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Pharmacy Residency Podcast: Residency Interviews and Advice

Sep 1, 2020

I wanted to talk a little bit about public health and getting that second degree. I think people misinterpret that second degree is just a number of classes that kind of overlap and just kind of an additional credential, but I've got Rachel Whitesitt on who was a P4 at the University of Iowa and she's actually using it as an expansion of whom she can help and to what level she can help them. So first, Rachel, welcome to the pharmacy residency podcast.

Thank you, Tony. I'm really excited to talk a bit more about pharmacy's role in public health.

Let's first start with what is pharmacy's role in public health? I know that we're a little bit hidden in what we do, whether it's adjudication or getting prior authorizations done. All the patient sees is that they're waiting, but what is it that made you decide to complete this PharmD/MPH program?

I decided to do the MPH program for a couple of different reasons. I'm really interested in doing more than just patient care. I love direct patient care but getting to organize things where we can touch more patients. So whether that's community initiatives or different clinical initiatives, such as doing the flu shot clinics or working on different CPAs or trying to push policy, getting pharmacists to be more engaged in chronic care management. I thought doing the MPH would help me get a little bit more background in that and it also really opened my eyes up to a lot of different opportunities at the work of pharmacists in public health.

Now I have a friend who did the Hopkins MPH. He spent an extra $80,000 on that. It just is a dagger to begin with that, but he also spent another two years on it. Did you have to go to any more school?

I did not. At the University of Iowa its a dual degree, so some of the pharmacy classes count for MPH and then our MPH courses count for our pharmacy electives. So it wasn't any more years, I did have to take some summer classes, but I got it all done in the four years.

Awesome. Well, tell me a little bit about how someone that has an MPH understands chronic diseases a little bit differently. I know there are some real buzz words when it comes to public health, the transtheoretical model of change, the health belief model, the social ecological model, and it's kind of like going into a new language. So could you tell us, first of all, a little bit about how you look at chronic diseases, maybe a little bit different and then the solutions for them maybe a little bit differently.

So really in one of the main things I've learned in public health is a lot of times why people are doing what they're doing and making the health choices that they are. And then how can we understand that and utilize that in our communication, in our marketing of these different things and especially with the transtheoretical model of health. So we do learn a little bit about that in pharmacy school, that's where our patient, we talk about that, especially with smoking cessation. They're maybe pre-contemplation, they haven't really thought about smoking cessation or if they're more in the preparation stage, that's where we can help them: Here are the different products for smoking cessation. So understanding that and kind of using those models to target how we're going to talk to patients and specifically, what will we talk to them about.

And then also including the health belief model, which includes now, what do patients think that their perceived susceptibility is, or the perceived seriousness of this disease? And I've seen that a lot with COVID. A lot of people just have a very low perceived susceptibility, or I'm probably not going to get it, or especially with the seriousness of the disease. Oh, I might get it, but I'll be fine. And really targeting those messages. That's something pharmacists can use when they're talking to their own patients using these type of theories and models to help their patients move to the health behavior that we think will be most beneficial for them.

And what about the social ecological model? That's a lot of Oles.

Yeah. So it is talks about the different levels that we can make change on. Individual pharmacists are working a lot more on the interpersonal, so helping the person at interpersonal levels but then we can really move if we really get organized, especially in our state pharmacy associations and national pharmacy associations, we can start to make change more in the community and then the policy level as well. So just understanding those different levels that we can make change.

Okay. And in these classes that you've been teaching with me, you've been teaching some pre-med students, pre-pharmacy, pre-nursing students, just a very diverse group. And one of the things that they say about you is that you're just very easygoing, approachable, and what you're really doing is becoming a model for what they think of a pharmacist. So the pharmacist that they're used to is hairy busy behind the counter, unavailable where you're the opposite. And so now they're seeing someone whom they can talk to and who also shows a significant level of understanding, and that you're teaching their course or part of teaching their course. Tell me a little bit about how interprofessionalism fits into an MPH, because I would expect that it's not just it pharmacy people in that program.

Yeah. In my program alone, we had multiple of my pharmacy classmates were also in it. We also had some medical students. We had one girl in my class had been a dietician previously, so everybody really brought a lot of different background, which was really nice to see. But then going more towards the future, it's really what we're moving towards in public health is what they call public health 3.0, where it's, we are using all these systems and seeing how they work together so we can work forward on like public health goals. So that's for us in pharmacy, collaborating with doctor's offices to work together and get more CPAs so there's a lot of room for interprofessionalism in public health.

So explain to me how you really, when you're talking about building those kinds of relationships, great, you're in the same class together, but explain what a practicum is. Cause I know what an APPE is, an introductory practice rotation in an APPE, which is an advanced practice rotation. And then what an internship is where you become an intern as you're working at a pharmacy and so forth, but what is a practicum? It has something to do with practical experience, but what exactly is that?

For every MPH around the country, it's part of the credentialing program, kind of the last final course that most people take is called the practicum. And it's very similar to an internship. It's 200 hours of work where you partner with an organization to create something. So whether it be a program or a type of handout or a toolkit and something that benefits the organization and also something that you're very interested in. I just completed mine with SafeNet RX. They're an organization in Iowa that provides medications to uninsured and underinsured Iowans. We worked with the Iowa Pharmacy Association and helped to create a pharmacy volunteer network through Iowa where pharmacists that wanted to get more involved in their community could go through this network to find more opportunities. And that would increase the capacity that these organizations could do so SafeNetRx can get more medications out to the under insured and uninsured Iowans.

