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Assessment of factors influencing recent graduates' selection of a community pharmacy practice site as their first practice position
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Currents in Pharmacy Teaching and Learning 4 (2012) 84 –91 http://www.pharmacyteaching.com
Research
Assessment of factors influencing recent graduates’ selection of a community pharmacy practice site as their first practice position Kristen L. DiDonato, PharmDa,†, Kristin A. Casper, PharmDa,*, Jennifer L. Rodis, PharmD, BCPSa, Tara R. Green, PharmDa,b, Katherine A. Kelley, PhDa a b
College of Pharmacy, The Ohio State University, Columbus, OH Kroger Patient Care Center, The Kroger Co., Lewis Center, OH
Abstract Objectives: To identify factors that influence recent college graduates’ selection of first practice position in a community pharmacy and determine whether exposure to or engagement in pharmaceutical care services during advanced pharmacy practice experiences (APPEs) or internship experiences correlate with any of the identified factors. Methods: A web-based survey that corresponds to the stated objectives was developed, pilot tested, and distributed in January 2009 to pharmacists graduating within the last five years (2004⫺2008) from participating colleges of pharmacy in the state of Ohio and five of The Ohio State University College of Pharmacy’s peer institutions. Survey data evaluated first practice site selection and correlation with APPEs and internship. Results: Four-hundred twenty respondents (16% response) completed the survey instrument, with 201 (48%) practicing in community pharmacy as their first practice position. The top factors influencing selection of first community practice position were salary, geography, schedule, benefits, and a positive experience with the company through internship. Seventy percent of participants were involved in pharmaceutical care services during APPEs vs 57% during internship. Those having exposure and involvement with patient education associated with point-of-care testing (POCT) during APPEs were significantly more likely to list “established pharmaceutical care services” as a top factor in selecting their first practice position. Conclusions: Although pharmaceutical care was not a significant factor for community pharmacists selecting a practice site after graduation, providing more opportunities for POCT during APPEs or internship experiences may result in an increased desire to provide these services. © 2012 Elsevier Inc. All rights reserved. Keywords: Community pharmacy; Career choice; Pharmacy internship; Pharmaceutical care; Advanced pharmacy practice experiences
Background Choosing a career path within the profession of pharmacy is an important decision pharmacy graduates must
† Kristen L. DiDonato is currently Clinical Assistant Professor, School of Pharmacy, University of Missouri–Kansas City. Previous presentations of this research: Poster (research in progress) at the American Pharmacists Association Annual Meeting, San Antonio, Texas, April 3⫺6, 2009; poster at the Ohio Pharmacists Association Annual Meeting and Trade Show, Columbus, Ohio, April 17, 2009; poster at the Ohio State University Research Day, Columbus, Ohio, May 20, 2009; podium presentation (research in progress) at the Great Lakes Pharmacy Resident
make. An analysis of the factors that influence career choices can assist employers with recruitment and retention of employees. In addition, colleges of pharmacy can use this information about graduates’ career choices to help guide
Conference, West Lafayette, Indiana, April 30, 2009; poster (contributed papers) at the American Pharmacists Association Annual Meeting, Washington, DC, March 12⫺15, 2010; poster at the University of Missouri–Kansas City Schools of Pharmacy and Nursing Research Day, Kansas City, April 21, 2010. * Corresponding author: Kristin A. Casper, PharmD, College of Pharmacy, The Ohio State University, Parks Hall Room A220, 500 W. 12th Ave., Columbus, OH 43210. E-mail address: [email protected]
1877-1297/12/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.cptl.2012.01.010
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the experiences students gain from didactic and experiential work. Studies identifying factors influencing career choices have been assessed across a number of health care professions, including dentistry, radiology, pharmacy, nursing, and several medicine specialties, such as surgery, internal medicine, and pediatrics.1–11 Three key studies have been published that evaluated the factors that influence career choices in the pharmacy profession. A study by Besier, et al evaluated practice area choices by entry-level pharmacy students in their final year of study at 12 pharmacy schools in the Midwest in November 1988 to January 1989. This study showed that chain community pharmacy was chosen most frequently when assessing first practice choice, and that the three most influential factors affecting practice choice were personal fulfillment, salary, and the opportunity to use one’s abilities and education.3 A study by Piercy, et al in 2008 assessed whether specific factors have influenced pharmacists to choose retail pharmacy over academia. This study found that an average of 89% of retail pharmacists agreed that salary was the greatest factor influencing their decision to work in retail. Both groups felt they were adding value to their institution.4 A study by Savage, et al in 2008 evaluated factors that influenced career goals of pharmacy students in each of the four professional pharmacy years at the research institution. This study found that the most important factors that influence career goals were the work environment and benefits, with most respondents indicating that the retail chain setting would be their projected area of practice.5 Although these studies assessed many factors that influence career choices, factors specifically aimed at the community pharmacy setting are not predominant despite the fact that nearly two-thirds of the pharmacy workforce is in a community pharmacy practice setting.12,13 Specific links among advanced pharmacy practice experiences (APPEs), internship experiences, and factors that influence career choices in community pharmacy have also not been assessed. In addition, evaluation of pharmaceutical care services as an influencing factor for practice site selection seems to be absent from the existing studies, yet many pharmacies are providing pharmaceutical care services, such as medication therapy management (MTM) and pointof-care testing (POCT) for patients. This study took students’ experiences and pharmaceutical care services into account when evaluating factors that influence career choices and practice site selection in a community pharmacy practice setting.
Rationale and objectives The primary objective of this study is to identify factors that influence recent college graduates’ selection of first practice position in a community pharmacy site. As a secondary objective, collected data were assessed to determine whether exposure to or engagement in pharmaceutical care
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services during APPEs or internship experiences correlate with any of the identified factors.
