What Pharmacy Students Need to Know to Land Their Dream Residency Part I

There is no doubt that the practice of pharmacy is changing at a rapid pace. Recent legislation in states like Ohio has recognized pharmacists as providers and expanded scope of practice which will have lasting positive impacts on future pharmacy graduates. Many pharmacy schools are preparing their students to enter residency after graduation where once they may have directly entered practice to help prepare the profession for these changes.

What does this mean for you? What does the road to residency look like? Whether you are a pre-pharmacy student exploring your career options, a current third year student evaluating your options post-graduation, or somewhere in between, it is never too early to begin the process of preparing for residency. Make no mistake – most pharmacy graduates still enter the workforce after graduation in a variety of roles and residency is not required to be a successful, effective pharmacist. Despite recommendations to have all pharmacists in patient care roles be residency-trained by 2020, this has not become a reality.1 Residency, however, is an unparalleled opportunity for clinical education, professional and personal growth, networking, and confidence building to become the most effective and successful pharmacist possible. 

If this appeals to you, taking active steps to develop yourself as the best residency candidate you can be right now is in your direct interest. Let’s start with some sobering facts:

• There are not enough residency positions for the number of candidates. 
• In 2020, 6,185 candidates for post-graduate year 1 (PGY1) residencies submitted rank lists for only 3,924 PGY1 positions.2 
• The number of positions is not keeping up with demand. 

Hearing these odds can discouraging, but early preparation can substantially improve your chances of matching. So, let’s begin!

Is a residency right for me?
When considering residency, the first question you should ask is why you want to pursue a residency. 

• What have you enjoyed most about pharmacy school or your internships? 
• Have there been IPPEs or APPEs you have particularly enjoyed or disliked? 
• Where do you see yourself in 5 or 10 years? 

Pursuing residency should also be about preparing to achieve your goals. Here are two additional questions you should ask yourself:

• Are you pursuing residency to not do something (like avoiding a job or IPPE you didn’t enjoy)?
• Are you pursuing residency because you think someone else wants you to? 

You will only get out of residency what you put in, and if your heart is not behind your reason for pursuing residency, you are risking burnout and disengagement down the road.3 Residency is not the only post-graduate option: in addition to entering the workforce directly, fellowships and graduate school are additional modalities to achieve specific goals.

What kind of residencies are there?

Pharmacy residencies are not a singular entity. One of the important reasons to decide what your goals are early is because there may be a targeted residency program for your interests. While some aspects of pharmacy residencies like completing a research and quality improvement project, are universal to all programs, the settings and structure can vary. 

Let’s explore the different types of PGY1 residencies!

Pharmacy Practice

This is the traditional “pharmacy residency,” making up 88% of all available positions in 2020. A pharmacy practice residency is a year of clinical training which most often occurs in a hospital setting but can take place in outpatient practice. 

• These involve clinical rotations with medical teams in a wide variety of areas as well as administrative and project-based rotations. 
• Graduates of pharmacy practice residencies often pursue PGY2 training in a clinical specialty area or pursue positions in clinical practice. 
  • Not all PGY1 graduates fill clinical positions in hospitals, though – graduates of pharmacy practice residencies are prepared to fill positions in both traditional and non-traditional pharmacist roles.
• Pharmacy practice is the best choice for students interested in a career in clinical practice or if you know you want more training, professional growth, and mentorship, but don’t have a clear post-residency destination in mind. 

Community 

Community pharmacy residencies are the second most common PGY1 pharmacy residency, making up 7% of available positions in 2020. 

• These positions are often affiliated with a college of pharmacy and involve a combination of traditional dispensing roles, patient counseling and medication therapy management (MTM), community practice and business management, education, and other community focused roles.  
• Graduates of community residencies may pursue PGY2 training in a specialty area or enter management or leadership roles within community practice. 
• These residencies are excellent for pharmacy students who love working in their communities, counseling patients, and are interested in innovation and advancing the practice of community pharmacy.

Managed Care 

Managed care pharmacy residencies place residents within the heart of the financial engine of pharmacy practice. 

• These programs are often with private PBM companies but may be with managed Medicaid organizations or health-system based insurance plans. 
• Residents are trained in the fundamentals of the role of the pharmacist in managed care, population care management, formulary and benefit management, client relations, product development, and contract negotiations. 
• Graduates of managed care residencies are prepared to enter roles within PBMs, the pharmaceutical industry, or other corporate healthcare organizations. 
• These residencies are excellent for pharmacy students who want to practice in a systems-level position and want targeted training to develop the skills necessary to succeed in these more business-oriented roles.

Health-system Pharmacy Administration and Leadership (HSPAL)

HSPAL programs are varied in their settings and structure but are a growing subset of pharmacy residency programs. 

• HSPAL programs are two-year residency programs, unlike most residencies which are only one. 
  • Standalone post-graduate year 2 (PGY2) HSPAL programs also exist for candidates who complete a general PGY1
• HSPAL programs often offer a master’s degree program with the residency in the form of an MBA or MS in health-system administration, providing an academic component in conjunction to experiential rotations. 
• HSPAL programs incorporate the components of a pharmacy practice PGY1 throughout the experience, allowing for a balance of clinical rotations and leadership training. 
• Graduates of HSPAL programs are prepared to act as managers and directors of pharmacy in hospital, health-system, and corporate environments. 
• These residencies are ideal for the pharmacy student who knows she or he would thrive in a leadership role influencing the growth and development of a department of pharmacy and wants mentorship and guidance in this area. 

PGY1&2 combined specialty programs

While uncommon, some institutions offer combined PGY1 and specialty PGY2 programs. 

• Pharmacotherapy is the most common combined program, where residents dedicate two years to become true pharmacy practice generalists with experience in a wide variety of clinical areas.
• These programs are excellent for candidates with a clear career path in mind and want two years of dedicated training at the same institution. 

As you can see, a variety of programs exist and pharmacy practice is not the only option. Identifying your goals early will help you when selecting a mentor and preparing to be the best candidate possible if you decide to pursue a more unique PGY1 experience. 

How early do you need to think about applying for a residency? 

It is never too early to think about applying for residency. The earlier you think about pursuing residency, the more prepared you will be. A successful residency candidate is someone with well-rounded experiences and clear goals. Spending the time to develop your CV and goals will give you the best chance of matching. It is never too early – but it can be too late! 

• While possible, deciding to pursue and preparing for residency in the fall of your P4 year is not ideal. Start preparing as early as the thought of residency enters your mind.
• As we will discuss in subsequent sections, entering APPE rotations with the goal of residency already in mind will help when selecting letter writers, preparing your letter of intent, and developing your final application.

Written By: Andrew Webb, PharmD, @AJWPharm

PGY1 Resident at Mayo Clinic, Rochester, MN, incoming PGY2 Critical Care Resident at Oregon Health Sciences University, Portland, OR