The roots of pharmacy can be found throughout many cultures around the world. Histories of men and women discovering and preparing remedies can be traced back thousands of years, long before the first pharmacy was ever created. These were times where medicine would go hand-in-hand with magic, and it wouldn’t be uncommon for these two services to be performed together — of course, not the card tricks or pull-the-rabbit-out-of-the-hat magic, but the magic that heals and cures ailments.

Pharmacy can also be tracked back to religions. In Greek and Roman mythology, Hygieia, the goddess of health, was responsible for compounding medicines. So, it can be seen that the idea to designate someone to properly, meticulously, and safely prepare a mixture meant to cure and heal, is not a new one.

Although the origins of pharmacy may have grown out of plants, herbs, and the humble mortar and pestle, it has retained some of its magical qualities as it has bloomed into the dynamic profession that we see today.

Upon graduation, there are more career paths for a pharmacist now than ever before. Whether you’re a current healthcare professional, a budding pharmacy student, or just curious about the world of pharmacy, it’s valuable to understand the different roles the modern day pharmacist can play in our current healthcare system. Below, we take a high level look at a few different pharmacist roles.

The community pharmacist

From large grocery store chains to “mom and pop” pharmacies, people are most familiar with this pharmacist role. The pharmacist has many responsibilities, but ultimately ensures that the patient is getting an appropriate and safe medication.

After a pharmacy receives a prescription from a provider or a patient, it goes through numerous steps completed by a pharmacy technician or a pharmacist. This includes responsibilities like:

• Verifying the authenticity of the prescription
• Ensuring the medication is available
• Reviewing health insurance coverages
• Checking for potential drug interactions
• Making sure the prescribed dose is correct

Other services that have been brought to the community pharmacy include vaccinations and health screenings like blood glucose levels, blood pressure, and much more. 

Although many graduates go directly into community pharmacy after completing pharmacy school, some continue training by completing a PGY-1 residency in community pharmacy. These pharmacists typically go into an administrative role, such as store or district management, focusing on pharmacy experiences and services instead of frontline duties.

The hospital pharmacist

For the purpose of this article, this is a general term for pharmacists who work in a hospital setting. But the range of roles and specialties that can be found within a hospital is vast to say the least.

Hospital pharmacists play integral roles on the healthcare team in providing the best possible medication therapy to patients. This may include rounding with the medical team to track a patient’s daily progress, recommending medications based on patient-specific factors, preparing patients for discharge, compounding IV medications and chemotherapies, and responding to hospital codes.

Some of the areas that hospital pharmacists can be found to service alongside physicians include:

• Emergency medicine
• Critical care
• Internal medicine
• Infectious disease
• Solid organ transplant
• Oncology
• Investigational drugs

The ambulatory care pharmacist

For chronic conditions like high blood pressure, high cholesterol, and diabetes, patients often see providers in outpatient clinic settings. These types of conditions do not generally need the intensive attention and care as seen in the hospital setting.

The ambulatory care (also referred to as “amb care”) pharmacist can be found in a wide variety of clinics, from family medicine practices to surgery centers to dialysis centers. Depending on the state and the type of clinic, pharmacists often serve patients as a part of a collaborative practice agreement (CPA) with a physician who also resides in that facility. The pharmacists’ role is focused on, but is not limited to, medication therapy.

Other ambulatory care pharmacist duties may include:

• Patient interviews
• Physical assessment
• Point-of-care testing
• Dose adjustments
• Therapy recommendations

There are post-graduate residencies that focus on ambulatory care. This additional training can prepare the graduate in a variety of ways such as managing a clinic, starting a new pharmacy service, or going into academia, just to name a few.

The informatics pharmacist

Complex technologies are at the forefront of many professions and healthcare is no exception, especially within pharmacy. Regardless of whether a pharmacist is in the community, hospital, ambulatory care or any other setting, computer systems have become an integral part of pharmacy practice.

Informatics pharmacists both lead and assist the integration of technologies into healthcare workflow, especially around medication utilization. The use of electronic health records (EHR) has grown exponentially and the demand for qualified personnel to support the use of the system has grown just as fast.

Pharmacists on informatics teams work on systems such as computerized provider order entry (CPOE) and barcode medication administration (BCMA), which ultimately increase safety around medication use. There are also telehealth and remote order entry and review systems, where providers can deliver care through video, telephone, and computers when distance and convenience are factors in an individual’s healthcare.

The home health and infusion pharmacist

As healthcare advances, the ability for patients to receive medical care outside the hospital has greatly improved. This can be seen by the growth of infusion clinics and home health services, where patients can receive medication infusions at a clinic, a living facility, or even their own home.

