Sg2013 Final All

Landing your dream job

New numbers show it has indeed gotten tougher out there for new pharmacy grads. But there are exciting opportunities for those who know where to look

By Sonya Felix

Contents

2013/2014 Student Guide

Landing your dream job ............................. 1

Critical appraisal ........................................ 4

The Pharm D shift ...................................... 8

assoCiaTe eDiTorBrett ruffell

eDiTor-in-ChiefVicki Wood

arT DireCTorLima Kim

PuBLisherJackie Quemby

aCCounT Managersscott Tweed, Pauline shanks

rogers heaLThCare grouPexeCuTiVe PuBLisherJanet smith

eDiToriaL DireCTorrick Campbell

rogers PuBLishing LTD. senior ViCe-PresiDenT anD gM steve Maich

ViCe-PresiDenTsimmee Chee Wah, Patrick renard

A supplement from

Contents copyright 2013 by rogers Publishing Ltd. The 2013 student Career guide is published by rogers Publishing Limited.

one Mount Pleasant road, 7th floorToronto ontario M4Y 2Y5T (416) 764-2000f (416) 764-3931

pharmacypractice 2013 StudentCareerGuide 3 2 pharmacypractice 2013 StudentCareerGuide CanadianHealthcareNetwork.caCanadianHealthcareNetwork.ca

pharmacists who want a job wont find one. With that in mind,

we asked experts to share some career advice for tomorrows

pharmacists.

Small town advantagesWhile Tario doesnt yet have a job lined up, she is well aware that

prospects are better in smaller communities. Im open to work-

ing in an underserviced area, she says.

Thats a good idea, according to David Edwards, Hallman

director of the School of Pharmacy and associate dean, Faculty

of Science, University of Waterloo. The job market is definitely

tighter than it once was. This is especially true in some of the

larger urban centres, and I advise students to be open to prac-

tising anywhere [...] in Canada. You should never settle for a job

you hate just because it is in the right city. That almost never

ends well.

Jason Perepelkin, assistant professor of social and adminis-

trative pharmacy, College of Pharmacy & Nutrition, University

of Saskatchewan, agrees that the ability to secure a job in any of

the 10 cities where schools of pharmacy are located in Canada

is difficult and has always been that way, even during the time

of bonuses and multiple offers.

[Students] should consider what opportunities are one to

two hours away from their dream location, he says. Many

times a more rural location offers a greater scope-of-practice

for pharmacists and one can learn many invaluable skills and

improve ones practice expertise that would help them secure

that dream job in the future.

Focus on acquiring skillsGetting a job isnt as big a concern as finding one that encour-

ages initiative, innovation and creativity, says Tario. I realize I

am picky, but I really want a job that is right for me. To compete

in the job market, she is preparing to differentiate herself. No

matter what pharmacy program you go through, the knowledge

you acquire is basically the same. So extra skills and any com-

munity experience you have is important to show your initiative

and leadership qualities.

Dr. Wayne Riggs, professor and associate dean, Faculty of

Pharmaceutical Sciences at the University of British Columbia

suggests that students prepare by enhancing their soft skills

such as verbal and written communications, fostering leader-

ship skills and developing their interpersonal skills. As well,

he says that students need to be innovative in developing new

practice models as opposed to fitting into current models that

appear to be largely saturated.

Getting as much experience as possible in a range of differ-

ent types of pharmacy practice settings is also a good idea, says

Edwards. This will help identify what areas pharmacy students

are passionate about. Pharmacy students at UWaterloo have

the advantage of a 16 months of co-op experience that allows

them to make connections with a number of pharmacists and

potential employers and understand what pharmacy practice is

all about in the real world.

The preparations for starting a career as a pharmacist should

really start the day students receive their acceptance letter to

pharmacy school, says Perepelkin. Networking is a must, es-

pecially in a tight job market. Students should develop their

own personal brand by thinking about what image they want to

project to colleagues and future employers. What must not be

lost is the fact that the faculty at your pharmacy school are well

connected throughout the countrydont burn bridgesthis

goes for employers while in school and SPEP preceptors.

