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Pharmacy Residency Podcast

Dec 25, 2017

Dr. Anna Shields is now a Clinical Pharmacist in Seattle, Washington working for Kaiser who completed her PGY-1 at Kelley-Ross Pharmacy Group One of the reasons she chose her site was the progressive nature of the state that now offers provider status for pharmacists. 

She was an entrepreneurial pharmacy intern at NuCara Pharmacy in Pleasant Hill, Iowa as part of Drake College of Pharmacy and Health Sciences Delta RX. She also worked with me as a curricular development assistant for the pharmacy technician program at Des Moines Area Community College.

Originally growing up in Menasha, Wisconsin, she graduated in May, 2016 PharmD and MBA dual degree from Drake University in Des Moines, Iowa. As a student, Anna served as president of Drake’s National Community Pharmacists Association Student Chapter and was an active member of Phi Delta Chi Professional Pharmacy Fraternity.

LinkedIn - Anna Shields, PharmD, MBA 

Twitter @annashields4

Ep_13._Residency_Outside_the_Match_Clinical_Pharmacist_Anna_Shields_PharmD_MBA Drake_University

Welcome to the Pharmacy Leader's Podcast with your host Tony Guerra. The Pharmacy Leader's 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.

Ok, Merry Christmas or happy holidays whichever it is for you. I'm really excited that the Pharmacy Leader's Podcast has kind of taken off pretty well right where we left off from the Pharmacy Future Leaders. So for today we're going to talk a little bit about residencies outside the match. I know, many of you are getting your residency applications perfect, cover letters and letters of intent perfect and everything submitted and then there's going to be a long waiting period but I just got in touch with Anna Shield and she gave me a little bit of advice in terms of what's going on outside the match because she actually did a PGY-1 outside the match and I think there's a misunderstanding that going outside the match is something that you do after you have not gotten something in the match. But she actually did both and picked what was outside the match over those choices that she would've had in there but she talks about how there is some very, a lot of fellowships out there with really flexible application processes and then there's some really interesting pharmacy jobs you can get as a new grad whether you're doing MTM for a chain or working for an MTM entity. There's lots of clinics in manage care systems, have refilled [indecipherable 00:01:48] pharmacists to facilitate for providers so there's plenty of other options out there for you as you're kind of trying to figure out what you're going to do because when we talk to Brandon Dyson in probably with that second week of January, we're going to talk about again, interviews for the match residencies or jobs and things like that and doing the math, really only about 53% of the whole number of people that are going into the, that have put their money down to be in the match end up with something in that way 47% are going to do something else. So we want to make sure we address that 47%, that's a huge number. So anyway here is rewind of Anna Shields who at the time was a PGY-1 pharmacy resident and she had some excellent advice on what you can do outside the match.

This is Anna Shield, PharmD, MBA and community pharmacy resident at Kelly Ross Pharmacy Group. And you're listening to the Pharmacy Podcast.

Anna Shield's come to Kelly Ross Pharmacy Group from NuCara Pharmacy in Pleasant Hill, Iowa where she served an entrepreneurial, as an entrepreneurial pharmacy intern as part of Drake College of Pharmacy and Health Sciences Delta RX. Additionally she served as a curricular development assistant for the Pharmacy Technician Program at Des Moines Area Community College right here. Anna grew up in [indecipherable 00:03:29], Wisconsin and graduated in May 2016 with her Doctor of Pharmacy Degree along with her Masters Business Administration from Drake University in Des Moines, Iowa. As a student and as served as president of Drake's National Community Pharmacist Association Student Chapter, NCPA and was an active member of the Phi Delta Chi Professional Pharmacy Fraternity. Welcome to the Pharmacy Podcast.

Oh, thank you for having me here today.

Anna, we're so excited to have you back, it's so often that we just lose somebody after they leave or they graduate and you were here and for six years in Des Moines. Now you're in Washington State so, so excited to have you. And I just want to get right to it. So everyone's leadership road is different, let's start where you are today and how you got in to your current position. Fill in some of the gaps, maybe from that introduction.

