With more pharmacists growing weary of day-in and day-out pill-dispensing duties, clinical pharmacy is attracting druggists who want to play a vital role on the healthcare team.

Unlike many other pharmacists, clinical pharmacists are directly involved in patient care. The average hospital-based clinical pharmacist makes rounds with doctors, suggests drug therapies and monitors patient responses. In ambulatory care clinics, clinical pharmacists often determine formularies, and in industrial settings, they may conduct cost-benefit analyses on medications or educate insurance companies about new drugs.

Whatever the venue, more doors are opening for clinical pharmacists as doctors and nurses increasingly rely on druggists to help manage growing patient loads and insurance companies look to them to scrutinize drug expenses. The hours may be less predictable than in the retail environment, but the pay is comparable and the satisfaction levels are higher for pharmacists who enjoy a challenge.

"Opportunities are growing for clinical pharmacists," says Dr. Joe Calomo, assistant dean of experiential education and professional affairs at the Massachusetts College of Pharmacy and Health Sciences in Boston. "More hospital administrators are beginning to see the value of having a clinical pharmacist on staff, because it can save costs and improve patient outcomes."

Getting into the Field

While clinical pharmacists require no special licensing or education beyond the PharmD degree, landing a clinical pharmacy position typically means completing a one-year residency. Experts say hospitals prefer to hire seasoned pharmacists for clinical positions because of the work's critical nature.

"You need at least two years of experience on the job to be a qualified clinical pharmacist," says Karol Matsune, president of the Northern California College of Clinical Pharmacy. "Doing this job without experience is dangerous to the patients."

That's because hospital patients are generally more ill -- sometimes even critically so -- and the drugs more potent. Clinical pharmacists prescribe higher doses of medication, often intravenously, because they are able to monitor patient outcomes closely.

Stressful Rewards

Because they are more directly involved with choosing patient medications, clinical pharmacists carry more responsibility than pill-dispensing pharmacists. For that same reason, clinical pharmacists often say their jobs are more rewarding.

"Clinical pharmacy is new every day," says Keri Sims, immediate past president of the Gateway College of Clinical Pharmacy in St. Louis. "You get to see the direct effect of your recommendations -- good or bad."

If the patient has an adverse reaction to a drug, then it is the clinical pharmacist's responsibility to notify the doctor and suggest a better treatment. Clinical pharmacists also monitor dosages to make sure patients are getting enough -- but not too much -- of the drug therapy.

"I enjoy watching patients get better right before my eyes and knowing that I had a hand in it," says Matsune, who is also on staff at ValleyCare Health System in Pleasanton, California. "But it's serious business, because if you recommend a drug to the doctor and harm comes to the patient, then you feel responsible."

The Pharmacist-Doctor Relationship

Before they'll ever experience the stress or rewards of direct patient care, clinical pharmacists must establish trust with doctors.

"Trust is essential when you are affecting the well-being of a doctor's patient," Matsune says. "It takes time to build that trust, but once you are over that barrier, the relationship is very smooth and doctors begin to rely on you, because they know you can provide the same level of care in terms of drug therapy."

Sims says the clinical pharmacist's experience with a doctor will depend greatly on that physician's past interactions with pharmacists. "If you are working with physicians that have never worked with a clinical pharmacist or that haven't had positive interactions with them, then it can be more challenging to prove your worth," she says. "But if you position yourself as a competent resource, then it won't take long to win their trust."

For more information about careers in clinical pharmacy, visit the American College of Clinical Pharmacy and the American Society of Health-System Pharmacists Web sites.