Of the directors who consulted social media sites, 52% found questionable photos and posts that revealed “unprofessional attitudes,” according to the study. Reporting in the February 2011 issue of the 

American Journal of Health-System Pharmacy

, lead author Jeff Cain, EdD, MS, wrote that “offensive or inappropriate photos and written comments were the two areas that respondents found most disconcerting.”

	Whether you’re just completing PY1, starting a clinical rotation or internship, or looking for a full-time position to launch your career, it’s critical not only to be found online, but to project your best qualities to anyone who might be searching for you. This means grooming your existing online presence, building a network of professional contacts, and finding creative ways to earn recognition online for your accomplishments.

	Whether you’re a newcomer or a seasoned veteran, social media can be messy. Most people dive right in before devising a strategy to keep their professional and personal activities separate. As your network grows, however, so do your chances of alienating an important professional contact.

	Student pharmacists are preparing for a very public role in which professionalism and ethics are paramount. Even if you aren’t posting vitriolic rants about patients or professors, it’s a good idea to clean up your existing online profiles and create a strategy for each going forward.

	First, take inventory of what you’re already doing online. Revisit past postings, photos, and group memberships and ask yourself this obvious question: “If I were a recruiter or pharmacy program director, would I want to see this?”

	Purging your profiles of questionable content is worth the effort. Familiarize yourself with privacy controls on each site, utilize Facebook’s friend lists and custom privacy settings, and be prepared to edit yourself carefully.

	When you’re confident that your online profiles won’t sabotage your career prospects, it’s time to begin building your professional network in ways that will boost them. Creating a profile on LinkedIn is a great way to start.

	Because all of LinkedIn’s 90 million users share a similar goal, the site fosters a unique social environment. It’s completely acceptable and encouraged to share your accomplishments, solicit recommendations from past and current colleagues, and reach out to relative strangers for information that can aid your job search.

	Students often feel they don’t have enough experience to build an impressive profile on LinkedIn, but that simply isn’t true. If you haven’t yet had formal work experience, use your profile to showcase classes you’re taking, any special projects you’ve completed, or extracurricular activities related to your degree and professional interests.

	Consider using apps to add a pharmacy-related Twitter feed to your page, share slides from a presentation you’ve given, or publish posts from your personal blog. Use your profile as a hub for all your professional achievements and qualifications, and you’ll be one step ahead when it’s time to submit job applications.

	It takes time and effort to build a strong foundation on LinkedIn, but here are steps you can take now:

	Add pharmacy school professors and advisers, current and former supervisors or preceptors, and classmates. If you’re a recent graduate, join your pharmacy school’s official alumni group. If a group for your school doesn’t exist yet, start one!

	Use the site’s group directory to connect with like-minded pharmacists. Consider official groups that represent national and state pharmacy associations as well as ones that unite users with a shared interest, such as pharmacy entrepreneurship or medication therapy management.

	If your goal is employment at a national retail chain, use the site’s company directory to learn more about each chain, receive updates about events or job openings, and browse profiles of current employees. Before going on interviews, look up the people you’re preparing to meet. Take note of their professional backgrounds, interests, and anything that might come up in an interview.

	At the heart of social media is the exchange of ideas. Finding new ways to share yours will help you stand out in a crowd of qualified candidates and connect you with experienced pharmacists who can guide you in the right direction.

	Pharmacists share an intellectual curiosity that is infectious. Nowhere is that more apparent than on Twitter. The site’s freewheeling atmosphere inspires creativity, and its egalitarian structure gives those with less experience the opportunity to swap ideas with experts in the field. If you don’t have an account, create one with the sole purpose of discovering what topics are engaging your professional peers in discussion.

	As for participating, the same rules apply to Twitter as to all social media sites. Always be positive, authentic, and polite when offering or asking for expertise. Remember that although sharing is the goal, listening is just as important. Once you’re familiar with the landscape, join the conversation. What happens next is up to you. 

Building a Professional Presence Online

The pathway to a career in pharmacy can also include nontraditional roles in fast growing areas such as specialty pharmacy, as well as in industry, managed care, and management opportunities.

	Pharmacists can be found in virtually every aspect of health care. While the vast majority of pharmacists work behind the counter in retrail, there are other great options for students to consider, such as managing an in-patient hospital pharmacy or servicing a long-term care facility. 

	Many of today’s students are looking for careers with a pure clinical focus or those leading to management. Here are some excellent pathways to those goals.