WATERLOO STUDENTS PRODUCE DRAKE PARODY VIDEOThe four University of Waterloo pharmacy students behind last years smash hit Call the Pharmacy have dropped their latest single. This time the group, which includes Danielle Paes, Bhupender Sayain, Kacie Lunn and Jaskiran Otal, parodied Drakes Started from the Bottom video that the rapper filmed in an Ontario pharmacy.

The students say their version, Started from the Product, is about pharmacists embracing new opportuni-ties. Its also about informing both the public and healthcare professionals about the profession. At the very least, peo-ple can hear a little bit about how pharmacists are making a difference and see how the profession is evolving to address challenges within our healthcare system, says Paes.

Catch Started from the Product here, and their previous hit Call the Pharmacy here.

When Allison Tario enrolled in the pharmacy program at the University of Waterloo three years ago, she heard all kinds of horror stories about how hard it would be to find a decent job at graduation.

People said Havent you heard that staff and salaries are be-

ing cut and drugstores are closing? and Why would you want

to be a pharmacist? says Tario, who has just started her fourth

year and hopes to work at an independent community phar-

macy after graduation.

But despite all the worries about how lots of pharmacies

would close as a result of drug policy reforms, she notes that

hasnt happened. I think pharmacy has adapted well to the

changes and will continue to evolve as long as we are open to

new ideas and willing to keep learning. I am genuinely excited

about the future.

Such optimism might be surprising to some, especially to

those who are having trouble landing a job. While more than

92% of registered pharmacists were employed in pharmacy in

2012, more than two-thirds of the remaining 8% were seeking

employment, according to the Canadian Institute for Health

Information (CIHI), Pharmacist Workforce, 2012.

But pharmacy still seems to be a good bet for a well-paid ca-

reer. Canadas Best Jobs 2013, an annual feature published by

Canadian Business, ranked pharmacist as #27 this year, using

Statistics Canada data to compare wages and employment pros-

pects. Based on a median annual salary of $95,680 in 2012, phar-

macist is the fourth highest paid among the top 50 jobs listed,

with wages having increased by 21% between 2006 and 2012.

Still, the projected job openings in 2020 are only 0.71 for

every person looking for a job. That could mean that three in 10

GOOD TIP: THINK ABOUT YOUR DIGITAL FOOTPRINT!If something unflattering is posted online, there is a permanent record of that, even after you personally delete it, cautions Jason Perepelkin, assistant professor of social and administrative pharmacy, College of Pharmacy & Nutrition, University of Saskatchewan. The vast majority of employers today, before ever contacting you for an interview, will do a search of your digital footprint, and if there is something that doesnt align with that organizations brand, your chances of securing an interview are all but gone.

Expect to work hardAs Perepelkin notes, even though demand for pharmacists

may be far greater than supply once the baby boomers retire,

finding a dream job will always be a challenge to secure. While

building the desired practice many struggles occur, including

failures, but the one thing that [successful] practitioners have in

common is the will to continue on and learn from each experi-

encegood or bad.

And dont be afraid to dream big. As a new pharmacy student,

Tario had never considered opening her own pharmacy, but the

idea is growing on her. Obviously, that wont happen initially

since I first have to find a job where I can continue learning as

much as I can, she says.

Pharmacy is at a delicate point where we are facing numer-

ous budget cuts, changing our compensation model and need-

ing to prove the value of patient-focused care to patients and

government. We have to balance making money with providing

patient services and I think having my own pharmacy could

give me freedom to be as creative and innovative as I want. And

thats pretty exciting.

Students should develop their own personal brand by think-ing about what image they want to project to colleagues and future employers

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4 pharmacypractice 2013 StudentCareerGuide CanadianHealthcareNetwork.ca

Critical AppraisalHow to extend the half-life of your education so that youre always on the crest of the latest evidence-based practice wave

By Bryan GrayA drug half-life is defined as the time required for half the quanti-ty of a drug to be metabolized or eliminated. A longer half-life can impart

a longer duration of action. Now, what is

the half-life of your pharmacy degree?

Four years? Ten years? Twenty years?

