Life Off-Label

A little while ago I, along with some other pharmacy students, volunteered in a mock interview session with pre-pharmacy students at the school. The pre-pharmacy students were also allowed to ask us some questions and bring up any concerns they had. Although we don’t serve on the admissions committee and  can’t definitively tell them “this will get you in” or “saying this will get you rejected”, we try to use our experience with interviewing for pharmacy school to help guide them in the right direction.

Some students have a lot of pharmacy experience before applying to pharmacy school. I worked almost two years full-time at a hospital, so I had a lot of specific things to draw on from that experience in my interview. One of the students, having had only shadowed a pharmacist a few times, asked me if it would be bad that most of her answers don’t involve pharmacy experience, and instead were drawn from her teaching experience. I told her that I don’t think it’s a bad thing as long as she could relate her answer to pharmacy. I have a lot of respect for teachers, and one thing they have that pharmacists need is the ability to communicate well with many people, especially when those people can be frustrating.

Before I worked as a pharmacy tech, I worked for years at a grocery store while I was in undergrad. Some of it was just as a cashier, and later I got promoted to working as a bookkeeper and in customer service. That didn’t teach me anything about drugs, but it did teach me that there are people in the world that can be difficult, and will resort to things like anger and personal insults just to get what they want. I learned how to deal with those situations, and I think I’ll be a better pharmacist for it.

I don’t want to discredit pharmacy experience when applying though. If I were on an admissions committee, I’d find it a huge red flag if someone had absolutely no pharmacy experience whatsoever. Pharmacy isn’t for everyone. Pharmacists don’t get the glory that doctors do. We have to put up with difficult people regardless of the field we work. The hours aren’t necessarily a comfy 8-5. Of course, there are many great things about being a pharmacist, but I think it’s important that people have at least dipped their feet in pharmacy so that they can see the downsides and really weight out the pros and cons. If they still say, “Hey, you know what, this is still worth it to me,” they should apply to pharmacy school. It’s a long four years and a lot of money to invest to change your mind.

But as far as experience for the sake of learning things like drug names, it’s good but not necessary. That’s what IPPE hours are for. I personally would rather have someone who is a little more well-rounded. People come to pharmacy school from a variety of backgrounds. Some came from different sectors of healthcare like nursing, others had more of a research background, and others came from completely unrelated fields like IT. I think each different experience can contribute different perspectives to the profession, and that kind of diversity will make us better as a whole. Experience is what you make of it.

Yesterday, while at my site visit, I had to make something I hadn’t seen before. When I was done, the pharmacist asks me, “Would you like to do your first counsel?”

Do I? Yes!

Sidenote: I can’t believe how much I’ve already done in my first couple months as a P1. I know a lot of schools don’t start IPPEs in the first semester, and people in Texas can’t even get their intern licenses until after their P1 year is completed, so I realize how awesome it is to get the chance to do things like this so early.

The medication was a Topical Prochlorperazine gel, which is used for to treat nausea. Since sometimes people feel so nauseous that they don’t want to swallow a pill (and would like to avoid the suppository route), they can squeeze their prescribed dose of this gel onto a thin area of skin and rub it in. Preferably, people use their wrist and basically rub their wrists together like they just sprayed on some perfume. It’s also a good alternative to pills because the onset is a little more rapid and people tend to experience fewer side effects. He explained all of this to me, and showed me how to show the patient how to use the syringe and make sure they get the right dose each time.

I felt ready, and he asked if I wanted him to come along. I said he should just to make sure I didn’t miss something, but I wanted to try to do everything on my own. I walked up to counter and introduced myself. As soon as I started talking about the medicine, she informed me that she’s been using it a while and that she already knows what to do, so I didn’t get to do as much counseling as I thought this time around.

On the bright side, I didn’t get a chance to do anything wrong!

One of the big issues with Occupy Wall Street and politics in general is student loans. I just read an article that talked about how total student loan debt in the US has exceeded total credit card debt, which is truly amazing. But what I really love is when older generations scoff at that and call my generation irresponsible because they were able to graduate with much less debt. They forget that education used to be more heavily subsidized by the government, and tuition was far cheaper than it is now. For perspective, my friend’s dad went to UT, and his tuition for all four years is cheaper than a semester was for me.

