Why You Should Take Risk In Your Pharmacist Career
Risk and healthcare are not friends. Pharmacy schools teach us to be thorough, thoughtful, deliberate, and precise. We are taught how to consume volumes of information and synthesize it into a patient-specific care plan. We are taught how not to take risk with medical decisions – how to follow the data. We are taught to avoid risk, and if unavoidable, to minimize it to the greatest extent possible. We are taught to calculate risk – risk of toxicities, risk of statistical errors, risk of an intervention, risk of an unaccepted recommendation. The only risk we are focused on is risk to patient care. This is where we are risking are professional future.
I was a very conservative clinician coming out of pharmacy school, arguably like most pharmacists. I knew enough to know what I didn’t know could be dangerous. I chose to complete post-graduate residency training because I knew I needed the extra structure and extra time. I quickly learned pharmacy school must teach you black and white – you have to pass exams after all – but we live in a gray world; the real education begins after school. Residency training helped me continue to build my knowledge, my clinical and operational repertoire, and it solidified what I learned in school about risk – minimize it at all costs. If you suggest a “risky” clinical recommendation, your preceptor’s job is to highlight it, question you about it, dig into your reasoning, and make you defend it – you better have a good rationale for going outside the norm. This is expected – if you were my mother’s oncology pharmacist you better be able to explain yourself under fire.
What school and residency don’t teach you is that there may be some risk that is beneficial in your pharmacist career
Career risk was a completely foreign concept to me. I chose healthcare to have a stable career. I chose residency training to reduce the risk of unfulfilling work. I chose an oncology clinical pharmacist position because that’s the road residency training opens for you – the thought to look for a different position did not even cross my mind. I managed to get through almost a decade of training taking as little risk as possible. Now, one could argue there was risk involved in that process – I took on a lot of student loan debt, I moved out of state for residency training, I moved again for my specialist position (to Cleveland of all places – haven’t you heard their rivers catch on fire?!). But honestly, none of those things felt risky to me – I could see the big picture.
“Change is hard” wouldn’t be a cliché if change wasn’t, in fact, HARD!
What did feel a little risky to me was leaving my position at a large academic center and going to a small community hospital. My title was the same, oncology pharmacy specialist, but I knew the work was very different; I would be the only oncology pharmacist. I was leaving my specialty knowledge of bone marrow transplant and jumping into the deep end of general oncology practice; all-comers walked through our doors, often with metastatic disease and a plethora of complicating co-morbidities. That change felt risky but I know how to learn and knew I could talk to patients as much as I wanted, hands-down the favorite part of my day. Even though my patient population and daily duties were different, the role was very traditional; not outside the proverbial box at all.
Other doors on my pharmacist career path
I enjoyed the impact I was having in my community hospital. It was overwhelming, at times, to be the only oncology pharmacist, but I could see the value I brought to the clinic every day. Throughout my career recruiters have often reached out and my response was usually the same – “I’m not currently looking for a new opportunity but keep me on your list for the future.” When I received an email about an opportunity in another state, I replied, indicating I wasn’t interested in moving at this time. The response back was that the role didn’t require me to move – I thought to myself, “what kind of oncology pharmacist role is in another state that doesn’t require relocation?!” It was enough to get on the phone and start a conversation.
The company was looking for an experienced oncology pharmacist to work as a consultant for a large academic medical center that was implementing an electronic health record in their oncology areas. I had heard of consultants in business settings and in long term care but never in oncology – was this even a legitimate job?! I was intrigued enough to keep learning about it. They needed a liaison to communicate between the clinical end users and the technical team building the oncology treatment plans. They were using a full-time oncology pharmacist at the time, but she had patients to take care of and did not have enough available time to commit. The role leveraged my oncology experience but entailed leaving direct patient care behind, my biggest hang-up. And yet I was considering it – seriously considering it.
Why would I make that type of change when I had spent so long getting to my career “goal post”? I loved my patient interactions, and educating patients, residents, and other pharmacists; I loved being an oncology pharmacy specialist! But what I had noticed was that I was at the top “rung” of my career ladder. It seemed strange but there I was, only 5 years out of residency. I was not interested in a move into pharmacy administration, so my future career trajectory looked the same for the next however many years. Sure, I would keep volunteering on professional committees, presenting at conferences, hopefully author a few papers, but my role as clinical oncology pharmacist would remain in the same swim lane.
Gain versus loss in your pharmacist career
I took time to seriously consider this opportunity which brought up many more questions than answers. What if I didn’t like it? What if they didn’t like me? Could I get used to the travel schedule? What skills would I learn? What skills might I lose? What other doors might this open or close? What will my colleagues think about it?
At the end of the day, it all boiled down to 2 questions:
What have I got to lose?
What have I got to gain?
It’s easy to focus on the negative outcomes – what might I lose with this decision? Maybe it’s the optimist in me, but I would much rather spend time envisioning what I could gain from the experience. I think about new connections I’ll make, new health systems or companies I’ll become knowledgeable about, what skills I could learn (and not just pharmacy areas but project management, new software, new EHRs, etc).
For me, the potential gains outweighed the risks and I made the leap – and it felt like a blind leap off a cliff.
Now you might be thinking that all sounds good in theory but in the real-world avoiding career risk is safer. But I would ask you how safe are you feeling these days about the pharmacy profession? I bet it’s not all that safe with the wave of disruption and change we all feel coming towards us. After about 6 months I realized I made the less risky choice – it was far riskier for me to stay in my traditional role.
