FIVE YEARS AGO, the 303-bed Children’s National Medical Center in Washington, D.C., supported only two first-year pharmacy residents. Since then, the program has tripled in size to a total of six residents: three in the PGY1 pharmacy residency and three in the recently formed PGY2 pediatric pharmacy residency.
The dramatic expansion in post-graduate education resulted from the convergence of need, opportunity, and the right people, according to Ursula Tachie-Menson, B.S., Pharm.D., the hospital’s acting chief of the division of pharmacy.
“We recognized that there was a real need for a PGY2 program focused on pediatrics. There aren’t many out there, and competition for them is huge,” she said, adding that she is unaware of any other pediatric-focused PGY2 slots in all of Virginia and across a huge swath of the eastern seaboard between Baltimore and Chapel Hill, N.C.
A Strong and Growing Need for Pediatric Pharmacists
Demand for pharmacists who practice in this specialty area is widespread and growing. According to the Board of Pharmacy Specialties, approximately 70 percent of all pediatric hospital bed days are for chronic illnesses, and the Children’s Hospital Association reported that shortages of pediatric care results in many young patients having to wait weeks and sometimes months to get an appointment.
PGY1 Residency Program Director Katherine Pham, Pharm.D., BCPS, was impressed with the clinical environment when she joined Children’s National in 2008 as the NICU clinical specialist and residency coordinator. When Dr. Pham surveyed the formidable pharmacy staff at her new employer, it seemed as if the department was “just built to have second-year residencies.”
With a core of then four (now six) clinical pharmacy specialists and a substantial number of decentralized pharmacists who had completed at least one year of residency, “there were just so many clinical pharmacy resources to draw from,” she said. “We have many talented clinical specialists who can provide a high level of residency training.”
In addition, because the hospital is one of the rare freestanding pediatric hospitals on the east coast, any residency program becomes, de facto, one of pediatric specialization. Residencies in general population hospitals are more broadly based by nature.
“We knew there were not enough PGY2 programs for pediatrics on the East Coast,” said Dr. Pham.
Pursuing a PGY2 Seen as a Career Boost
Given the competitive job market faced by clinical pharmacists in some regions of the country, more opportunities for advanced clinical training are clearly needed. When Kelli Covington, Pharm.D., a current PGY2 resident at the hospital, decided to pursue a second post-graduate year (she completed her PGY1 at Children’s National), she knew it would boost her marketability.
Her decision hinged as much on the potential career boost as on her desire to participate in a clinically oriented program focused entirely on pediatrics. “I’m being trained to be an independent pediatric pharmacist,” she said. “Most PGY2 programs don’t provide that opportunity.”
In addition, the residency has opened an avenue into academia—another of her interests. Dr. Covington is currently a preceptor and lecturer at the nearby Howard University College of Pharmacy.
Both Drs. Tachie-Menson and Pham emphasize that the expansion of the residency program owes much to steadfast support from pharmacy leadership and hospital administrators. David Stockwell, M.D., executive director of improvement science in the hospital’s intensive care unit recognizes the rewards of a strong residency program.
“Residents think and act at a high level, so they’re able to operate in very complex situations,” said Dr. Stockwell. “That delivers value to our patients and therefore to our organization. And when our residents move on, they’ll help somebody in a different place, so everyone benefits.”
Residency Experience Transfers Well
Rebecca Deoras, Pharm.D., a pediatric pharmacotherapy clinical specialist at the 464-bed Brooklyn Hospital Center in New York, was among the inaugural PGY2 class of two residents in 2011-2012 at Children’s National. She calls her decision to embark on the PGY2 “hands down one of the best decisions I’ve made.”
After pharmacy school, Dr. Deoras became a staff pharmacist at a pediatric satellite facility in New York. Three years later, her path led to the Children’s National PGY1 because she sought a higher degree of clinical training and, she hoped, a competitive edge in the job market. Her choice to stay on for another post-graduate year paid off.
“I was competitive for every job I applied for,” said Dr. Deoras. “Employers were really looking for that second year of specialty training.”
Now, as the only pediatric pharmacy clinician in a community hospital, Dr. Deoras’s responsibilities run wide—PICU, NICU, general pediatrics, hematology/oncology, outpatient asthma, and the emergency department. Yet she has felt completely prepared for the demands of multiple roles, largely, she says, because of the experience and knowledge gained during the PGY2. Because “Children’s National offered me a first-hand look at what’s involved in building a PGY2 from the ground up,” Dr. Deoras hopes to develop one at her hospital.
Patients, Residents Benefit
Second-year resident Gabriella Blyumin, Pharm.D., also anticipates that a PGY2 will bestow some professional advantage, but takes a cautious view. She’s not so sure the opportunities are as plentiful as generally believed, especially for job seekers who are regionally restricted. “There are a lot of overly saturated areas and not every hospital has a pediatric unit,” she said.
Still, for pharmacists such as herself who want to immerse themselves in pediatrics, the second-year residency at Children’s National offered an attractive opportunity. From the time of her first neonatology rotation in pharmacy school, Dr. Blyumin knew that pediatrics was right for her. But because her PGY1 was at an adult community hospital with a 20-bed pediatric unit and a 44-bed NICU, her exposure to young patients was limited to two rotations.
That changed immeasurably when Dr. Blyumin arrived at Children’s National.
“I wanted something very heavy in clinical pediatrics. Last year, I spoke with residents here, and that affirmed to me that the clinical experience was much more in depth than I would experience at other places and that I would see things here that I wouldn’t see elsewhere,” she said. “They made a place for me on the unit, and they don’t hold my hand. I feel like I have a lot of impact on patient care here at Children’s.”
The bottom line, said Dr. Tachie-Menson, is that the pharmacy leaders believed they had the ability, clinical skills, and motivation to create a robust and dynamic residency program that serves patients and residents.
“I think we’ve succeeded in doing that,” she said. “We’ve also been successful in preparing our residents to leave here and find the jobs they really want.”
–By Steve Frandzel