Methods This study was submitted to The Ohio State University’s Institutional Review Board and was approved as exempt research. A list of 24 peer institutions was compiled, consisting of colleges of pharmacy that are similar to The Ohio State University in public perception, academic quality of programs, research focus, publications, accreditation, and/or community residency programs. The programs selected were derived from the perception rankings of U.S. News and World Report, The Annals of Pharmacotherapy “Ranking of US pharmacy schools based on perception, funding, and publications,” American Society of Health-System Pharmacists’ (ASHP) Online Residency Directory list of Community Pharmacy Residencies, the Big 10 Conference Schools, and a listing of Ohio colleges of pharmacy.14 –17 Each institution was contacted via e-mail requesting e-mail addresses of alumni graduates from the years 2004-2008. Seven of the 24 institutions agreed to participate in the study, and all external participating institutions requested to distribute the survey directly to their alumni rather than releasing the addresses to investigators. A nonvalidated web-based survey tool was developed to collect the data necessary to meet the stated objectives. Survey questions were predominately multiple choice and yes/no format. Questions pertaining to APPEs and internship experiences were adapted from a pilot survey developed by a faculty member and previously distributed to graduating PharmD students at The Ohio State University.18 Selection factors were determined through an evaluation of the literature.3,4,18,19 To include a variety of factors, several categories were considered: characteristics of a job, incentives of a job, pharmaceutical care factors, and internal factors. Factors were not separated into categories within the survey to avoid possible influence on participants’ responses. Terminology included a mixture of factors from previous studies and factors developed by the authors. Previous studies assessed a variable number of factors, ranging from 10 to 21. Nineteen factors were selected for analysis in this study, with a variety to represent the four categories mentioned above. The number of factors was limited because of the desire to keep the length of the survey at a minimum in hopes that participants would complete it in its entirety. A complete listing of factors can be found in Table 1. The survey tool was pilot-tested by a small group of community/ambulatory pharmacists (n ⫽ 12) and then modified to ensure clarity and relevance of questions. Modifications were minor and primarily consisted of clarifications in wording of questions. The survey instrument used Zoomerang (http://www.zoomerang.com; MarketTools, Inc., San Francisco, CA), a web-based survey tool. Contacts from participating institutions received an invitation e-mail providing a brief explanation of the research
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Table 1 Frequency of factors influencing selection of first community pharmacy practice position for community pharmacy survey respondents (n ⫽ 201) Factor
n (%)
Salary* Geography* (location of the pharmacy) Benefits* (eg, health insurance, retirement planning) Positive experience with the company through internship(s)* Schedule* (eg, hours in a workday, part-time, flexibility) Previous experience in provision of pharmaceutical care services with selected first community pharmacy position Sign-on bonus Positive interpersonal interactions with pharmacy staff at selected first community pharmacy position Vacation Company philosophy Characteristics of pharmacy patient population Obligation to company because of tuition reimbursement Opportunity to be involved in the development and/or expansion of new pharmaceutical care services Opportunities for advancement within the company Staffing Prescription volume Positive experience with the company through APPEs Other Established pharmaceutical care services at pharmacy Precepting opportunities
110 (55%) 91 (45%) 90 (45%) 86 (43%) 82 (41%) 49 (24%)
47 (23%) 43 (21%)
40 (20%) 38 (19%) 37 (18%) 37 (18%) 36 (18%)
36 (18%) 29 (14%) 26 (13%) 24 (12%) 17 (8%) 16 (8%) 13 (6%)
* Selected significantly more often (p ⬍.05).
project and a URL link to the survey tool, to be forwarded directly to participants. Completion of the survey instrument served as consent to participate in the study. Participants were informed that the responses would be kept confidential and that data would be reported in aggregate. An incentive was offered for completion of the survey in the form of a drawing for three gift cards in the amount of $50 each. The survey was distributed to participating institutions in January 2009 and participants were given four weeks for completion based on distribution date. Reminder e-mails were sent to the institution contacts at two weeks with a request for redistribution of the invitation. The survey was closed in early March 2009. Participants from all practice settings were invited to complete the survey because surveys were distributed directly from the participating institutions and the researchers had no way of pre-identifying the practice setting of the graduates. The intention of the study was to focus specifi-
cally on data from community pharmacy practice settings. The first set of survey questions assessed the pharmacists’ first practice position after graduation from pharmacy school, as well as factors that influenced the selection if their first practice position was in a community pharmacy. Participants could choose up to 6 factors from a list of 19. This assessment of factors in community pharmacy was then followed by a question asking whether participants provided pharmaceutical care services while employed at their first pharmacy practice site, with pharmaceutical care services defined as pharmacy services offered above and beyond required patient counseling as defined in the Omnibus Budget Reconciliation Act of 1990.20 The next question set related to APPEs during the last year of pharmacy school. APPEs were defined within the survey as unpaid experiential rotations each student completes during his/her last year of pharmacy school. Exposure to and involvement with pharmaceutical care services during these experiences was assessed. Exposure and involvement were not defined within the survey. It was intended that exposure meant the student witnessed or observed the provision of these services, but did not participate in the encounter. Involvement meant the student participated in the interaction with the patient and provided a component of the pharmaceutical care service to the patient. Questions regarding exposure to and involvement in pharmaceutical care services during paid internship experiences then followed, including an assessment of whether participants’ first position was with the same company as the internship experience, and whether tuition reimbursement was accepted. Internships were defined as paid pharmacy work experience completed while in pharmacy school. The last portion of the survey consisted of demographic questions. Survey responses were summarized by reporting frequencies and proportions for each answer. Factors that influence selection of a community pharmacy practice site were reported as proportions and ranked in order of frequency. McNemar tests were performed to compare the most frequent influential factor responses to the other response options, using Holm’s step-down testing procedure to adjust for multiple comparisons. Fisher’s exact 2 tests were also used in secondary analyses to evaluate associations between first practice site selection factors and the influences of APPEs, internships, and demographic characteristics. Within each factor, Bonferroni adjustments were made to control type I error. Survey results were downloaded from Zoomerang and statistical analyses were performed using the SAS System version 9.1 (SAS Institute, Cary, NC).
Results A total of 2582 survey invitations were distributed among recent graduates from seven participating institutions in Arizona, Minnesota, North Carolina, Ohio, Tennessee, and Virginia. Between January 15, 2009 and March 2,
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Table 2 Distribution and response of surveys by state State where attended pharmacy school
State of current residence
States
Total surveys sent (n ⫽ 2582)
Community practice setting (n ⫽ 182)*†
Noncommunity practice setting (n ⫽ 196)‡
Community practice setting (n ⫽ 182)*
Noncommunity practice setting (n ⫽ 196)‡
Arizona Minnesota North Carolina Ohio Tennessee Virginia Other
302 552 414 610 574 130 —
10 (5%) 39 (21%) 25 (14%) 57 (31%) 29 (16%) 22 (12%) —
22 (11%) 43 (22%) 23 (12%) 52 (27%) 41 (21%) 13 (7%) 2 (1%)
7 (4%) 36 (20%) 19 (10%) 46 (25%) 26 (14%) 23 (13%) 25 (14%)
13 (7%) 34 (17%) 18 (9%) 44 (22%) 26 (13%) 15 (8%) 46 (23%)
* 182 participants completed demographics (vs total n ⫽ 201). † “Community Practice Setting” identifies survey respondents who are currently working in a community pharmacy setting. ‡ 196 participants completed demographics (vs total n ⫽ 219).