Yeah, so currently I am the Community Pharmacy Resident with Kelly Ross Pharmacy Group. As you mentioned I'm here in Seattle, Washington. So throughout pharmacy school, you know, I kind of rejected the idea of completing the residency, I thought that six years was enough of training. But when I really listened to what a year of residency could expose me to. I really started to reconsider, so, my interest has, you know, consistently been in clinical community pharmacy and I wanted a job where I could pair my passion for patient care along with my interest in business. And I truly believe that I found a place that shares those same passions and interests in Kelly Ross because I believe that community pharmacy can really be as clinical as you want to make it. And a community residency has been the ideal place for me to begin growing as a clinical community pharmacist.

No, I have to agree with you there. Well I teach at a community college. Mindy, my wife as you know did a clinical community pharmacy residency with the Iowa and she's working at the VA and she's doing a lot of clinical work there. So the community pharmacy residency I really really back it, I really really think it's a fantastic thing. Well the Pharmacy Future Leaders segment is giving away a free student registration to support a future student leader to go to ASHP med-year but tell us how you fit the aspects of choosing applying and visiting potential residency sites during that really busy APPE fourth year.

Yeah, it's definitely an overwhelming busy time as you said and it's a really big decision process that you're having to go through and it feels like it's happening really really early but it does, you do have to make your decision because the graduation does come up faster than you think. So when beginning new residency search process myself I use the ASHP website to explore residencies nationwide. I mean I lived in the mid-west my entire life, I went to school in the mid-west and I really thought residency is an opportunity to really push my boundaries. I also wanted to open myself up to the wider variety of possibilities at different communities, cities, states and regions have to offer and ultimately state legislation was a big factor in swaying my final decision especially to come to Washington.

Ok, and we'll talk about that a little bit later, provider status coming in January and we'll certainly want to have you back on after you've had that happen, after you've had those things, have that happen to you but after that comes through and we'll see how that changes practice out there in Washington State.

Yeah I also attended NCPA annual meeting last June-October which exposed me to a number of community pharmacy residency programs and being there was really the first time that I have been exposed to community residency as an option but so from there I kind of created a spread sheet on excel to compare the different locations, the demographics, opportunities, expectations, benefits, whether or not there were teaching opportunities and what clinical services were offered at each site. This really helps me keep the program straight and also the Kelly Ross program isn’t accredited to the ASHP match but that didn’t really turn me away. Because I was really looking for residency program that match my wants, my needs and would really push me to grow the most as a business minded clinical community pharmacist.

That's awesome and it sounds like you got your first choice.

Yes, I did.

That's awesome. Alright, so, well, why don’t you discuss a little bit how you first felt when you became a leader at Drake University and how did the opportunities you had there helped you? I think we first talked about NCPA and find out the kind of summer internship, Tyler Dalton who was just Dalton talked about how really his road started in his P-1 year and I think a lot of people are waiting to graduate and then see what's out there and it sounds like you started very early P-1 P-2 year or maybe even before that.

Yeah the awesome thing about Drake University is that the six year program which really encourages freshmen staffs that really wants to become involved in pharmacy as a profession before even entering the professional program. So for me I'm not sure exactly when I became a leader at Drake, joining Phi Delta Chi as a freshman I had the opportunity to really start taking non-leadership positions really as you mentioned. So I first served on smaller committees but from there, my evolvement kind of blossomed into a more significant cultural position leading a philanthropy even for Saint Jude Children's Hospital. But once I was in the professional program I was also working towards my MBA and I found out that there was a pharmacy organization, NCPA that would also expose me to the business side of pharmacy practice. And this really really excited me, even though [indecipherable 00:09:42] was relatively small at that time. So I was actually the only active participant from my class that year but when I heard that we could work on a business plan, my interest was really peaked and so I really took advantage of having that opportunity to get my impression from older students too. So on along with that you mentioned my entrepreneurial leadership in friendship with NuCara at the beginning. These internships were advertised to all students and I really wanted to work for one of these companies specifically but the internship actually went to someone else. So I was really disappointed but I was so determined that I applied to the organization separately just to work as an intern throughout the school year. And so I actually was hired and then approached by the pharmacist who managed to close HIV pharmacy just specifically because entrepreneurial intern that summer. So I would almost call it like a mini residency because I had the chance to work on implementing some new processes, still working very closely with patients and then really diving into the financial intricacies of independent pharmacy ownership and so, from here I felt much more prepared to take on what you would call a formal leadership position and I've been president of NCPA as well at Drake and from there we really build up the tractors as there was only myself and two other students at that time and I really feel that we tried to integrate ourselves with the independent community pharmacist in Iowa and get other students excited about the business of pharmacy. So that's a long answer to your very short question but I would say that, you know, my story of leadership is cumulative and that each opportunity that was presented to me was, it came to me due to my fearlessness to challenge myself throughout the course of pharmacy school and so I would really encourage current students to do that at themselves as well.

