Reconsidering the Idea of PGY3 Subspecialty Training in Clinical Pharmacy

Should PGY3 subspecialty residencies be part of future clinical pharmacy training?

Should postgraduate year 3 (PGY3) subspecialty residencies be part of future clinical pharmacy training?

This question was raised by a fellow Pharmacy Times contributor who made several painstaking points related to the advantages and opportunities that PGY3 programs could offer, but I must admit that I wasn’t thoroughly convinced to agree with the author’s conclusions.

Before I proceed, I must disclose that I’ve completed PGY1 and PGY2 residency training with specialization in emergency medicine pharmacy. This training has been undoubtedly invaluable to my own practice as an emergency medicine pharmacist.

Although there has been significant growth in the number of PGY2 emergency medicine pharmacy residency programs in recent years, the demand for dedicated emergency medicine pharmacists hasn’t matched the supply of newly trained emergency medicine pharmacists who complete these programs on an annual basis.1 PGY2 training also may not be available for everyone who practices in the emergency department, and the first year or 2 may involve learning the essentials of emergency medicine pharmacy that were averted by effective PGY2 training.

The results of the 2016 pharmacy residency match paint a picture of the current climate, as more than 1500 candidates didn’t successfully match to a PGY1 program. Some may argue that these candidates can pursue a nonresidency pharmacist position for a year and then reapply to PGY1 pharmacy residency programs the next year, but again, the statistics are rather telling.

Over the past several years, the number of applicants who applied for the match but weren’t about to graduate, such as previous graduates of the current match year, has hovered at approximately 8%, and only half of those candidates were matched successfully.

Those statistics speak to the concept harbored by many individuals in recent years: there simply aren’t enough PGY1 pharmacy residency programs to meet the increasing demand from candidates.2 Clearly, this issue needs to be resolved before we can even consider expanding the number of PGY2 programs available, let alone establishing PGY3 ones.

The author pointed out potential areas where PGY3 training may be worth pursuing, such as advanced heart failure and cardiac transplantation, but formal postgraduate training already exists for some of them. For instance, there are several existing 1- and 2-year fellowship programs dedicated to training pharmacists in the field of clinical toxicology, most of which are affiliated with a poison control center.3 In addition, obstetrics and clinical pharmacy gained a groundbreaking program a few years ago, with mentorship provided by none another than one of the field’s founding fathers.4

It’s difficult to say there’s high demand for clinical pharmacists in many of these subspecialties, unless you practice at one of the few institutions that cater to them. For any residency program to be effective, it’s essential to ensure there are a sufficient number of clinical subspecialists dedicated to training residents. However, there may be only a few clinical specialists scattered throughout the country who practice in highly specialized institutions where their services are essential and highly valued by their respective multidisciplinary teams. The author noted some of these points, but they shouldn’t be passed over for the sake of pursuing the idea of PGY3.

Postgraduate residency training should lay the framework for a formal skillset within a specific area of clinical pharmacy. Finding and honing a niche within a specialty of clinical pharmacy may take time and effort, but it fosters professional development among those who make the pursuit part of the spectrum of their career.

Could a PGY3 residency provide some ease on the journey through guidance and tutelage of mentors and a formalized educational curriculum for learning? Perhaps, but it’s heavily dependent on individual motivation, perseverance, and dedication, and mastered expertise of a niche over several years of real-world experience and clinical practice speaks volumes relative to any number of years spent completing postgraduate residency training within a particular subspecialty of clinical pharmacy.

References

1. Acquisto NM, Hays DP. Emergency medicine pharmacy: still a new clinical frontier. Am J Health Syst Pharm. 2015;72(23): 2092-2096.

2. Engels MJ, Flint NB, Corbett SM, et al. Overcoming the residency capacity challenge as 2020 draws near. Curr Pharm Teach Learn. 2015;7(3): 405-410.

3. Hayes BD. Clinical toxicology residency and fellowship programs for pharmacists. Am J Health Syst Pharm. 2011;68(6): 480, 484, 486.

4. Nelson L. Pharmacy resident in obstetrics debuts at Spokane Hospital. news.wsu.edu/2014/10/29/pharmacy-resident-in-obstetrics-debuts-at-spokane-hospital Accessed April 15, 2016.