Whatever the actual number may be,

its guaranteed that much of what you

are learning now will drastically change

over the span of your pharmacy career.

New waves of research trials, guidelines,

meta-analysis are being published at an

unprecedented rate. At graduation, your

SG2013 Critical Appraisal [Print].indd 4 12/24/13 11:17 AM


conferences, talks, lectures and presentations. Sign up for

email updates from evidence databases. Talk with your peers,

colleagues and other healthcare professionals. In the not-so-

distance future when you eventually have your own phar-

macy students working with you, ask them what they have just

learned in school!

As Theodore Roosevelt once said, Believe you can and

youre halfway there.

So remember these tips when you get no for an answer:

Stay true to the anchor of critical appraisal.

Hone your collaborative relations.

Stay up-to-date.

These approaches will help extend the half-life of your edu-

cation so you can continue to provide the best level of care for

your patients.

this one time the ezetimibe will actually prevent heart disease.

The thing is, you should be headed upstream. When you

decide to turn your back on whats comfortable, routine and

what some would call common sensewell, thats just the

beginning of experiencing the challenges and rewards of

evidence-based practice.

It can be difficult explaining to patients that the diclofenac

theyve taken for years may cause a stomach ulcer or increase

their risk for heart disease. Its tough sharing with a woman

that the hormone replacement therapy shes taken for 10-plus

years may increase the risk for breast cancer.

From there it only gets tougher. So make sure youre ready,

because the easy way out will always be there, ready to wash

you away. Stand true to your anchor of criti-

cal appraisal: relative vs. absolute risk reduc-

tion; NNTs and NNHs; surrogate vs. clinical

outcomes. These are the tools youll require

to ride the wave of evidence-based clinical

practice.

Patient-Centered Care: A paradigm shiftThe term patient-centered care will take on a

new meaning. By helping patients make ev-

idence-based decisions regarding their own

health, they will in turn become their own biggest advocates.

In using the best available evidence to facilitate patient edu-

cation and self-management, you support enhanced health

literacy and better health outcomes.

In my experience, one of the most impactful moments is the

completion of a Framingham risk score. The patients surro-

gate outcomes (age, gender, blood pressure, cholesterol) are

entered into a risk calculator, which generates a meaningful

number for their personal risk of developing heart diseasea

clinical outcome. Here is when the patient will usually pause

and think, and then look up to me and ask what they should

do. This is a teachable moment.

I then provide the relative risk reductions for each interven-

tionquitting smoking, reducing blood pressure, taking lipid-

lowering therapyand let the patient decide where they want

to focus.

Offering recommendations to prescribersYouve just written a comprehensive, thorough and accurate

list of recommendations to the prescriber. As you dial the fated

seven-digit number, the fax machine swallows your recom-

mendation. Did it make it? Did the prescriber read it? Days lat-

er, your response curls out of the fax machine like a tidal wave.

No, is the only response to your three-paragraph, 250-word

recommendation with an attached reference. No explanation,

no rationale, no nothingjust a No.

This process is fraught with challenges. While many provid-

ers are eager to access the knowledge, skill and judgment of

the pharmacist, others are less receptive. Issues of territory,

hierarchy and politics are often front and centre. At times you

may feel as if you are engaged in a battle to ensure that opti-

mal medication management is provided. It can seem a little

claustrophobic and scary. Thats just youyour fears; your

doubts; your insecurities.

It can be tough when your recommendations get shot down.

Though you may have the most up-to-date evidence available,

my suggestion is to tailor your approach based upon the level

of urgency (please see the Kaiser Permanente Pyramid, fig. 1).

Staying up-to-dateStaying afloat with all the new evidence will be tough. Attend

Student leader honouredYouve likely heard about her vocal stylings (if not, see page 3). But the university of Waterloos danielle Paes, the 2013 Commitment to Care and Service award winner for Student leadership, has much more to offer than her mic skills.

