Ep 15. Residency and BCPS Advice with the Persistent Pharmacist Brian K Fung PharmD

Dec 29, 2017

Brian K. Fung, PharmD, BCPS is a Medication Management Informaticist at an academic medical center in Rochester, MN and a Clinical Assistant Professor at the University of Florida, College of Pharmacy. He received his B.S. in Human Nutrition and PharmD from the University of Florida and is currently pursuing his MPH from the Johns Hopkins Bloomberg School of Public Health. He completed a PGY-1 in Pharmacy Practice at Sarasota Memorial Hospital and a PGY-2 in Pharmacy Informatics at the University of Utah Health Care. Brian is board certified in pharmacotherapy and has also received additional training in Antimicrobial Stewardship through MAD-ID.

https://www.youtube.com/channel/UCvniQtnTLVv2nJQZHC7Sh6A

Full Transcript:

Audio:   Audio: 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.

Brian:    Hey everyone, my name is Brian Fung. I'm an informatics pharmacist, and you're listening to the Pharmacy Leaders Podcast.

Tony:     Hey, welcome to the Pharmacy Leaders Podcast. I want to throw a shout-out to Kevin Yi, who introduced me to Brian Fung, who is an all-around great guy and an informaticist. We're going to talk in a separate podcast episode about that, but in this podcast episode we're going to talk a little bit about his YouTube channel and the value that you can get out of just some of the videos that he has, whether it's deciding whether you want to become a resident, what to do if you don't match, and how to study for the BCPS. If you're clinically-minded or you've got a clinically-minded future, Brian Fung's YouTube channel has a ton of valuable content. I recommend that you go over there after you listen to the podcast. I'll definitely have some links in the show notes. Here we go with interview with Brian Fung, informaticist.

Brian K. Fung, PharmD, BCPS, is a medication management informaticist at an academic medical center in Rochester, Minnesota, and a clinical assistant professor at the University of Florida College of Pharmacy. He received his Bachelor of Science in Human Nutrition and PharmD from the University of Florida. He is currently pursuing his MPH from the Johns Hopkins Bloomberg School of Public Health. He completed a PGY1 pharmacy practice at [inaudible 00:01:46] Memorial Hospital and a PGY2 in pharmacy informatics at the University of Utah Healthcare. Brian is board certified in pharmacotherapy and also received additional training in antimicrobial stewardship through MADID. Welcome to the Pharmacy Leaders Podcast.

Brian:    Thanks, Tony. Thanks for having me.

Tony:     Okay, well, we always start with the same question, just to kind of get a little bit of background. Everyone's leadership road is a little bit different. Tell us a little bit about your leadership road and how you got to where you are.

Brian:    All right, well, it's been a long journey. Well, I think ... Where can we start? I think we can start where, I had a lot of interest as a kid growing up in the engineering world. I loved computers. I loved games, and growing up, I did everything kind of techie. I worked on computers. I did computer programming. I thought I was going to be a computer engineer when I was growing up. Then I think what had shifted my next career path or direct trajectory, I guess, would be my grandma. She came down with ovarian cancer when I was in undergrad, and that kind of shifted my mentality and gravitated me towards pharmacy. Mainly because I cannot see blood, but no one in my family was really in the healthcare sector and I wanted to do something to understand the complexity of medicine, to figure out what was going on and to help someone that I really cared about.

I looked into pharmacy, got into there. Got into pharmacy school. Studied real hard. Enjoyed it. Did a residency, PGY1, and pharmacy practice. Then was deciding between infectious disease or informatics, and because of my previous interests in computer engineering, computer programming, decided to go with a PGY2 in pharmacy informatics. Afterwards, I got hired to work on a awesome project that was an epic implementation. We're implementing, bringing new [inaudible 00:04:08] across 24 different hospitals and it's a fantastic experience. That's kind of my story in a very small nutshell.

Tony:     Very cool, very cool. Just for everyone, we went to the same undergrad just a couple years apart.

Brian:    Yes! Go [crosstalk 00:04:26].

