Hello Pharmacy Pain Enthusiasts! I’ve been contemplating various topics for this very first blog post for several weeks and probably mulled over 50 different pain-specific topics. Finally, after a well-rested vacation in Narragansett, Rhode Island, it came to me; I was driving home and speaking with an enthusiastic PGY-1 Pharmacy Resident aspiring to launch an eventual career as a pharmacy pain specialist. Ah, I thought…the perfect topic, especially considering the monthly requests I get from PY-3 pharmacy students curious about what they might expect on a pain rotation in their final year of college. Then there’s the looming carrot that one day, we may [will] see a BPS certification specialty in pain and palliative care. Those specialty attributes were eloquently outlined by a group of pharmacy pain peers in the “Executive Summary, Background and Recommendations: Strategic Planning Summit for the Advancement of Pain and Palliative Care Pharmacy”. The Board of Pharmacy Specialties issued a press release role delineation on April 11, 2011, only to be denied a year later as outlined in an open letter to BPS. How ironic, that just two days following the original announcement on 4/11/2011 that a BPS certification in pain and palliative care would be considered, the FDA released a final Risk Evaluation and Mitigation Strategy (“REMS”) required for all extended-release opioid medications. REMS has since moved forward and on July 9, 2012, the FDA announced the implementation of REMS. 
All this attention surrounding drug and pharmacist specific pain management is surely a springboard to an imminent successful pharmacy specialty. The question in my mind isn’t “if” it will happen; the question is “when”. So, why should you care, and what should you ask? Here are common questions posed by pharmacy students and PGY-1 residents…
- What do I need to do in order to become a specialist in pain management? Most probably, one would need to complete a PGY-1 residency in general practice, followed by a PGY-2 specialty residency or fellowship in pain (and perhaps) palliative care.
- Are there any groups that I should focus on or join in order to keep my thumb on the pulse of this burgeoning specialty? Yes. ACCP has a pharmacy pain & palliative PRN (network) that focuses on pain and palliative care. ASHP has a Section Advisory Group on Pain Management and Palliative Care; they also have a Pain and Palliative Care Traineeship. Other important groups include the American Pain Society, American Society of Pain Educators, American Academy of Pain Management, and more (feel free to post).
- Are there many PGY-2 pain residencies for pharmacists? There are currently 6 ASHP accredited programs and a few pending accreditation. We started a program at the Stratton VA Medical Center in Albany NY this year and intend to apply for (retroactive) accreditation beginning July 2013. The accredited programs (updated as of August 9, 2013) are as follows:
Name of Site Type Code State Central Arkansas Veterans Healthcare System (PGY2) Palliative Care/Pain Management Pharmacy 71004 AR North Florida/South Georgia Veterans Health System (PGY2) Palliative Care/Pain Management Pharmacy 33012 FL Stratton Veterans Affairs Medical Center (PGY2) Palliative Care/Pain Management Pharmacy 22048 NY Summa Health System – Akron City Hospital (PGY2) Palliative Care/Pain Management Pharmacy 44031 OH The Johns Hopkins Hospital (PGY2) Palliative Care/Pain Management Pharmacy 35110 MD The Ohio State University College of Pharmacy/HospiScript Services, LLC (PGY2) Palliative Care/Pain Management Pharmacy 44047 OH University of California, Davis Medical Center (PGY2) Palliative Care/Pain Management Pharmacy 92066 CA University of Maryland (PGY2) Palliative Care/Pain Management Pharmacy 35318 MD UW Medicine (PGY2) Palliative Care/Pain Management Pharmacy 95007 WA West Palm Beach VA Medical Center (PGY2) Palliative Care/Pain Management Pharmacy 33551 FL - What kinds of clinical activities do you provide?