I really envy your path and I'm just really so proud of what you've done. And the more I talk to students the more I find the activities they do outside of the regular classroom or the ones that are leading them to the most satisfying opportunities and I don’t mean to in anyway say what's going on in the classroom is unimportant rather, I just feel like you're a magnet for awards and opportunities and you won an award in your P-4 year. Am I allowed to say how much it was?

I don’t know.

Ok, so I think it was 25000 dollars.


And I think the people that are listening are like, I would like an award like that in my P-4 year when you have to pay for three semesters instead of two. What was it that you think made you, I want to say eligible for the award but you mentioned the leadership activities that you've done but how does somebody go about getting a giant award like that.

Yeah, so, my student experiences at the college level certainly helped me with the national achievements that I've been presented with. The word you're talking about, I am a cardinal health scholar and in addition to that I was awarded several other scholarships as well based on my campus involvement community service and my interesting community pharmacy specifically in the independence fear. And to kind of answer your question I think that it's answered best by one of my favorite quotes that people don’t buy what you do they buy why you do it and I think that my passions really shine through when I'm applying my skills to something that I love. And so one of my awards included actually a trip to Live Oak Bank's Pharmacy Student Program in Wellington, North Carolina where myself and three other students spent a week learning about pharmacy financing, the realities of pharmacy ownership and what considerations wonders are making. And this is something that I would highly encourage pharmacy students to look into because I know that it's something that definitely stood out to those who were reviewing my resume or speaking to me in an interview. Because it was an experience that very few other students had had and so, you know, another award that I had won sponsored my trip to the NCPA annual meeting last year and that's ultimately where I found the Kelly Ross residency program. So I think that it's everything that I'll kind of add it together but I think that it goes back to my favorite quote.

That is a great answer and I actually was listening to the Pharmacy Podcast in Ireland and heard Todd's interview with the Live Oak Bank guys and that was just, it was really great to understand that somebody doesn’t have to be necessarily that wealthy coming out of pharmacy school that their wage, that they can leverage money into becoming an owner so if it really is their dream to become an owner. It might be closer than they think. So that brings us now to where you are, what activities are you doing at Kelly Ross pharmacy group? You mentioned some exciting work keeping patients with cardio-conditions out of the hospital, what are you doing up there?

Yeah, so at the residence in Kelly Ross I have my hands in pretty much everything that's going on where I get to hear about all the other exciting projects that are happening around me. And that's kind of one of the things that sit outs to me most at this program is that I have the chance to develop my skills in all areas of the company throughout the course of a year. As compared to some residency programs who operate on more of a rotational basis, kind of like, another year of rotations.

Oh, alright.

Yeah I wanted to be able to develop my skills, you know, for the course of the year instead of for a five weeks of the time again.

Yeah I understand, I understand.