	Pharmaceutical manufacturers employ pharmacists in great numbers to lead the manufacturing of their products and conduct research and the development of new compounds. Many manufacturers have established critical positions for pharmacists with responsibilities including medical science liaison. These positions fill an important role in communicating specific information regarding technical and clinical aspects of a product to a variety of health care providers. Other pharmacists have started out “carrying a bag”—or as detail men or women&mdash;calling on physician offices to discuss the features and benefits of particular products.

	Wholesalers play an important role in pharmacy beyond the distribution of products. All major wholesalers provide critical services to multiple classes of pharmacy. AmerisourceBergen, for example, has developed 2 voluntary groups called “Family Pharmacy” and “Good Neighbor Pharmacy.” Under these banners, customers are offered a myriad of services including pharmacy systems, central fill, advertising, signage, private label, generics, auto-shipping, price management, and planograms. Pharmacists who are employed at the wholesaler’s headquarters play a key role in managing these programs.

	Another growing role for pharmacists is in managed care. With nearly 90% of all pharmaceuticals being managed by some third-party plan, pharmacists play a key role in determining the appropriate use of limited financial resources. A managed care pharmacist may work in mail order, reviewing drug utilization, counseling physicians on appropriate use of medications, or negotiating formulary placements. Pharmacists are also employed by health maintenance organizations, Prescription Benefits Managers, and insurance companies.

	Specialty pharmacy is a great place to practice clinical pharmacy. The field continues to grow because so many of the new medications coming to market are biotech products. Specialty pharmacy is a great practice setting for biotech medications to be launched by pharmaceutical manufacturers. Biotech products typically require clinical management due to more stringent FDA regulations. The FDA and Biotech Pharmaceutical Manufacturers mandate clinical programs such as Medication Therapy Management (MTM) and Risk Evaluation and Mitigation Strategies (REMS).

	Pharmacists who practice specialty pharmacy become specialists in disease state management and cutting-edge biotech products. It’s a unique opportunity for pharmacists to play a huge role in the launch of new therapies and medications. Pharmacists can also build strong relationships with patients as well as provide critical clinical outcome data directly to the pharmaceutical manufacturers. This feedback and information has been used to improve adherence and compliance.

	Pharmacy margins continue to decline year after year. One solution to the problem is getting reimbursement for clinical services. Specialty pharmacies are now getting paid for their clinical services because of the improvement in patient outcomes. In fact, it is safe to say that specialty pharmacies are molding the future practice of pharmacy. Additionally, pharmacist surveys are seeing an increase in job satisfaction for pharmacists who practice specialty pharmacy. This career option lets students put their knowledge and skills to use in improving patient outcomes, while being on the cutting edge of pharmacy practice.

	With the consolidation in the drugstore industry, chains and other institutional pharmacies have risen in prominence. Pharmacists can be found in all levels of management including operations, marketing, managed care, purchasing, information systems, and administration. Rounding out opportunities in pharmacy are the very rewarding positions of management roles in government, public health services, military academia, and professional associations.

	For students looking forward to a career in pharmacy, it is still necessary to fight the public’s impression of pharmacist as that person behind the counter at the corner drugstore, preparing one prescription after the other. While retail practice dominates by sheer numbers, the reality is that pharmacists play critical roles in many other areas related to health care.

	Do not hesitate to reach out and ask pharmacists outside of traditional retail for a few hours of their time, and gather firsthand accounts of nontraditional career paths. Most pharmacists in these settings are very proud of their contributions to the profession—and you’ll find them very willing to mentor the future leaders of pharmacy. 

, and a Principal of D2 Pharma Consulting LLC. Quintin Jessee, RPh, BSPharm, of D2 Pharma Consulting LLC, is director of specialty pharmacy consulting with more than 10 years of senior management experience in specialty pharmacy operations. 

Nontraditional Pharmacy Practices

Diverse positions are available in the United States Public Health Service Commissioned Corps for those who are interested in pursuing a pharmacy career in military.

	The mission of the United States Public Health Service (USPHS) Commissioned Corps is to provide for the health and safety of the nation through “rapid and effective response to public health needs, leadership, and excellence in public health practices, and advancement of public health science.”

	The great diversity of positions available in the Commissioned Corps means that military pharmacists, and even current students, can help to meet this goal with a career path tailored to their own interests and strengths. 

	Currently, the USPHS Commissioned Corps consists of more than 6000 full-time, highly skilled professionals from a number of health care fields. All pharmacists in the Corps are uniformed officers, and they serve in the US Department of Health and Human Services and other federal agencies.

