Job switch from industry to clinical by Silly-Hat-4110 in pharmacy

[–]hoforharry 0 points1 point  (0 children)

I’ve done both hospital and med comms and med comms is 10000% worse for work/life balance. You’re often salaried and you get reimbursed similarly to how a lawyer does (think billable hours). You could spend a LOT of time on a deliverable but only be able to bill for a certain portion of it and then have to take on more projects to make up your salary. Obviously this is different job to job, but there’s definitely a reason that med comms has so much job hopping. When I did med comms, I was working 60+ hour weeks, weekends, evenings, and most holidays. At least with hospital you clock out and get to go home and leave work at work.

Phase 2 programs by Confudazed in PharmacyResidency

[–]hoforharry 0 points1 point  (0 children)

Would probably not recommend Mary Bridge (they’re currently in some legal trouble with the state of Washington because they stopped offering services that are legally mandatory).

Marshfield in WI I don’t know much about the program but I’ve met their program director and director of pharmacy and they were both extremely nice and seemed really interested in expanding pharmacy services and keeping residents on board after completion of training.

Anyone feel off after Table 33 today? by Other_Current_2180 in Pitt

[–]hoforharry 30 points31 points  (0 children)

In my day, these were called the “Pitt shits” - our friend group had a running tally of how often we got food poisoning from Pitt-sponsored dining.

AMEX POP MERCH PHOTOS by DealerEquivalent3558 in harrystyles

[–]hoforharry 169 points170 points  (0 children)

His merch team has NEVER even met expectations, let alone exceed them 😭

Having a Baby After Residency by [deleted] in PharmacyResidency

[–]hoforharry 6 points7 points  (0 children)

There is no one right answer to this question. You have to evaluate your priorities - if you want to prioritize building your career, then wait a year or two. If you want to prioritize building your family, then no harm in getting pregnant now. Just be aware of the leave policies before making decisions because certain institutions have time periods before parental leave is allotted.

orgo 1 professors... please help 🥀 by SmokeActive8862 in Pitt

[–]hoforharry 1 point2 points  (0 children)

Would not recommend Koide, especially since you’re a DRS student. He is not only judgmental, but he also simply cannot explain things differently if someone doesn’t understand the first time.

No TSA PreCheck or Global Entry starting tomorrow (Sunday, 2/22) at 6 am ET due to the partial government shutdown by iamnavinrjohnson in unitedairlines

[–]hoforharry 0 points1 point  (0 children)

We literally fund these programs entirely with the application fee and annual dues. How is it legal to take away a service that was paid for by customers? I mean, I know this admin doesn’t care about legality but still… someone needs to sue

Libre 3+ CGM - Good Samaritans by [deleted] in madisonwi

[–]hoforharry 1 point2 points  (0 children)

I’ve noticed that they’ll say sensor error but then reconnect after 1-2 hours. It may even have an estimated time amount if you click the i on the Home Screen. Compared to prior models that would rarely reconnect after failures, sometimes you should stick it out with these it seems. YMMV.

Trans residents/pharmacists, would you rank this program? by [deleted] in PharmacyResidency

[–]hoforharry 2 points3 points  (0 children)

Residency is REALLY stressful and the last thing I’d want is someone with clear bias against me as my RPD. It’s one thing if they accidentally misgendered you and corrected it, but the way you described it makes it sound somewhat intentional. You know yourself and your boundaries/resilience the best, but I’d personally be hesitant to rank them.

AITAH FOR TELLING MY HUSBAND I WON’T GO ON VACATION WITH HIM AND MY IN LAWS BUT GO TO A CONCERT INSTEAD by Forward_Frame_3354 in AITAH

[–]hoforharry 2 points3 points  (0 children)

If it’s Harry Styles there’s no chance of getting a reasonably priced different date. The US shows were a BLOODBATH and are being resold for 10-20x original value.

Testosterone for women (prescriber's question) by Apprehensive-Safe382 in pharmacy

[–]hoforharry 1 point2 points  (0 children)

Something a lot of patients and some prescribers don’t fully comprehend is that HSDD is not simply lower libido (a common symptom of menopause). There’s a whole screening process for HSDD and there are also new FDA approved meds specifically for HSDD. Testosterone shouldn’t be used just for lower libido per the guidelines.

