What’s better: hospital or community pharmacy?

two pharmacists

Here’s why we need to end any tension between hospital and community pharmacists, writes Matthew Tom

What’s better, hospital or community pharmacy? I’ve practiced in both so people often ask me that question.

Unsurprisingly, I don’t believe there is a clear answer. It really depends on what you’re looking for.

Each has its pros and cons, and depending on your individual preferences, those will be different. I personally found my work as a ward pharmacist in a public hospital very engaging and I loved working in close proximity to other health professionals.

However I felt there was a lack of autonomy in the role at times and this can limit your impact.

As a pharmacist based in a community pharmacy I got a lot of satisfaction out of the ongoing nature of the relationship with our regular customers.

Community pharmacy offers a great opportunity to become a central figure in your patient’s health and I find this very gratifying, however the role comes with the trade-off of having to take on business and administrative roles, which can be a difficult balance sometimes and not every pharmacist’s cup of tea.

Despite the day-to-day operations in hospital pharmacy being quite different to community-based practice, I personally found the skill set required is fairly similar.

Whether you are performing a dosing calculation to ensure safe and appropriate vancomycin dosing for a patient with renal impairment on a hospital ward, or processing a request for chloramphenicol drops for a child in a community pharmacy setting, at the end of the day you are actually just applying a protocol driven method to utilise your clinical judgement to ensure the patient gets the right medicine at the safest and most efficacious dose.

To me it’s less important what task you are completing, than how you are completing it. I also believe it is how you complete the task that defines your potential positive impact as a pharmacist, rather than the task itself.

I am part of a Facebook chat thread with some of my friends from university, the makeup of which is about half/half community based versus hospital based pharmacists. The nature of the conversation often involves light-hearted banter about which setting is “the best”.

Every time one of my peers has a negative experience with a colleague from a different practice setting they are quick share the anecdote to point out how “useless hospital pharmacists are” or vice versa.

Now this is meant in jest, but there is a degree of more serious competitiveness in the wider industry over this exact issue, and that has no doubt prompted some of the questions like the one I started this piece with.

What is seriously concerning is the notion that this difference of opinion could come to affect pharmacist’s practice and have a negative impact on patients.

At PSA16 I listened to both George Savvides and Frank Jones mention to the audience that lack of respect and communication between hospital and community pharmacists is a barrier for pharmacists expanding their roles into primary health care.

If the RACGP President and former Managing Director of Sigma and Medibank have noticed, maybe it’s not just light-hearted banter?

Maybe it’s a major hurdle in the evolution of the profession, and maybe it’s not the time to be asking which one is better, but time to remember that hospital and community pharmacists aren’t just playing the same game, but we’re actually on the same team.

Matthew Tom, an early career pharmacist, was a hospital pharmacy intern who now works in a Coffs Harbour community pharmacy.

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  1. Michael Buxton

    Having worked in both settings, in my experience there has always been good relations between the two branches. The relationship is not without its niggles from the late discharge (often not the pharmacist’s fault) or the medication history which has taken some time to arrive (community pharmacists cant stand over the fax machine 9-5), but overall there is great respect. Individuals are not better pharmacists by virtue of their workplace type, but the opportunities and relevant skill sets have significant differences as well as areas of overlap.

    One branch isnt therefore more skilled than another and the SHPA in their King review submission have highlighted that accreditation or certification would be their recommended way of maintaining standards in the performance of more involved cognitive services regardless of the primary workplace of the pharmacist (GP practice, independent, community or hospital pharmacy).

    There has been a change in recent years which was noted by SHPA in their submission to the King review that with significant differences in award wages between the branches that staff preferences may become biased towards one branch.

    However, there is an easy way to resolve that situation … improving the award wage for the lower paid employee group.

  2. A Medicine Specialist

    Prof Dooley (the SHPA president) was right about one thing though:
    ‘while all practising pharmacists can be considered experts in pharmacy, not all can be considered medicine specialists’.

    Indeed, a natural consequence of being a hospital pharmacist is that you do inevitably become medicine specialists in one way or another but the same cannot be said about some community pharmacists.

    Discount pharmacy models are impeding the advancement of professionalism of some community pharmacists and they have only themselves to blame for this.
    This is also why it is much more difficult for a community pharmacist to become a full-fledged, hospital pharmacist than vice versa.

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