Jul 20, 2018
The Iowa City VA Health Care System (ICVAHCS) in Iowa City, Iowa is a comprehensive tertiary health care center, teaching hospital, and research facility. It has a strong and effective affiliation with the University of Iowa College of Medicine, Nursing, and Pharmacy. The Medical Center operates 83 beds, including 37 medicine, 21 surgery, 10 intensive care, and 15 psychiatry beds. The Medical Center operates seven community based outpatient clinics in Bettendorf, Waterloo, Dubuque, Cedar Rapids, Ottumwa and Decorah, Iowa; and Galesburg, Quincy and Sterling, Illinois. The Medical Center also operates a satellite outpatient clinic in Coralville, Iowa. Our facility offers two residency programs. Four PGY-1 pharmacy residency positions and one joint PGY-2 psychiatry residency position with the University of Iowa Hospitals and Clinics.
The ICVAHCS PGY 1-Pharmacy residency program prepares graduates to assume general clinical pharmacist positions in the inpatient and ambulatory care setting, to serve as adjunct faculty for a college of pharmacy, to pursue board certification and to be eligible for PGY-2 residency training. The ICVAHCS is a teaching hospital providing the unique opportunity for our residents to engage in direct patient care, practice management and medication related education. We provide residents experience in anticoagulation clinic, drug information/formulary management, primary care, internal medicine, and pharmacy management. Residents will also have the opportunity to gain experience in endocrine, ICU, surgery, transplant, oncology, pain and virology. Besides clinical activities, each PGY-1 resident will participate in patient and staff education, present formal lectures and case discussions, and precept University of Iowa pharmacy clerkship students. In addition, residents will conduct a research project, present results, and produce a manuscript suitable for publication.
https://www.iowacity.va.gov/pharmacy_residency_program_iowa_city.asp
Contact Information
Residency Program Director
Nancee Waterbury, Pharm.D., BCACP
Iowa City VA Health Care System (119)
601 Hwy 6 West
Iowa City, Iowa 52246-2208
(319) 338-0581
ext: 5115
Fax: (319) 331-2068
Email: nancee.waterbury@va.gov
Full transcript:
welcome to the pharmacy leaders
podcast
with your host Tony Guerra the pharmacy
leaders podcast is a member of the
pharmacy podcast network with interviews
and advice on building your professional
network brand and a purposeful second
income from students residents and
innovative professionals hello my name
is Kelsey zante I'm a p4 ap PE student
from the University of Iowa and today
I'm excited to speak to dr. Nancy
Waterbury who has been a clinical
pharmacy specialist at the Iowa City VA
since 2001 she graduated from the
University of Iowa College of Pharmacy
in 2000 and completed the specialized
practice residency in ambulatory care at
the Iowa City VA in June 2001 dr.
Waterbury is currently the pgy one
pharmacy practice residency program
director her primary areas of clinic
involvement include diabetes hepatitis C
and virology so welcome to the pharmacy
leaders podcast thank you so let's start
out everyone's leadership road is a
little different can you tell me about
where you started and how you got to
where you are today
sure as the end pharmacist I was
fortunate to be surrounded by excellent
preceptors and eventually those
preceptors became my colleagues and they
were involved themselves at the local
state and national organizations they
encouraged me very early to become
involved and actually nominated me for
several leadership opportunities within
the Johnson County pharmacy Association
and then the Iowa pharmacy Association
so with their guidance I was able to
serve in leadership roles for both of
those organizations and I've been I've
remained involved in both throughout the
years perfect so you said that you were
involved in in Johnson County pharmacy
Association and IPA as a pharmacist but
let's say go back to when you were in
pharmacy school what kind of
professional organizations were you
involved in sure there so I will say
that the opportunities as a student now
have evolved quite a bit from the
opportunities that we had 15 years so
one of the organization's I was involved
in was Kappa side
and then the other for our organization
was I would pharmacy Association so I
think now most students are in the Iowa
pharmacy Association kind of from day
one but that was not the case for us
when we went through the College of
Pharmacy and so it was something that
you had to seek out as far as going to
their meetings requesting to be on
different committees and that sort of
thing
so I think you know from a student
standpoint I'm really glad that colleges
of Pharmacy have really expanded the
opportunities for organizational
leadership because those opportunities
weren't as robust yeah as when as when I
went through school yeah that's great
and yeah we are kind of automatically
put in my shoes and that was a change
that I PA made actually and I know we're
going to talk about this alone a little
bit but when I was on the board of
trustees that was actually a
conversation that we were having of how
to get more people involved oh cool so
you were actually involved in that
