Consider your scope of practice in postgraduate training

CAREER

Matthew Westling, PharmD, MPA, is a PGY-2 psychiatric pharmacy resident at the Richmond VA Medical Center in Richmond, VA.

Many considerations should be made when looking at residencies or fellowships for postgraduate training programs. Applicants often focus on factors such as location and types of experiences, but ignore one key aspect. Although often overlooked, a state’s scope of practice (SOP) can impact postgraduate experiences, especially since it influences the types and level of interventions that pharmacists can make. It is essential to be mindful of the variability in pharmacists’ SOP in areas such as autonomy and required training when considering fellowship or residency programs.

State-specific conventions

For instance, some states may have a statewide protocol that allows all pharmacists to order a limited number of medications without a medical provider’s approval, while others may allow pharmacists to order a larger variety  but have stringent certification or specialty training requirements. Individuals who prefer to develop close interprofessional relationships with prescribers may like to train in a state that primarily uses collaborative practice agreements. I chose to pursue a residency within the federal system because federal pharmacists’ authorities are not limited by state-specific SOPs, and instead, practitioners often define their SOP in alignment with their institution.

It is important to recognize that even if postgraduate training is completed in a state with a more restrictive SOP, opportunities exist to develop and implement projects that may expand your institution’s SOP or pharmacist protocols; for example, I am working to assess the need for a new neurology pharmacist within my institution. Expansion of state pharmacist authorities or institutional implementation projects can take many forms, but it is best to approach them with specific goals in mind.

Pharmacist role expansion advice

First, assess feasibility of the project, considering workload and time constraints. SOP policies can take time to implement and evaluate. Although 1 year may seem long, it is often insufficient for start-to-finish SOP assessment projects, especially if institutional review board approval is required. Full projects are more conducive to fellowship or residency programs lasting 2 years. Trainees may consider composing a proposal that would be completed over multiple years and thus may begin with initial considerations, handoff project development, and next steps for subsequent trainees to complete.

Then, consider if there is a project in development that can benefit from support in the assessment or implementation phases. Postgraduate trainees can easily integrate themselves and develop training initiatives into a research project with outcomes. Trainees can present findings to peers, state legislators, or national conference attendees to advocate for the profession on a larger scale while concurrently satisfying any presentation requirements.

Lastly, focus efforts and maintain a realistic timeframe and expectations. Overall, SOP is an integral part of pharmacy practice that influences the extent of pharmacists’ clinical  impact. When exploring postgraduate opportunities, research and ask about the SOP of that state and institution. Try to understand how a specific SOP influences post-graduate experiences by asking preceptors what pharmacists are allowed or expected to do and evaluate if this aligns with your goals. This way, you can find the place that’s right for you.