So one of the, my favorite things that I get to do is, in-home medication coaching and so we provide, we visit with patients in their homes and to provide medication management services. So at a patient visit we learn more about their goals, their conditions, how they are interacting with all of their medications on a daily basis and so we're performing medication reconciliation especially for a transition of care patients. So that we can compare what the patient is doing to what their providers think they're doing. And this is kind of where cardio vascular patient population comes in. We are specifically working on a pilot project for patients with CHF or heart failure so we're also kind of doing these appointments. We're performing clinical assessments and using rating skills to determine how well patients are responding to treatments and then we also live in their providers so they can follow up with the patient as well. And so if you are in home services we have multiple different referral sources more than just transitions of care. And there's also a few different reimbursement models kind of in place. So I say this is a pretty large part of my residency but I also have a research project that I'm working on. It's kind of tied into the home visit service but specifically looking at servicing elderly residence in affordable housing buildings and so I'm going to begin our data analysis soon. I just turned in my abstract last week so the things are moving along quickly in residency. So as a resident too I'm also working with students I precept fourth year rotation students from a number of universities and they really challenge me to stay up to date and create a meaningful learning environment for sure. Also in addition to teaching students on site I'll be doing [indecipherable 00:18:07] so through the university of Washington I will be developing my teaching style in the classroom in our pharmacy skills lab course so I have a mentor there as well. So I would say lastly just to kind of sum up what I do I also staff as a pharmacist as well in our retail location and our compound in pharmacy so I'm really kind of pulled into a lot of different environments. Our retail location is located inside of a building of clinic and so we're doing a lot of new patient councils for the majority of the day. So through staffing I feel like, you know, it's a role as a pharmacist to be taking prescriptions and providing patient counseling and in sometimes undervalued or viewed as a routine but I have a whole new appreciation in having transitioned from a student to a pharmacist in that, it really does take a lot to maintain your focus and make those clinical decisions while there's so much happening around you but I really enjoy the challenge of being in such a fast paced environment and I really do feel privileged to work alongside the pharmacist and the technicians at Kelly Ross every day. But I would also add to this but these are just a few of the things that I'm working on at the resident and that's a fun part about my position. As a resident I do pretty much get pulled into kind of any exciting pain that comes along, so.

You know, that's awesome that you have that [indecipherable 00:19:41] that goes along with what's set out for you but it sounds like, it sounds like you're almost doing the work of two residents, that is awesome. Washington State's gearing up in January for provider status. Can you tell us what Kelly Ross is doing to move forward with that opportunity?

Yeah, with pharmacist recognized as health care providers in the state of Washington mandated through commercial pairs so it's not Medicare or medicate quite yet. So community pharmacist will finally be able to bill for patient care services in so further time. It sounds really easy when you say it but it's definitely more.


Complicated than that.


More complicated than I had expected before getting here. I feel so lucky that I'm here for my residency during such a major transition time, I think it's going to make my experience that much more valuable and so kind of throughout our conversation I've mentioned a few of the things that Kelly Ross offers for clinical services but there is so much more going on. So in addition to the in home services we also have an HIV pre-exposure profile access program which is known as our one step prep program.


And so we also have a travel vaccine clinic that's pretty well embedded to organizations within our community. And then we're also in the pilot phase of providing spirometry testing and then evaluation for patients and providers in the community pharmacy. So as we transition into the New Year our focus is really on streamlining our processes for a successful reimbursement from those commercial insurance providers so that we can create more access for patients. A lot of what we're doing right now is on a cash basis or through some sort of a grant or contracted kind of reimbursement plans. So that does limit who's eligible for some of our services and I think that, you know, the transition to providers status is more complicated than we expected through coding and the limitations that are put on how your notes have to be structured. So these are all things that providers, doctors, nurses they've all been doing for so long but applying them to the community pharmacy environment is going to be, I think a challenge. But since being here, the Washington State Pharmacy Association has been supporting pharmacies and pharmacist kind of through this. In August I attended a medical billing workshop put on by the association and it was extremely informative. It really brought to light a lot of considerations that we need to be making having clinical charting and all sorts of things that we've never had to before. And [indecipherable 00:22:55] is also planning to have some online training courses and be there to support community pharmacist through this transition period.

No, that's awesome. Here in Iowa, you know, we have this great pharmacy association as well and we bring the mid-west together with a number of pharmacy associations in the spring or late winter so that's fantastic that they're not behind you and that they can support you in that way. My wife completed her community pharmacy resident at Iowa and landed at very clinically focused job with a VA hospital. But I think many of the listeners are familiar with the residency match but there's some good residencies, great residencies it seems outside the match including the community residencies. Can you explain how you chose which residencies to apply to in and outside of the match and that's kind of a little bit confusing so maybe you can clarify it for people that are thinking, ok, well I got these outside these inside, how do you keep it all straight?