2009, the survey was completed by 420 participants, giving a 16% response rate. Table 2 shows the distribution and response by state. Among the 420 respondents, 201 (48%) practiced in a community pharmacy setting as their first practice site. These sites included community pharmacy chains, grocery/supermarkets, independents, and mass merchandisers. Most community respondents were female (n ⫽ 128; 70%), the predominant age range was 25–29 years (n ⫽ 117; 64%), and 32% (n ⫽ 59) graduated from pharmacy school in 2008. Most of the participants attended pharmacy school in Ohio and are living within the same state. The remaining demographic characteristics for respondents practicing in community pharmacy can be found in Table 3. Survey participants were asked to select (but not rank) their top six factors influencing selection of their first com-
Table 3 Demographics of community practice survey respondents (n ⫽ 182)* Variable
n (%)
Men Women Age (y) 20⫺24 25⫺29 30⫺34 35⫺39 40⫺44 45⫺49 Year of graduation from pharmacy school 2004 2005 2006 2007 2008
54 (30%) 128 (70%) 5 (3%) 117 (64%) 44 (24%) 11 (6%) 4 (2%) 1 (1%) 30 (16%) 25 (14%) 35 (19%) 33 (18%) 59 (32%)
* 182 participants completed demographics (vs total n ⫽ 201).
munity pharmacy practice position. Responses of community pharmacists can be found in Table 1. When using the McNemar test with Holm’s adjustment, the factors “salary,” “geography,” “benefits,” a “positive experience with the company through internship,” and “schedule” were each selected significantly more often than each of the other factors (adjusted p ⬍.001 for each pair). The frequency of these top 5 factors did not differ significantly. Factors related to pharmaceutical care were not found to be significant influences when selecting a first practice position in community pharmacy. “Previous experience in provision of pharmaceutical care services with selected first community pharmacy position” was the sixth most frequently selected factor with 49 respondents (24%), and “opportunity to be involved in the development and/or expansion of new pharmaceutical care services” was thirteenth with 36 respondents (18%). The last of the factors related to pharmaceutical care was “established pharmaceutical care services at pharmacy,” and this factor ranked eighteenth of the 19 specified factors with 16 respondents (8%). Although these factors were not significant influences when selecting a practice site, 53% (n ⫽ 106) of community respondents provided pharmaceutical care services while employed at their first practice position.
APPEs Survey participants were asked to provide the number of completed APPEs in community pharmacies during the last year of pharmacy school, followed by the number of these experiences where pharmaceutical care services were provided. Most participants had two (31%) or three (22%) community APPEs, yet 31% of participants revealed that none of their sites provided any pharmaceutical care services. The predominant number of community APPE rotation sites that provide these services was 1 (n ⫽ 63, 33%).
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Each survey participant was asked a series of questions to assess both exposure to pharmaceutical care services during community pharmacy APPEs, and involvement with these services. Specific services listed included comprehensive medication reviews, immunizations, a variety of point-of-care experiences, and disease state management. The distribution of responses can be found in Table 4. Overall, 70% of participants were involved in pharmaceutical care services during APPEs. The most common area of exposure and involvement was in POCT, with 47% being exposed and 42% being involved in this service. Survey participants with exposure to POCT during APPE (adj. P ⫽ .03) and those with involvement in POCT (adj. P ⫽ .048) during APPE were significantly more likely to list “opportunity to be involved in the development and/or expansion of new pharmaceutical care services” as a top factor in selecting their first practice position. Twenty-nine percent (n ⫽ 55) of respondents took their first job with the same community pharmacy where an APPE rotation was completed. These respondents were significantly more likely to list positive APPE experience as a leading factor (adj. p ⬍.001) for practice position selection. Internships Participants who engaged in paid pharmacy internship experiences during pharmacy school were asked to define their pharmacy setting(s). Participants could select more than one setting if applicable. This distribution can be found in Table 5. Overall, 82% of participants engaged in a paid pharmacy internship, with 79% practicing in a community setting. The most common community setting was a chain pharmacy (n ⫽ 88, 44%). The results of the assessment of exposure and involvement in pharmaceutical care services during internship experiences can be found in Table 4. Overall, 57% of respondents were involved in pharmaceutical care services during internship experiences. The most common area of exposure and involvement was immunizations, with 30% being exposed to and 22% being involved with this service. Sixty-eight percent (n ⫽ 104) of respondents took their first community position with the same company as their internship experience, and 45% (n ⫽ 53) of respondents received tuition reimbursement from the company. Survey participants taking their first practice position with the same company where they completed a paid internship (adj. p ⬍.001), those who received tuition reimbursement for an internship position (adj. p ⬍.001), and community pharmacists engaged in paid pharmacy internships in the grocery/ supermarket setting (adj. p ⬍.03) were significantly more likely to select “obligation to the company due to receipt of tuition reimbursement” as a top factor in selecting their first practice position. Respondents whose first pharmacy job was with the company where they completed a paid intern-
ship were significantly more likely to list “positive internship experience” as a leading factor (adj. p ⬍.001) and less likely to list “schedule” as a top factor (adj. p ⬍.001). Discussion and conclusion There are a variety of factors that influence pharmacy graduates’ choice of first practice position. This study evaluated the top factors selected by new graduates when choosing a community pharmacy practice site as their first practice position. The overall top factor selected by survey participants for this study was “salary.” In the studies by Besier, et al and Carter et al, salary and financial rewards were top factors for community pharmacists when selecting their first practice position.3,21 Furthermore, salary was found to be the greatest factor influencing decisions to work in community pharmacy over academia in the study by Piercy, et al.4 According to the 2011 Pharmacy Compensation Survey Fall Edition, conducted by Mercer, the annualized base pay weighted mean was $118,700 for staff retail pharmacists and $112,000 for staff hospital pharmacists.22 Although this difference in salary is not large, this evidence shows community pharmacists are generally paid higher salaries. Selection of salary as a top factor may suggest that pharmacists are seeking financial stability, particularly after an extensive education that may have left them with significant amounts of debt. It is not surprising that “geography” is a top factor, selected by 45% (n ⫽ 91) of participants, because job seekers are often limited to a certain area based on personal preferences. Although Besier, et al did not assess geography as a factor, Savage et al found that as students advance in their pharmacy curriculum, geographic preference becomes a more important job consideration, with fourth-year students considering geographic preference of high to very high importance in their career goals.3,5 Furthermore, studies by Carter, et al and Traynor, et al showed that geographic location was of great importance and a strong influence when accepting a first practice position.21,23 As pharmacy jobs become saturated in select geographic locations because of changes in the economy and the increasing number of new pharmacy schools, it will be interesting to see whether this factor becomes less important. Students may need to be more open to the possibility of moving to secure a job in pharmacy practice. “Benefits” are also an important consideration for recent graduates. Forty-five percent (n ⫽ 90) of participants selected this factor as being influential in their choice of first practice position. This may suggest that health care needs and retirement planning are top priorities for new practitioners. “Benefits” was one of the most important factors for pharmacy students in Savage’s study as well.5 It was either not specifically assessed or not found to be significant in the other studies.3,4,21,23 Results of this study showed that a “positive experience with the company through internship(s)” was a top factor
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Table 4 Exposure and involvement with pharmaceutical care services during APPEs and internship experiences APPEs (n ⫽ 190)†
Internship (n ⫽ 190)‡
Pharmaceutical care service
Exposure
Involvement
Exposure
Involvement
POCT
94 (47%)* (Adj. p ⫽ 0.03) 89 (44%) 76 (38%) 74 (37%) 69 (34%) 42 (21%) 52 (26%) 5 (2%)
85 (42%)* (Adj. p ⫽ 0.048) 62 (31%) 60 (30%) 72 (36%) 63 (31%) 37 (18%) 60 (30%) 3 (1%)
33 (16%)
31 (15%)
60 (30%) 22 (11%) 27 (13%) 24 (12%) 10 (5%) 73 (36%) 3 (2%)
45 (22%) 18 (9%) 26 (13%) 20 (10%) 9 (4%) 87 (43%) 1 (1%)
Immunizations Disease state management Patient education associated with POCT Comprehensive medication reviews Pharmacist-initiated follow-up with POCT Not applicable Other
* Significantly more likely to list “opportunity to be involved in the development and/or expansion of new pharmaceutical care services” as a top factor. † 190 participants completed APPE questions (vs total n ⫽ 201). ‡ 190 participants completed internship questions (vs total n ⫽ 201).