The situation also hasn’t been helped by the famous picture circulating all over Facebook of the supposed student who pulled his or herself up by their own bootstraps and was able to graduate debt-free:

First of all, if this is even true, I can almost guarantee their scholarship was need-based, not merit-based. Most “moderately priced in state univerisities” don’t have as much to offer in scholarships compared to private universities. What they do have is saved mostly for grad students and athletes. Yes, there are some merit-based scholarships, but the likelihood that they cover 90% of her tuition is very rare. It’s a lot more likely that, if she did get that much help, at least some of that came from the fact that her parents make an extremely low income. I’m sorry I didn’t work harder to make my parents make less money?

The things is, my story isn’t that much different from hers. My high school didn’t calculate GPA on a four-point scale, but I think a 98+ average would, at minimum, put me at a 3.8. I was also in band, an officer in German Club, NHS, volunteered through church, took as many AP classes as I could, and had a part-time job my senior year. I had a FastWeb account and could remember applying for any scholarship I remotely qualified for. My scholarship grand total? A couple thousand. My tuition at UT (also a moderately priced, in-state university) was roughly $4,000 a semester. So… $2,000/($4,000 x 8 semesters) = 6.25%. That’s close, right?

So, in addition to 93.75% of my tuition, I had to cover living expenses. I lived in a dorm my first year and then a cheap apartment with three other roommates in a bad part of Austin for the last three years. I took the free shuttle to class to save money on gas. Sure, I went out to eat every now and then. You try living in Austin for four years and avoid stepping foot in one of their amazing restaurants. I’m just being realistic here. I also worked as much as 30 hours a week (at a job that paid above minimum wage), so forgive me for using some of that money to treat myself every once in a while.

In a nutshell, I feel like I also pulled myself up by some strong bootstraps, but I still didn’t come out close to debt-free. I was also blessed with VERY supportive parents, so I only had about $20,000 in loan debt for undergrad, some of which I already paid down in the past couple years while I was working full-time. Not as many people get to have parents like that though, and I can see why the debt for some is even higher.

Admittedly, using my situation as anecdotal evidence doesn’t prove the person in that picture is lying. So say they did get this magical scholarship, and good for them. There are many students that max out their loans and piss that money away on things they don’t need while in school, so I applaud this person’s responsibility. But I still don’t like the message behind this. Is anyone who has to take out loans for their education making a bad decision? Sure, I could have saved a lot of money by staying at home and going to UTA or UNT, but I didn’t. I worked my ass off in high school to get into a school like UT, so why should I feel irresponsible for going there? Why should the student who got into Yale or Harvard be forced to go to a less prestigious school because they can’t afford it?

Maybe it’s just me, but educating yourself should never be considered an irresponsible decision. Even with all the loans I plan to take out for pharmacy school, I still consider it a worthwhile investment. When less privileged people start feeling guilty about doing the one thing that can have such a huge impact on their social mobility, there is a major flaw in the system.

1. Bake banana bread.

2. Watch various YouTube videos of dachshunds.

3. Add more movies and shows to my Netflix queue.

4. Write this blog entry.

5. Watch the maintenance guy fix the gap under our door.

6. Stare at the ceiling.

7. Debate whether I should replace players on my fantasy football team.

8. Listen to Christmas music.

9. Watch baseball. (Go Rangers!)

10. Facebook in between all of the above things.

You wake me when I can no longer snooze
Especially after a night of too much booze
I can’t explain what you to do to me
All I know is without you, I’m unhappy
No really, sometimes I get very moody
In that way that’s more intimidating than Judge Judy
But then, I find a moment to have a sip of you
And the grass looks so green and the sky so blue!
Just like a friend who has a good drinking buddy
You’ve brought me good times when I need to study
Some might say my love for you is an addiction
That I obsess over you like I have a sick condition
But they don’t understand the better person I am
When you stimulate my nervous system
You do have some drawbacks, like how much you make me pee
But overall, I have to say, you complete me