Tony:     Yeah, go Gators. But tell me a little bit about the undergraduate experience. What made you choose Florida? There are a couple other schools in the state. What made you stay in Gainesville? Were you close by or was there something about the program that made you want to go to UF and hang around in Gainesville?

Brian:    Okay. I guess you're asking more so from why I went for undergrad, or for pharmacy school?

Tony:     Why'd you go to pharmacy school after Florida? Because some people like to say, okay, well, I went to Gainesville for undergrad. Maybe I'll go down to Miami or maybe I'll go out of state.

Brian:    I got you.

Tony:     What made you stay in state and stay at Florida?

Brian:    Great question. I think that there was a couple reasons. I was hoping you were going to ask me in undergrad, because it was for the girls. But for pharmacy school, I actually applied to pharmacy school in my third year, and I only applied to UF. I got rejected. I guess going back to the original question though, why I applied to UF is because it was one of the cheaper programs. It's a well-known program. It was ranked number nine at the time, and it was the only ranked program in Florida. I really wanted to stay. It was a great program. I knew the people. I knew the friends. I was there for four years. Close to family. There was a lot of good reasons. I did apply to a lot of out-of-state schools as well, but I don't think at that time I was ... How old was I? Like 21, or something like that, and I wasn't mature enough to really be a go-getter and apply to the number one or number two ranked schools. I was happy. It was the number nine ranked school. It was a great program, so I just stuck around. No real good, good, reason I guess, per se.

Tony:     Okay, well, I was 18 when I applied to Florida. It was a fifteen-dollar application and I went down there. Because of my SATs and GPA and all that, they gave me an out-of-state tuition waiver. But they only gave it to me for two years, so I had to go back to Maryland.

Brian:    Oh, okay.

Tony:     To talk about how good Florida is, just like the whole experience, I had a fraternity brother who applied to Yale Law and Florida Law. Got into both. He had a perfect LSAT score. He turned down Yale to go to Florida.

Brian:    Wow.

Tony:     Because he was like, "Why would I leave? This is fantastic," so, you know, Florida. It's also got one of the better online programs. Florida, I know, is pioneering with helping people finish with their PharmD, so a lot of reasons to go to Florida, for sure. I'm not just saying that because it's one of my alma maters. Yeah, I definitely miss it. Well, take us now to pharmacy school. You're in pharmacy school. Let's say you're around a P3, P4, somewhere in there. There's, I don't want to say pressure, from the faculty, but the faculty have gone and done residency so you hear about residency all the time, top of the license, those kinds of things. What solidified residency for you?

Brian:    That's a fantastic question. I went into pharmacy school knowing very well, I didn't know about residency, first off. I went into pharmacy school thinking I was going to come out as a pharmacist working at CVS or Walgreens. Get your six-figure paycheck. Get a sign-on bonus, and that was it. I didn't know anything about residency. The program in itself, I would say UF is very heavy clinically. They prep you for the practice, on top of your license, like you said. But it wasn't actually the program that sold me. It was very, very, very much so attributed to one guy and his dad. That guy is Ryan Holmes Child. His dad is Mark Holmes Child. They are amazing, amazing individuals.

Mark, I believe, is with a drug company. I can't remember which one. very personable, charismatic, and they both taught me about, it's all about who you know in the pharmacy world and not what you know. But all about networking and a lot of things like that. They're like, "Brian, you want to ... There's a lot of potential out there. There's a lot of things we could do in pharmacy." They knew I studied a lot at the time. They're like, "We think you'd be fantastic in the clinical world." I don't want to say clinical world because our retail colleagues do a lot of great, awesome clinical work as well, but there's a lot of ... There's a big world out there in pharmacy. I think that's the best way to put it. They were telling me about all these things that pharmacists did on rounds, in hospitals, and I didn't know any of that existed. They taught me all about that. They were the ones that really pushed me towards solidifying my residency, I guess.

Tony:     Okay, well, we'll talk about how good your P4 year was as part of your BCPS preparation in a little bit.

Brian:    Yeah.