process of in the beginning of that
conversation yeah and how to get more
students involved oh very cool well like
you said you're still a member of the
Johnson County pharmacy Association you
know you mentioned that your mentors
kind of helped guide you in that path
but you did service terms as vice
president and president and past
president so is that your preceptors the
main way that you got involved a great
question though as a resident I had a
preceptor dr. Kathy Reinhardt and she
was actually the president of Johnson
County pharmacy Association as a
resident I had the opportunity to
present at that organization and our
residents still today give us the e
program for the local organization and
so once I graduated the pharmacy program
she was like I think this would be a
great opportunity you know I'm still
part of that leadership team so I can
help mentor you and coach you leadership
has always been something that I've been
interested in so she nominated me
honestly it's not a very popular
position for people you know to want to
serve just cuz it takes a lot of time
and so I was selected and really with
her guidance was able just to find out
what local organizational leadership is
all about and
have changed throughout the years we
actually wrote a lot of grants to try to
get funding so we could pay speakers to
come in that has since changed but you
know I think trying to get pharmacists
involved within the community to support
your local organizations is challenging
and we've been very fortunate and within
Johnson County to still have a good
following of marmosets and you know it's
interesting it's not just pharmacists as
technicians it's retired pharmacist we
have students who come so I think it's a
good mix you know of different people
interested in pharmacy throughout
Johnson County yeah and it's kind of
nice you know you get that mixed
diversity of people you know what their
role is and you know they're all locals
absolutely on there
readily accessible to talk to our
meeting about sort of and I like the
fact that a lot of the residents within
the Iowa City Johnson County area
presented these meetings so I think it's
good for them just to understand what
local organizational leadership is about
and have an opportunity to kind of give
back to the community yeah absolutely so
not only are you active you know at that
local level but you're also active in a
state association the Iowa pharmacy
Association like we talked about and you
also participated in the leadership
pharmacy conference was that white the
leadership pharmacy conference is
actually a conference with both Iowa and
Wisconsin and they put on the conference
every summer you nominee young
pharmacist to attend that conference I
was very fortunate to do that it's a
weekend and it's really just a great
opportunity to network you know to meet
other young pharmacists they have kind
of leadership different activities
team-building they have primary speaker
who will talk about different leadership
topics and I think it's just a
refreshing weekend and your goal
obviously is for you to take some of
those skills that you learned and take
it back to your practice site and
obviously to continue your involvement
within that organization that sounds
really cool I'm actually going to the
student pharmacist leadership and
friends day gal aider this fall so I'm
hoping that I can really build upon my
you know communication leadership skills
kind of like you did but you know as a
student pharmacist so that's really
exciting you also won the young
pharmacist of the
did um can you tell us a little bit
about what that is and kind of what that
meant to you sure so I believe it's
still pharmacist within their first 10
years of practice and you had to be
nominated by your colleagues and like I
said starting here as a young clinical
pharmacist I was very blessed to have
some experienced pharmacists who had
been leaders at both the local state and
national levels and I was fortunate that
they you know saw in me some leadership
abilities and so they nominated me for
the award at that time I had taken on
the responsibility being residency
director and you know had done some
publishing had done some teaching at the
college and so I think just kind of the
combination of my involvement us also at
the Johnson County pharmacy Association
and you know my I guess the criteria
pretty strong so it was it was a great
ceremony they do it at the annual
meeting where they announce the winners
of all their awards for the year and so
you get to go up and thank the
individual who nominate you know that's
my class so it was it was a great
evening and I just feel very fortunate
to in in my young professional career to
be surrounded by such great mentors yeah
and it seems like early on I mean you
were getting involved in many different
things I was but you know you know it's
interesting I think if you're surrounded
by individuals who are involved you
yourself tend to be involved because
that's just what is displayed for you
and so I even though I've always enjoyed
leadership and you know in high school
you don't find myself doing leadership
things you know I really think it was
just this environment that allowed me to
continue that well it's great so not
only you know are you staying involved
