Michael Tsai
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Thursday, January 10, 2019
Inpatient – Cardiology
On this rotation, I got to experience the day-to-day of a
clinical pharmacist specialist in a health-system. My schedule would consist of
working up patients early in the morning to make sure I had the most up-to-date
lab results for the patients on my service and to check if anyone was admitted
overnight. I would start rounding with
the medical team at around 9 am. The team consisted of an attending physician
and 3 medical residents. During rounds, the medical residents would update the
attending about the patients and make suggestions. They would also see the
patient and update them on their progress. My role during rounds was to collect
information and make any recommendations I previously discussed with my
preceptor. I was actively thinking of labs to order and optimizing medication
regimens. Outside of rounds, I also was responsible for medication
reconciliations to ensure the medications the patient was taking at home was
the same ones ordered in the hospital. I educated patients if they were put on a new
anticoagulation medication and oversaw warfarin dosing and monitoring.
Throughout my rotation, I had the opportunity to work with
three different medical teams, which showed me different leadership styles and
receptiveness to recommendations. Additionally, I picked up on procedures and
surgeries commonly seen in the cardiology floor. While they are not taught in
our pharmacy curriculum, they may determine which medications the patient
should receive.
Days were long on this rotation since there were up to 16
patients to follow at times, but it was a worthwhile experience as it sharpened
my clinical knowledge. It also provided an experience in interprofessional
teamwork. Working with physicians showed me how little I knew about medical
procedures and surgeries, but also gave me confidence in my pharmacy knowledge,
as I answered many of their questions about medications.
Drug Information – Managed Care
My next rotation was with the prescription drug plan of an
employer group. This was my favorite rotation so far since I am interested in
pursuing a managed care pharmacy career after graduation. Assignments on this
rotation were project-based. The first task I had was to prepare documents for
advisory committee meeting, where formulary decisions would be made. With a new
medication recently approved by the FDA, I summarized the characteristics of
the medication, clinical trial results, proposed place in therapy, and economic
considerations. After presenting this to the advisory committee and hearing the
committee’s final decision, I drafted the prior authorization criteria and
medication request form for this medication. These were to be used by the
plan’s pharmacy benefit manager to determine if coverage would be provided for
patients requesting the medication.
Another highlight of the rotation was learning to use
Microsoft Excel. Managed care deals with large populations, so datasets are
commonly analyzed through Excel. I conducted a drug utilization review, where I
identified an at-risk target population from medical and pharmacy claims data. Using
this information, the plan sent out letters to prescribers identifying their
patients who were at-risk.
During this rotation, I also got to sit in on several
meetings, including ones with a mail-order pharmacy, specialty pharmacy,
pharmacy benefit manager, and medical benefit. These meetings showed me how a
health plan interacted with these other healthcare stakeholders. Additionally, my
preceptor allowed me to attend the Academy of Managed Care Pharmacists (AMCP)
Nexus conference. On top of learning from multiple sessions about trending
topics in managed care pharmacy, I also had the opportunity to network with
managed care pharmacists and speak with residency programs at the residency
showcase.
I enjoyed seeing projects from beginning to end on this
rotation. Since it was a smaller health plan, pharmacists were the
jack-of-all-trades and worked on all aspects of managed care pharmacy. I learned much more about this career field and gained valuable experiences.
Open rotation
At the University of Michigan College of Pharmacy, there is
an option to leave one rotation free. I chose to have this
rotation off to work on residency applications, serve as a groomsman in a friend’s
wedding, and visit friends and family in California. I was glad to have some
time off to rest and recuperate (and catch nice photos like the one below).
Now that the sun has set on 2018, I’m looking forward to new
experiences in 2019!
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