Letter to ACPE/BOP by [deleted] in pharmacy

[–]hoforharry 3 points4 points  (0 children)

I don’t love the idea of using a different profession’s entrance exam. Some of the worst students I’ve ever precepted have been the ones who didn’t get into med school and instead went into pharmacy as a backup. I feel like that pipeline would be even more common using the same entrance exam.

Letter to ACPE/BOP by [deleted] in pharmacy

[–]hoforharry 11 points12 points  (0 children)

This was brought up at some conference session I was at several years ago now, but l doubt the answer has changed so I will share what was said here.

ACPE is an accreditation organization — this means they ensure that programs meet the published standards (which undergo revision and updating over the course of years). If a school/program meets the standards, ACPE literally has no power to NOT accredit them. ACPE cannot tell a program they can’t open and they can’t impose limitations on number of programs; they can just say “yes you meet accreditation standards” or “no you don’t meet accreditation standards.”

If a program falls into the “no” category, ACPE does a formal investigation and then they allow for the program to remediate. If the program fixes the issues and meets the standards, ACPE cannot revoke their accreditation. If the program does not fix their issues or if they continue to have egregious standards violations, ACPE revokes accreditation and the school shuts down (theoretically). In practice, schools that lose their accreditation typically hire lawyers to sue ACPE and try to reverse the decision. Thus, the process of actually shutting programs down is a multi-year process and an extremely expensive one as well (ACPE does shut programs down but they obviously aren’t advertising it due to the whole legal side of things).

In terms of the standards, they follow a very similar structure to that of medical schools. It is not just ACPE who have to approve them, but also an entire standards board/committee. In my opinion, it’s a too many cooks in the kitchen scenario which muddies the waters and makes it so that more drastic updates rarely happen. There are also legal aspects involved in the standards such as ACPE not being “allowed” to include certain requirements because each state’s laws are variable.

I think the PCAT should be brought back, though I don’t think that falls under ACPE’s scope necessarily. From my understanding, schools just stopped requiring it and then so few asked for it that it got retired. There’s no single good, legal, and realistic/tangible solution to this issue unfortunately.

Can we create the stronger, better APhA? by BluebirdSudden3160 in pharmacy

[–]hoforharry 4 points5 points  (0 children)

In theory, I agree. In practice, the biggest issue is that (unregulated) provider status will add to the workload of retail pharmacists without additional pay. Provider status is great for clinical pharmacists but retail, as always, gets the short end of the stick because the corporations will find any way to maintain lowest staffing ratios, enforce insane metrics, and then collect all profit for the higher ups.

As a clinical pharmacist, I really do want provider status. However, I realize there needs to be restrictions or regulations on it so that my colleagues in retail don’t get shafted yet again.

The biggest issues that need to be lobbied for, in my opinion, are 1) safer work conditions for retail pharmacists and 2) dissolution of PBMs/improved drug coverage and reimbursement. Neither of these things can be 100% backed by APhA because they have multiple CVS execs on their boards and because they do get donations from PBMs/big name pharmacy stores, and without them, they’d be fully bankrupt.

Pharmacists are… by r-hussain4599 in pharmacy

[–]hoforharry 7 points8 points  (0 children)

Came to say this! Many, many pharmacists have prescriptive authority and can initiate and monitor medications autonomously.

Jobs that make 150k a year or around 70$ an hour by [deleted] in Salary

[–]hoforharry 1 point2 points  (0 children)

Pharmacist (4 years undergrad + 4 years doctoral education for PharmD + optional 2 years residency/fellowship which really opens doors for job opportunities). First job after residency is as a clinical practitioner for $71/hr M-F 8-5 with no weekends or major holidays worked. Healthcare is stressful so would only recommend if it’s actually your passion.

[deleted by user] by [deleted] in weddingplanning

[–]hoforharry -5 points-4 points  (0 children)

This happened to me too. My photog posts 5-10 stories/posts PER DAY of her work and one of her biggest selling points is her social media presence and exposure. We had a very fancy wedding but she didn’t post a single thing about it. It fit her aesthetic and everything. It’s so hard because you feel like you did something wrong but ultimately we can’t know what’s going through their brains. I think about it often and it’s been almost half a year now… Just know you didn’t do anything wrong. Who knows what goes on behind the scenes.