for new community practitioners. This finding is similar to what was expected because it is presumed that an internship site is selected with the same mentality that a person would choose a new practice position. It is interesting to note that 68% (n ⫽ 104) of respondents took their first job with the same company where they completed an internship, yet only 45% (n ⫽ 53) of respondents received tuition reimbursement from the company. This suggests that half of the interns who continued to work for the same company were not committed before graduation and perhaps were uncertain of their postgraduation plans. This could be a focus area for recruitment efforts, both early in pharmacy school when internships are being selected, as well as in the months before graduation. Retaining interns may reduce training costs and capitalize on employee experience with the company, which can be invaluable for pharmacy employers. Pharmacy schools could consider providing guidance to students early in the curriculum about selecting a quality internship position, and encourage participation in school
Table 5 Distribution of pharmacy settings for internship experiences (n ⫽ 190)* Pharmacy setting
n (%)
Community pharmacy, chain Community pharmacy, grocery/supermarket Community pharmacy, independent Community pharmacy, mass merchandiser Hospital pharmacy Long-term care pharmacy Mail-order pharmacy Other
88 (44%) 45 (22%) 13 (6%) 14 (7%) 27 (13%) 2 (1%) 2 (1%) 4 (2%)
* 190 participants completed internship questions (vs total n ⫽ 201). Participants could choose more than one response for this question.
career fairs where possible internship and future employment opportunities would be showcased. Because schedule can largely affect lifestyle, the type of schedule, flexibility, the number of hours in the workday, the timing of the shifts, or perhaps the ability to work part time, may all be considerations when selecting a position. Schedule, in terms of flexibility, was evaluated in the studies mentioned here, but was not found to be significant. In this study, flexibility was assessed under the factor “Schedule (eg, hours in a workday, part time, flexibility).” “Schedule” was found to be a significant factor influencing selection of first practice position, with 40% (n ⫽ 82) of participants selecting this factor. Further research is needed to determine specifically which aspects of schedule are most important to community pharmacists. An important consideration regarding these “top factors” is whether these are the factors that we want our students to have as they enter the workforce. Salary, geography, benefits, and schedule are factors that may be outside of our influence as educators. These may stem from values and experiences that have been impressed upon the student early in life through family and culture. The top factor—“positive experience with the company through internship(s)”— might suggest the importance of mentoring and providing quality experiences to students during internship. Of particular interest to the authors was the area of pharmaceutical care. With changes in the profession to focus more on patient-centered care, it was hoped that these factors would be more influential. One consideration is whether students may not feel prepared to provide these types of services. Alternatively, perhaps pharmacy practice may be a few steps behind the advanced training we are providing to students in the curriculum, making it difficult to visualize and pursue this type of practice. Determining the reasons why these services are not more important
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factors in first practice position selection is an area for future study. One important finding related to pharmaceutical care was that pharmacists who had been exposed or involved in POCT during APPE were significantly more likely to list “opportunity to be involved in the development and/or expansion of new patient care services” as a top factor. Finding ways to provide more exposure for students and interns may allow pharmaceutical care services to be more influential to their practice site selection. This may involve schools of pharmacy being more selective when approving rotation sites, focusing more on those that offer these services, or implementing activities within the curriculum to allow students to observe or practice their skills. Exploring student attitudes toward expanded services and how to modify those attitudes may be beneficial as well. Table 4 illustrates that APPEs provide many more opportunities for exposure and involvement with pharmaceutical care services than internships. Overall APPE involvement was 70%, compared with 57% of respondents having involvement during their internship. This is not unexpected because often interns may be hired to assist with day-to-day activities within the pharmacy and learn the processes involved with dispensing prescriptions vs spending time involved with the provision of more expanded/advanced patient care services. Involving pharmacy interns in the provision of patient-centered care may lead to a more robust internship program, which could potentially improve retention of interns for company employers. The use of an e-mail survey provided a number of limitations, including limited access to alumni e-mail addresses, incomplete e-mail lists for all classes, and confidentiality issues, meaning surveys were distributed to recent graduates via a primary contact person at participating institutions. This allowed for the possibility of surveys being undeliverable because of spam filters and invalid addresses. The low response rate, lack of geographic diversity, and nonresponse bias may limit external applicability. Another limitation to the survey is recall bias, because participants were asked to remember their perceptions from one to five years ago when they graduated from pharmacy school and accepted their first practice position. Exclusion of introductory pharmacy practice experiences (IPPEs) as influential factors could be considered a limitation in this study as well. IPPEs may influence graduates’ job selection, particularly because they occur earlier in the pharmacy curriculum during a time when students may be more impressionable. An understanding of the factors that influence recent graduates’ selection of their first community pharmacy practice position is an important consideration for colleges of pharmacy and pharmacy employers. Despite the shift in the pharmacy profession from product provision to more of a focus on patient care, in this study pharmaceutical care is not a significant factor for recent graduates when selecting a first practice position in community pharmacy. With 53% of participants providing pharmaceutical care services at
their first practice positions and increased emphasis on pharmaceutical care through didactic education, it is important to evaluate why this factor is not a more significant influence. If recent graduates have little to no interest in providing patient-centered care or if they do not feel well-prepared, this could affect the future of our profession. Providing more opportunities for POCT during APPEs or internship experiences may enhance student understanding and interest in providing patient care services. In addition, pharmacy employers could consider placing more emphasis on internship programs and providing interns with more exposure to and involvement in pharmaceutical care services. Increasing the number of opportunities and the desire to provide pharmaceutical care services among pharmacy students and interns is necessary to grow the number of community pharmacists offering expanded patient care services and to advance the profession of pharmacy.
