Elayne D. Ansara, PharmD, BCPS, BCPP
PGY2 Psychiatric Pharmacy Residency Program Director
Richard L. Roudebush VA Medical Center
Dr. Ansara is a mental health clinical pharmacist specialist and PGY2 Psychiatric Pharmacy residency program director at the Richard L. Roudebush VA Medical Center in Indianapolis, Indiana. Dr. Ansara received her Doctor of Pharmacy from Purdue University. She completed her PGY1 Pharmacy residency at IU Health in Indianapolis, Indiana and her PGY2 Psychiatric Pharmacy residency at Eskenazi Health and Purdue University, also in Indianapolis, Indiana.
So you want to start a residency program? Before logging-on to register for the Match and attending the Midyear Clinical Meeting in December, here are a few considerations when starting (or expanding) a new residency program. Here are three questions to ask yourself as you embark on this endeavor.
Does my facility have the resources to start a residency program?
First, ensure you have the resources at your facility to run an effective training program. If you have an existing program and are looking at expansion, you probably have a good idea about whether or not you can accommodate another trainee. For those looking to start a new program, a thorough self-assessment of your facility’s ability to support and sustain a residency program should be conducted. The American Society of Health-System Pharmacists (ASHP), which accredits all residency training programs, offers an online self-assessment tool to help you with this process.1 The “RU Ready Self-Assessment Tool” reviews all the required elements of running a successful residency program. These include not only the primary consideration of funding for the program, but also adequate staff to support the training of a pharmacy resident. The tool uses the residency accreditation standards as well as the defined competency areas, goals, and objectives to generate thought-provoking questions tailored to help the examiner determine if the support for starting a residency program is in place at the proposed training site.2,3
How do I fund the position?
If after performing a self-assessment it is determined that support exists for either expanding or starting a new residency program, a large hurdle that will need to be overcome is securing funding for the resident. In the case of Post Graduate Year One (PGY1) residency training, funding through the Centers for Medicare and Medicaid Services (CMS) can be obtained to provide payments to hospitals to support graduate medical education, this is usually referred to as Medicare “pass-through” funding.4 Reimbursement through CMS is not available for Post Graduate Year Two (PGY2) specialty programs; however, other funding sources can be explored to help support the program. Partnering with a local College of Pharmacy may be an option to help financially support a program. Other avenues of financial support may be grant funding from programs within your health-care organization. Conversations with your director of pharmacy, or if available, an educational officer within your organization can be helpful to determine what funding sources are available to you.
A major part of justification of the program, for both funding purposes and also to garner support from staff, is highlighting the benefits of having a trainee (or in the case of expansion, more trainees) at your facility. In a 2010 White Paper published by the American College of Clinical Pharmacists the authors illustrate several potential benefits, financially and otherwise, of having a trainee in the organization.4 These include areas such as clinical service contributions (e.g., direct patient care, research) and administrative service support (e.g., formulary review, committee membership). Potential indirect revenues from supporting a trainee include areas such as increasing the capacity of medical providers or garnering additional payments for pharmacy student education. Offering residency training programs can also help with staff recruitment, development, and satisfaction. Additionally, resident trainees can be utilized to help increase the organization’s capacity to deliver education and scholarship. In addition, they can be useful champions for supporting innovative and new pharmacy services.4 All of these areas should be considered, along with the role the resident can play, when justifying the need to expand or start a training program.
Where can I look when I have no idea what to do?
Additional support should be sought out from other programs at your facility (if in existence). Seek mentorship from those who have already paved the path to creating a program and capitalize on what they have learned in that process. If you are starting the first program at your facility, seek multiple mentors. Reach out to other residency program directors or advice or information about justifying a new program. Additionally, professional organizations such as ASHP as well as CPNP can provide useful tools and communities to help you with this endeavor. Within CPNP, a useful resource is being a member of the RPD Community. This community of RPDs serves to support and assist each other with residency related issues. Although the process of justifying a new residency training program can be, well in a one word…painful, the rewards of creating a sustainable program are numerous.