Rotation 3 - Specialty Pharmacy

Posted by Jared at Wednesday, September 28, 2016

My third rotation brought me to the community site for a specialty pharmacy up in Flint, MI. I was really excited for this rotation, as I have interned in the community setting since P1 year, and I felt this would bring a new angle to it.

When I walked in the first day, I was honestly shocked at the manpower this pharmacy had. There were 3-4 pharmacists + the pharmacist-in-charge (PIC) working at the same time, along with roughly 20-30 technicians (I honestly don't know the exact number, but there were a lot) working on various things (i.e. processing, register, counting, shipping, inventory, etc.). Coming from pharmacies where the norm is one pharmacist and a few techs, this was certainly like sticker shock to me.

Typical Day

The other P4 on rotation from Ferris State and I would usually arrive in the morning at 9 AM. We would generally start by doing doctor calls and following on problems that the pharmacists or techs wanted us to resolve. Afterwards, we would do a number of different things. We might help out in the pharmacy with answering phones, counseling patients, answering questions, or practice verifying prescriptions. We would have a half hour break for lunch, and then essentially doing similar things until I left for the day at 5.

Sprinkled throughout the rotation, I would work on various projects, topic discussions, along with shadow different parts of the pharmacy and ask questions. It was interesting to me that interns at this site had office space, so it allowed me to get away from the busy, loud environment of the pharmacy and gave me some quiet time to get away. Also, we did immunizations and MTM sessions as well! I would also often tell patients that were getting controls or narcotics about issues we had filling them. These often involved warnings about how we might not fill them in the future for whatever reason, or if we were denying them because they had filled too many of these types of prescriptions at too many pharmacies. I certainly had a lot of interesting interactions from these encounters.

Overall Thoughts

Having a community background from interning, I was a bit nervous in general about how this was going to go. I had heard horror stories from previous P4s and different classmates about how many people on their community APPE just get stuck doing tech work because it's too busy for them to really talk with their preceptor and learn. Luckily, this site was nothing like that at all. My preceptor really tailored the rotation to things that he felt would help me the most in terms of learning. Due to the nature of the site, I was exposed to a lot of specialty drugs I had not really heard of in the past. From this, I was able to learn different regulations that go into being able to dispense these medications, along with the limited amount of pharmacies nationwide that are able to dispense them.

Also, my preceptor didn't have us do any typical tech work at all (counting/processing), which I was really thankful for. The topic discussions we did really helped me to revisit OTC medications, which I honestly hadn't dealt with since P1 year. I also got much stronger at my counseling skills, due to the sheer number of questions we fielded either from prescribers, nurses, or patients. Furthermore, my projects I did were really tailored to what I was interested in looking at. For example, I did a topic discussion on Hepatitis C and a presentation on transitions of care and the potential role community pharmacy could play. Finally, I was able to go to the company's corporate headquarters for a few days and shadow different people to get a further sense of what specialty pharmacy is really like, along with their daily operations on a national level.

Ultimately, I think this rotation was really fantastic. I'd highly recommend it if you have previous community experience and want to see a different side to things. The pharmacists and techs are great and really emphasize student learning, as they almost always ask a student to deal with the problem first if we're capable of doing so. However, I will say that if you have never worked community before, I would almost recommend going to a larger chain, as I feel everyone needs the experience of counting a lot of medications, along with processing insurance to really get a comprehensive community experience. Due to my site's system, along with some of the complex, expensive medications that might have to be billed, I don't know that P4s would necessarily be able to jump in and deal with insurance, as it would really interrupt the site's workflow.