Acknowledgments We acknowledge Colleen (Clark) Dula, PharmD, for support with this project, and Kyle Porter, MAS, for statistical support.
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Research
Assessment of factors influencing recent graduates’ selection of a community pharmacy practice site as their first practice position Kristen L. DiDonato, PharmDa,†, Kristin A. Casper, PharmDa,*, Jennifer L. Rodis, PharmD, BCPSa, Tara R. Green, PharmDa,b, Katherine A. Kelley, PhDa a b
College of Pharmacy, The Ohio State University, Columbus, OH Kroger Patient Care Center, The Kroger Co., Lewis Center, OH
Abstract Objectives: To identify factors that influence recent college graduates’ selection of first practice position in a community pharmacy and determine whether exposure to or engagement in pharmaceutical care services during advanced pharmacy practice experiences (APPEs) or internship experiences correlate with any of the identified factors. Methods: A web-based survey that corresponds to the stated objectives was developed, pilot tested, and distributed in January 2009 to pharmacists graduating within the last five years (2004⫺2008) from participating colleges of pharmacy in the state of Ohio and five of The Ohio State University College of Pharmacy’s peer institutions. Survey data evaluated first practice site selection and correlation with APPEs and internship. Results: Four-hundred twenty respondents (16% response) completed the survey instrument, with 201 (48%) practicing in community pharmacy as their first practice position. The top factors influencing selection of first community practice position were salary, geography, schedule, benefits, and a positive experience with the company through internship. Seventy percent of participants were involved in pharmaceutical care services during APPEs vs 57% during internship. Those having exposure and involvement with patient education associated with point-of-care testing (POCT) during APPEs were significantly more likely to list “established pharmaceutical care services” as a top factor in selecting their first practice position. Conclusions: Although pharmaceutical care was not a significant factor for community pharmacists selecting a practice site after graduation, providing more opportunities for POCT during APPEs or internship experiences may result in an increased desire to provide these services. © 2012 Elsevier Inc. All rights reserved. Keywords: Community pharmacy; Career choice; Pharmacy internship; Pharmaceutical care; Advanced pharmacy practice experiences
Background Choosing a career path within the profession of pharmacy is an important decision pharmacy graduates must
† Kristen L. DiDonato is currently Clinical Assistant Professor, School of Pharmacy, University of Missouri–Kansas City. Previous presentations of this research: Poster (research in progress) at the American Pharmacists Association Annual Meeting, San Antonio, Texas, April 3⫺6, 2009; poster at the Ohio Pharmacists Association Annual Meeting and Trade Show, Columbus, Ohio, April 17, 2009; poster at the Ohio State University Research Day, Columbus, Ohio, May 20, 2009; podium presentation (research in progress) at the Great Lakes Pharmacy Resident
make. An analysis of the factors that influence career choices can assist employers with recruitment and retention of employees. In addition, colleges of pharmacy can use this information about graduates’ career choices to help guide
Conference, West Lafayette, Indiana, April 30, 2009; poster (contributed papers) at the American Pharmacists Association Annual Meeting, Washington, DC, March 12⫺15, 2010; poster at the University of Missouri–Kansas City Schools of Pharmacy and Nursing Research Day, Kansas City, April 21, 2010. * Corresponding author: Kristin A. Casper, PharmD, College of Pharmacy, The Ohio State University, Parks Hall Room A220, 500 W. 12th Ave., Columbus, OH 43210. E-mail address: [email protected]
1877-1297/12/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.cptl.2012.01.010
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the experiences students gain from didactic and experiential work. Studies identifying factors influencing career choices have been assessed across a number of health care professions, including dentistry, radiology, pharmacy, nursing, and several medicine specialties, such as surgery, internal medicine, and pediatrics.1–11 Three key studies have been published that evaluated the factors that influence career choices in the pharmacy profession. A study by Besier, et al evaluated practice area choices by entry-level pharmacy students in their final year of study at 12 pharmacy schools in the Midwest in November 1988 to January 1989. This study showed that chain community pharmacy was chosen most frequently when assessing first practice choice, and that the three most influential factors affecting practice choice were personal fulfillment, salary, and the opportunity to use one’s abilities and education.3 A study by Piercy, et al in 2008 assessed whether specific factors have influenced pharmacists to choose retail pharmacy over academia. This study found that an average of 89% of retail pharmacists agreed that salary was the greatest factor influencing their decision to work in retail. Both groups felt they were adding value to their institution.4 A study by Savage, et al in 2008 evaluated factors that influenced career goals of pharmacy students in each of the four professional pharmacy years at the research institution. This study found that the most important factors that influence career goals were the work environment and benefits, with most respondents indicating that the retail chain setting would be their projected area of practice.5 Although these studies assessed many factors that influence career choices, factors specifically aimed at the community pharmacy setting are not predominant despite the fact that nearly two-thirds of the pharmacy workforce is in a community pharmacy practice setting.12,13 Specific links among advanced pharmacy practice experiences (APPEs), internship experiences, and factors that influence career choices in community pharmacy have also not been assessed. In addition, evaluation of pharmaceutical care services as an influencing factor for practice site selection seems to be absent from the existing studies, yet many pharmacies are providing pharmaceutical care services, such as medication therapy management (MTM) and pointof-care testing (POCT) for patients. This study took students’ experiences and pharmaceutical care services into account when evaluating factors that influence career choices and practice site selection in a community pharmacy practice setting.
Rationale and objectives The primary objective of this study is to identify factors that influence recent college graduates’ selection of first practice position in a community pharmacy site. As a secondary objective, collected data were assessed to determine whether exposure to or engagement in pharmaceutical care
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services during APPEs or internship experiences correlate with any of the identified factors.
