Stay Up to Date
Breaking News,
Updates, & More
Click Here to

So You Want to Be an Oncology Pharmacist Specialist. What Are Your Options?

TOP - February 2012, Vol 5, No 1 published on February 28, 2012

I will say right up front that I am all in favor of specialty pharmacy training and the subsequent board certification. The real questions are: how much training is enough? how much is too much? and what options are available? I’ve been in the oncology business for over 30 years now and began when there was no real specialty training to speak of. In fact, my introduction into the specialty just happened; it wasn’t planned at all. I wanted to stay in Madison, Wisconsin, when I finished my hospital pharmacy residency, but I was actually more interested in emergency care. I happened to come across an announcement that the oncology department was looking for a coordinator to handle their new National Cancer Institute (NCI) contract, so on a fluke I went in and talked with the physician who was the principal investigator. We got along, and I was hired to manage the University of Wisconsin Comprehensive Cancer Center’s phase 1 NCI contract, working directly with the principal investigator. I had worked as a pharmacist on the oncology unit of the university hospital but had no additional formal oncology training. The rest, as they say, is history. The bottom line is that I learned on the job. I was allowed to do what I was able to do and demonstrate that I was competent. So, I basically did everything. I saw all the phase 1 patients, helped the fellows do workups, wrote all the orders for the patients, followed the patients, had my own clinic, started most of the IVs, kept all the experimental drugs, mixed and administered all the drugs, did all the pharmacokinetic blood drawing, sample handling, etc, and kept all the records for the program. I managed between 70 and 100 patients each year for 2 to 3 active phase 1 trials. I also went to the phase 1 meeting at the NCI and was expected to present our data.

As I see it, specialty recognition is a 2-step process: one is training, and the other board certification. I know everyone is aware of the medical model with general medical/surgical training followed by specialty training and board certification. This is the model that pharmacy, for good or for bad, adopted years ago. First, the American Society of Health-System Pharmacists created accredited specialty residencies. The first accredited oncology specialty residency was in 1984. Once training was standardized to some degree through specialty residency training, it became easier to establish a scope of practice for oncology pharmacists. Once a scope of practice could be established, certification could be sought. So as far as oncology pharmacy goes, we have both accredited training and board certification available.

So, let’s add up the years. The average PharmD program in the US is now 6 years. Many students (like those at the University of Texas) have completed more than the 2-year pre-pharmacy program as our degree is now designed. A large percentage of our students already have an undergraduate degree upon entering pharmacy. If the average pharmacy student has already put in between 6 and 8 years of college before completing both a PGY-1 and then an oncology specialty PGY-2 year, the total time of training can easily reach 10 years. Also, many students, some of whom are married and have children, have completed up to 8+ years of pharmacy training and need to “get out” of school, take a break, and earn some money. Note that the $40,000 to $60,000 generally earned during the residency process may not be adequate for many of these students. This leads to the question, is 8 to 10+ years of training to become an oncology pharmacist specialist reasonable? Apparently many would say yes, because this is the process and timeline today. As I tell the students I interact with, you do graduate work and residency training (or any type of extra training) so that you can hopefully have a better chance of landing that job that you will love getting up for every morning. Those with the most credentials will generally have the better chance and more options available for getting a job they love. This brings up the issue of money. As I also tell the students with whom I interact, all the extra training you do may not mean you will make a lot of extra money in terms of salary, but hopefully it will mean that you will be happy at work every day. I can say after 30+ years of doing this, loving what you do every day easily trumps the money.

However, if you just cannot go straight through the 10+ years for your specialty training (including pharmacy school), is getting out and getting your oncology experience while you work as a pharmacist OK? My answer to this is yes!

Can someone learn oncology on the job? Absolutely! It just may not be the most efficient or ideal way of doing it. Trying to find a “clinical” position in a hospital or clinic may be difficult without residency training, but probably not impossible. Back in the day when there was no formal specialty training process, learning on the job was much more common. If you were a pharmacist who worked in oncology, sooner or later you were viewed as the oncology pharmacist (by default). Things have come a long way since then, and finding that perfect position where you can learn on the job is probably less common today. Many people hiring today want to bring in someone who can do the job right off the bat.

Another issue with all the training required for specialization is that many young people may not know what area of specialization they want to settle into at the time of their graduation or even residency training. Many of these do PGY-1 general training, and some even do PGY-2 specialty training in pharmacotherapy, yet they may not know exactly what they want to do for a living. From my years of training here in San Antonio, I can give you numerous examples of residents who completed their pharmacotherapy specialty residency training but are now “oncology pharmacists” in a variety of positions across the country. I have always called these my “recent converts” (those who swore they didn’t like oncology and did pharmacotherapy instead, only to “see the light” shortly after that and then “convert” to oncology). Even more recently, one of our master’s/pharmacotherapy residents is now an oncology specialist and lecturer at a college of pharmacy.

Is all the training—either going straight through or learning on the job—worth it to be an oncology pharmacist? It has been for me, but I cannot answer for you. You will have to decide...

Related Items
The Cost of Cancer Drugs: How High Is Too High?
Jim Koeller, MS
TOP - February 2013 VOL 6, NO 1 published on March 4, 2013
Oncology Is a Small World
Jim Koeller, MS
TOP - April 2012, Vol 5, No 2 published on April 30, 2012
Last modified: July 22, 2021