A decade or so ago, patients could leave the hospital without seeing, speaking with or even thinking about a vital member of their healthcare team: The pharmacist. Tucked away from patients, pharmacists typically dispensed medications that physicians prescribed and nurses administered. Today, pharmacists have more clinical training and are eager to use it as they step onto patient floors and assume an integral spot on patient-care teams.

"Pharmacists are the experts in medication therapy, compared to nurses and physicians," says Jill Haug, PharmD, MBA, director of the American Society of Health-System Pharmacists' New Practitioners Forum. "They've had the most study in medication and are the best-suited to counsel on patients' medication therapy."

Pharmacy students often find their hospital rotation an "eye-opening experience," Haug says, because they use their clinical training daily and can see how it affects patients.

Variety of Venues and Positions

Hospital pharmacists, who work in teaching, cancer, pediatric, Veterans Affairs, psychiatric and other types of hospitals, typically hold:

• Staff positions, advising on medication selection, administration and dosing.
• Clinical positions involving direct patient contact.
• Administrative positions managing and coordinating the pharmacy and staff.

Hospital pharmacists also teach and conduct research.

The work of the following hospital PharmDs illustrates the level of clinical involvement, visibility and variety that hospital-based pharmacists enjoy:

Dual Duty

As a clinical specialist in pediatric intensive care, Sean O'Neill, PharmD, spends 70 percent of his time making patient rounds at Children's Hospital of Philadelphia.

O'Neill also helps develop policies and guidelines regulating the new drugs added to the hospital formulary and those used in the pediatric unit, a challenge he especially relishes. "Many new drugs don't have literature regarding the effects on pediatric patients, so we try to extrapolate the literature to pediatric patients and anticipate the effects," he says.

O'Neill spends his remaining time on his other passion: Infectious diseases. As clinical specialist in infectious diseases, he's responsible for the hospital's antibiotic approval system. He also makes rounds related to this specialty.

"I was lucky to find a job that involves my two areas of interest," he says. Demand for pediatric pharmacists is keen, but since there aren't many children's hospitals or ones large enough to support a pediatric pharmacy, opportunities may be limited.

With just two years' experience, O'Neill foresees a career path in which he moves up to clinical coordinator or clinical manager in a few years, then possibly to director of patient care -- a route similar to that of pharmacists who treat adults.

Academic Freedom

"We have a little something for everyone," says Mort Goldman, PharmD, assistant director of pharmacy for pharmacotherapy services at The Cleveland Clinic, a large academic medical center.

In 1991, Goldman left a position as clinical specialist in infectious diseases at the Cleveland VA Medical Center for a similar role at The Cleveland Clinic. He rose through the ranks, and in his current position, he's responsible for clinical pharmacy services, research and teaching.

Goldman supervises a 35-person staff, consisting mostly of pharmacists. In addition to acute-care clinical services for inpatients and ambulatory clinical services for outpatients, he is responsible for the drug information center, which manages the hospital's formulary and answers drug information questions from healthcare professionals. His research includes investigational drug services, pharmacoeconomics and outcomes research, and drug-utilization quality projects.

As part of their teaching duties, Goldman and his staff supervise pharmacy students on rotation from local universities; teach pharmacology at the Ohio College of Podiatric Medicine; and speak to the Clinic's medical staff and residents on pharmacology, therapeutics and cost-effective drug therapy. They even launched a pharmacology curriculum at the Clinic's new Lerner College of Medicine.

Clinic pharmacists work as traditional staff pharmacists, clinical staff pharmacists and clinical pharmacy specialists. Most clinical pharmacy specialists have completed specialized residencies and are more involved in research and education.

New grads coming in as clinical staff pharmacists typically receive an orientation and training for the first six to 12 months, then complete a core curriculum to learn additional clinical functions. They can pursue a concentration in areas such as ICU, oncology or internal medicine. Alternatively, they can diverge into an administrative role or, for more direct patient contact, move laterally into ambulatory care.