Methods This study was submitted to The Ohio State University’s Institutional Review Board and was approved as exempt research. A list of 24 peer institutions was compiled, consisting of colleges of pharmacy that are similar to The Ohio State University in public perception, academic quality of programs, research focus, publications, accreditation, and/or community residency programs. The programs selected were derived from the perception rankings of U.S. News and World Report, The Annals of Pharmacotherapy “Ranking of US pharmacy schools based on perception, funding, and publications,” American Society of Health-System Pharmacists’ (ASHP) Online Residency Directory list of Community Pharmacy Residencies, the Big 10 Conference Schools, and a listing of Ohio colleges of pharmacy.14 –17 Each institution was contacted via e-mail requesting e-mail addresses of alumni graduates from the years 2004-2008. Seven of the 24 institutions agreed to participate in the study, and all external participating institutions requested to distribute the survey directly to their alumni rather than releasing the addresses to investigators. A nonvalidated web-based survey tool was developed to collect the data necessary to meet the stated objectives. Survey questions were predominately multiple choice and yes/no format. Questions pertaining to APPEs and internship experiences were adapted from a pilot survey developed by a faculty member and previously distributed to graduating PharmD students at The Ohio State University.18 Selection factors were determined through an evaluation of the literature.3,4,18,19 To include a variety of factors, several categories were considered: characteristics of a job, incentives of a job, pharmaceutical care factors, and internal factors. Factors were not separated into categories within the survey to avoid possible influence on participants’ responses. Terminology included a mixture of factors from previous studies and factors developed by the authors. Previous studies assessed a variable number of factors, ranging from 10 to 21. Nineteen factors were selected for analysis in this study, with a variety to represent the four categories mentioned above. The number of factors was limited because of the desire to keep the length of the survey at a minimum in hopes that participants would complete it in its entirety. A complete listing of factors can be found in Table 1. The survey tool was pilot-tested by a small group of community/ambulatory pharmacists (n ⫽ 12) and then modified to ensure clarity and relevance of questions. Modifications were minor and primarily consisted of clarifications in wording of questions. The survey instrument used Zoomerang (http://www.zoomerang.com; MarketTools, Inc., San Francisco, CA), a web-based survey tool. Contacts from participating institutions received an invitation e-mail providing a brief explanation of the research
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Table 1 Frequency of factors influencing selection of first community pharmacy practice position for community pharmacy survey respondents (n ⫽ 201) Factor
n (%)
Salary* Geography* (location of the pharmacy) Benefits* (eg, health insurance, retirement planning) Positive experience with the company through internship(s)* Schedule* (eg, hours in a workday, part-time, flexibility) Previous experience in provision of pharmaceutical care services with selected first community pharmacy position Sign-on bonus Positive interpersonal interactions with pharmacy staff at selected first community pharmacy position Vacation Company philosophy Characteristics of pharmacy patient population Obligation to company because of tuition reimbursement Opportunity to be involved in the development and/or expansion of new pharmaceutical care services Opportunities for advancement within the company Staffing Prescription volume Positive experience with the company through APPEs Other Established pharmaceutical care services at pharmacy Precepting opportunities
110 (55%) 91 (45%) 90 (45%) 86 (43%) 82 (41%) 49 (24%)
47 (23%) 43 (21%)
40 (20%) 38 (19%) 37 (18%) 37 (18%) 36 (18%)
36 (18%) 29 (14%) 26 (13%) 24 (12%) 17 (8%) 16 (8%) 13 (6%)
* Selected significantly more often (p ⬍.05).
project and a URL link to the survey tool, to be forwarded directly to participants. Completion of the survey instrument served as consent to participate in the study. Participants were informed that the responses would be kept confidential and that data would be reported in aggregate. An incentive was offered for completion of the survey in the form of a drawing for three gift cards in the amount of $50 each. The survey was distributed to participating institutions in January 2009 and participants were given four weeks for completion based on distribution date. Reminder e-mails were sent to the institution contacts at two weeks with a request for redistribution of the invitation. The survey was closed in early March 2009. Participants from all practice settings were invited to complete the survey because surveys were distributed directly from the participating institutions and the researchers had no way of pre-identifying the practice setting of the graduates. The intention of the study was to focus specifi-
cally on data from community pharmacy practice settings. The first set of survey questions assessed the pharmacists’ first practice position after graduation from pharmacy school, as well as factors that influenced the selection if their first practice position was in a community pharmacy. Participants could choose up to 6 factors from a list of 19. This assessment of factors in community pharmacy was then followed by a question asking whether participants provided pharmaceutical care services while employed at their first pharmacy practice site, with pharmaceutical care services defined as pharmacy services offered above and beyond required patient counseling as defined in the Omnibus Budget Reconciliation Act of 1990.20 The next question set related to APPEs during the last year of pharmacy school. APPEs were defined within the survey as unpaid experiential rotations each student completes during his/her last year of pharmacy school. Exposure to and involvement with pharmaceutical care services during these experiences was assessed. Exposure and involvement were not defined within the survey. It was intended that exposure meant the student witnessed or observed the provision of these services, but did not participate in the encounter. Involvement meant the student participated in the interaction with the patient and provided a component of the pharmaceutical care service to the patient. Questions regarding exposure to and involvement in pharmaceutical care services during paid internship experiences then followed, including an assessment of whether participants’ first position was with the same company as the internship experience, and whether tuition reimbursement was accepted. Internships were defined as paid pharmacy work experience completed while in pharmacy school. The last portion of the survey consisted of demographic questions. Survey responses were summarized by reporting frequencies and proportions for each answer. Factors that influence selection of a community pharmacy practice site were reported as proportions and ranked in order of frequency. McNemar tests were performed to compare the most frequent influential factor responses to the other response options, using Holm’s step-down testing procedure to adjust for multiple comparisons. Fisher’s exact 2 tests were also used in secondary analyses to evaluate associations between first practice site selection factors and the influences of APPEs, internships, and demographic characteristics. Within each factor, Bonferroni adjustments were made to control type I error. Survey results were downloaded from Zoomerang and statistical analyses were performed using the SAS System version 9.1 (SAS Institute, Cary, NC).
Results A total of 2582 survey invitations were distributed among recent graduates from seven participating institutions in Arizona, Minnesota, North Carolina, Ohio, Tennessee, and Virginia. Between January 15, 2009 and March 2,
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Table 2 Distribution and response of surveys by state State where attended pharmacy school
State of current residence
States
Total surveys sent (n ⫽ 2582)
Community practice setting (n ⫽ 182)*†
Noncommunity practice setting (n ⫽ 196)‡
Community practice setting (n ⫽ 182)*
Noncommunity practice setting (n ⫽ 196)‡
Arizona Minnesota North Carolina Ohio Tennessee Virginia Other
302 552 414 610 574 130 —
10 (5%) 39 (21%) 25 (14%) 57 (31%) 29 (16%) 22 (12%) —
22 (11%) 43 (22%) 23 (12%) 52 (27%) 41 (21%) 13 (7%) 2 (1%)
7 (4%) 36 (20%) 19 (10%) 46 (25%) 26 (14%) 23 (13%) 25 (14%)
13 (7%) 34 (17%) 18 (9%) 44 (22%) 26 (13%) 15 (8%) 46 (23%)
* 182 participants completed demographics (vs total n ⫽ 201). † “Community Practice Setting” identifies survey respondents who are currently working in a community pharmacy setting. ‡ 196 participants completed demographics (vs total n ⫽ 219).