in the pharmacy organizations but
obviously you know you meet with
patients on a regular basis so your
board certified ambulatory care
pharmacist I am how does that Board
Certification help you in your primary
areas of clinic like in hepatitis C and
diabetes I think one of the
as you get out in practice is to keeping
up with with the literature advancements
in practice especially maybe in those
areas that you don't work in every
single day obviously our patients are
complex and so it's as a pharmacist it's
important to know a little bit about
everything right a little bit isn't
enough and so that's one of the great
things about board certification is that
once you become board certified one of
the ways that you can recertify that is
to do your continuing education modules
and at the board certification level
those modules are peer reviewed so it's
not just like reading an article and
answering some questions it's a lot more
advanced than that moment so I have
found that to be very beneficial for me
in keeping up with advancements in
practice I also like to use those
modules not only for my own learning but
also for our students in our residents
who rotate through here
and we can go we we have them read the
module and then we have them answer the
questions and just kind of work through
some of the cases and I think it's a
good learning tool yeah it's kind of
nice because sometimes when you think
about the court certification you think
about that big exam at the beginning you
don't realize you know it provides you
with so much de and information you know
right certainly is the process and
individuals who take the time to become
board certified you know they may they
dedicated you know their time to
continue to stay up to date with
pharmacy practice and so it's it's not
just a one-time thing as something that
you know you need to continue to to keep
up and I think that's a very positive
thing as pharmacy continues to change
right I mean when I leave school things
are gonna be changed I know in the first
year so you gotta constantly you know
keep learning well so we mentioned that
you are involved in the hepatitis C
clinic and I find that really
interesting could you kind of walk us
through what a typical day is like in
that setting sure so hepatitis C clinic
for us really became a standalone clinic
after the approval of harvoni which was
in the fall to 2014 prior to them prior
to then treatment really wasn't very
good for our patients with hepatitis C
long durations not overly effective but
as
people know now for many patients we
were able to treat them with one pill
once a day for 812 weeks so I'm
fortunate to work with we have a
multidisciplinary team with a physician
a nurse care manager and then myself my
rule is I review the patients that are
coming into clinic looking at all their
patient characteristics and so what
other medications are they taking what
genotype of hepatitis C do they have if
we know that information have they been
treated before how healthy is their
liver is their is their liver nonce
erotic or do they have cirrhosis so all
those patient factors and then before
the patients even seen talking with the
provider as what our treatment options
would be if the patient is truly
interested in being treated that our
physician goes in and sees the patient
does a physical exam and if the patient
agrees to treatment then I go in and do
all the education set up all the
scheduling for our follow-up and other
labs I see patients typically about
every four weeks while they're on
treatment making sure that the
medication is working effectively based
on how their labs are trending and then
also just to make sure they're
tolerating things okay no new
medications have been added I would say
probably the most rewarding thing is
when you can call them and tell them
that they've been cured of their
hepatitis C oh yeah we've had people cry
we've had people screaming for joy um
you know it's something that these
veterans many of them have lived with
for 30 40 50 years right and to be able
to cure them of that now is pretty
incredible they probably didn't even
know this was gonna be an option right
you know at any point in their life so
that's pretty amazing might have you
know such a great impact on for many of
them just a big relief
ya know now that they have grandchildren
you'll hear stories of the you know they
don't want there to be any chance and
even though the chance of them spreading
it would be very low to them that would
just be devastating right so to take
that pressure off of them and you know
just give them the peace of mind that
now they're cured is is great that's
really cool so are you the only
pharmacist that works in that clinic I
am don't my pharmacist that works in
that clinic here I know or the
University they're also pharmacists that
work and so it certainly has been an
area of advancement for pharmacists to
get involved and
so as we talk about staying up-to-date
with literature you know prior to 2014
that really was in an area that Pharmacy
had a lot of involvement but now you
have complete practice areas that are
pharmacists run or pharmacist driven so
we can treat more and more people with
hepatitis yeah and it's so great that
you know the pharmacist has such an