	Rear Admiral Scott F. Giberson, assistant surgeon general and chief pharmacy officer, USPHS Commissioned Corps, says, “PHS Pharmacy allows for unparalleled diversity and opportunity. Our pharmacists become an integral part of a unique career path that can involve advanced pharmacy practice, health policy development, emergency and humanitarian response, public health leadership, global health, and much more.”

	Captain Carmen Clelland, PharmD, MPA, director of the Health Professions Support Branch of the Indian Health Service, says that the majority of career opportunities in the corps are focused on patient care and counseling. Captain Clelland explains, “There are many opportunities for recent graduates with the corps. Primary care, ambulatory care, and institutional practice opportunities include working with the Indian Health Service, Division of Immigration Health Services, and US Coast Guard. Many initiatives of these 3 organizations allow pharmacists to utilize their clinical skills recently learned in pharmacy school.”

	For recent graduates who are interested in policy making, academia, or administration, other agencies can provide important employment opportunities. The FDA, the Health Care Financing Administration, Health Resource and Services Administration, National Institutes of Health, Substance Abuse and Mental Health Services Administration, and Centers for Disease Control and Prevention also utilize Corps pharmacists, though Clelland says that many of these positions are not entry level.

	To become a member of the Commissioned Corps, pharmacy graduates must be US citizens, be 44 years or younger, and pass a physical examination.

	Pharmacy graduates also need to hold a degree from a program accredited by the American Council on Pharmaceutical Education. Corps candidates need a current, valid, and unrestricted pharmacy license for one of the 50 states, Washington, DC, Puerto Rico, the US Virgin Islands, or Guam. Recent pharmacy graduates who do not yet have a valid license may still apply to the Corps, but will be appointed for a limited tour of duty until licensure is complete.

	Once accepted into the Commissioned Corps, the required length of service is 2 years with the same agency. If a pharmacist qualifies for and receives a sign-on bonus, the length of service is 4 years at the initial duty station. After that term, Corps pharmacists have the opportunity to apply for positions at different agencies.

	The benefits of a career with the Commissioned Corps are generous. New pharmacists who enroll receive competitive starting pay, free medical and dental care for the pharmacist and low-cost medical care for family members, taxfree housing and meal allowances, 30 days’ paid vacation, and paid sick and maternity leave.

	For newly commissioned pharmacists, the Corps offers a $30,000 accession bonus for signing a 4-year active-duty agreement. Pharmacists in the Corps may also be eligible for an annual $15,000 retention bonus.

	In addition to these benefits, the USPHS will cover moving expenses incurred during relocation. In recognition of the financial burden a pharmacy student accepts by going through professional schooling, the USPHS also offers loan repayment and other educational and family support programs for those who qualify.

	Captain Clelland notes that there are nonmonetary benefits to a career in the Corps as well. Flexibility and career growth are 2 big benefits to a career in the Corps.

	Rear Admiral Giberson says, “We [in the Commissioned Corps] desire professionals and pharmacists that want to serve a mission, become part of something special, and want to make a difference in the lives of people.”

	Pharmacy students who are interested in careers with the USPHS Commissioned Corps can call 800-279-1605 for more information or visit www.usphs.gov/applynow/.

	The Commissioned Corps also has programs exclusively for current students. Students who have completed at least 1 year of study in a master’s or doctoral program or 2 years in a professionally accredited bachelor’s program may qualify for the Junior Commissioned Officer Student Training and Extern Program (JRCOSTEP). Assignments in JRCOSTEP last from 31 to 120 days, and are scheduled during school breaks and the summer months. Students are paid for their time and are not obligated to join the Corps upon graduation.

	A similar program, the Senior Commissioned Officer Student Training and Extern Program (SRCOSTEP), was created for full-time students entering their last year of professional training in an accredited program. SRCOSTEP participants receive financial assistance to complete school, and agree to serve in the Corps after graduation for twice the amount of the time for which they received assistance. Students interested in the JRCOSTEP and SRCOSTEP programs can check their eligibility at 

https://dcpweb.psc.gov/ rab/scripts/app_main_menu.htm

Three outstanding military pharmacists were recently recognized for their dedication to their patients and public health at the Next-Generation Pharmacist

Awards, a prestigious annual awards program presented by 

and Parata Systems. You can read profiles of all 3 Military Pharmacist of the Year finalists at 

. For more details about the winners, including Military Pharmacist of the Year and 2011 Next-Generation Pharmacist 

winner Major Jeffrey Neigh, PharmD, BCPS, visit 

USPHS: Leading the Way in Public Health

	Mass merchants account for nearly 10% of the total retail prescriptions filled, according the National Association of Chain Drug Stores, outpacing prescription sales growth for the rest of the retail pharmacy industry. These mass merchants are providing patient services that rival the services offered at drug chains and independent pharmacies—and they offer the pharmacy student an alternative career choice.