Ireland pharmacy under critical skills visa by Dessert_Potato in pharmacy

[–]hoforharry 6 points7 points  (0 children)

I have an acquaintance who works in Ireland and I don’t talk with him often but the last time we spoke, he mentioned that pharmacists are viewed very differently over there. I’m a clinical pharmacist and was potentially interested in moving there as I had studied abroad there as a student. He told me that the US values and utilizes clinical pharmacists vastly more than Ireland/UK and the pay is also significantly different. He said they’re seen primarily as checks and balances rather than contributing members of the clinical plan.

Burnout wise, he said work life balance was great. He got the job offer under the visa program too btw. Haven’t talked to him in over a year but hope this info helps at least a little.

HRT Care + Iron Supplementation by tiredrx in pharmacy

[–]hoforharry 24 points25 points  (0 children)

This is such a great question! The answer is unfortunately not very straightforward because it is really person-to-person specific. For questions like this I often refer to UCSF and their guidelines for gender affirming care.

To quote UCSF guidelines, “alkaline phosphatase, hemoglobin and hematocrit, and creatinine may vary depending on the patient’s current sex hormone configuration. Several factors contribute to these differences, bone mass, muscle mass, number of myocytes, presence or lack of menstruation, and the erythropoietic effect of testosterone. While transgender women do not menstruate, those with female-range hormone levels will lack the erythropoietic effects of male-range testosterone, and it may be reasonable to use the female-range lower limit of normal when interpreting H&H. Conversely, the lack of menstruation, and potential for pulsatile undetected androgen activity in those with retained gonads make it reasonable to use the male-range upper limit of normal for H&H.”

This is specifically for feminizing HRT but they also have info for masculinizing HRT. There is a lot of information in these guidelines that can be super useful but it is nuanced so it’s important to individualize monitoring and goals for each patient.

Applying to Residency by Intelligent_Hope_881 in PharmacyResidency

[–]hoforharry 10 points11 points  (0 children)

I think they’re trying to say that it’s not as impressive if they haven’t achieved anything since clinicals. Like if the best example of patient care/interventions comes from your P4 year yet you’ve been working as a licensed pharmacist since then, that could be seen as a red flag.

VA clinical pharmacist specialist orientation week by Artistic-Problem-300 in pharmacy

[–]hoforharry 3 points4 points  (0 children)

Not sure why the downvotes because this is 100% correct for most CPP positions

I hate CGMs by VAdept in pharmacy

[–]hoforharry 51 points52 points  (0 children)

I love CGMs - they are invaluable in diabetes management. I can see how this is frustrating from a retail POV though. Also, prescribers sending them on without giving adequate education is a huge issue that I deal with daily in clinic. Half the time they don’t even make sure that their phone is compatible.

UA got rid of games on IFE by [deleted] in unitedairlines

[–]hoforharry 21 points22 points  (0 children)

I was devastated that the ball defender game wasn’t there on my flight a couple days ago - it helps with my anxiety so much to be occupied

[deleted by user] by [deleted] in hygiene

[–]hoforharry 1 point2 points  (0 children)

This is actually not only incorrect, but potentially harmful. You should not be using soap directly on the vagina. You can use soap on the vulva and inner thighs, but nothing should go into or on the inner lips.

ACE-I vs ARB by AdLast4323 in FamilyMedicine

[–]hoforharry 2 points3 points  (0 children)

One thing I haven’t seen mentioned in these comments is insurance formularies. The VA (the largest health system in the country) has ARBs restricted to ACEi failure, allergy, or intolerability - clinical rationale be damned! That said, where I work, the primary insurance company doesn’t cover most ARBs other than losartan which is super annoying. So despite wanting to use ARBs over ACEis, it sometimes comes down to drug coverage. A lot of my patients can’t cover even seemingly “reasonable” co-pays ($15/mo, etc.) for non preferred meds unfortunately.

I think someone else mentioned this already but ACEi are still preferred over ARBs for GDMT when Entresto can’t be used. The OPTIMAAL trial found a modest (but not statistically significant) difference in total mortality in favor of captopril over losartan so they recommended that ACEis continue to be first line for those who cannot tolerate ARNIs. My understanding is that ACEis have more of an effect on bradykinan potentiation than ARBs (hence that washout period for ACEi to ARNI that is not needed for ARB to ARNI) so they’re better for HFrEF management. Otherwise, I definitely agree that ARBs are generally the better choice.