important role on that team absolutely
no more obviously so not only do you see
no patients in clinic but you're also
the pgy one residency director so for
our pre pharmacy or even p-one and p-two
listeners why should they consider a
residency so what kind of informal and
formal learning opportunities does a
residency provide sure so I think it's
easy to maybe consider a residency just
another 12 months of rotations it's so
much more than that a residency really
teaches you how to look comprehensively
at a patient gives you that confidence
to make a solid recommendation you'll
get a full other year of being able to
become familiar with the literature so
when you are maybe having a patient
where there's a couple of different
options that you feel comfortable
reviewing the different studies so that
you can have a strong conversation with
the team on what would be the best
option because in many situations
especially in the hospital setting there
may be isn't just one option and it
takes additional training to really get
comfortable with identifying you know
what directions you can go down and
being comfortable reviewing that
literature to make a solid
recommendation to the team you know
other things that a residency gives you
is you'll gain experience in research
you looking at experience and
understanding some of the behind the
scenes that goes on with leadership in
that healthcare system all residents
spend time with management teams our
residents are required to do a residency
research project and even though
research may not be something that an
individual is interested in pursuing
long term just understanding some of the
methodology that goes into research I
think really helps down the road and
evaluating journals when you yourself
are trying to look at an article to see
if it would apply to your practice
setting or particular patient
that you're trying to make a good
clinical position on all of our
residents get experience developing
continuing education programs speaking
in front of audiences both big and small
yeah and also their writing skills so if
it's writing within the medical record
or even you know writing a drug class
review writing in their research in
their research abstracts and in their
research papers and so it's just another
big comprehensive year and I think the
residents work walk out of training just
a lot more confidence in knowing that
they can make a difference on that
healthcare team yeah and I think you
know obviously it gives you so many
opportunities to learn and work with
patients but then you also are working
alongside you know mentors and preset
patterns in you and that just kind of
helps you know them learn even more so
that's also another nice aspect of
things so you were once a resident at
the VA and now you're the residency
director so you saw kind of two sides of
the coin there what do you see now that
you didn't see when you were a resident
so going back to your preceptors as a
resident I don't think you can truly
appreciate how important preceptors are
but as the residency director I mean our
program would not be as strong if it
wasn't for the preceptors we have and
very fortunate to have a large number of
receptors people who have been here for
as long as I have very experienced and
then we also have some new young
preceptors which I think can relate to
our residents and maybe preceptors who
just graduated two years ago and
understand what the residents are going
through preceptors are so important for
the mentoring and coaching of residents
and especially if you have a program
that has dedicated preceptors willing to
put that extra time in to help the
residents learn is is critical so as the
resident going through I didn't really
appreciate that now that I'm on the
other side truly appreciate all the
preceptors that we have yeah and now you
see all the behind the scenes of how
much work goes into just making things
run smoothly and all of that and you
know speaking of behind the scenes when
you're reviewing applications and
conducting interviews
what kind of qualities in a candidate
have you found necessary to be
successful in your resident residency
program so the residency is a long year
and I think the big difference between
residency and going on student rotations
is that many times in a residency you're
going to have projects that don't just
end at week five right you don't have
that final presentation then you move on
to something different and so most most
of the time during the residency you
kind of have these lingering projects
presentations that you're working on
behind the scenes and so being able to
multitask and being able to kind of put
something aside work on something else
for a couple weeks come back to that is
very important and so having individuals
who have been involved throughout their
pharmacy school been able to maintain
good grades maybe even work a part-time
job just shows residency directors and
whoever else is on that committee that
they've had opportunities to multitask
and have been successful in doing that
other things that I would say that we
would look for people who can self
evaluate and reflect there's always
going to be areas that residents are
very strong in and people tend to
gravitate towards their strengths but
