Residency Training in Wisconsin
by Kristin Hanson, MS, RPh
s the role of the pharmacist ASHP, working closely with its partners, GROWTH – KEEPING UP WITH THE
in health care today contin- continues as the sole organization recognized DEMAND
ues to expand, the need for and responsible for accreditation of pharmacy The number of pharmacy graduates continues
individuals with advanced residency training programs. to climb. The American Association of Colleges
and specialty training does as of Pharmacy (AACP) tracks and trends graduate
well. The numbers of residency programs and RESIDENCY TRAINING VISION data on an annual basis. The 10,988 pharmacy
positions continue to grow in Wisconsin and The value of post-graduate training is well school graduates in 2009 is over 50% higher
throughout the country – a positive sign indeed. recognized. In 2002 The American College than ten years earlier.5 Table 1 reflects the annual
The challenge lies in the fact that the need in of Clinical Pharmacists (ACCP) included a number of graduates with their first professional
our profession and the demand for amongst lofty vision statement as a part of its strategic degree according to AACP. With new schools
graduating pharmacy students; outpace the plan stating “Formal, postgraduate residency of pharmacy opening and others expanding the
growth of programs and positions. The ques- training will become mandatory before one can class size, the number of graduates is expected
tion we must all ask ourselves, are we at our enter practice.”2 This ACCP vision was further to climb in the coming years.
residency program capacity? defined in 2006 stating “By 2020, residency The increasing number of unique residency
training should become a prerequisite for training programs throughout the country is
BACKGROUND entry into pharmacy practice.”3 The following impressive as well as depicted in table 2, with
A pharmacy residency is defined as “an year, ASHP endorsed the vision in a position the number of programs nearly tripling from
organized, directed, postgraduate training statement “To support the position that by 1999 to 2009.6 The number of pharmacists
program in a defined area of pharmacy the year 2020, the completion of an ASHP- in both PGY1 and PGY2 residency programs
practice.”1 Residencies and post-graduate accredited residency should be a requirement continues to climb steadily as well as shown in
internships have been in existence since the for all new college of pharmacy graduates who table 3 reaching the 1886 PGY1 residents and
1930s. Standards related to these post-graduate will be providing direct patient care.”4 While it 436 PGY2 residents in 2009.
training programs were originally drafted by may not be clear what percentage of pharmacy Despite significant efforts in recent years to
American Society of Health-System Pharmacists school graduates will move into direct patient develop new residency programs and expand
(ASHP) in 1948 followed by a revision in 1962 care roles, one could argue that vast majority of existing ones, the demand for these residency
which also established an accreditation process. graduates would fall into this category. positions, PGY1 positions in particular,
Since that time, standards for residency training
have continued to evolve and training programs PROFESSIONAL PHARMACY DEGREE5
TABLE 1: FIRST First Professional Pharmacy Degree
have been delineated as post graduate year one
(PGY1) and two (PGY2). The focus of a PGY1 12,000
training program is broad in nature and serves
as a prerequisite for entry into a PGY2 program
in any number of specialized areas. A limited 10,000
number of 24-month combined PGY1/PGY2
programs, most commonly with a PGY2 in
health system pharmacy administration, are
also in existence; including two in Wisconsin.
While residency programs have traditionally 6,000
been hospital based, the expansion of
pharmacists practicing in different settings
has necessitated creation of additional types 4,000
of training programs. In recent years, new
standards for PGY1-community and PGY1-
managed care pharmacy residency programs 2,000
have been developed by ASHP through
partnerships with American Pharmacists
Association (APhA) and Academy of Managed 1996-97 1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09
Care Pharmacy (AMCP), respectively.
22 JPSW July/August 2010
continues to grow at a much faster pace. Table
TABLE 2: #PGY1 PROGRAMS IN ASHP ACCREDITATION PROCESS6
# PGY1 Programs in ASHP Accreditation Process
4 is an illustration of this situation with the
gap between the number of applicants and 800
the number of programs widening. Accredited
residency programs and those in the process 700
of seeking accreditation, are required to
participate in the pharmacy resident matching 600
program managed by National Matching
Services, Inc. The 2010 resident match saw 500
its biggest numbers to date, matching 1651
# of Programs
PGY1 applicants and positions. The 1114 400
unmatched candidates, however, were left
scrambling for the remaining 150 unfilled 300
positions.7 As noted earlier, with an increasing
numbers of pharmacy school graduates in the
coming years, it is fully anticipated that the
demand for residency training positions will
continue to grow. Unfortunately, the gap will
likely continue to grow as well.
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
INCREASING RESIDENCY TRAINING
POSITIONS – DUAL STRATEGIES program at your site and performs well is upon the type of service, outcomes can have
As we work to increase opportunities for post often one of the most qualified candidates positive financial, quality, and/or customer
graduate training, two strategies are necessary. for a position following program completion. service impacts.
• Increase the number of sites or programs In addition, students who may have looked Project Completion – Residents are
conducting residency training at your program but ended up elsewhere for required as a part of an accredited program to
• Increase the number of residents training residency may be inclined to return to apply for a complete a major project. Selecting projects
at each site permanent position at some point in the future. that are of mutual interest to both the resident
Expansion of Services – The presence of and site can be beneficial in accomplishing high
JUSTIFICATION AND BENEFITS OF a pharmacy resident may enable you or your priority and important initiatives. Examples
RESIDENCY TRAINING department to explore new services. Examples may include development of a new treatment
Budgets are tighter than ever for most us, so may include developing pharmacy services in guideline or collaborative practice program.
