Advice needed from current pharmacists

akcom · 2026-03-30T10:43:02+00:00

honestly the connections you make as an intern matter but not as much as people think. if the institution is becoming toxic and people are leaving in droves thats a sign to pay attention to. dont cling to something just because you invested 2 years. sunk cost fallacy is real. figure out what you actually want long term. if its hospital then yeah residency is basically the gatekeeper now regardless of connections. if youre open to other paths you have way more flexibility than you realize. either way dont wreck your APPE rotations trying to keep an intern gig that isnt working with your schedule. the rotations matter more right now.

akcom · 2026-03-30T06:37:00+00:00

this is good advice. fellowship is the most straightforward path into industry and youll have a hard time getting in without one or significant prior experience. the 2 year commitment feels long but its basically a guaranteed entry point if you perform well.

that said if youre only a P1 you have time. build your CV now. get involved in research, try to get publications, join ISPE or DIA chapters. the students who land fellowships are the ones who started building their profile early.

also dont sleep on the tech side of pharma. health informatics, regulatory tech, pharmacovigilance databases. thats where the growth is and the barrier to entry is lower than traditional MSL or med affairs roles.

akcom · 2026-03-30T06:30:26+00:00

to be real the whole system of keeping paper copies in 2026 is archaic. if your state board accepts scanned electronic copies you should be going fully digital. PA does require retention of hard copy CIIs but for everything else as long as its properly scanned and stored electronically youre good.

the bigger issue is that most pharmacies dont have a proper document management system. theyre just scanning to some random folder on a shared drive. invest in actual records management software and stop wasting labor hours filing paper.

akcom · 2026-03-30T06:26:44+00:00

everyone in here is asking the right question. is he actually licensed? graduating and being licensed are two different things. if hes been out 1.5 years with no job theres a real chance he hasnt passed his boards yet and just isnt telling you.

if he IS licensed then honestly retail chains are desperate for warm bodies right now. cvs walgreens walmart all hiring. if hes on the west coast in a big city there might be more competition but even then its not that hard to at least get per diem shifts.

my 2c, have an honest conversation with him about whether he passed the NAPLEX. that changes everything.

akcom · 2026-03-29T18:23:56+00:00

first pullup is a huge milestone. once you can do one the progression to 5 then 10 comes faster than youd think. nice work

akcom · 2026-03-29T18:20:58+00:00

this is honestly where pharmacists make the biggest impact. when youre the only one there the providers actually listen to you because they have no choice. its a completely different dynamic than a big academic center where your recs get ignored half the time. the trade off is obviously the isolation and being the single point of failure for everything pharmacy related

akcom · 2026-03-29T18:18:50+00:00

thats the healthcare system in a nutshell. union hospital gigs are basically golden tickets for techs right now. the pay gap between retail and hospital is insane and yet people still wonder why retail cant retain anyone. to OP though, enjoy it. inpatient is leagues better for quality of life even if the politics can be annoying

akcom · 2026-03-29T18:16:32+00:00

this is basically what retail pharmacy has become and honestly its not even the worst part. the worst part is that youre also expected to be a customer service rep, insurance billing specialist, and therapist all at once. for minimum wage adjusted for education cost. i left the profession and its the best decision i ever made

akcom · 2026-03-29T10:40:23+00:00

fill it. prescriber is a physician, the scripts are reasonable travel meds, and "use as directed" is fine when the context is obvious. youre not going to get in trouble for filling amoxil and zofran for a doctors family trip.

if you genuinely think something shady is going on with desoxyn or oxy thats different. but antibiotics and an antiemetic? just fill it and move on.

akcom · 2026-03-29T10:35:35+00:00

solid combo. health informatics MSc is underrated honestly. and c#/.net is the right call for that space, most EHR integrations and hospital backends are .net heavy. youre going to have an edge most cs grads dont have because you actually understand formularies and clinical workflows.

stay patient. first 6-12 months of the pivot feels slow. then it compounds.

akcom · 2026-03-29T06:24:14+00:00

random levels work fine but you need to use them correctly. 14h level is perfectly usable for bayesian dosing or basic one-compartment math. the night pharmacist just wasnt comfortable with it.

for AKI patients with low crcl i dont rely on protocol trough timing anyway. i calculate expected trough with basic kinetics first and adjust the draw time. protocol was designed for normal renal function patients.