really for a residency program we want
people to work on the areas that they're
not so good at the areas that they need
to improve upon so they can build
confidence in those areas yeah so being
able to be honest with yourself to
self-reflect on you know I really need
to spend some more time in the ICU
because I'm not good there ya know I
know it's gonna be a really challenging
five weeks I think for an individual
who's going into residency training
that's a very good trait to have because
it's easy to be comfortable it's hard to
be uncomfortable but you learned so much
more we can make or someone oh yeah and
sometimes it's even hard to kind of
acknowledge okay that's hard for me you
know sometimes you just want to stay
away from Italy versus you know facing
it head-on
so right you know that's an important
thing to just learn as much as you can
so I know that the VA system and
licensure is very different
makes your program unique compared to
other residency programs sure they're so
in the VA system pharmacists have a
scope of practice depending upon the
areas that they're working in their
areas of expertise
so for example my work in the virology
clinic and hepatitis C clinic and so I
can prescribe all the antivirals for HIV
and for hepatitis C whereas some of my
colleagues you know are working like in
the anticoagulation clinic or maybe they
work up in our geriatric clinic and so
they have a different scope of practice
and so from a residency standpoint our
residents are working side by side with
us and able to really learn from
individuals who are practicing at the
top of their game we can prescribe
medications we can prescribe labs we
make appointments really working as a
practitioner and I think that's unique
to the VA system
we don't have collaborative practice
agreements and we are the pharmacists in
charge well that's great so you know you
mentioned obviously the scope of
practice at the firms that pharmacist
has but also the residents get kind of a
good balance between the inpatient
outpatient experiences so what would a
typical day like look for them and I
know that'll be different you know
charting on what time of the residency
year it is but I guess in general you
know what can what does a residents day
look like show so if they are on like an
inpatient experience then every day
there in that inpatient setting rounding
with the team going to meetings giving
maybe like a little in service to the
team and as we mentioned or as I talked
about earlier you know many times
there's longitudinal projects or things
they're involved in so for example once
a month our residents will have a what
we call a pepper program so that's the
teaching program for all the pharmacy
residents in this area at the University
of Iowa College of Pharmacy and so one
day a month they go over for a noon
session just to talk about different
precepting topics we also have like a
project advisory board that meets like
over the noon hour once a month they're
involved in different committees and so
usually I would say every day every
other day there's some sort of noon
meeting or something else that they will
- now if they're in their ambulatory
care kind of block every day for them is
a little bit different and we try to
make their schedule very similar to one
of our schedules so for example my days
are very different on Mondays I do
diabetes education - says I have her
ology Wednesdays I have hepatitis C and
so when we have a resident who's in like
your ambulatory care block then each one
of their days is different they make
them anticoagulation clinic on a Monday
and then they may go to pain clinic on a
Tuesday and primary care on a Wednesday
just so they get the feel of what it's
like to be an ambulatory care clinical
pharmacist that's really nice that you
know you mix it up even day to day that
way they're not kind of stuck in the
same thing day after day right you know
they're always having a new experience
so that's really great so what advice
would you give to a p4 student like
myself who's you know looking at
residency preparing for mid-year where
should their focus be at when they get
to that meeting so if you've never been
to mid-year before it can be extremely
overwhelming meeting mm-hmm so much
information and opportunities there but
in my opinion if you want to get the
most out of it go in with a plan okay if
you have some specific programs or maybe
areas of the country that you're
interested in looking at do some work
beforehand to review those programs
you'll make sure that maybe you have a
question for them every time that you
talk to a program think of it as like a
mini interview first impressions are
important and so you want to always make
sure that you're putting on that
professional face and so programs know
that you're interested there's lots of
opportunities to network at the meeting
so besides the showcase where the
residency programs are on display
there's also opportunities to go to like
different topics and different
discussions there's early breakfast ha's
and late dinners and everything yeah so
it's a good opportunity just to kind of
meet other people from the showcase
standpoint it can be very overwhelming
so I certainly encourage students to
look to see on what day their particular