2009, the survey was completed by 420 participants, giving a 16% response rate. Table 2 shows the distribution and response by state. Among the 420 respondents, 201 (48%) practiced in a community pharmacy setting as their first practice site. These sites included community pharmacy chains, grocery/supermarkets, independents, and mass merchandisers. Most community respondents were female (n ⫽ 128; 70%), the predominant age range was 25–29 years (n ⫽ 117; 64%), and 32% (n ⫽ 59) graduated from pharmacy school in 2008. Most of the participants attended pharmacy school in Ohio and are living within the same state. The remaining demographic characteristics for respondents practicing in community pharmacy can be found in Table 3. Survey participants were asked to select (but not rank) their top six factors influencing selection of their first com-
Table 3 Demographics of community practice survey respondents (n ⫽ 182)* Variable
n (%)
Men Women Age (y) 20⫺24 25⫺29 30⫺34 35⫺39 40⫺44 45⫺49 Year of graduation from pharmacy school 2004 2005 2006 2007 2008
54 (30%) 128 (70%) 5 (3%) 117 (64%) 44 (24%) 11 (6%) 4 (2%) 1 (1%) 30 (16%) 25 (14%) 35 (19%) 33 (18%) 59 (32%)
* 182 participants completed demographics (vs total n ⫽ 201).
munity pharmacy practice position. Responses of community pharmacists can be found in Table 1. When using the McNemar test with Holm’s adjustment, the factors “salary,” “geography,” “benefits,” a “positive experience with the company through internship,” and “schedule” were each selected significantly more often than each of the other factors (adjusted p ⬍.001 for each pair). The frequency of these top 5 factors did not differ significantly. Factors related to pharmaceutical care were not found to be significant influences when selecting a first practice position in community pharmacy. “Previous experience in provision of pharmaceutical care services with selected first community pharmacy position” was the sixth most frequently selected factor with 49 respondents (24%), and “opportunity to be involved in the development and/or expansion of new pharmaceutical care services” was thirteenth with 36 respondents (18%). The last of the factors related to pharmaceutical care was “established pharmaceutical care services at pharmacy,” and this factor ranked eighteenth of the 19 specified factors with 16 respondents (8%). Although these factors were not significant influences when selecting a practice site, 53% (n ⫽ 106) of community respondents provided pharmaceutical care services while employed at their first practice position.
APPEs Survey participants were asked to provide the number of completed APPEs in community pharmacies during the last year of pharmacy school, followed by the number of these experiences where pharmaceutical care services were provided. Most participants had two (31%) or three (22%) community APPEs, yet 31% of participants revealed that none of their sites provided any pharmaceutical care services. The predominant number of community APPE rotation sites that provide these services was 1 (n ⫽ 63, 33%).
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Each survey participant was asked a series of questions to assess both exposure to pharmaceutical care services during community pharmacy APPEs, and involvement with these services. Specific services listed included comprehensive medication reviews, immunizations, a variety of point-of-care experiences, and disease state management. The distribution of responses can be found in Table 4. Overall, 70% of participants were involved in pharmaceutical care services during APPEs. The most common area of exposure and involvement was in POCT, with 47% being exposed and 42% being involved in this service. Survey participants with exposure to POCT during APPE (adj. P ⫽ .03) and those with involvement in POCT (adj. P ⫽ .048) during APPE were significantly more likely to list “opportunity to be involved in the development and/or expansion of new pharmaceutical care services” as a top factor in selecting their first practice position. Twenty-nine percent (n ⫽ 55) of respondents took their first job with the same community pharmacy where an APPE rotation was completed. These respondents were significantly more likely to list positive APPE experience as a leading factor (adj. p ⬍.001) for practice position selection. Internships Participants who engaged in paid pharmacy internship experiences during pharmacy school were asked to define their pharmacy setting(s). Participants could select more than one setting if applicable. This distribution can be found in Table 5. Overall, 82% of participants engaged in a paid pharmacy internship, with 79% practicing in a community setting. The most common community setting was a chain pharmacy (n ⫽ 88, 44%). The results of the assessment of exposure and involvement in pharmaceutical care services during internship experiences can be found in Table 4. Overall, 57% of respondents were involved in pharmaceutical care services during internship experiences. The most common area of exposure and involvement was immunizations, with 30% being exposed to and 22% being involved with this service. Sixty-eight percent (n ⫽ 104) of respondents took their first community position with the same company as their internship experience, and 45% (n ⫽ 53) of respondents received tuition reimbursement from the company. Survey participants taking their first practice position with the same company where they completed a paid internship (adj. p ⬍.001), those who received tuition reimbursement for an internship position (adj. p ⬍.001), and community pharmacists engaged in paid pharmacy internships in the grocery/ supermarket setting (adj. p ⬍.03) were significantly more likely to select “obligation to the company due to receipt of tuition reimbursement” as a top factor in selecting their first practice position. Respondents whose first pharmacy job was with the company where they completed a paid intern-
ship were significantly more likely to list “positive internship experience” as a leading factor (adj. p ⬍.001) and less likely to list “schedule” as a top factor (adj. p ⬍.001). Discussion and conclusion There are a variety of factors that influence pharmacy graduates’ choice of first practice position. This study evaluated the top factors selected by new graduates when choosing a community pharmacy practice site as their first practice position. The overall top factor selected by survey participants for this study was “salary.” In the studies by Besier, et al and Carter et al, salary and financial rewards were top factors for community pharmacists when selecting their first practice position.3,21 Furthermore, salary was found to be the greatest factor influencing decisions to work in community pharmacy over academia in the study by Piercy, et al.4 According to the 2011 Pharmacy Compensation Survey Fall Edition, conducted by Mercer, the annualized base pay weighted mean was $118,700 for staff retail pharmacists and $112,000 for staff hospital pharmacists.22 Although this difference in salary is not large, this evidence shows community pharmacists are generally paid higher salaries. Selection of salary as a top factor may suggest that pharmacists are seeking financial stability, particularly after an extensive education that may have left them with significant amounts of debt. It is not surprising that “geography” is a top factor, selected by 45% (n ⫽ 91) of participants, because job seekers are often limited to a certain area based on personal preferences. Although Besier, et al did not assess geography as a factor, Savage et al found that as students advance in their pharmacy curriculum, geographic preference becomes a more important job consideration, with fourth-year students considering geographic preference of high to very high importance in their career goals.3,5 Furthermore, studies by Carter, et al and Traynor, et al showed that geographic location was of great importance and a strong influence when accepting a first practice position.21,23 As pharmacy jobs become saturated in select geographic locations because of changes in the economy and the increasing number of new pharmacy schools, it will be interesting to see whether this factor becomes less important. Students may need to be more open to the possibility of moving to secure a job in pharmacy practice. “Benefits” are also an important consideration for recent graduates. Forty-five percent (n ⫽ 90) of participants selected this factor as being influential in their choice of first practice position. This may suggest that health care needs and retirement planning are top priorities for new practitioners. “Benefits” was one of the most important factors for pharmacy students in Savage’s study as well.5 It was either not specifically assessed or not found to be significant in the other studies.3,4,21,23 Results of this study showed that a “positive experience with the company through internship(s)” was a top factor
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Table 4 Exposure and involvement with pharmaceutical care services during APPEs and internship experiences APPEs (n ⫽ 190)†
Internship (n ⫽ 190)‡
Pharmaceutical care service
Exposure
Involvement
Exposure
Involvement
POCT
94 (47%)* (Adj. p ⫽ 0.03) 89 (44%) 76 (38%) 74 (37%) 69 (34%) 42 (21%) 52 (26%) 5 (2%)
85 (42%)* (Adj. p ⫽ 0.048) 62 (31%) 60 (30%) 72 (36%) 63 (31%) 37 (18%) 60 (30%) 3 (1%)
33 (16%)
31 (15%)
60 (30%) 22 (11%) 27 (13%) 24 (12%) 10 (5%) 73 (36%) 3 (2%)
45 (22%) 18 (9%) 26 (13%) 20 (10%) 9 (4%) 87 (43%) 1 (1%)
Immunizations Disease state management Patient education associated with POCT Comprehensive medication reviews Pharmacist-initiated follow-up with POCT Not applicable Other
* Significantly more likely to list “opportunity to be involved in the development and/or expansion of new pharmaceutical care services” as a top factor. † 190 participants completed APPE questions (vs total n ⫽ 201). ‡ 190 participants completed internship questions (vs total n ⫽ 201).