Paes belongs to a long list of professional associations (six at last count). Since her first year in the program, shes also been active in the Canadian association of Pharmacy Students and Interns (CaPSI) and helped coordinate the ontario Pharmacy Students Integrative Summit. In 2012 she was vice president of the university of Waterloo Society of Pharmacy Students, welcomed new pharmacy students as orientation committee chair, and edited the school yearbook.

this past year she sat on the pharmacy admissions inter-view panel at the university, was her student councils mem-ber rep for the Canadian Society of hospital Pharmacists, and was elected to the CaPSI executive, where she is editor of the national newsletter. She takes her love of learning on the road, regularly attending national conferences and local interdisciplinary events.

and in her spare time she volunteers with Community action now, helping with the soup kitchen and food drives. Paes is clearly driven by a passion for helping those in need. I want to be someone who makes a difference in a stran-gers life, the fourth-year student says on her nomination form. Pharmacy has given me the opportunity to do this.

clinical knowledge will be at the crest of the evidence wave and

you are likely to be the most up-to-date you will ever be.

After thatwell, its up to you. So whats the solution to extend-

ing the half-life of your education and riding that evidence wave

for longer? The answer is critical appraisal skillstools that en-

able you to assess the trustworthiness and relevance of evidence.

Making the tough decisionWhat is each day but a series of conflicts between the right

way and the easy way? It takes less effort to swim downstream,

taking the path of least resistance. Sure, you could let that pre-

scription for atenolol be dispensed again. Hopefully the aspirin

and warfarin will behave themselves and not interact. Perhaps

The Kaiser Permanente Pyramid: When collaborating with prescribers, consider the urgency of the recommendation and best approach. For more minor recommendations, faxing is usually appropriate. For more urgent matters, a phone call is more effective. And if you have the luxury of working in close proximity to prescribers, nothing will get a problem solved faster than walking down the hallway! Modified from www.scotland.gov.uk/Publications/2009/12/03112054/4

FIgure 1

StaYIng uP-to-date WIth evIdenCe Make Sure to SIgn uP For:dynaMed - dynamed.ebscohost.com/about/weekly-update BMJ Best Practice - bestpractice.bmj.com/best-practice/welcome.html MedScape - www.medscape.com/pharmacists BS Medicine podcast - therapeuticseducation.orgMental health - www.morethanmeds.com/more-than-meds-news.htmlMedication InfoShare - medicationinfoshare.com

Level 0

Level 1

Level 2

Level 3

Inequalities targeted high risk primary prevention

Self-management 70-80 % of LTCSelf management

Poorly controlled single condition 15-20 %Disease/care management

Complex co-morbidity 3-5 %Intensive case/care management

In person

phone

fax

Population Wide Prevention, Health Improvement & Health Promotion

SG2013 Critical Appraisal [Print].indd 6-7 12/24/13 11:18 AM

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8 pharmacypractice 2013 StudentCareerGuide CanadianHealthcareNetwork.ca

The PharmD ShiftAs schools upgrade to entry-level doctor of pharmacy programs, what will change and what will the move mean to you?

By Joe McAllister

Students Sumaira Hasan and Danielle Paes are happy with the way the University of Waterloo is instituting its new entry-level doctor of pharmacy (ELPD) degree. Although theyre still waiting for details of how they will transi-

tion into the program.

The two pharmacy students are part of Waterloos existing

bachelor of pharmacy program. But this January the school

enrolled its first ELPD class.

In December, Hasan finished a co-op turn at the Canadian

Pharmacists Association in Ottawa. She hopes to transition

to the PharmD program and is awaiting details on entrance

requirements.

I am very happy with the curriculum changes being con-

sidered, she wrote in an e-mail. At the University of Waterloo,

students are consulted at the end of every school year for their

feedback regarding coursework, course load, and course con-

tent They take student consultations very seriously.

Fellow student Paes says she expects to graduate with a

bachelor of pharmacy (BScPhm) degree, but is considering up-

grading to PharmD status in the future. After the faculty held

a number of town hall meetings about the change, she thinks

about 90% of current Waterloo BScPhm students will upgrade.

I am thrilled that this option will be available to me.

Waterloo, like most of Canadas faculties of pharmacy, seems

to be ahead of the PharmD game. Canadian pharmacy faculties

pledged two years ago to upgrade their curriculums to ELPDs

by 2020. It looks like most will achieve their goal by enrolling

their first ELPD classes three or four years before the deadline.