Tony:     But let's talk a little bit about why you became a YouTuber. You had some mentors that have helped you, that kind of exposed you to things that maybe you didn't know about. I discovered pharmacy backwards. I was pre-med, chemical engineering, through my two years at ... No, I was pre-med chemistry. I think I'm still a chemistry major although I got an AA from UF. I was thinking med school all the way. Then I discovered pharmacy and I got into pharmacy school before I ever ended up even applying to med school. Tell me a little bit about, I guess, how your path kind of went.

Brian:    Applying to, or why I got into pharmacy, per se?

Tony:     Yeah, so why didn't you go on to medical school after you ... You were going to go to, you decided on residency, but you didn't end up going to medical school. You had a couple of videos about that, and you shared ... I guess it was more about the sharing. Like, you had mentors that shared about undiscovered topics for you, and now you're sharing, as a YouTuber, with other people.

Brian:    Yes.

Tony:     Like, hey, some of you are just trying to figure out, should I go to med school or should I go to pharmacy school? Here's a video. I can tell you what happened to me. What made you do that?

Brian:    I got you. You know, this is probably more of a darker subject, but I'll go through it because I think honesty is important and truth of the matter. Just segueing off what I was just saying, I was very, very hyped. I was excited to practice at the top of my license. I was always reading guidelines and journal articles. I was very on top of the literature going into P4 rotations. During P4 rotations I think what I've noticed was like, pharmacy isn't for pharmacists, the ones I witnessed at least, were not practicing at the top of the license as I had imagined. You know, you think of what it is like, but in reality it wasn't like that.

It was more like, you go on rounds. The doctors, the attending, and the students are presenting a patient case. Then after they're done, you might make a recommendation. You know, something like that, but that was not what I pictured. I guess I thought it would be more leading. I don't know. I just didn't know what rounds were going to be like, but, I guess that was a little just different for me. A lot of my experiences was just that, the pharmacist wasn't the final decision-maker. I really wanted that, because I felt as though I had great training. You know, UF is a great program. I knew a lot of knowledge and I wanted to do more, and I wanted to be the decision-maker.

Tony:     Mm-hm (affirmative).

Brian:    That kind of shifted my mentality towards wanting to pursue medical school.

Tony:     What made you put it on YouTube though? You talked about getting a 15 out of 30 on their MCAT. Most people don't go on YouTube to say, "Hey, I just wanted to let everybody know that, my PCAT practice test, I was getting like a 50 or 45." You know, you don't ... You know, you're being very vulnerable on YouTube. I guess, what made you say, you know what? People have got to hear this to find out that maybe they think they're the only one. Maybe they think they're imposter syndrome, things like that.

Brian:    Yeah. I think, I actually have a great post on this on my blog. I talked about the façade of social media nowadays. Social media nowadays is just like what you're saying. Everyone talks about their achievements, the highlights of their life, and everything like that. I think it leads to this false image of everyone should be doing the best. Everyone is going out and succeeding in life, but that's not the case. I think that ... I don't want to perpetuate that.

I think it's important that we share our failures, which are just as important as our successes. I do want to put myself out there and talk about the places that I've failed so people are like, just like what you said, yes, there are people out there like me. You know, it's okay to fail in certain places, and you can move on. I think that's my influence and kind of my reason why I put a lot of my failure ... I think I have quite a bit of failures online, but I think that's why I put it on there.

Tony:     Okay, yeah. No, I took Calculus I twice, Calculus II twice, Organic II twice, Biology twice, and Physics twice.

Brian:    Well ...

Tony:     So if anyone's wondering if UF undergrad is rigorous, I assure you it is. I ended up with a 99 on the PCAT because I took everything twice.

Brian:    Wow. Well, it's -

Tony:     But let's kind of segue into something. The people that follow you or that put the big numbers up on your YouTube views tend to be talking about residency, so let's kind of shift to that. You didn't match for a residency. I feel like there's a huge fear. You go into the showcase. There's thousands of people there. Everybody is thinking, okay, I'm going to get this. I'm going to match. You didn't. What happens when you don't match, and can you tell us a little bit about the video that you posted?

Brian:    Sure. It was another very dark, dark time.

Tony:     I didn't mean this to go down this direction. You're like, "Come on, man, we went to the same college. Help me out."

