Program Directors Make the Case for PGY2 Training to Build the Neurology Pharmacy Pipeline

In this episode of Mind the Meds, host Erica Marini, PharmD, MS, BCPS, speaks with Kat Chester, PharmD, BCCCP, BCGP, FNCS, a PGY2 neurology residency program director at Grady Memorial Hospital in Atlanta, and Michael Armahizer, PharmD, BCCCP, a clinical pharmacy specialist in neurocritical care at the University of Maryland Medical Center. Marini notes that the American Society of Health-System Pharmacists directory lists roughly 6 formal neurology training positions, compared with 55 PGY2 programs in cardiology and 199 in critical care. Both guests came to neurology without dedicated training and describe how their programs grew out of expanding neurology services, institutional support, and a market survey showing demand for neurology-trained pharmacists.

Both Chester and Armahizer make the case that a PGY2 offers depth that a short rotation or on-the-job learning cannot. Residents get repeated exposure to complex cases such as refractory status epilepticus and see neurologic care across inpatient and outpatient settings. Chester points to the volume of practice-changing literature and to the share of new FDA approvals related to neurology, which she puts at about 1 in 5 to 1 in 7. Chester and Armahizer note that they expect the greatest growth to be in ambulatory care, driven by antiamyloid therapies, multiple sclerosis disease-modifying therapies, neonatal Fc receptors and complement inhibitors for myasthenia gravis, and new migraine treatments. They name proving return on investment, low awareness of what pharmacists contribute, and a limited workforce as the main barriers.

For PGY1 residents weighing the specialty, Chester rejects 3 common misconceptions: that neurology is too niche, too difficult, or short on career opportunities. They both recommend taking a neurology or neurology-adjacent rotation and talking with practicing neurology pharmacists. Midcareer pharmacists can build expertise through protocol work, mentorship programs, organizations such as Certified Pediatric Nurse Practitioner, the Neurocritical Care Society, and the American Academy of Neurology, and by teaching. Residency graduates are seen as neurology’s strongest advocates, because they start new programs and help train medical residents who later push for pharmacists on their own teams.