	Chains such as Kmart are responding to the consumer’s interest in both convenience and affordable cost when it comes to health care. These stores allow consumers to purchase most of their household and health care needs in 1 location, while providing the level of professional pharmacy care they would expect to find at a neighborhood pharmacy.

	“We give our pharmacists the opportunity and encouragement to counsel patients and customers, and encourage them to take an ‘ownership’ mentality,” said Howard Kramer, RPh, director of pharmacy human resources and government affairs at Sears Holdings, the parent company of Kmart.

	Pharmacists know that Kmart expects them to operate the pharmacy as if they were the owners. “We provide our pharmacists with extensive financial information to help them make the best possible decisions in terms of operational activities,” said Kramer. “Our pharmacists are empowered to take care of patients and improve their lives.”

	Kramer noted that every prescription filled is an opportunity to improve outcomes—and improved outcomes are frequently a result of patient counseling. “The nature of our practice setting at Kmart gives us multiple opportunities to work with providers and patients to provide the best possible medication therapy management (MTM),” he said. Kmart’s MTM programs focus on medication adherence, with particular attention paid to diabetic and cardiovascular issues. “Our stores frequently hold diabetic and healthy heart events, with free blood pressure monitoring,” said Kramer.

	To insure that pharmacists are spending their time with their patients, Kmart has made an investment in pharmacy workflow and automation systems that allows for the balance of workloads. “This balance allows pharmacists to process prescriptions during off peak hours,” explained Kramer. “Our automated system allows patients to call in to refill their prescription and informs them when their prescription will be ready.”

	Kramer noted that when a company is focused on the patient, a national retailer with largefootprint stores can still feel like a community pharmacy. “Community pharmacy is one of the best practice types to be able to utilize all of those patient counseling skills students learned and practiced while in pharmacy school,” said Kramer.

	Practicing in a national mass merchant chain offers a multitude of advantages over other practice settings. Kmart, for example, operates in 45 states as well as Puerto Rico, Guam, and the Virgin Islands. Other career paths can include pharmacy management teams, district manager, divisional director, or at the corporate level, operations, human resources, or pharmacy administration.

	Another mass merchant offering convenience and economic options for patients is Walmart.

	This company provides employment opportunities that are as far-reaching as its brand, while giving patients the level of care they would typically find at a smaller pharmacy. As the world’s largest private employer, Walmart has 2.1 million associates and more than 9700 retail locations worldwide. The company has a philosophy of giving back locally and thinking globally; it supports more than 100,000 charitable and community-focused organizations.

	But that doesn’t mean the individual doesn’t count. “Our focus is in the details, so we operate our stores and pharmacies 1 customer at a time, 1 prescription at a time, and 1 pharmacy at a time,” said Walmart spokesperson Christi Davis Gallagher.

	Susanne Hiland, PharmD, senior director of health and wellness regulatory affairs in the Health and Wellness Division at Walmart, defines characteristicss about the pharmacy profession that should never change as “trust, quality, compassion, accessibility, and expertise” in a recent Careers “Industry Voices.” Within the walls of this mega-giant mass merchant, it is all about “the trust that our patients place in us… cultivated by many things, including the advice you give, the accuracy and quality of the products you provide, and the care and compassion you display,” noted Dr. Hiland.

	Walmart launched the $4 prescription program in 2006, and it has saved Americans more than $3.4 billion on their prescriptions. Since the launch, the program has added certain 90-day prescriptions for $10; popular women’s health medications; and free mail delivery for eligible 90-day prescriptions for $10.

	“Time and time again, our pharmacists tell us they are proud to work for a company that is making such a dramatic in its customer’s lives by providing access to affordable prescriptions that many customers might otherwise opt not to purchase,” said Gallagher.

	In-store medical clinics also offer affordable and accessible heath care for their communities, and pharmacists work closely with their neighbors to provide the best care. Additional career paths may include various areas of the business—health and wellness, operations, merchandising, information systems, or Walmart. com.

