When I Grow Up

One of the reasons I enjoy blogging so much is that it gives me a great opportunity to reflect and organize my thoughts. Just the act of writing things down helps me not only solidify ideas, but make realizations of beliefs and opinions that I have that I didn't even realize I had. I do a lot of recording the events of my life here, but it's been awhile since I've done any sort of reflection.

There are many reasons that I started down the path of a pharmacy career. There was nothing "wrong" with my previous career; I enjoyed programming, and frankly I was good at it. I could probably do an entire series of lectures on my reasons for leaving the computer business and moving to Minnesota, but I'll save that for another blog at another time. I had four big reasons for getting into pharmacy.

1. There is currently a shortage of pharmacists, so there is relative job security for the next couple of decades.
   
2. On a related note, pharmacists are well compensated. I knew I was eventually going to get married and have kids, and as long as I was reconsidering my career, why not pick one that gives my future wife the option to not work and stay home with the kids?
   
3. I informally interviewed a number of different people in different occupations, including doctors, software engineers, consultants, salespeople, and pharmacists. Pharmacists were the only ones who unanimously recommended pharmacy to me. Yes, I could have had a biased sample, but regardless I found the exercise to be enlightening.
4. It was an opportunity to "help people". If I make the radio in your car display the time and radio station properly, I've done my job and I can take a certain amount of satisfaction from that. If someone says that they feel miserable and haven't slept in two days, and I point them to a drug that can alleviate their symptoms, I've done my job and I can get immense satisfaction with that.

Throughout the process of getting into pharmacy school, I was going to be a retail pharmacist. Why? The classic options for a pharmacist for the last 30 years have been:

• Work for a large pharmacy chain
  
• Buy and run a drug store
• Work in a hospital

I did not necessarily want to go out and buy a drug store. I had enough retail experience to realize that although I didn't mind working for a retail outlet, I had no desire to be the one in charge of it. I didn't really know what a hospital pharmacist did, but I knew someone who was a dispensing pharmacist in a hospital and I don't think she really liked it. I guess that didn't leave a good impression on me. But I knew I was good at retail. After all, I rocked at my McDonald's job. And the pharmacists I'd used at Target and Walgreen's seemed nice enough.

Then my classes started, and I learned more about what's available. The cool thing about pharmacy is that there are all sorts of options available to you with a pharmacy degree. I obviously had no idea. In addition to the options above, pharmacists can do research, teach, compound (mix specialty drugs), deliver IV drugs to people in their homes, work with animals, be a hospital administrator, or go into pharmaceutical sales, just to name a few. There is the traditional dispensing in hospitals, but there are also specializations; for any medical specialty, you can be a clinical specialist in that area.

Now I'm not sure what it is I want to do when I grow up, but I think I have a direction. Don't get me wrong; I could change my mind next week or next year. It's nice to have three-and-a-half years to settle on it.

There is a relatively "new" concept in the medical world called "pharmaceutical care". The federal government refers to it as "Medication Therapy Management" (MTM). I say "new" not because the services have never been provided, but because it was never structured in a way that the services could be reimbursed.

Now what is MTM? Don't try to wikipedia these terms; the entries don't exist. (Hmmm... I've secretly always wanted to start a wikipedia article... Note to self...) Basically, pharmaceutical care is a service where people go "see a pharmacist", much in the same way they go to "see a doctor". Pharmaceutical care practitioners then evaluate people for drug therapy problems. They figure out what's going on with a patient, what drugs they are taking that they shouldn't, what drugs they aren't taking that they should, if drugs aren't working, if drug doses are too high or low, if they aren't taking the right drug for their condition, and if a drug is something the patient is willing and able to take.

Can you see the need for this? Seriously, off the top of your head, how many people do you know that are taking at least six medications? They've analyzed the work so far, and the average number for people under 65 is 5, and for over 65 it's 7. Or on a more personal level, how many drugs do you take? If the number is small, keep in mind, caffeine, alcohol, tobacco, herbal remedies, over-the-counter medications, vitamins, and minerals all count as medications. Do you know how they all interact? Do you know what time of the day you should be taking them? Do you know if it matters or not? Do you know what foods you should be avoiding?

I could go on and on about the need for it, probably due in no small part to the fact that I'm taking a class on it right now. To make a long story short, I think this is what I want to do. I think this would be an ideal way be able to influence people's lives in a meaningful and impactful way on a daily basis.

What would the practice look like? I'm not 100% sure. As I alluded to earlier, insurance companies just started reimbursing for this service in May 2006, so financially viable models are just starting to emerge. Not to worry, people are making a living doing this, and three years more is a long time to make progress on that front.

At any rate, that's where my thoughts are right now. Who knows, maybe I'll find out my talents lie elsewhere. But that's all part of the fun.