Steph’s Note: ‘Tis the season! For pharmacy residency decisions. (Amongst other things, of course.) Many of you are likely more than a little nervous. Should you apply to a residency program? Should you take the first job that you can find? How do you get to be a fully fledged pharmacist? We all clearly remember these thoughts and the confusion that comes with them.

Facts in this post are gonna be hot like Hansel. Yeah. (Image)

If this is resonating with you, seek a mentor! Definitely check out some of our other tl;dr posts on this topic because sometimes it just helps to hear what others have to say. In the meantime, until you find that mentor, Clayton Hamilton is here to drop some facts and numbers to add to others’ posts on this subject. And he’s gonna drop ‘em like they’re HOT.

Dr. Hamilton is an informatics pharmacist and program manager for the Whole Health service located at the Salt Lake City Veteran Affairs (VA) Health Care System. He earned his PharmD at the University of Montana and completed a PGY1 residency with the VA in Helena, MT. Afterwards he completed a PGY2 residency specializing in pharmacy outcomes and healthcare analytics at the VA’s VISN 21 Pharmacy Benefits Management office located in Reno, NV. Dr. Hamilton is passionate about providing world-class patient care through skills in data analytics, evidence-based pharmaceutical care, and population health management. In his spare time he enjoys rock climbing, hiking in national parks, and exploring topics such as machine learning and computer programming with Python. Connect with him via Twitter: @HamiltonPharmD.

Let’s get to it with Dr. Hamilton’s three key questions for consideration as you work through the residency decision.

# 1: What are your motivations for seeking a pharmacy residency?

Some pharmacists a couple years into their careers. (Image)

I’ve met several residents in my career who have openly admitted that they pursued residency because they felt it was the “right thing to do.”

BTW, not a good answer. Why?

Typically, these are the pharmacists that you find burned out and generally unhappy with their careers within only the first few years post-residency.

This may be due to a number of factors but the largest is likely that they pursued a career path that they were initially not fully invested in. They applied and matched with a residency program only because their pharmacy school professors encouraged them to do so, the program was just one of many programs that they ranked, or for some other arbitrary reason.

Choosing a program for wrong or unclear reasons must be avoided at all costs.

Think back. Which topics in pharmacy school drew you in the deepest? Was it endocrinology? Oncology? Why did you connect with these topics? Do you have an affected family member, or perhaps you met a certain patient who touched your heart?

How you feel at the end of a long day - IF you’ve chosen your path well. (Image)

Invest time to find what you love about pharmacy and why you love it. If you successfully find your true path, it will pay more dividends in career satisfaction than any amount of money you could earn pursuing a position just for the fat salary. I promise that if you find a career that leaves you feeling sustainably satisfied, 12+ hour days will fly by, and you will leave work feeling refreshed and hungry for more.

“The only way to do great work is to love what you do.”

-Steve Jobs

#2: What is your current financial state?

During my time in pharmacy school, I enjoyed learning pharmacoeconomics. My professor was clearly on her true path, and you could feel her enthusiasm as she taught. At the beginning of the semester, she introduced our class to the concept of the opportunity cost.

The basic idea of this is that when selecting one of two choices, the opportunity cost is the cost associated with not choosing the other option. These costs are hidden in every decision that we make, and choosing residency is no different.

Take a moment to explore opportunity cost as relates to a pharmacy residency decision.

The average pharmacist salary in the United States is $133,263 as of June 2019. The average salary for a resident pharmacist is $40,442 as of July 2019. Simple math tells us that the opportunity cost of choosing residency for one year is $92,821. If you pursue a second year, the opportunity cost doubles to $185,642.

But wait, there’s more!

In 2018, the average pharmacy student graduated with $166,528 in student loans with an average interest rate of 6.3%. If loans are placed on hold during residency, the compound interest alone will increase the original loan amount by just over $10,000 per year.

Without including relocation expenses and miscellaneous, the opportunity cost associated with pursuing two years of residency post-graduation for the average pharmacist is approximately $200,000.

I know. Mugatu can’t believe the numbers either! (Image)

Essentially, the back-of-the-napkin opportunity cost of pursuing 2 years of residency will cost the average pharmacist more than the debt incurred during both undergrad and 4-years of pharmacy school - combined.