	Gallagher offers these words of advice to students: “We encourage pharmacy students and interns to make a list of the things that are the most important to them when looking for a career. If quality of life, excellent benefits, a great working environment, growth and leadership opportunities, flexible scheduling, and appreciative patients are at the top of that list, then Walmart is the place for them.” 

Ms. Petersen is a freelance writer based in New Jersey. 

With the changing landscape of health care, community pharmacists have an opportunity to take on a larger role in improving patients' health. Here is what national retail chains are doing to set up.

Mass Merchandisers Offer Career Choices

Six years after hitting rock bottom, Winn-Dixie is gearing up for a strong return by revamping its stores, revitalizing its brand, and modernizing its pharmacy services.

	The past few decades haven’t been easy for Winn-Dixie Stores, inc. But after years of watching its market share dwindle and dealing with financial hurdles, the Jacksonville, Florida—based supermarket chain is ready to turn the page.

	Earlier this year, Winn-Dixie embarked on a companywide overhaul that has included remodeling several stores and rebuilding its brand and culture.

	As of September 2011, 5 stores had been completely remodeled, boasting a “cleaner and more modern” look that features high ceilings and hardwood floors. However, the transformation is about more than just aesthetics, according to Dan Lafever, Winn-Dixie regional vice president. As part of the overhaul, selected stores now feature an expanded produce section, a deli department serving hot and cold prepared foods, a Wi-Fi—enabled sitting area where free coffee is served, a wider selection of wines, cheeses, and fresh seafood, and a remodeled pharmacy with wellness center.

	The goal is to provide consumers with “a onestop grocery destination” that caters to the needs and preferences of the surrounding community, said Lafever.

	The company has already reaped financial benefits from the overhaul, reporting that the revamped stores are exceeding the industry average of $475 in annual sales per square foot. An additional 15 renovations are planned for the fiscal year that ends June 2012. If the stores continue to perform well, it could mark a significant step forward for Winn-Dixie, which filed for bankruptcy in 2005.

	Since then, the company, which operates 484 stores (including 379 in-store pharmacies) in Florida, Louisiana, Alabama, Georgia, and Mississippi, has been focused on winning back some of the market share it lost to rival stores. One way that Winn-Dixie hopes to attract a wider audience and increase local appeal is by featuring foods and products that reflect the needs, tastes, and preferences of a store’s geographical area, according to John Fegan, BSPharm, RPh, vice president of pharmacy. For example, the newly revamped Winn-Dixie store located in Aventura, Florida, features a variety of koshercertified products and freshly prepared foods.

	“With locations that have been remodeled and upgraded, the guests will experience a broad, current selection of food products that best fit their lifestyles,” said Fegan. “Adding the fact that patients can combine their shopping visit with a trip to the pharmacy for their health-related medications, availing themselves of the services that a Winn-Dixie pharmacist provides, we have found a very high satisfaction level among our shoppers.”

	Whereas the companywide strategy for WinnDixie has revolved around a physical transformation of the stores, the pharmacy department’s overhaul has centered on creating a more convenient experience for patients.

	The company recently introduced RxConnect, a centralized prescription record system that links all pharmacies at Winn-Dixie and SaveRite stores, which is designed to simplify the process of ordering and picking up medications. In August 2011, Winn-Dixie began converting all SaveRite grocery stores to conventional WinnDixie—branded stores and discontinuing the SaveRite banner, a process the company expects will take about 4 months.

	In the meantime, all patients will be able to review medication profiles online, print out medication history reports, request refills online, and view images of the medications they are taking through RxConnect, according to Fegan.

	“A centralized prescription record system that links all Winn-Dixie and SaveRite pharmacies actually benefits both the shoppers and the pharmacists,” he said. “For the shopper, they will experience the convenience of having their prescription information available at whatever Winn-Dixie location they choose.  For the pharmacist, patient information is easily retrievable and can be used to quickly fill prescriptions, review prescription and patient records in order to answer questions, or provide a printout of health records.”

	In addition to RxConnect, Winn-Dixie has launched a number of other initiatives aimed at improving the patient’s overall experience. The pharmacy now accepts Flexible Spending Account and Health Savings Account debit cards at all registers, making it easier for patients to save money on health care purchases. Most Winn-Dixie pharmacies also offer:

	• Free total cholesterol and diabetes screenings (with results available online)

	• A full line of specialty diabetic products

	• A smartphone application that can help users find the closest store, view weekly circulars, and create and manage shopping lists

	Through these initiatives, the company hopes to achieve continued growth and position itself as the top supermarket chain in the South.