- Pain Team member
- Outpatient clinic, therapeutic & pharmacokinetic drug monitoring (serum analysis and urine drug screens)
- Patient evaluations and follow-ups (prescribing medications and ordering necessary lab tests)
- Consultations to primary care providers
- Telehealth
- Inpatient consults (acute pain management)
- PCA and interventional devices
- Policy development
- Regular education to all professional staff (pharmacists, MDs, NPs, PAs, RNs, and patients) live and via videoconference/webinar
- ..and lots more
5. What’s the big picture and how might it affect me? Pain management is a huge potential area for growth that is begging for more trained specialists and residency programs in which to train pharmacy colleagues. Another exciting area that has expanded for specialty PharmD’s includes expert legal work, a proficiency that has expanded because so many patients have been harmed by underdosing or overdosing, and an equal amount of prescribers have been falsely accused by patients or regulatory agencies of overprescribing or inappropriately prescribing various analgesics or combinations. Julius Caesar stated the problem well in one short sentence, “It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.” Simply put, our profession needs you! Pharmacists, healthcare providers, students, residents; PLEASE FEEL FREE TO POST! Guest Authors are welcome! Please e-mail Dr. Fudin directly, jeff@paindr.com. Click here to read “About Dr. Fudin”.
I recently was part of the P1 student (from Texas) having a phone interview with you a few days ago.
I just want to spend a few moment to thank you for your time and generosity answering our questions.
I have been visiting and reading about pain, palliative care, and pain management. I think that this field does have a growing potential and I would like to learn more about. As I read more and more, I realize that as a P1 I have learned too little at this point to grasp the whole concept completely. However, I’m really interested in pain management and would like to consider it for my residency in future years.
Thank you for your time!
Lan
Dr. Fudin,
Great blog! I recently had a client request help for a Pain Management Specialist and having trouble identifying qualified pharmacists – any suggestions?
Brandon Jacobson
President
Affiance Group, LLC
Brandon@affiancegroup.com
Brandon,
Thank you for your comments. I have a CE section posted on this site at https://paindr.com/ceus-by-fudin/. I included some upcoming programs below. There are others in NYS and coming up at state, regional, snd national pharmacy meetings. Also, there is a monthly series coming out in Drug Topics all on pain that is starting this April 2013. As of today, there are now 8 ASHP affiliated PGY2 Pain Residencies throughout the US.
April 5-6, 2013:
NYSCHP 2013 Pain Management Practice Based Certificate Program
Dr. Jeffrey Fudin, Course Moderator and Organizer
St. John’s University, Bartilucci Center
175-05 Horace Harding Expressway, Fresh Meadows, NY 11365
Follow this link to register: REGISTER
LECTURERS:
Ebtesam Ahmed, Pharm.D.
New York, NY
Jeffrey Fudin, BS, PharmD, DAAPM, FCCP
Albany, NY
Steven Levy, Pharm.D., BCPS, CGP
New York, NY
Steven D. Passik, PhD
San Diego, CA 92127
April 19, 2013: Fudin → Specific topic to be announced (Pharmacology and Pain Medications) New York State Pain Society Annual Meeting (White Plains NY, April 19-21, 2013)
May 5, 2013: Fudin → Update on Opioid REMS NYSCHP 52nd Annual Assembly: Medication Safety (May 2-5, 2013. Turning Stone, Verona NY)
*********************************************
Managing Chronic Pain: applying knowledge of pain pathways to treatment selection, May 8, 2012 (A medical education broadcast)
Update on Risk Evaluation and Mitigation Strategies (REMS) associated with long-acting opioids, Drug Topics Oct. 15, 2011
Opioid Pain Management: Balancing Risks and Benefits, Drug Topics Sept. 15, 2011
As I further my career, an aspiring pain and palliative care pharmacist, I come to appreciate more and more the role of a mentorship. Dr. Fudin is an *excellent* resource for students and residents looking toward a career in pain/pall care, as are the many pharmacists that can be found on the above mentioned websites/organizations (i.e., ACCP Pain & Palliative Care PRN, etc).
If anyone would like the perspecitive of a current (2012-2013) Pain Management and Palliative Care Pharmacist, please feel free to contact me and I would be more than happy to speak with you, or direct you to another current PMPC resident:
Lee H. Stringer, Pharm.D.
