The second part of our series exploring the range of specialty career opportunities available to pharmacists
In the August issue of the AJP, we looked at 15 potential career paths for pharmacy graduates, beyond the usual two options of community pharmacy or hospital pharmacy.
- Community pharmacist
- Hospital pharmacist
- Consultant pharmacist
- Non-dispensing (general practice) pharmacist
- Pharmaceutical industry/clinical trials
- Locum pharmacist
- Aged care pharmacist
- Government and NGO policy roles
- Complex care coordinator
- Drug safety officer
- Regulatory affairs associate
- Management and mentorship
This month we speak with pharmacists working in some exciting specialist areas of pharmacy.
The Australian Defence Force (ADF) employs registered pharmacists to work in the army, navy or air force.
Depending on the role, this job pathway can offer both undergraduate and graduate entry with salary increasing on educational attainment.
Full-time pharmacists may be posted with other allied health personnel to work on board navy ships, or be deployed with their unit into remote areas of Australia and overseas. There are also roles in the Royal Australian Specialist Reserve.
Some well-known Australian pharmacists have served in the military. For example, current chair of the Pharmacy Board of Australia Bill Kelly was Chief Pharmacist of the Australian Army during the 1980s. He also served for more than a decade as a Colonel Consultant Pharmacist for the ADF, before moving on to become Deputy CEO of the PSA, CEO of the Australian Association of Consultant Pharmacy, and a Member of the Pharmacy Board.
Wendy Walker, vice-president of the Military and Emergency Pharmacy Section of the International Pharmaceutical Federation (FIP) based in the Hague, Netherlands, has served in clinical, logistics, administrative and operational roles within military pharmacy.
Walker tells the AJP she has loved her career in the military, which began in 1989.
She says working as a senior pharmacist in a military hospital in the 1990s involved a mixture of ward rounds/hospital pharmacy, outpatient pharmacy and community type pharmacy.
“[Back then] we dealt mainly with fit, young and healthy individuals with the main medicines dispensed being analgesics, anti-inflammatories and antibiotics.
“Since then, the military has retained many of the older generation, so now we dispense the range of medicines one would in a community pharmacy.”
Walker was deployed to Bougainville, Papua New Guinea, for four months in 2000.
“It was more logistics: ordering, receipting, etc. I was responsible for the day-to-day running of the hospital: dealing with staff issues, appeasing specialist surgeons/anaesthetists, organising medivacs, etc. This was a very intense role but one I enjoyed immensely.”
Her second deployment was to the Solomon Islands in 2004-05.
As you progress in rank, so your role in the military changes, explains Walker.
“In 2007 I was promoted to Lieutenant Colonel with the title of Staff Officer Grade 1; in essence I was the ADFs senior/chief pharmacist.
“I had clinical oversight of the ADF pharmacies and pharmacists, as well as developing purchase descriptions for health consumables and equipment the military requires, in order to keep members fit and healthy for deployment.”
Walker resigned her full-time commission at the end of 2012 and, in addition to working for FIP, is now in the Army Standby Reserve undertaking a governance role for the Army.
“I wouldn’t change anything if I had my time again,” she says.
Mental health pharmacist
Pharmacists interested in working with mental health patients can find roles in government units, outpatient clinics, community centres and specialist hospitals.
The focus of this work includes managing the supply of antipsychotic medications such as clozapine as part of pharmacological interventions for people with a mental illness.
Mental health pharmacists in hospitals are responsible for providing clinical pharmacy services to the adult mental health in-patient wards, and psychiatric assessment and planning units.
Those practising in this area need strong teamwork skills and current drug knowledge in psychotropic drug therapy.
Steven David, who works as a Senior Clinical Pharmacist Mental Health for the Western NSW Local Health District in Orange, NSW, says the job is challenging but rewarding.
“I look after the Children and Adolescent Mental Health Service in-patient unit, intensive care unit and adult acute units,” says David.
He is the senior pharmacist in a team with three other mental health pharmacists.
“Together we cover 165 beds in the mental health facility. It’s busy in terms of patients, but especially with the responsibilities. I need to attend drug committee meetings, and all medications for the facility need to be approved through us first.
Prior to this role, David was working as a clinical pharmacist at Bankstown- Lidcombe Hospital for three years, as both a general clinical and a mental health pharmacist.
“I’ve got a close family friend who was diagnosed with bipolar disorder, which instigated me to move into it more. I’ve been in this role for four months now.
“Ever since I’ve been a pharmacist I’ve been interested in [mental health], it’s an area I’ve always enjoyed working in.”