Brian:    That's okay. You got to balance the light with the dark, for all the Star Wars fans. But, no, it's great. This was another example of vulnerability. This is one of those things that I never wanted to talk about. It took a long time to talk about, but I think in talking with some of my close friends with it during the time, it helped me get through it. Then putting it online, I think, helps a lot of individuals now that's going through the process to know that, okay, what do you feel like, what are those emotions, and what do you do if you don't match. I think this will hopefully help resonate with those individuals that are going through that process.

About that video. I think there's a couple important things to point out. I think the first thing is just that it was a very humbling experience. I think pharmacy schools nowadays have shifted towards this clinical mentality versus the traditional roles. There's a lot of important roles in compounding, dispensing, counseling. So very traditional pharmacy roles I think that we're moving away from and it kind of scares me because we're losing that side of it as well, when we're shifting towards this clinical mentality. But because we are shifting towards this clinical mentality and saying, practice at the top of your license, I think that we also get very arrogant.

Which was the case for me and why I wanted to put the video on there, is, I was an extremely arrogant individual during P4. Not as much during residency, but especially during P4, I thought I was better than the med students. I felt I knew everything. This was like a wake-up call to me that says, hey, you are not the smartest guy out there. Far from it, if anything. I wanted to put that video out there to say, it's important to be humble in your life. It's important to be kind and just be friendly to other people that you encounter. Just that experience, it was a rough time. It was dark. Didn't match. What helped me was just talking about it with friends. That was kind of it.

Tony:     Okay, well, let's get you out of the dark place. Let's play the country music record backwards.

Brian:    There you go.

Tony:     Get your dog back, your life back, your wife back, your truck back.

Brian:    Okay.

Tony:     So, you have a video with you pulling the Pharmacy BCPS certification out of the envelope. I thought you had, I couldn't tell if you had gloves on or something, but it was like that movie where they have the Declaration of Independence and they're being very careful with the document.

Brian:    Oh.

Tony:     Some national treasure, or something. You go from these kind of dark places where you didn't match and you've shown tremendous persistence. You did make PGY1. You did a PGY2 in Utah. Tell me about becoming BCPS certified. I'm not clinical so I don't really know much about it. Can you first walk us through why would somebody want to be certified? What does that mean?

Brian:    Okay. That's a great question, again, there. For board certification, I guess the easiest way to put it is just like, it's that official recognition for a specific area of interest, just like medical school. I think a lot of pharmacy mirrors or tries to mirror what medical is ... They use medical, how do you say?

Tony:     Pathways, right? I know what you're saying.

Brian:    Yeah, as the model. I think this was their way of saying, there's ways to certify that you are the clinical expert in various fields. You can get board certified as a pharmacist in pharmacotherapy, which is just general, overall knowledge of various clinical topics. There's board certification in nutrition, board certification in geriatrics, nuclear pharmacy. Various areas that some people would want someone that's more specialized to see that you have additional training. Because some of these areas are very important, that, if you make that mistake, it could cost someone's life. You want to be, you have the extra training in that area. That's just a general sense. Just gives employers, if anything, additional comfort to know that you're certified in a certain area.

Tony:     Can you explain to me, why, I guess, if I hear an informatics pharmacist, I guess I picture computers, and health records and things like that. I don't picture anything clinical. Can you help me with that divide that informaticists work on computers, and how do they relate to clinical pharmacy or why is that clinical pharmacy certification necessary for someone that's an informaticist?

Brian:    That's a very, very great question. I think this is one of those things I always harp to for students that are interested in informatics. I think first and foremost the reason is, we are pharmacists first. We can never forget our pharmacy roots, our backgrounds, because we will then become just an IT professional. That's not the purpose of pharmacy informatics. The purpose of pharmacy informatics is to be the liaison between our clinical folks, like our pharmacists, and physicians, and nurses, et cetera, and then our IT folk. We speak both languages. If we lose our clinical competence or clinical knowledge, then we become the IT side, and that just kind of fails. I think that's one. This was, for BCPS, one way to kind of force yourself to maintain, because they make you do, I can't remember how many, but it's a lot of CE credits to maintain that certification.