Pharmacists play an important role in delivery and safety especially in this area as the medications are often compounded to each patient’s specific needs. As in most healthcare settings, collaboration is extremely important with physicians, nurses, and technicians to provide the most appropriate dosing regimens for patients with complex conditions. Services can range from IV antibiotics for patients with infectious diseases to medications for patients with autoimmune disorders to total parenteral nutrition (TPN) for patients who need nutritional support.

The long-term care pharmacist

Nursing homes are probably the most well-known type of long-term care (LTC) facility. Pharmacists can be found there, as well as in skilled nursing facilities, performing some of the same duties as hospital pharmacists.

Pharmacy services are usually split into two areas of focus: dispensing medications and providing consultations. This also includes duties such as:

• Monitoring drug levels in patients
• Adjusting medication dosages
• Dispensing medications to the floors
• Checking drug interactions
• Managing drug formularies

As many residents of long-term facilities are elderly, special attention is paid to the geriatric population. As the human body ages, its functions change. This includes how the body processes medications, which is important when it comes to monitoring drug level concentrations. This is why it’s common for long-term care pharmacists to be board certified in geriatrics.

The specialty drugs pharmacist

Specialty pharmacies are similar to community pharmacies in that they provide prescription medications directly to patients, but these pharmacies cannot be found in your local chain grocery store. Specialty pharmacies are named so because they focus on specialty drugs, which aren’t typically found in traditional retail pharmacies.

There are a variety of ways a medication can get classified as a specialty drug. One of the most common is if it has a very high cost. Specialty drugs can be extremely expensive, sometimes costing tens of thousands of dollars for a single bottle or package. Specialty medications can also be classified by their:

• Indication (complex and/or orphan disease)
• Route of administration (usually injectables)
• Side effect profile
• Special monitoring
• Administration
• Storage requirements 

Pharmacists in specialty pharmacies are experts in complex disease states, such as chronic inflammatory conditions, organ transplants, or various types of cancers that often require complicated medication therapy with close monitoring. Lab testing for drug levels to measure how the patient is responding to treatment is not uncommon. If a medication costs thousands of dollars, it is important to confirm that the patient is benefiting from the treatment.

Specialty pharmacists not only collaborate with prescribers to verify and document the appropriateness of medications, but also to determine if there are any suitable alternatives. There are times when a specific medication is no longer available, is too expensive, or causes intolerable side effects. In these situations, the pharmacist and prescriber work together to find the best options available for the patient. They also spend a great deal of time monitoring the patient to assess the medication for efficacy and side effects. Missed doses or improper handling have an impact on a medication’s efficacy, so it is especially important that specialty medications are taken correctly. As such, specialty pharmacists focus on educating patients on proper use and expectations. 

The oncology pharmacist

Oncology is the branch of medicine that focuses on cancer. Pharmacists who specialize in this area have many responsibilities which may include:

• Dosing
• Monitoring
• Compounding chemotherapy
• Dispensing chemotherapies, immunotherapies, and other supportive treatments for patients with cancer

Oncology pharmacists can be found both in the hospital and the ambulatory care settings, and many have had additional training focusing specifically in oncology, such as completing a PGY-2 residency and/or are board certified in oncology (BCOP).

Oncology pharmacists work closely with providers, nurses, and pharmacy staff to supply chemotherapy and supportive medications to patients. This can be a complex process as there are numerous types of cancers, many of which do not have simple, straight-forward treatment options. Pharmacists are often required to page through large amounts of research to find potential treatment regimens and work with providers on tailoring these regimens to meet a patient’s individual needs.

In general practice as well as for safety reasons, chemotherapy is time-intensive to dose and compound, and it requires high levels of attention for everyone that comes into contact with it, therefore, it is no surprise that it is also very costly to make. Pharmacists play a key role in managing the chain of custody with chemotherapy (and other high-cost medications), which helps reduce costs by preventing missed doses and minimizing waste.

They also play an important role in patient education on the types of medications they are taking and how to safely take them. By educating patients on the potential side effects of chemotherapy, how it may affect their body, and establishing realistic expectations of treatment, pharmacists have been shown to have a positive effect on medication adherence and outcomes in patients.

The nuclear pharmacist

A nuclear pharmacy provides medications that contain radioactive materials to hospitals and clinics for various types of procedures. These types of medications can be used for treatment, such as therapy for cancer, but a majority of the medications provided are used for diagnostic purposes.

Radioactive materials can be used in digital imaging procedures such as CT scans and MRIs. Regardless of the type of procedure, a nuclear pharmacist works on calculating how much of each element is needed for each medication and prepares doses accordingly, specific to each individual patient (though they typically don’t see any patients).

