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Residency is a highly competitive, detailed and challenging process designed to create independent pharmacy practitioners who can advance the dynamic profession and provide direct patient care.¹  National Matching Service results demonstrate continued demand for this form of specialized training with nearly 3,500 post-graduate year 1 (PGY-1) and over 1,000 post-graduate year 2 (PGY-2) positions filled in 2017; a 36% increase in residency positions over the past five years.²  The decision to complete a residency may occur at any point during your professional career, but the application process will generally begin early in the final academic year with preparation for and identification of prospective residency programs.   Residency programs vary in many regards, including specialty and practice site, so how do you pick the right residency?

Factors to Consider

It can be overwhelming and intimidating when starting to search for residency programs, especially given the large number of quality options.  A few things to consider when applying include: your career goals, geographic location, number of programs, and program specifics.

Your ultimate career goals are the most important consideration to make when determining where/how to focus a residency search.  Prior to exploring residency programs in depth, you should reflect on what type of work activities you value most.  If you see yourself visiting with patients in a clinic on a daily basis, a PGY-1 program in an exclusive hospital setting may not be as ideal as one with a heavy ambulatory care component.  For individuals who are interested in management or leadership positions, a PGY-1/PGY-2 combined residency program in health-system pharmacy administration may be of interest. If you are more undecided regarding the direction of your career path, a PGY-1 residency with a variety of rotations can be helpful in making that decision.

Another consideration when deciding which residency programs to apply to may be geographic location.  With residency programs offered in every state and setting (urban, suburban, rural) there are many options.  It is important to remember if you are searching nationally, you will likely be expected to travel to interviews, which could include flights, hotel stays, and/or a rental car.  Programs often do not reimburse for these expenses.

The number of programs to apply to, application costs, and time demands should be your next considerations.  This will vary by candidate, but conventional discussion suggests targeting approximately six to ten residency programs, with the range varying from one program to dozens.  If you are looking at very highly sought after residency programs, you may want to apply to more programs; conversely, if you are more selective or feel confident in your program choices, applying to fewer programs is appropriate.  Cost is a factor in the number of programs to apply to as well. In 2017, the application cost was $100 for the first four residency applications and $40 for each subsequent application.³ Additionally, residency interviews occur in an approximate six week period from late January to early March, so keep in mind how much time is needed to dedicate and prepare for interviews when applying to programs.  Consider organizing your rotations around this time period to keep yourself open and available for interviews.

Residency program size should also be a consideration.  Some programs have one resident position while others have dozens at one or multiple sites.  Choosing the size of a residency program is based on individual preference; some may prefer having many colleagues completing training with them while others may prefer to be the only resident at a site.  For individuals who know they will pursue specialty PGY-2 training program after PGY-1 training, choosing a program with a residency in their PGY-2 area of interest can be desirable as programs may “early commit” PGY-1 residents into PGY-2 programs.  The early commit process occurs before the national matching deadline and oftentimes before the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting and Exhibition, which may reduce anxiety associated with searching for a PGY-2 program during PGY-1 training.  On the other hand, completing PGY-2 training at a different site than PGY-1 training can offer a unique perspective on practice or ability to train in a diverse geographic location.

Residency program type should be evaluated and considered as it relates to your career interests.  There are four general types of PGY-1 residency programs accredited by the ASHP: pharmacy, community, managed care, and combined PGY-1/PGY-2 training programs, where a candidate commits to two years of training in a specialty area (e.g. pharmacy administration).⁴  Evaluating program training site specifics is important. For example, a PGY-1 pharmacy residency may train residents in a hospital or ambulatory setting, or both.  Residents may operate in an academic medical center, community hospital, or critical access facility.  Additionally, health-system involvement or multi-site practices may be available.   For example, some larger or specialty hospitals may offer PGY-1 resident rotations in specialty areas such as transplant or pediatrics, while other locations may not. Additional considerations for residency programs include teaching opportunities or affiliations with colleges of pharmacy, teaching certificate programs, residency project offerings, patient demographics, and core and elective rotations.

One way to determine if a residency program will prepare you for your career of choice is to evaluate how and where past residents are now employed.  This can help you infer if the residency program will prepare you for your desired career.  There are many paths to get to your ultimate career goal.  Choosing a residency type that best aligns with future career goals is a good way to jumpstart a career path, but is not the only way to get there.

A few final and practical considerations are the stipend (generally similar across programs), cost of living in the area, health insurance, retirement offerings, start/stop date, and the staffing commitment. The significance of these factors will vary by individual, and while important, should not be the driving factor in the decision to apply to a particular residency program.

Gathering Information

It is helpful to have a strategy about how to begin to gather the necessary information to evaluate the above considerations.  A few important resources include the ASHP Residency Directory, the ASHP Pharmacy Student Forum Student Residency Guide, residency showcases (both local/state and national), the individual program site website (if applicable), and any contacts you have made through networking.