Despite what some people think, the point of the “99%” is not a bunch of people bitching about their personal situation on a Tumblr account (or at least it’s not supposed to be). Just as people should be held accountable for depending on welfare while being lazy, living above their means, or taking out way too many loans to go to a private school for a liberal arts degree, there are corporations that received bailout money and used it to further line their pocketbooks instead of repairing the damage they caused. And that’s why I agree with the point of the movement. I want to hold the people in the “1%” accountable for their bad decisions that caused the recession, housing foreclosure crisis, and skyrocketing unemployment. I want to hold our people in government accountable for putting the needs of their big corporate donors ahead of the people. It’s great if you’ve made the right choices and things are still working out fine and dandy for you, but that doesn’t mean the system shouldn’t be fixed. Look at the bigger picture.

PS – These charts help illustrate that bigger picture.

I had my first day as an intern at my IPPE site, which is an independent pharmacy about 30 minutes away on the freeway, which is only a little longer than my commute to work was in Dallas. I wasn’t sure what to expect, especially having never worked in a community setting before. It also doesn’t help that two of my classmates had, um, interesting first days at their sites. One got to witness a robbery, and another was there when a narcotics agent tried to do a sting buying Sudafed with a fake ID. I’ve also heard horror stories from pharmacists I worked with of just being ignored and treated as free labor. When I got there though, I knew I had an awesome site when the lady with pink hair greeted me and informed me she’s my preceptor.

I showed up in professional attire like we were told to do in class. I wore a nice black shirt with gray dress pants and black work shoes, but I definitely stood out since everyone there wears scrubs. I plan on going back for a few more hours Saturday, and since I have a bunch of scrubs from my old job, I ask if it’s ok for me to wear scrubs from now on as well. She goes, “Oh absolutely, but Saturday is jean day, so you might want to wear jeans.”

Seriously, coolest pharmacy ever.

As I said before, having no prior experience in this setting, I felt a little out of my element at first. I do know that pharmacies have a pretty orderly work flow, and being unfamiliar with it I didn’t want to start doing things that would disrupt someone’s job. I let my preceptor and the techs tell me what to do until I got more comfortable with how things ran. By the end of my shift, I was able to be more proactive with filling prescriptions.

I also took a few prescriptions over the phone, which is something I have never done (aside from a mock phone-in in my class). I wrote down everything I would need to ask ahead of time, so I wouldn’t forget anything. I felt pretty blonde at one moment, because I asked the lady on the other line to spell “Medrol”, and I could tell she was thinking, “uh… seriously?” Oh well. I know with time it’ll be easier and more natural, but I hate being in that new slow phase.

I think the weirdest thing for me is to separate myself from the technician role and be more like the pharmacist. I’m so used to asking the pharmacist questions and doing what they tell me, and it’s a little intimidating to know that eventually I’m going to have to take that leadership role and be the one running the place. At the same time, that’s also exciting, and I think it’s why I’m so eager to learn.

Many jobs have been replaced by machines and robots, but are pharmacists next? This article from Slate magazine would have to believe so, but this goes back to the perception that all we do is count pills. Most of the article’s argument comes from the idea that pharmacists have a mindless job. That just because we don’t have to compound most medicine now, we don’t do anything. We just stick a label on it and bill the insurance, right? If that actually were the case, I could see where a robot would do the job, but under the surface there are many things pharmacists do that aren’t so menial. Problems arise and customers are unpredictable, and I don’t think we’d want to trust a robot to handle them.

On the bright side, Mr. Robot doesn’t take bathroom breaks. I guess he has me beat there.

I don’t think this is something we should ignore. It’s a very real threat, especially since robots aren’t as prone to human error, but the ball is in our hands to demonstrate our value about how much clinical knowledge we have and how well we could use it. We need to create a better image with the public, because it’s up to them where they take their prescriptions, and it’s up to them whether it’s important to just get their medicine from a machine or if they want to have that relationship with their pharmacist. Personally, I’m irritated when my cashier isn’t a person. No robot can ever recreate that everyday chit-chat and interaction the way a real human being can, and it’s especially important that healthcare professionals stay human to maintain that relationship with their patients. Maybe we could start by airing a PSA about how annoying it would be to get counseled by C-3PO. That would be pretty effective.

The title is brought to you by the great Ice Cube.