Tony:     Okay.

Brian:    One thing is, it forces you to keep up with literature. That's one thing. I think the second thing, and I'll probably say three things, but the second thing, real quick, would be just that, commonly when you are an informatics pharmacist, you're presenting in front of a lot of folks. It could be clinical. It could be managerial. It could be non-pharmacy individuals. BCPS is a very widely, probably the most widely recognized, pharmacy credential out there for clinical pharmacists. I think it gives you that clout. It's like, "Oh, it's not an IT person. It's someone that actually knows clinical speak." It gives you just that additional clout. This is probably more of a, not a super in-depth reason to get it, more of a shallow reason, but that's the second reason I got it. I think a lot of people didn't think I understood clinical, so this is a reason, just to say, "Hey, I do understand it."

Tony:     You get a pin, right? So, you can just put the pin on.

Brian:    Yes, you get a pin. I wear the pin every day.

Tony:     Make it easier. I'm guessing that that's probably why they made the pin, just so people would just go, "Oh, you're clinical. We're good. I don't need to explain what hematocrit is, or what this is, to you."

Brian:    Absolutely. That is probably why. You know, and it works, because they see the pin, and then they know.

Tony:     Okay. Well, I guess, maybe do take us a little bit into informatics and kind of explain what it is. I have a Master's, I just got it, a Master's in Human Computer Interaction. I know cognitive psychology, usability testing. I can tell you why a webpage doesn't work right or why a certain process doesn't work right. Tell me, the EHR was supposed to be a savior, and let's just say it gets a bad rap. We'll just leave it there where we can vilify it all we want. What are the things you're doing to make the EHR better as an informaticist, or make the user experience better?

Brian:    Wow, that's a very powerful question. Yeah, you know, that question probably came out of your Master's.

Tony:     No, okay, let's make it kinder. We don't want to go back to the dark place.

Brian:    No, no. I think it's a fantastic question, though. I think, all of us, I'm happy to answer the question.

Tony:     Okay.

Brian:    I think it's important because it hits on one of the key domains of informatics. I'm sure you probably learned about it in your Master's as well, is, humans factors engineering.

Tony:     Yep. It's the first class you take, yeah.

Brian:    Oh, wow. See, so, I'm not the expert on this topic. Feel free to just correct me whenever I say something wrong here.

Tony:     No, no.

Brian:    For me, I feel pretty strongly about this because the whole reason informatics really exists in my opinion and why we push so hard for it really comes down to, like, there was a pivotal study from the Institute of Medicine in 1999 or 2001, called, "To Err is Human."

Tony:     I know this one!

Brian:    They talked about it.

Tony:     I know that. Yeah.

Brian:    Exactly. It was a fantastic topic. It talked about how humans make all these errors. There's a human error factor and we have to have systems. There's not bad people. There's bad systems. We need to design the systems to help us make it better. Humans factor engineering, what I do and why I harp, going back to the BCPS, is you have to know pharmacy first. You have to know the clinical workflows first. You have to understand the clinical impact of why a pharmacist does, or why do they care about total body weight, ideal body weight, adjusted by [inaudible 00:25:52]. Why do they have to see all these different values? Why? You have to understand the why.

When you understand the why, I think it really helps to understand how to design the screens you see when you interact with the computer. How do you interact with a pop-up that you see? What information is important? I think ... So, that's what I care about, a lot, is the design, because I do a lot of design. I work with the end users. Like, what would they want to see. I picture myself in their shoes. Because I can't just be asking them questions all day, I try to design a system that I would personally use. That's how I try to make it better. I try to put myself in their shoes. I try to understand what they do on a day-to-day basis. I understand their woes and their happiness, what makes them happy. Those are the kind of things that I try to do to make the usability better on their side.

Tony:     Okay, and I think you're talking about things like alarm fatigue, where there's an alarm for everything. You're like, which alarm should be, kind of like the black box warning of alarms.

Brian:    Mm-hm (affirmative).