Gradual acceptanceLess than 10 years ago many in the pharmacy community were

opposed to the upgrade. But the profession eventually under-

SG2013 PharmD [Print];6.indd 8 12/24/13 11:12 AM


students in the first years, says Dr. David Edwards, dean of the

faculty of pharmacy at the University of Waterloo. The class-

room component wont be changing too dramatically. (We) only

started our pharmacy program in 2008, so it didnt require dras-

tic change. The most substantial change is the change in clerical

experience our students will get,

The four BScPhm co-op placements, which were part of

Waterloos curriculum, will be reduced to three, and a six-

month clinical rotation focused on direct patient care added.

At Waterloo, co-op is the strength of the university, and weve

applied that to pharmacy program. We have been met with a

lot of success and enthusiasm. Weve had a focus on the busi-

ness aspect of pharmacy and

Im sure other programs will

put their own unique twist

on the program as well, says

Edwards.

Despite Waterloos empha-

sis on co-op, he thinks Canadian pharmacy programs will all be

similar. They wont be wildly different. We all have to meet the

same accreditation standards.

The U.S. exampleThe Canadian programs will be similar to the established

American PharmD programs, familiar for many in Canadas

pharmacy faculties. Many, like Hill and Edwards, have taken

advanced degrees, or taught, in the U.S.

Neil MacKinnon, a Canadian, has crossed the border more

than once. He earned his doctorate at a U.S. university, returned

to Dalhousie for 12 years in the pharmacy faculty, served as

president of the Canadian Society of Hospital Pharmacists, and

was appointed dean of the University of Cincinnati this past

year (2013) after a stint teaching at the University of Arizona.

Its an interesting dynamic in that the U.S. made the move 10

or 15 years ago, so it is all entry-level PharmD here.

Its a very large change in Canada I think there is a sense

in the profession that it is a good thing. As pharmacists scope

of practice has expanded, we need to ensure the curriculum

reflects that.

But he adds a word of warning for students enthusiastic

about the change: Putting my scientist, evidence-based hat on

and asking where is the evidence that pharmacists graduating

with a PharmD do better than those with a bachelors degree?

There really is none as far as I know.

the province talking to hospital and community pharmacists

and pharmacists in family health teams. I think there is a lot

of enthusiasm, and Im optimistic we will have enough clinical

training sites.

Because we are in a smaller urban setting without teaching

hospitals, we needed to reach out to the pharmacy practice

community in the province.

What about my bachelors degree?Another problem most schools will face is how to handle exist-

ing BScPhm students or recent graduates. At Waterloo, Hasan

will probably be allowed to transition into the PharmD program

with an extra year of schooling, while Paes will have the oppor-

tunity to upgrade her degree after graduation. At Saskatchewan,

the school will offer distance learning courses allowing present

BScPhm grads to earn their PharmD designation.

Hasan says she understands at Waterloo that the 2016 gradu-

ating class will be the first to have the opportunity to transition

from BScPhm to PharmD. Being a young pharmacy school,

Waterloo has taken advantage of the feedback that students

provide, and they actively incorporate all comments and con-

cerns into the curriculum.

No one expects the quality of students or number of appli-

cants to change greatly. At most schools up to 50% of students

already hold a BScPhm before being admitted to pharmacy.

Most schools already have admittance criteria placing empha-

sis on a candidates personal and community interaction, and

not just academic marks.

Personally, I am quite happy and encouraged to see our cur-

riculum transform to meet the educational needs for our evolv-

ing pharmacy practice. As a result of the modifications made to

our training, I believe pharmacy students graduating today will

be well equipped to take on the expanding scope of pharma-

cists within Canadas healthcare system, agrees Paes.

And he doesnt believe all of Canadas new PharmD graduates

will end up utilizing their advanced skill set. There is consider-

able variation between jurisdictions, provincial or state, with a

very wide variation of what pharmacists are doing. Some com-

munity pharmacists are still more traditional dispensing and

a bit of counselling. In others they are doing disease manage-

ment. In the U.S. there is something called Medication Therapy

Management (MTM), while in Canada there are obviously

medication reviews, among other things.