Yeah. And it's funny, we're talking about, you know, exposing the world to pharmacists, but that's probably one of the most hidden places and they do that intentionally. They don't want to say, Hey, here's where the drugs are, but it's just kind of funny. I've been to that building. I've been on a tour of it and it's amazing what they do. But it's kind of hidden back there. So I guess someone wouldn't just kind of stumble across this, how does someone get involved in these kinds of organizations? You went through a formal master's degree. But how are you getting involved in public health before you even graduate?

Yeah, so definitely with my practicum has been really great and just in other opportunities there are so many ways to get involved. Maybe you don't think of it as being public health, but one of the main partners that we partnered with my practicum was the Free Clinics of Iowa. I had volunteered at the Iowa City free clinic for about a year, which was really interesting to see, not having to do all the insurance things and really filling in that need in our community was really important. But really if you, especially for students, if an organization that would need volunteers, if you're interested in volunteering, reach out to them and do that. Or, and I've gone to SafeNetRx before with some of the pharmacy fraternities, we went over for a morning one weekend and helped volunteer there. Um, that just kind of opened my eyes to what SafeNetRx could do. And that's one of the reasons I reached out to them to do my practicum.

Now, when we talk about the requirements for a residency, we're looking to do service to show that we help the community and then also do research. But sometimes that service is just kind of a one and done. And in this case, I feel like you were able to combine service and research in a very meaningful way where you could see maybe to some extent what the outcomes are. How did this degree, how did this practicum work to kind of further your service and research?

Yeah, definitely. Especially with research, I did some research at the beginning, just some basic epidemiological insurance research on how many people in Iowa are uninsured and how many are underinsured to figure out kind of what our whole population was. And then also doing this project has been a research project. So that shows that when I hopefully get into a residency, I will be able to do this project relatively independently, since I've already had this previous experience doing this. And then for service, it wasn't necessarily the volunteering that you normally think of, but I was working with this organization closely, a little bit more for a community service, and then working with Iowa Pharmacy Association, as well as a little bit more of a professional service, and really helping the pharmacy community and filling in a need that we saw in the pharmacy community.

Okay. So we've talked about the degree, we've talked a bit about the practical experience that you need and how valuable it is. Tell me a little bit about how you see pharmacy's role and then how you kind of expand from individual to state to maybe even nationwide.

I really think that everything that pharmacists do and, pharmacies, the bigger organization are really an integral part to public health. Now, whether we think about or not. So really everything that pharmacists do on a day to day basis, especially administering immunizations, is a huge part of public health. And we are very important part to getting those hours. And doctor's offices may not be in every County and 95% of people live within five miles of a pharmacy now being able to administer immunizations is especially crucial. And hopefully we'll see that a little bit more with the amendment that HHS just put out, allowing pharmacists to give childhood immunizations that will also be very important, as well as managing chronic diseases.

So right now, a lot of pharmacists are dispensing these drugs for hypertension or diabetes. But a lot of pharmacies are moving towards helping the doctors manage these chronic diseases. So monitoring people's blood pressure and their A1C, and then really educating these patients also on what their chronic diseases are and how they can get that better under control, and why we want to get them under control as well. So it's even just a couple of things that individual pharmacists can do. I think a little bit more on the, even getting to the state and regional level, pharmacy is a really important for filling any gaps in care, which are especially in a rural States, such as Iowa. And I mentioned that there's not doctor's offices everywhere. Down at Indianola, we are really the most Southern place in our county that has a pharmacy or a doctor's office. And so a bunch of people in the County are always coming to Indianola for all their stuff. So it's important that we are able to give immunizations and do all these things for our patients. And then there's also a big role for pharmacists in communities to serve in public health departments and on boards of health, there are a lot of pharmacists that do that. And that's something that I would definitely be interested in doing in the future

When you were talking about nationwide, how we can really get into some of the organizations that are in the news every day, the CDC, the FDA, and so forth. What are some maybe positions that would be possible for an MPH in those?

Pharmacists with an MPH can work in these organizations. There are especially APPE rotations for pharmacy students at the CDC and FDA. One of my classmates in the year above me did a rotation at the CDC and is now working at the CDC as a pharmacist, which I think is really interesting. So working in one of those bigger health organizations within the government, but also helping talk to our legislators to getting pharmacists written into legislation and different policies, allowing us to be able to give these immunizations and then also just get paid for our services. So getting paid for educating patients and taking blood pressures and all this stuff that helps us monitor chronic diseases. It's important that we work closely with the legislature and then the different national organizations to pass this legislation and these policies.

I guess the last question I would ask is, so someone is interested in public health. Do you need the degree or what was it that their degree really did in terms of advancing not only your abilities, but maybe some of the doors that are going to open? What was the most valuable part of getting the degree that you feel?

Yeah for me, I think it really helped me open my eyes to what was out there, especially learning the basis of public health, all these models that we had just talked about. And then also getting to meet other people that are out there doing wonderful things in public health, whether they be pharmacists or non-pharmacists, we all play a role. But that's originally why I started it. I think having this extra MPH, does look good, you know, on the CV but it also shows people that are looking at it that I'm interested in doing a little bit more broader stuff especially in public health.

Awesome. Well, Rachel, thanks so much for being on the pharmacy residency podcast.

Thank you for having me.