While the rural setting provides a fantastic lifestyle—with Orange just three hours away from Sydney—it’s not without its challenges.
“There’s good work–life balance. However due to the rural setting, continuity of care and access to medications can be challenging.
“We’ve got to make sure to keep that continuity of care going by linking up with other healthcare providers.”
Women’s & newborns pharmacist
Do you like working with women, children and infants?
Dr Karen Whitfield has worked in hospital pharmacy for more than 25 years and trained in general medical, general surgery, paediatrics and intensive care, before choosing to specialise in women’s and newborns pharmacy.
Now she is the Women’s and Newborns Pharmacist Team Leader at the Royal Brisbane and Women’s Hospital (RBWH), where she looks after a team of five pharmacists that provides a clinical pharmacy service to maternity and neonatal patients.
“My day begins at 8am by attending the daily Neonatal Intensive Care Unit (NICU) ward round. The Grantley Stable NICU at RBWH looks after babies born prematurely who can weigh as little as 500grams and require specialist care for many weeks,” Whitfield tells the AJP.
“The pharmacist has a significant role in providing advice on safe and effective medication dosing and administration in infants.
“Our team also provides a clinical service to our maternity patients. With advancing technology, we are now seeing increasing numbers of women able to conceive with chronic disease states that necessitate management with a variety of medications.
“Many of these medications are not licensed or are ‘off-label’ during pregnancy, and consequently the specialist women and newborns pharmacist has a role to play in providing the latest evidence available for the safe and effective use of medications in pregnancy.”
For newly registered pharmacists interested in this area, Whitfield says it is important to get a broad foundation knowledge in hospital pharmacy.
She suggests utilising the Society of Hospital Pharmacists Australia (SHPA) Residency Program, a two-year structured, nationally accredited, experiential program targeted at early career pharmacists.
SHPA also offers specialty practice streams, one of which is women’s and newborn health.
“The career pathway for the hospital pharmacist is exceptionally bright,” says Whitfield.
“Hospital pharmacy provides many exciting prospects for diversity and allows pharmacists the opportunity to specialise.
“I get to work with a group of likeminded health professionals to provide excellence in patient care to our obstetric and neonatal patients.
“I have the best job in the world.”
Drug information specialist
Medicines information (MI) specialists serve a vital role in ensuring the safe and appropriate use of medicines.
Dr Geraldine Moses, an Adjunct Associate Professor at the University of Queensland’s School of Pharmacy, works part-time (three days a week) for a medicines information (MI) service at the Mater Hospital in Brisbane—a role she has been in for more than 25 years.
Moses was the driving force behind NPS MedicineWise’s Adverse Medicines Events Line, which she began with a colleague back in 2000 as part of her doctoral research.
In addition to the MI service for the Mater, she also provides a national MI service five days a week to the Australian Dental Association called “Pharma-Advice”, answering dental questions when she’s not at the hospital.
“My work involves answering questions about any kind of medicine: prescription and non-prescription drugs, vitamins, supplements and herbal remedies,” Moses tells the AJP.
“Questions often relate to adverse reactions, drug interactions and precautions—the latter especially in dentistry.
“Safety in special populations is another common area, such as the very young and the very old. Also in pregnancy and breastfeeding. Dosing, storage, legal issue also often come up.”
Interested pharmacists should work in a hospital setting to gain experience, she suggests.
“If you are interested in working in medicines information I’d suggest the best training is in hospital MI services with people who have been working exclusively in that speciality for a long time.
“Also SHPA have structured to MI training with a workbook to ensure it is somewhat standardised.
“We’re all MI pharmacists in a way, but the questions asked in hospitals are often tough ones about critically ill patients, and your responses can be heavily scrutinised so they have to be right!
“The key to being a good MI pharmacist is to always clarify the question until you really know what you’re being asked. And always be sure that you can substantiate your response with good evidence, i.e. resist the temptation to answer off the top of your head.”
Emergency & acute medicine pharmacist
As with any role in the emergency department (ED), working as a pharmacist in emergency and acute medicine isn’t for the faint of heart.
Hamish Crisp, Senior Pharmacist in the ED of Launceston General Hospital in Tasmania, shares the details of his “rather unorthodox” role.
“I have held the emergency pharmacist position for four years now,however for much of the first three years I was in multiple acting roles—so have only been full-time in the ED for the last 14 months.
“Prior to this role I held a number of temporary positions with the Tasmanian Health Service. I was also a pharmacist in the RAAF for a little over four years.