programs are gonna be there try not to
cram too much in a day and if you feel
that you can't reach a program or you
know something happens and you are
spending too much time with one program
and don't get to everybody
how about could have their contact
information or reach out to them
beforehand or even after the meeting
sending maybe a follow-up email is great
to see you
you know just wanna but you know I'm
really interested in your program what's
really great it's a good you know advice
to get it from your side and from your
perspective because a student's you know
it's so intimidating there's so many
people so many things going on so it's
nice to hear that so as we've kind of
discussed you know you're involved in so
many different aspects of pharmacy at
the VA I mean obviously pharmacies a
enormous portion of your life how do you
separate work and home life so I have
two boys and they are very active in
sports and different school activities
and so my husband and I really enjoy
watching them in the evenings and
attending whatever sport happens to be
in season I'm actually on speaking of
leadership I'm on the board of their
baseball organist the two Sunday schools
so it's nice because honestly I feel as
soon as I leave work I flip the switch
and I become mom and mm-hmm then when I
arrive to work I flip the switch and you
know become firm pharmacist you know it
is very important to try to keep that
work-life balance I think sometimes it's
easy as a young professional especially
if you're coming right out of school and
you're used to studying all the time to
want to take stuff home and do that but
it's important to give time for yourself
you know just so when you do come to
work you're relaxed you're refreshed and
you're ready to go and you know be able
to give 110% sure yeah I think that's
really important you gotta keep work at
work and home at home and that's you
know just the way it has to go so my
last question here is what excites you
most about the future of pharmacy you
know as I was thinking about how far
pharmacy has come since I graduated
pharmacy school I mean there are so many
just new concepts new ideas
pharmacogenomics and what that term
didn't even exist
you know so I think what excites me the
most is just the opportunities that lay
ahead of us you know so much
conversation about provider roles and
you know the fact that I'm fortunate to
work in a healthcare system that allows
pharmacists to practice at the top of
their license you know in the in the
years to come
I really foresee a lot more pharmacy
driven clinics Pharmacy driven
opportunities you know hospitals really
wanting pharmacists to manage you know
all the medications and we're starting
to see that with antimicrobial
stewardship and having pharmacist
involved in making sure we're not over
using drugs and pharmacopoeia pharmacal
economic side and making sure that when
we do prescribe something that there is
a reason for it and it's not just
something that stays on the medication
list indefinitely you know so I just as
far as he has come so far in in the last
15 20 years and I'm excited to see where
it goes from here yeah it is super
exciting and obviously you know I'm
getting ready to graduate you know here
in the last hundred years so yeah
there's a lot out there I know I've
asked you a number of questions is there
anything else that you would like to
talk about that we haven't already
discussed you know I just think that the
future is bright for pharmacy I think
there's a lot of opportunities you know
obviously as the residency director I
think anyone who's interested in
postgraduate training you'll never
regret that decision just because you
complete residency training doesn't mean
you have to go on and do a PG y2 or you
have to go on and do research you know I
think any time that you can advance your
training it just makes you overall a
better pharmacist a better clinician no
matter what practice setting that you're
in I think your network will grow
tremendously if you find if you are
willing to get involved in organizations
and if all of them it doesn't always
have to be a big time leadership
position you know involvement can be
going to an annual meeting attending
different committees those types of
things it doesn't have to be
be president or vice president because
depending upon where you're at in your
life that just may not be and a
possibility and that's not okay
some of the best advice I had from one
of my mentors very early was I think
there's a tendency to want to be
involved in everything yeah and the
problem is is that yes you can pay your
dues but you can't dedicate your time to
everything and so instead of doing that
pick one or two organizations that you
feel passionate about and get involved
in them you know so it's not just paying
your annual dues but be involved give
back to that organization and I've
really taken that to heart and so like I
said my involvement specifically with
Iowa pharmacy Association is something
that you know I feel that they've given
a lot to me over the years and that now
it's my turn to make sure I get back to
them great well I thank you so much and
for all of your wonderful insight and
for joining me on the pharmacy leaders
podcast thank you
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