This brings us back to the importance of finding your true motivations. If you remain undaunted about the financial cost and still desire to pursue your passion through residency (highly encouraged, don’t get me wrong), then you must ensure you find the right program.

The education that you receive at the residency of your choice should arguably be of higher quality than what you received in pharmacy school. Do your homework, speak to past residents, evaluate the careers they have chosen post-residency, and determine if their path fits your long-term goals. Only apply to programs that align with your true path. And then, use tl;dr’s Mastering the Match to make sure you do everything you can with eyes wide open to obtain that chosen residency!

Check the facts about your possible residencies BEFORE you get in too deep. And don’t go to this school.

Also, do your absolute best to at least pay off the monthly interest accumulating on your student loans. I consider my two years in residency a financial success because I was able to graduate without additional student loan debt.

Another option is to take a job immediately post-graduation, live frugally, pay off your student debts, and then apply to a residency program. If you don’t match for residency this year, all is not lost - take it from this guy! In fact, at a minimum, this will allow you to avoid student loan interest and save money to assist with the year of reduced income. It’s not easy, but this delayed path is possible.

“Some people are so poor, all they have is their money.”

-Blake Griffin

#3: What is the state of the pharmacy profession?

There are currently 143 accredited schools of pharmacy in the United States. The number of full-time enrollments has increased on average by 2.7% annually since 1990, but growth appears to be leveling off in recent years.

Data acquired from the American College of Clinical Pharmacy (ACCP)

In 2006, the American College of Clinical Pharmacy (ACCP) released a comprehensive argument that all pharmacists in direct patient-care activities should have completed an accredited residency program prior to practice. This position is widely supported by the field, and the target to achieve this was set for the year 2020.

Um, yeahhh, about that. Reality check, please?

Data acquired from the ASHP Match Statistics

At this point in time, there are not enough residency programs in existence to provide every pharmacy graduate with a residency position. Therefore this goal will likely continue to remain unmet after 2020. However, the trend towards requiring residency for direct patient-care and other unique pharmacy positions will likely only continue to increase.

This means that pharmacists who have chosen careers in retail pharmacy post-graduation will find it more and more difficult to find positions outside of retail due to a lack of residency training. Also, pharmacists who apply to residency after 1+ years in retail will be competing with fresh graduates with up-to-date field knowledge. Meanwhile, pharmacists who have completed a residency will be in higher demand, even in this changing pharmacist market.

“Start with the end in mind.”

-Stephen R. Covey

In conclusion, there are a number of considerations that must be weighed prior to pursuing residency. First, what is your true path? If you have chosen to pursue residency immediately after school, find the PGY2 programs that align with your interests and research their previous residents and the PGY1 programs that they were accepted from.

Hopefully that 10+ year pharmacist isn’t burnt out like Derek after ONE DAY in the mines. Hopefully, YOU don’t feel burned out like that now! Think about it. (Image)

Never hesitate to reach out to previous residents and ask for their opinions about the path they have taken. While you are on student rotations, try to find the pharmacist who has been in the position that you are interested in for 10+ years and pay close attention to them.

Are they burned out, happy, enthusiastic? It is very possible that you will eventually feel the same way if you pursue their career path.

If pharmacy school graduation is right around the corner and you are still unsure, it may be best for you to either find a job that you are interested in while you continue to explore your interests. Or maybe you can find a residency program that will expose you to a broad range of clinical activities. When choosing between these two, think about your current level of internal motivation.

Are you excited about pharmacy? Do you feel burned out?

Be warned, if you feel burned out after pharmacy school and pursue residency without an end goal, you will likely suffer. Residency is rigorous. There is a reason that your professors say that 1 year of residency is the equivalent of 3–4 years of practice in the field.

There is no shame with foregoing residency while finding your true interests. In fact, this may be a better move for you financially. Double check those numbers from earlier!

So take time to deeply consider your internal motivations, your current financial state, and the current state of the field as you make your decisions about whether or not to pursue pharmacy residency. And good luck!

Is Pharmacy Residency the Right Path for You?