Yeah when it comes to applying for residencies I really did a lot of research online, most programs have a ton of information available. I also asked a lot of my mentors and my preceptors for guidance but, you know, they know who to kind of refer you to and they kind of know who's big in the biz if you will.


They will be able to kind of guide you to programs who they know might be more well known for having a strong program but don’t really let that limit you from anything either. I also, you know, I spent a lot of time reflecting on what was truly important to me to make that decision. So, for some of you that might be the location, you might really want to have teaching opportunities or you might really be into research. You might really, it might be really important to you to have a co-resident, that's something I don’t have. And so for me, my goal was really to find an independent community pharmacy that would really challenge me and value my business background. You know, I wanted that entrepreneurial environment and so, you really need to figure out what it is that you want out of an experience and what you can bring to that experience as well because they don’t call it the match for nothing.

Ok, that makes a lot of sense. We we're coming to Iowa and I was pretty insistent that we be near the mother ship near Iowa city, I wanted that environment and that was something that I really wanted when we were thinking about it but it's very very individualized, it sounds like.

And so in regards to other programs that operate outside the match, I would encourage listeners to ask professors, mentors, leaders at their state associations because those are the key people who may know if there's a post grad residency or fellowship that is just getting started. I know that in addition to Kelly Ross there was another program that I had applied to. It was our first year initiating the program and so those opportunities are a little bit harder to find and they're usually shared by word of mouth so, asking around is essential.

That's awesome. What blanket advice do you have for residency hopefuls as they descend on. Well, first, New Orleans here in October, right? CPA and then Vegas for ASHP December 4th to 8th, what advice do you have?

Yeah, so I didn’t attend med-year but I do have some general tips and tricks.


Number one, wear comfortable shoes, convention shutters are usually huge and you'll probably be standing and walking around for a good portion of the day. So not your best time for brand new or fashionable footwear, I also say to bring snacks, this is one of the things that I heard about med-year specifically and that there are so many students in attendance that lines to speak with specific programs are actually shortest when most of the people break for lunch.

Oh that's a good one.

Yeah, so to take advantage of that moment when most people are trying to get lunch and you will also avoid the lines at lunch because everybody's trying to get their lunch.

Sounds good.

Last, oh, I have one more.

Oh, ok.

Handout personalized business cards and I'm not talking about the ones that are like, branded by your university. For me those are confusing because it's like, are you a university employee, do you work there?

Oh, yeah.

But I think that having a business card that you designed, it should be an extension of your personal brand. So it should be something individualized and when I did this, every single person, I'm like pretty sure, every single person who I followed up with, whom I had given my business card to. They're really like, you're the one with those business cards, so.

Oh, that's awesome.

Yeah, if you do it right, it can be a topic of discussion and can make you pretty memorable, so.

That's awesome, well, where can people find you?

Yeah, so I'm on Linkedin and twitter and also I publish a paper with you, Tony.


And the Iowa pharmacist.

Your first offer.


I'm really forth off.

No, that means you were the supervisory researcher.

That means you did all the work.

Oh then that's in the IPA journal.


Iowa Pharmacy Association journal.

Ok and then people can follow you on @annashieldsfor I think as you are a twitter handle freak.

Yes, yes.

Alright and then just a maybe three quick questions, speed round type questions. What is your best daily ritual to keep your work on track?

I have to eat lunch, like, I have to.


It's on my calendar.

Alright that is awesome. I think too many people work through lunch and that's why they're fading at the end of the day.


Best career advice you've ever received.

I've mentioned it a couple of times but to never undermine the importance of self reflection, there's something to learn from every situation, good bad or ugly.

That's great and what inspires you?

Seeing people I care about succeed.

That's fantastic. Well Anna thanks so much for being on the Pharmacy Podcast.

Thank you for having me.

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