how can we justify adding a pharmacy resident? the ED, expanding the presence of pharmacy in Projects aimed at improving safety, decreasing
While there are financial obligations involved an ambulatory clinic or offering a new patient costs, and /or increasing revenue can clearly
in residency training including the resident’s service in a community pharmacy. Depending benefit the site while fulfilling residency
stipend, travel allowance, accreditation fees
and perhaps some additional resources such
TABLE 3: #RESIDENTS IN PROGRAM6
# of Residents in Programs
as a computer, references, etc; be sure to look
at the benefits. Cost avoidance, improved 2000
quality and /or increased revenues can be tied 1886
to many of the items below to support position 1800
justification. Pass-through funding through
CMS may be available to many sites as well 1472
that can substantially off-set residency program 1400
Staffing – The resident’s staffing commitment 1200
# of Residents
is an easy place to start – not only can it be a 1000
931 PGY2 Residents
good learning experience for the resident, but 844 860
it can also help off-set some of the expenses by 800
filling a shift that would have otherwise required 544
a staff pharmacists to cover.
Recruitment – Training of pharmacy 400 332
residents can serve as an excellent source of 199
recruitment. In many cases, students are looking 200
to complete a residency in the geographical area
in which they wish to practice in the future. A 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
resident that completes an in-depth training
JPSW July/August 2010 23
proposal in the same manner as if you were
Unmatched POSITIONS & APPLICANTS6, 7
TABLE 4: UNMATCHED PGY1 PGY1 Positions & Applicants
developing the initial program. The most
1200 effective and efficient programs are often those
unmatched applicants that are incorporated into the structure of the
gap site or department – residents and the program
964 itself become a vital part of the site’s success.
857 One of the most important points, however,
is not to sacrifice quality for quantity. Discuss
modifications carefully with your preceptor
group – slow and steady growth more easily
600 557 allows for adjustments.
So back to the original question – are we
at our residency training capacity? The
269 282 demands on us continue to increase. We
work in a fast-paced, complex environment
and the consequences of mistakes are high.
0 Hiring well-trained pharmacists with strong
2007 2008 2009 2010
knowledge base and excellent problem-solving
and communication skills is imperative.
requirements. program. Taking time to read through the Residency training is a way to jump-start the
Precepting of Students – Residents often standards and reviewing the outcomes, goals development of a new pharmacy graduate’s
welcome involvement with students as a way and objectives; is an important starting point. skills; however, the competition to secure a
to develop teaching and precepting skills or Beyond the resources available online, residency training program is high. Wisconsin
help solidify a complex clinical topic by hav- networking with preceptors from existing has a long traditional of high quality pharmacy
ing to explain it to someone else. Likewise, a programs can be extremely valuable as is education – both during pharmacy school and
resident is often quick to connect and relate to attendance at conferences or sessions devoted beyond, with many of our graduates pursing
a student in a manner that provides guidance to residency training and / or precepting skills. post-graduate training. Of this year’s UW
and career planning. Residency Learning System (RLS) training is School of Pharmacy graduates, 53 participated
Staff Development – While the focus of a offered by ASHP in conjunction with several in the resident matching program. Thirty-seven
residency training program is to develop the national meetings such as the Midyear Clinical of those graduates matched with a PGY1
Meeting and the National Residency Preceptor
skills of the resident, the process in doing so can program somewhere in the country, yet 16 of
Conference and often upon request for more
be of benefit to existing staff as well. Activities our 2010 UW graduates were among the 1114
such as clinical discussions, journal clubs and local groups. The program is highly valuable for scrambling for one of those 150 remaining
case presentations necessitate involvement and all preceptors but especially critical for program positions. With such a high demand, we need
can stimulate discussion and learning for all. directors – a valuable tool as you design your to look for opportunities within our own sites
program. Make sure you also learn from your to initiate or expand residency training. ●
GETTING STARTED peers – exchange ideas, strategies and tools for
The ASHP website has a number of valuable success. If possible, arrange a site visit to their Kristin Hanson is the PGY1 Residency Program
resources related to residency training including program to meet those involved. Director at Froedtert Hospital in Milwaukee, WI.
documents specifically aimed at starting a new Having sufficient scope and depth of clinical
pharmacy services is a key factor as is having REFERENCES
qualified preceptors for the resident. Partnering 1. American Society of Hospital Pharmacists. Definitions of
pharmacy residencies and fellowships. Am J Hosp Pharm 1987;
with another site may be worth considering, 44:1142-1144.
especially if your clinical services or resources 2. American College of Clinical Pharmacy. The strategic plan
of the American College of Clinical Pharmacy. ACCP Report
are more limited. A multisite residency can be 2002; 21:S1–7.
easier to justify and create as you are sharing 3. Murphy JE, Nappi JM, Bosso JA, et al. American College
of Clinical Pharmacy’s Vision of the Future: Postgraduate
the resources and responsibilities. Pharmacy Residency Training as a Prerequisite for Direct
Patient Care Practice. Pharmacotherapy 2006; 26:722–733.
4. American Society of Health-System Pharmacists. Policy
EXPANDING YOUR PROGRAM Positions: Education and Training. www.ashp.org/Import/
For those sites with existing programs, I’d PRACTICEANDPOLICY (accessed 17 May 2010).
5. American Association of Colleges of Pharmacy. Trend
challenge you to consider expanding the Data. www.aacp.org/resources/research/institutionalresearch.
number of residency training positions. While (accessed 17 May 2010).
additional residents require more time, there 6. Teeters J. Residency Update 2009. Presented at ASHP
Midyear Clinical Meeting; Las Vegas, NV; 2009 Dec 7.
are efficiencies that are realized. Strategies noted 7. ASHP Resident Matching Program. Match Results. www.
above can be incorporated into an expansion natmatch.com/ashprmp. (accessed 21 May 2010).
24 JPSW July/August 2010