for new community practitioners. This finding is similar to what was expected because it is presumed that an internship site is selected with the same mentality that a person would choose a new practice position. It is interesting to note that 68% (n ⫽ 104) of respondents took their first job with the same company where they completed an internship, yet only 45% (n ⫽ 53) of respondents received tuition reimbursement from the company. This suggests that half of the interns who continued to work for the same company were not committed before graduation and perhaps were uncertain of their postgraduation plans. This could be a focus area for recruitment efforts, both early in pharmacy school when internships are being selected, as well as in the months before graduation. Retaining interns may reduce training costs and capitalize on employee experience with the company, which can be invaluable for pharmacy employers. Pharmacy schools could consider providing guidance to students early in the curriculum about selecting a quality internship position, and encourage participation in school
Table 5 Distribution of pharmacy settings for internship experiences (n ⫽ 190)* Pharmacy setting
n (%)
Community pharmacy, chain Community pharmacy, grocery/supermarket Community pharmacy, independent Community pharmacy, mass merchandiser Hospital pharmacy Long-term care pharmacy Mail-order pharmacy Other
88 (44%) 45 (22%) 13 (6%) 14 (7%) 27 (13%) 2 (1%) 2 (1%) 4 (2%)
* 190 participants completed internship questions (vs total n ⫽ 201). Participants could choose more than one response for this question.
career fairs where possible internship and future employment opportunities would be showcased. Because schedule can largely affect lifestyle, the type of schedule, flexibility, the number of hours in the workday, the timing of the shifts, or perhaps the ability to work part time, may all be considerations when selecting a position. Schedule, in terms of flexibility, was evaluated in the studies mentioned here, but was not found to be significant. In this study, flexibility was assessed under the factor “Schedule (eg, hours in a workday, part time, flexibility).” “Schedule” was found to be a significant factor influencing selection of first practice position, with 40% (n ⫽ 82) of participants selecting this factor. Further research is needed to determine specifically which aspects of schedule are most important to community pharmacists. An important consideration regarding these “top factors” is whether these are the factors that we want our students to have as they enter the workforce. Salary, geography, benefits, and schedule are factors that may be outside of our influence as educators. These may stem from values and experiences that have been impressed upon the student early in life through family and culture. The top factor—“positive experience with the company through internship(s)”— might suggest the importance of mentoring and providing quality experiences to students during internship. Of particular interest to the authors was the area of pharmaceutical care. With changes in the profession to focus more on patient-centered care, it was hoped that these factors would be more influential. One consideration is whether students may not feel prepared to provide these types of services. Alternatively, perhaps pharmacy practice may be a few steps behind the advanced training we are providing to students in the curriculum, making it difficult to visualize and pursue this type of practice. Determining the reasons why these services are not more important
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factors in first practice position selection is an area for future study. One important finding related to pharmaceutical care was that pharmacists who had been exposed or involved in POCT during APPE were significantly more likely to list “opportunity to be involved in the development and/or expansion of new patient care services” as a top factor. Finding ways to provide more exposure for students and interns may allow pharmaceutical care services to be more influential to their practice site selection. This may involve schools of pharmacy being more selective when approving rotation sites, focusing more on those that offer these services, or implementing activities within the curriculum to allow students to observe or practice their skills. Exploring student attitudes toward expanded services and how to modify those attitudes may be beneficial as well. Table 4 illustrates that APPEs provide many more opportunities for exposure and involvement with pharmaceutical care services than internships. Overall APPE involvement was 70%, compared with 57% of respondents having involvement during their internship. This is not unexpected because often interns may be hired to assist with day-to-day activities within the pharmacy and learn the processes involved with dispensing prescriptions vs spending time involved with the provision of more expanded/advanced patient care services. Involving pharmacy interns in the provision of patient-centered care may lead to a more robust internship program, which could potentially improve retention of interns for company employers. The use of an e-mail survey provided a number of limitations, including limited access to alumni e-mail addresses, incomplete e-mail lists for all classes, and confidentiality issues, meaning surveys were distributed to recent graduates via a primary contact person at participating institutions. This allowed for the possibility of surveys being undeliverable because of spam filters and invalid addresses. The low response rate, lack of geographic diversity, and nonresponse bias may limit external applicability. Another limitation to the survey is recall bias, because participants were asked to remember their perceptions from one to five years ago when they graduated from pharmacy school and accepted their first practice position. Exclusion of introductory pharmacy practice experiences (IPPEs) as influential factors could be considered a limitation in this study as well. IPPEs may influence graduates’ job selection, particularly because they occur earlier in the pharmacy curriculum during a time when students may be more impressionable. An understanding of the factors that influence recent graduates’ selection of their first community pharmacy practice position is an important consideration for colleges of pharmacy and pharmacy employers. Despite the shift in the pharmacy profession from product provision to more of a focus on patient care, in this study pharmaceutical care is not a significant factor for recent graduates when selecting a first practice position in community pharmacy. With 53% of participants providing pharmaceutical care services at
their first practice positions and increased emphasis on pharmaceutical care through didactic education, it is important to evaluate why this factor is not a more significant influence. If recent graduates have little to no interest in providing patient-centered care or if they do not feel well-prepared, this could affect the future of our profession. Providing more opportunities for POCT during APPEs or internship experiences may enhance student understanding and interest in providing patient care services. In addition, pharmacy employers could consider placing more emphasis on internship programs and providing interns with more exposure to and involvement in pharmaceutical care services. Increasing the number of opportunities and the desire to provide pharmaceutical care services among pharmacy students and interns is necessary to grow the number of community pharmacists offering expanded patient care services and to advance the profession of pharmacy.
Acknowledgments We acknowledge Colleen (Clark) Dula, PharmD, for support with this project, and Kyle Porter, MAS, for statistical support.
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