Tony:     There's all kinds of things that maybe we don't think about day to day where if we kind of tweaked this and fixed that, then it helps us all work together a little bit better. Well, I don't want to keep this too long. I appreciate you being on. Just a couple questions here at the end, just to kind of get some of your best practices, to kind of succeed down the road that you have. On a daily basis, what's your best habit to keep your work on track?

Brian:    Work on track?

Tony:     Are you a list person, or ...

Brian:    I switch back and forth, to be honest. I guess the best number one thing, and it's a good and a bad thing, is my Outlook calendar. If it's not on my calendar, I unfortunately, 99% of the time, miss it. I schedule in everything. Breakfast, lunch, dinner, brushing your teeth.

Tony:     The first person I ever interviewed said ... I was like, "What's your hack, or what's your trick?" She's like, "I have to eat every day." Something like that. Like, I schedule my meals. That's valid. I'm just validating your Outlook, to put food in there, because as pharmacists we don't pay attention to ourselves like that.

Brian:    Yeah.

Tony:     What's maybe the best career advice you've ever given or received?

Brian:    Ever given or received? I can think of, I think, two. I actually wanted to make a video on this. I think the first tip was when I was a P4 student on my administration rotation. I didn't know anything about operations stuff. I was told as a student that, "Brian, what we care for when we hire someone is your personality first. We can teach you the skills, what you need to learn to do your job. We can't teach you to be a nice person. We can't teach you to be a hard worker. That is what I look for when I hire." I always keep that in my mind. I think that's translated to be, be nice, be humble to others. Be friendly. Don't look down on others. I think that has gone a long way.

Then the second one is more so from a student mentality but I try to apply it everywhere as well, is I learned it from my ID rotation. He's the reason why I got into infectious disease. His name is Jamie Kistchen. He taught me as a student, I was a P3 at the time, that when you're in the classroom, to treat it as a classroom. Let's talk about anything that's on your mind. You can make the wrong decisions. Say what you truly think. It could be wrong. It could be right, whatever it may be, but we do it within the classroom. When we're outside in the patient care world, when we're talking with physicians or nurses, we don't just blurt things out. Don't just pull something out of your butt or [inaudible 00:30:07].

Tony:     Okay.

Brian:    You know, look things up before you say it. But he's saying to do it in the classroom because it really starts to trigger your critical thinking. That's how you train someone, is you make them think, and then you change the thought process. I thought that was always fantastic and I carry that with me ever since then.

Tony:     Then, last question, what inspires you?

Brian:    A lot of things inspire me. I think if there's one thing that's the most inspiring is, my family. My grandma is very inspirational to me. She is, I don't think I've kept count ... It's probably been 12 years or 13 years survivor of ovarian cancer. She lived through and survived a lot of rigorous treatments. She didn't really complain. She's the reason why I got into healthcare. She's always been very inspirational to me. I think that because of that, it's inspired me to help others. You know, great healthcare individuals took care of my grandmother. I want to be that healthcare professional that takes care of others' loved ones. Then, just my family. Grateful for the opportunity. My parents, they worked their butt off literally 24/7, every single day, to give me a better life. Their work ethic has definitely inspired me to work hard every day.

Tony:     Awesome. Thanks so much for being on the Pharmacy Leaders Podcast.

Brian:    Hey, thanks, Tony. Really, really excited, and appreciate your time and having me on here.

Now that you're done listening to the podcast, why don't you come over and check out my YouTube channel at www.youtube.com/BrianFungRX or ImproRX. I talk about a lot of things related to pharmacy, post-graduate training in pharmacy, residencies, fellowships, and other topics, especially related to pharmacy informatics. Would love to see you there. Come check it out.

Audio:   Support for this episode comes from the audio book, “Memorizing Pharmacology: A Relaxed Approach.” With over 9,000 sales in the United States, United Kingdom, and Australia, it’s the go-to resource to ease a pharmacology challenge. Available on Audible, iTunes, and Amazon.com in print, e-book, and audio book.

Thank you for listening to the Pharmacy Leaders Podcast with your host, Tony Guerra. Be sure to share the show with a hashtag, #pharmacyleaders.