PGY-2 Pain Management and Palliative Care Pharmacist Resident
University of Maryland School of Pharmacy
20 N. Pine Street, Room S436
Baltimore, MD 21201
Cell: 520-508-2214
Office: 410-706-1458
Work email: lstringer@rx.umaryland.edu
Personal email: leehallstringer@gmail.com
Pain patients everywhere in every capacity need you! Please let us know what we can do to help you get there.
Dr. Stringer,
Thank you for your kind words. More importantly, congratulations and thank you for choosing this difficult, rewarding, and sometimes comical (keeping a sense of humor to survive) PGY2 specialty. I want to encourage all of you potential PGY2 pain enthusiast to take Dr. Stringer up on his offer. Lee, you are fortunate to be training under Dr. McPherson; she is perhaps the most intelligent, warm-hearted, enthusiastic, and FUNNY of mentors in the field!
I’m going to take this a step further! Because this blog section has been extremely active and seems to get busier every day, and because it can offer an unusual contemporary opportunity for aspiring residents to publish, I’m thinking this is a huge opportunity to engage and connect PGY2 Pharmacy Pain Residents! Therefore Lee, I am inviting you to write a guest blog explaining “the road traveled to landing a PGY2 Pharmacy Pain Residency”. Then, with your help, together we can reach out to your counterparts throughout the country and we will start a Pharmacy Resident Pain Blog forum for all of you to share thoughts and experiences. Of course, I will reach out to all the mentors and encourage them to monitor the new area for ideas and mentorship.
The ball’s in your court!
Announcment: Our PGY2 Pharmacy Pain Residency at the Stratton VA Medical Center in Albany NY is still open. The application date is extended to 8/17/2012 with a start date on or before 9/1/2012. For more information, see https://paindr.com/wp-content/uploads/2012/07/Stratton-VAMC-PGY2-Pharmacy-Pain-Residency-Brochure-2012.pdf
My favorite rotation by far and a great area to be involved in. Stuck in retail pharmacy and would love to get into a clinical setting in an area like this. Am I too far out of college and practice to get taken seriously for a residency? Or is there another path to achieving this goal without a residency?
Erik,
Great to see you hear after a couple of years! I often hear these very same words from recent pharmacy graduates who rushed into community practice in some cases because that’s where they had most experience or in others because of salary incentives and looming student loans. But, I have seen folks such as yourself leave community practice, complete a residency, and move on to fruitful clinical careers.
To answer your question; No, you are not too far out of college or practice to “be taken seriously” as a resident candidate. I suspect that different residency directors have various opinions in the matter, but all considered I believe that someone such as yourself makes an excellent residency candidate. Consider that many resident applicants half-heartedly apply to and accept a residency because they are unsure what they want to do (not necessarily bad) or because they are frightened to enter the “real world”. Then we have folks like yourself that have real world experience and know for sure, “what I’m doing is not for me…HELP, get me out of here!” Personally, I am often biased towards the person that has experienced another type of pharmacy practice and knows now in which direction he/she wishes to gravitate professionally. For a PGY-2 residency, obviously you would need to complete a PGY-1 first. There are other options to sweeten up your C.V. if pain management is your ultimate goal. For instance, in NYS, I have lead several Pain Certification seminars through the NYS Counsel of Health-system Pharmacists. Other states have similar programs. You should also check out some of the links I provided in the main post and consider getting involved with some of the professional pharmacy organization sub-committees or groups that focus on pain. At this point, there are relatively few “thought leaders” in the area of pharmacy pain management nationwide and spending time with them professionally will really solidify your direction and desire to move into pain as a specialty area. They are all dedicated, down-to-earth professionals that want to see pain management become a recognized specialty area.
Thank you for your insightful questions and please feel free to call on me any time!
Hi Eric, I am a P4 student currently on rotation with Dr Fudin. When I read your comment/concern about being able to pursue a residency I was a bit startled. As I prepare my residency applications, I have had several conversations with residency directors who identify someone in your position as the perfect candidate! They are aware of the sacrifice required to begin a residency after many years of community practice and interpret your interest in a residency as an innate passion and drive to advance the clinical practice of pharmacy. So do not be discouraged and let your passion for pharmacy guide your career!
Exciting to see your first blog post live!