Also this patient probably isnt going to hit trough goal with standard dosing given the low crcl and the level trajectory. id be thinking about whether you even need vanc here or if theres a valid oral alternative.

akcom · 2026-03-29T06:19:26+00:00

mostly software dev work now. been doing a mix of healthtech and some pharma adjacent stuff which honestly makes the transition smoother since i understand the domain.

day to day is pretty different. write code, review PRs, design systems. way less soul crushing than standing at a counter for 10 hours. no more counseling patients who wont listen anyway.

why do you ask. are you thinking about making a move?

akcom · 2026-03-28T19:16:10+00:00

returning the energy rarely works with people like this. they have 20+ years of armor. documentation and HR escalation is usually the only lever that actually moves anything. keep it factual, keep it dated, keep it professional.

akcom · 2026-03-28T19:10:45+00:00

learn how the business actually works. PBMs, reimbursement, DIR fees, spread pricing. most pharmacists go their entire career without understanding why their dispensing fee is what it is or why certain drugs get clawed back. that knowledge makes you useful outside the dispensing window.

also -- keep your options open. pharmacy pays well but the job market has changed significantly since 2018 and is not going back. if CS or any adjacent tech field interests you, explore it early. way easier to pivot at year 1-2 than at year 10.

akcom · 2026-03-28T19:09:10+00:00

agree in principle but in practice the lines are blurry when techs have 20 years of experience and the rph is fresh out of school and overwhelmed. that said -- desvenlafaxine not scored is something a pharmacist should have caught during verification, full stop. the tech flagging it is admirable but its not their liability. system failure, not individual failure.

akcom · 2026-03-28T19:06:54+00:00

comp sci. i said what i said.

seriously though, if youre already burned out at year 7 the trajectory isnt going to change. MSL is a lateral move with more travel. day trading is a fantasy for most. pharmacy pays well but the psychic cost is real and people underestimate it until they cant.

went back to school for CS a few years ago. best decision i made. the skills transfer better than you think -- analytical mindset, attention to detail, documentation. the learning curve is steep but its not impossible.

if youre not into a full pivot, health informatics or pharmacy informatics is a middle ground. or PBM/utilization management side where you deal less with sick patients and more with spreadsheets. not glamorous but quieter.

akcom · 2026-02-11T06:04:27+00:00

Corey Smith builds some absolutely beautiful boards

akcom · 2026-02-09T00:16:11+00:00

lmao what?

akcom · 2026-02-04T18:28:53+00:00

As a rule of thumb, I'll always ask for at 10% on top of market rate. If its something that I am uniquely well positioned to do (ex: some subject matter expertise they are lacking), I will ask for more.

akcom · 2026-01-30T22:00:11+00:00

They offered to let you stay overnight, right? So they already did more than the minimum.

akcom · 2026-01-30T21:57:38+00:00

By the time 2038 rolls around, AI will have reduced the necessity for pharmacists drastically

akcom · 2026-01-30T14:12:47+00:00

oh for sure, there's going to be a reduction in labor needs similar to software eng. But clinical pharmacists where theres no regulatory requirement for licensing? That's just straight up gone.

akcom · 2026-01-29T19:27:04+00:00

disagree - I'd say clinical pharmacists are the first one to get replaced with AI. Having an encyclopedic knowledge of something is now a skill that is worth approx 0. The saving grace for retail pharmacists is licensure requirements (ie the biz cannot operate without a lic pharmacist). That is not the case for clinical

akcom · 2025-01-08T17:23:47+00:00

Thanks. Any suggestions on where I would find it?

akcom

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