In the hospital setting there is a similar dynamic. Some hos-

pital pharmacists are still doing distributive functions, maybe

not seeing patients at all, where others are using very, very ad-

vanced skills.

More real world experienceAt his school, fourth-year students spend the entire year in

clinical placements, which is part of the reason tuition is about

$17,000 a year. That figure is low for U.S. pharmacy schools.

Yearly tuition can be $40,000-plus at U.S. private, as opposed to

state-run, universities.

Part of it is additional costs for preceptors. That is a chal-

lenge every pharmacy school in Canada is going to have to face

in the first years, he says. Canadian students may not find the

additional clinic work is as valuable as they hoped.

As we move into PharmD will schools have bachelor-trained

pharmacists precept PharmD students? That is an interesting

question. Until there are a large number of PharmD preceptors,

that is a challenge the schools will face.

In the sparsely populated Prairies, the University of

Saskatchewan does not have access to the many sites for clini-

cal experience available in population centres like Southern

Ontario, admits Hill, but he doesnt foresee problems. We do

know this is going to be a major undertaking for our college, as it

will be for all the other programs ... We know getting the clinical

sites are going to be a challenge for all of us.

Well probably have a broader range of clinical placements

than we have ever had before. We will be innovative and crea-

tive about the type of practice sites we have available. I expect

international placements will be part of our plan.

Saskatchewans healthcare system has developed a number

of primary-care centres new to the province, and these have

great environments to place students to train in a professional

environment with physicians and nurses.

At Waterloo, Edwards says, Weve been going out around

AlbertA hAs other plAnsthe University of Alberta is not going to an entry-level to pharmacy doctorate route. this past fall the faculty enrolled its first dozen bscphm graduates into its inaugural pharmD course, a 14-month program that will concentrate on patient care. the bachelors program will still lead to professional accreditation. In future years, the pharmD program is expected to attract practising pharmacists who wish to upgrade their qualifications.

the U of A has also introduced Canadas first MbA/bscphm program in pharmacy, a 12-month course-intensive business program taken before the fourth year of a bscphm program. students completing the requirements graduate with a dual MbA/bscphm degree.

stood the need to change to meet the challenges pharmacists

will face in the future, as front-line professionals dealing more

directly with patients needs.

Im all for it, says David Hill, Dean of Pharmacy and

Nutrition at the University of Saskatchewan. Hill also chaired

the Blueprint for Pharmacy Task Force , a collaboration of na-

tional and provincial pharmacy organizations. The task force

reported in 2009 and, among other groups, lent its support to

the move to PharmD.

It is a move that had to take place. I spent a number of

years at the University of Colorado where the first professional

degree is a PharmD. The idea of going back to a baccalaureate

program makes little sense. The complexity of the healthcare

system, drug therapy and patient management problems are

such we can no longer pack all of that in a four-year baccalau-

reate program.

The first class of PharmD students at the University of

Saskatchewan will be enrolled in 2016. We are like most of the

other schools right now, engaged in specific curriculum rede-

sign processes that will lead

to new curriculums (and)

new doctor of pharmacy

programs. Apart from the

programs already there

Toronto, Montreal and

Lavalthe rest of us have committees in place that are actively

engaged in the redesign process.

Our target date is 2016 and the other universities all

seem to be converging around 2015 or 2016 for the start of new

programs.

The two Quebec universities are ahead of other schools; the

University of Montreal has already graduated its first PharmD

class, while Laval enrolled its first PharmD students two years

ago. The University of Toronto enrolled its first class of PharmD

student in September, 2013, and has now had its program ap-

proved by accrediting agencies. U of T and UBCs existing post-

grad PharmD will continue.

The University of Waterloo, which operates on a semester

system, was able to enroll its first PharmD class in January, 2014.

What change will look likeAlthough entrance requirements will probably include more

foundation courses in science and other subjects before accept-

ance, ELDP students wont find a huge difference from BScPhm

As pharmacists scope of practice has expanded, we need to ensure

the curriculum reflects that

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