Quality control is especially important for nuclear pharmacists. Additionally, as the radioactive materials used in these settings decay relatively quickly, the doses must be compounded the same day the patient receives it. This means nuclear pharmacist shifts can often start as early as 3 a.m.

Nuclear med orders can be received as early as a couple days before the patient needs it, or as late as a STAT order for a patient needing it within the next couple hours. Problem solving and time management are important skills to have. As well as the extensive on-the-job training a nuclear pharmacist needs to go through in order to handle radioactive isotopes, pharmacists can also become board certified in nuclear pharmacy.

The industry pharmacist

Such as the hospital pharmacist is a general term for pharmacists in the hospital, the industry pharmacist is a general term for the many roles a pharmacist can find themselves in within the pharmaceutical industry. One position an industry pharmacist can be found in is the role of Medical Science Liaison (MSL). Each MSL focuses on a certain therapeutic area and is an expert in a specific product, such as a pharmaceutical, biotechnology, or medical device. MSLs provide education and support to physicians and other healthcare professionals regarding their specialty, often answering questions and ensuring proper use of their particular product. 

Pharmacists can also be found in the research and development (R&D) role in industry, focusing on pharmaceutical research, project management, data management and more in order to develop and bring new drugs to the market. Sales and marketing, drug information, regulatory affairs, health economics and outcomes research (HEOR), and manufacturing are some of the many other areas where there are pharmacists in industry. While some industry pharmacists complete a fellowship after pharmacy school, this is not always necessary when pursuing a career in industry.

The managed care pharmacist

Pharmacists can also be found working for managed care organizations (MCOs), health plans, and pharmacy benefit managers (PBMs). An MCO provides a broad range of clinical services for patients while focusing on quality and cost-effectiveness. PBMs are third-party entities that manage the pharmacy benefits for health insurance plans or employers. They focus on reducing pharmacy expenditures and improving healthcare outcomes.

Managed care pharmacists work in a variety of areas, including prior authorization (approving medications for individual patients) and focusing on larger concepts such as overall patient safety monitoring, formulary and drug utilization management, and clinical program development. Pharmacists in these areas are also involved in working with pharmacoeconomic and health outcomes, which concentrate on areas such as cost-benefit, cost-effectiveness, and cost-minimization. While some managed care pharmacists complete a managed care residency, others enter the managed care field later in their careers.

The poison control pharmacist

Poison control centers provide information and recommendations about dealing with potential poisonings. Healthcare professionals and the general public who call the poison control center when facing these situations will find a pharmacist at the other end of the line. From snakebites to swallowing batteries, poison control pharmacists are great problem solvers who stay calm under stressful conditions. This is important as many of the situations encountered in a typical day can be out of the ordinary.

Depending on the type of poisoning and the situation, there may not be a lot of data available as compared to other areas of medicine, therefore, pharmacists and other healthcare professionals must use their clinical knowledge and expertise to provide the best recommendation for each specific situation. It is not uncommon to see pharmacists with a special certification in toxicology when working in this setting that requires assessment of potential poisonings. 

The drug information pharmacist

From hospitals to PBMs, pharmacists that work in drug information can be found in various settings. These pharmacists work on collecting, assessing, and evaluating literature on the many medications that are available.

Much of the curated information is shared with other medical professionals to help guide decisions on drug therapy regimens and with patients to educate them on the drugs they receive. Not only do drug information pharmacists work on providing answers to medication questions and problems that are not readily available, they are essential to multidisciplinary teams, such as pharmacy and therapeutics (P&T) committees, especially when making decisions regarding the drug formulary in hospitals.

The compounding pharmacist

Compounding medications, the science of mixing and combining ingredients, can be traced back to the origins of pharmacy. Not all medications are available off the shelf in the required strength or dosage form, and therefore need to be compounded from raw materials.

Different training and regulations need to be followed for sterile vs. non-sterile compounding. Although not all pharmacies compound medications, compounding pharmacists can be found in settings such as the community pharmacy, the hospital pharmacy, and the veterinarian pharmacy. They solve issues such as making pills into solutions for patients who have difficulty swallowing, creating custom doses or combinations of medications, producing large batches of IV medications for an entire hospital, or compounding the appropriate doses for our pets.

The takeaway

As you can see, there are many paths for a pharmacist to take. We have covered quite a few positions where pharmacists can be found but this is not an all-inclusive list. There are many more roles out there where pharmacists make a difference, and within the ever-changing field of healthcare, more opportunities will continue to develop. With the advances in technology and capabilities in medicine, we look forward to what the future has in store for the dynamic pharmacist.