Calculated risk in your pharmacist career
Most pharmacists are risk averse, including me. But taking risk in your career can be calculated which can mitigate some of the risk. If you are considering a risky move, consider these points that helped me:
1. Have a solid financial plan
This is number one in this list for a reason. You must understand your financial picture to make informed decisions. This does not mean you have to have student loans paid off (I didn’t) but it does mean you should know the details of your budget and have an emergency fund. Really think about how many months of expenses your savings can cover and your level of comfort with that. A solid financial plan also includes your tax strategy; pharmacists typically make good salaries and the more you make the more important it is to talk with a professional financial planner about how to maximize all available options. I have really liked working with Your Financial Pharmacist if you are looking for support.
2. Shift your mindset
Nothing rains on a parade like imposter syndrome – the feeling that you’re not good enough, that you don’t deserve to be paid $x, etc. Pharmacists are highly skilled clinicians so start acting like one! I speak from experience here. Specifically, I made assumptions about my value based on the traditional path I had taken in my career which suggests pharmacists with 2 years of residency training should work in a specific type of role and should be paid a specific amount of money. Here’s the thing that took me a long time to learn – your value as a professional is not tied to the hourly rate/salary your employer sets.
Louder for those in the back: Your value as a professional is not tied to the salary your employer is willing to pay!
The value you communicate and deliver daily defines that number. Before I gained this perspective, I made a huge negotiating mistake. I assumed I knew what a pharmacist’s value was in the marketplace, but had I thought about my value from a business perspective, I would have negotiated a lot differently. But when you know better you do better! This is one reason why coaching is so valuable – we all need people to push us!
Consider how your knowledge and experience is going to enhance, accelerate, and/or improve a work effort. In other words, what is the return on investment (ROI)? For example, if a project costs $100,000/month to run and your experience can help finish it faster (2, 4, 6 months faster), that’s a significant ROI! Think about where your experience shortens the learning curve for others because time is a highly valuable commodity.
3. Consider a side hustle or PRN position
This is also known as hedging your bets 😊. If you’re worried about the career move not working out, consider how you can insulate yourself by getting/keeping a foot in another door that can bring in revenue. For me, this was staying on PRN at my previous job and finding another PRN medical writing role. A downside is working more, but it also allows you to bring in more revenue and learn some new skills. Don’t forget to re-assess often if this extra role is still serving you.
4. Do your homework
Pharmacists are excellent self-learners so start researching and thinking about these topics:
Salary
It will be in your favor to find salary ranges for your new position. You should always negotiate – it is expected and probably weird if you don’t. You make your best deal going in the door so go to the negotiating table armed with information about your value. I would highly recommend reading a negotiating book – Never Split The Difference by Chris Voss is one I thought was helpful.
Benefits
We are so used to medical insurance coming from our employer that we may miss out on a great opportunity with a company that doesn’t offer it. Spoiler alert – you can purchase your own insurance! When I took a consulting role, I mitigated my risk by agreeing to be a W2 employee rather than a 1099 so I could have access to health insurance. Since then, I have purchased my own comparable plan through the marketplace and now factor in that cost to my salary requirements. Companies that don’t offer medical coverage know they are at a disadvantage, but you don’t have to be. When negotiating, tell them you need $xx more per year/hour to purchase your own coverage.
If you are considering a role that doesn’t offer perks you may be accustomed to (401k, professional development budget, etc) you can easily quantify how much that benefit is worth and add it to your salary requirements. If your employer doesn’t offer the ability to contribute to a retirement plan, talk to a financial planner because you have options where you can fund one yourself. Yes, it’s likely to be with after tax money until you file your return but that comes down to a cash flow thing – same end of year result.
Lifestyle
The risky career move you are considering may come with a different lifestyle. Mine came with a lot of travel. When I was first offered a consulting role, the travel requirements were every week. Fly out every Monday, fly home every Thursday, work from home every Friday. And I told them no. I didn’t want that much travel at that time. I was used to driving to the hospital every day not dealing with airport headaches. But when you have something of value you have more negotiating power – traveling every other week was acceptable to me and when they offered that I accepted. If I hadn’t thought through what that looked like I might have been unhappy with the new role. Ironically, I don’t mind more frequent travel now that I’ve learned the ropes so the lesson there is to consider what changes it will bring, but then readjust if needed. Isn’t life just an experiment anyway?!
A lot of non-traditional roles offer the ability to work remotely so if that’s on the table consider if you can thrive in that environment. It sounds great to most people I talk to – no commute saves time and money – but not everyone likes the isolation that may come with it. With that said, there may be workable solutions if you look around, such as co-working spaces (in the post-COVID world). Plus, there are opportunities to “hack” your workspace to make it work the best for you. For example, when I’m working remotely I know I don’t move around as much so I bought a stand up desk and a desk bicycle and it’s my favorite professional investment to date!
Tax implications
If you make a career move that involves working as a 1099 contractor, you should do thorough research on your tax implications (it’s a good idea even as a W2 also). And by research, I mean read enough to have an intelligent conversation with a knowledgeable tax professional but then meet with a tax professional! The US tax code is ridiculously complicated and the tax strategy you receive when you pay for professional advice is well worth it. Think of it like your patients consulting Google versus asking you questions 🤣.
I hope I have sparked some ideas about risk-taking in your pharmacist career. Everyone’s situation is different, but I appreciate having as much information as possible before making decisions. I hope I was able to offer some unique perspectives to you.
About The Author
Kelley is a board-certified oncology pharmacist that strongly believes oncology is the best specialty for pharmacists and that anyone can learn it. She founded the ELO (Enjoy Learning Oncology) program, the only private member network exclusively for oncology pharmacists. Want to get instruction and personalized support to take your oncology knowledge and career to the next level?