“I had had just enough experience at various hospitals whilst serving with the RAAF to know that I would love emergency medicine, so when this new role was advertised it was an easy decision to apply.”
He describes a typical day at work as “chaos, mixed with a lot of interruptions”.
“My main goal is to see as many patients as possible that will be admitted to hospital to ensure that their medications are correctly prescribed, and to provide advice regarding treatment options for their presenting complaints.
“We have far greater numbers of patients admitted than one pharmacist can see, so I’m usually run off my feet. I spend a lot of time liaising with other health professionals within the hospital and in the community.”
Like anything in the ED, things move rapidly, says Crisp.
“We have had high bed demand so discharging patients also becomes a priority.
“As soon as someone is earmarked for discharge they are usually whisked away to the waiting room to free up a bed. This brings challenges around patient counselling and supply of medications.
“Unsurprisingly I do a lot of medication histories and reconciliations. Yet being in the ED has given me a unique opportunity to provide support to most treating teams across the hospital.”
He says he “absolutely loves” his job.
“Even though I have much more work than what is possible to achieve in a day, and the stress of acutely unwell individuals needing rapid decisions to be made isn’t everyone’s cup of tea, to me it’s perfect.”
Antimicrobial stewardship is a vital role in any hospital and health facility—and it’s one that pharmacists fill perfectly.
Kelly Cairns has been the Lead Antimicrobial Stewardship Pharmacist at Alfred Health since 2011.
Her role is to coordinate the Alfred Health Antimicrobial Stewardship (AMS) program, in collaboration with the lead infectious diseases physician.
Cairns is involved in “a lot of very varied activities”, including:
- ensuring adherence to national accreditation standards;
- research and quality improvement activities relating to antimicrobials;
- supervision and mentoring of Alfred Health Clinical Pharmacy Fellows;
- education of clinicians about antimicrobial prescribing and appropriate use;
- writing, developing and modifying policies and guidelines;
- point of contact for the Infection Prevention Unit, the Microbiology laboratory and the Infectious Diseases unit; and more.
“I was introduced to antimicrobial stewardship during my time at John Hunter Hospital,” she says, referring to her time as the Immunology and Infectious Diseases Pharmacist at the Newcastle hospital from 2005 to 2011.
“We had a multidisciplinary AMS committee, strong links with the infection prevention and infectious diseases team, antimicrobial restriction, and about six months’ experience with AMS ward rounds.
“This solid foundation that I had built at JHH made the transition to my role at the Alfred relatively straightforward,” says Cairns.
“I love my job—antimicrobials and infection management is an area that I have been interested in from day one. It’s definitely a job that gets me out of bed in the morning, with no two days being the same.
“It has also afforded me some exciting opportunities including research collaborations, international travel and opportunities to share my knowledge and experiences far and wide.”
Pain educator, program director or consultant
Chronic and acute pain is an increasing problem, particularly when it comes to medication management and related issues.
Pharmacist and managing director of PainWISE, Joyce McSwan has dedicated her career to helping people manage their pain.
“I think it was more like pain management found me, rather than me ‘falling into pain management’. It was 2010 and I distinctly recall for months on end I had patient after patient, nurse after nurse, GP after GP consistently asking me questions about pain management.
“Despite years of clinical experience, it suddenly dawned on me that the more I tried to explain pain and find solutions for it, the more I realised how little I knew about it and there was a wave of changing science on the horizon which I had not realised or understood.”
McSwan says that before long she started to create materials to teach nursing staff about pain.
Her materials became the basis for the MedRN Pain Management for Nurses course, which was endorsed by the Royal College of Nursing Australia and went nationwide.
“By 2013 I was approached by the Gold Coast Primary Health Network to innovate the Gold Coast Primary Health Network ‘Turning Pain into Gain’ Program—Australia’s first primary health fully funded pain program for community access (until then pain programs were mainly in tertiary centres),” says McSwan.
“By 2014 PainWISE Pharmacy Professional Service Program was innovated and launched, and by 2015 I started my first private hospital based Inpatient Pain Program.”
McSwan was named 2013 UTS Innovative Pharmacist of the Year for her commitment to pain management education.
She says pharmacists are perfectly positioned to help people manage their pain, and her experience in 2010 helped her understand that.
“Little did I know that it was the beginning of a new journey in my career. In short, follow your nose and keep going even if you don’t know where it will end … but stay on the course and it will lead you there!”
This article was originally published in the November 2017 print issue of the Australian Journal of Pharmacy.