I had one of those “Where has the time gone?” moments today when I realized that it’s already been six years since my high school graduation, and it led to my reflection on what I’ve accomplished since then. Sure, like most high school classes, I’m faring better than our cliche screw-ups among the “popular” ones. However, some of my classmates have already found success with their careers and bought their first house. Others are married, and perhaps a kid or two has popped into their lives. As for me… I’m still in that limbo where I can’t settle down yet, but I shouldn’t envy those that can. Sometimes the “in progress” phase of our lives goes unappreciated, and I don’t feel so bad for basking in it.

If you asked me six years ago where I thought I’d be at this point, I would have figured I’d be done with pharmacy school and working as a pharmacist. I’m obviously a few years behind schedule, but the extra time it’s taken me to get where I want hasn’t all been for nothing. I spent more time in school and got a degree so that I could step back and question whether pharmacy was really right for me. It also gave me more time to mature and get through the whole “finding me” phase while still in undergrad. On the relationship side of things… I’ve definitely kissed my fair share of frogs, at least providing me with valuable insight on who I shouldn’t marry. I stuck my feet in the “real world”, seeing what it’s like to work 40 hours a week and learning how to responsibly manage my own income. No student loans, no parents, just bills. That job also gave me valuable pharmacy experience and allowed me to ultimately realize it’s what I wanted to do all along.

Most importantly, I haven’t strayed so far from my path that I’ve lost sight of my goals. The destination is important, but I’ve found that the journey can be just as worthwhile, even if it’s not the quickest way there. Sometimes it’s good to exit the interstate and take the scenic route instead.

I don’t want to scare anyone away, but I thought I’d post some numbers as a way of giving people a rough idea of just how much professional school costs these days. If you have super rich parents or won the lottery, then this doesn’t apply to you. But the rest of us have to rely on taking out loans, and though pharmacists make good money, the cost is rising much faster than pharmacists’ incomes. I also want to point out that, as an out-of-state student, I am on the high end of the cost spectrum. Those attending private schools can expect similar numbers, but most in-state tuition for public colleges will be a little cheaper.

This year I took out a little less than $60,000 to pay for out-of-state tuition, fees, books, and basic living expenses. Working during school really isn’t an option for me. My schedule is busy enough as it is, and it wouldn’t be worth it if I overwhelmed myself, failed a class, and had to take out more loans to retake the class again in the summer. Ideally, I can work over the summers and save a little money as well as try to get as many scholarships as I can, but for the sake of painting a worst-case scenario, I’ll leave that out of the equation. I also have some debt from undergrad that I’m deferring for four years, and including that, I’ll estimate my total debt at about $250,000. Basically, for what I’ll pay for pharmacy school, I could have taken out a mortgage on a really nice house.

To most people, that’s an insane amount of money to borrow for school. Admittedly, when I actually think about it, I wonder if I’m nuts. Frankly, I probably wouldn’t have done it if pharmacists didn’t make the kind of money that they do because it just wouldn’t be feasible to pay the money back in a reasonable amount of time. I used a student loan calculator I found online to estimate monthly payment based on a 6.8% interest rate (which the majority of my loans have). When I graduate, I want to try and repay mine back within ten years, which puts me at about $2900 per month.

Yikes! That’s more than I made in a month working full-time as a tech! Thankfully, pharmacists make a lot more than techs, so let’s assume I start out at a $100K salary. After taxes (assuming I live in Texas, I’ll have no state income tax), 401K contributions, and benefits deductions, that might net me around $70,000, which is a little less than $6,000 a month. After paying my student loans, that leaves me around $3,000 a month for rent, bills, fun times, etc. Some people might scoff at that, but I was able to live pretty comfortably on 2/3 of that, so to me it’s not the end of the world. If people want, they can do the 25-year plan and keep more of their money per month, but in the long run you pay a lot more in interest.

These obviously aren’t exact numbers, but the point is that if you were hoping to go on a shopping spree after pharmacy school, this is something worth considering. However, if pharmacy is truly your passion, you’re by no means living in a box after graduation. It’s a lot of debt, but you can do it. On the bright side, this will probably deter a lot of the people who would only go into pharmacy for the money, and I’m fine with that.