The ASHP website has a variety of information about residency training, including resources for applying to residency programs. Many materials have been created by the ASHP Pharmacy Student Forum and are available on the website.⁵ Additionally, the ASHP Residency Program Directory provides information regarding accreditation status, national matching service code, program contacts, and structured information about each residency program.⁴ The ASHP website and Residency Directory are excellent places to begin gathering information on residency programs.

Determining when and which residency showcases to attend is also an important factor in gathering information on the right residency for you. Many state societies or colleges of pharmacy offer regional residency showcases in the fall, and can offer you an early experience in approaching residency programs. These showcases are an economical way to learn about and meet representatives from many residency programs in a particular geographic location.

The ASHP Residency Showcase is held during the ASHP Midyear Clinical Meeting and Exhibition.⁶ The ASHP Residency Showcase includes hundreds of residency programs from across the country and is typically held over two days in separate 3-hour sessions.  It is very important to review the ASHP Residency Showcase website prior to attending Midyear to learn which programs are attending, which day and time each program is available in the showcase, and where the booth for that program will be located.  You should create a coordinated plan for the programs you want to visit during all showcase blocks.  This plan can be developed before travelling to Midyear and should be reviewed and confirmed prior to attending each showcase.  The ASHP Residency Showcase is primarily intended for final-year students, but students earlier in their professional training are able to attend the last hour of each session.  Personnel Placement Service (PPS) interviews for some residency programs also occur at Midyear, particularly for specialty residency programs.  The ASHP Residency Showcase and PPS can be especially beneficial in information gathering for individuals interested in residency programs across a large geographic area.

Reviewing a residency program’s website can provide significant information about the training site as a whole.  Generally, information related to the location’s mission, vision, and goals will be on the organizational website.  This can give you an idea of how close the facility matches with your own philosophy.  The program-specific website can provide more information on rotations, preceptors, and other specifics compared with the ASHP Residency Directory.  Similarly, speaking with colleagues who are employed by, or have previously completed residency training at the site of interest, can be an invaluable opportunity to learn more about the residency program.  

Making Decisions

After deciding which programs to apply to, coordinating references, letters of intent, supplemental applications, and interviews, you will need to decide on the right residency for you.  Arguably, the biggest criterion for both parties (program and candidate) is to determine the “fit” during your interview.

Prior to the interview, ask yourself what you want to know about the program that you have not learned through your preparation.  Coming to an interview with a list of insightful questions shows you are well prepared and will ensure you have similar information for all program interviews.  Observe how the residents act, individually and with each other.  Find out what is expected of each resident, from the program director, preceptors and the director of pharmacy.  Do not be afraid to ask several questions of your interviewees, even asking the same question of multiple people.  Ultimately, you want to see how the program fits your needs, and how you fit the program’s needs.  Be sure to take notes as you go through the day, and do not overlook any “gut feelings” you may have related to the people, site or program.  The “fit” can be valuable in determining the right residency program for you and increase your chances of a successful year.  The more information you get in preparation and on site, the easier your decision on ranking may be.

After completing all interviews, you will rank those residency programs. Review your notes from each of the programs, what each program can offer (e.g. do all programs offer all the rotations or components you feel are important?), and your “feel” of each program (what you liked and disliked).  You may realize that one or more programs do not fit your search criteria/goals as well as you thought, or you did not like the “feel” of it.  In this case, you should seriously consider not ranking that program.  It can be a difficult decision, but ultimately you need to feel comfortable with every program you rank as there is a chance you may match there.  Matching with a program is a one-year commitment and not one to be taken lightly.  Before submitting your final list, reach out to mentors, past and current residents, and anyone else whose opinion you value, to discuss your decision.  Ensure you feel comfortable with all programs you have ranked and the order in which you have ranked them.

The ranking decision can be difficult, but by carefully reflecting on what is important to you and ensuring you have adequately gathered information will make the process smoother and confirm you have chosen the right residency program for you!

Acknowledgements: A special thanks to the ASHP New Practitioner Forum Career Development Advisory Group for their feedback on the final draft.

Disclaimer: The views in this article reflect those of the authors and may not reflect the views of ASHP or its members.

References

1. Johnson TJ. Pharmacist workforce in 2020: implications of requiring residency training for practice. Am J Health Syst Pharm. 2008;65(2):166-70.
2. National Matching Services Inc. Summary results of the Match for positions beginning in 2017 combined Phase I and Phase II. ASHP Resident Matching Program. 2017.  Last accessed: April 13, 2017. Available at: https://www.natmatch.com/ashprmp/stats/2017applstats.html
3. ASHP Phorcas. Payments and Fees. Last accessed: February 27, 2017. Available at: https://portal.phorcas.org/phorcasHelpPages/frequently-asked-questions/payments-and-fees/index.html
4. ASHP. Online Residency Directory. Last accessed February 27, 2017. Available at: https://accred.ashp.org/aps/pages/directory/residencyProgramSearch.aspx
5. ASHP. Student Residency Guide. Last accessed February 27, 2017. Available at: http://www.ashp.org/menu/MemberCenter/SectionsForums/PSF/ResidentInfo.aspx
6. ASHP. Meetings and Conferences. Last accessed February 27, 2017. Available at: http://www.ashp.org/menu/Events/Conferences