Ninety percent of graduates from the University of Iowa College of Pharmacy landed the residences they wanted in 2016. That’s well above the national average of 68 percent, according to the American Society of Health System Pharmacists.

As recently as a decade ago, it was far less common for pharmacists to complete residencies after graduation, but they’re becoming more common as a way of providing soon-to-be-pharmacists with extra training—and to make them more competitive job candidates.

The number of residencies nationwide, however, has not kept pace with the growing number of pharmacy schools. In addition, a transformation in the way pharmaceutical services are delivered requires pharmacists to know and do more than ever before.

As a result, competition for residencies is fierce.

"We’re in an extraordinarily competitive environment," says Donald Letendre, dean of the UI College of Pharmacy. "That so many of our students are getting residencies speaks to the quality of our students. It speaks to their education and training, and it speaks to the dedication of our faculty."

Today's pharmacists are highly trained medical professionals who can do much more than dispense medication. They are well versed in drug-therapy management, preventative care, patient counseling, and chronic–disease-state management, which includes high blood pressure, diabetes, and high cholesterol. Pharmacists also are allowed to administer immunizations, except in four states—Wyoming, West Virginia, New York, and New Hampshire—where the types of vaccines they can administer are limited.

Letendre says pharmacists are improving the quality of health care and reducing the number of hospital readmissions by helping patients manage medications and follow treatment plans after they return home.

"In order to do that effectively, pharmacists need the highest level of education and training they can possibly get to work side by side with other health care professionals and to ensure patients get the best quality of care," Letendre says. "That's where the residencies come in: They provide that extra training and experience."

A variety of pharmacy residency programs across the nation range from one- to two-year posts, some even longer. Some take place in community pharmacies, while others are at hospitals and large acute-care facilities where pharmacy residents can specialize in areas such as pediatrics, psychiatry, administration, and ambulatory care.

Pharmacy residencies work much the same as medical residencies. Students apply to hospitals, medical centers, and community pharmacies that offer residencies across the country, interview at many of them, and then rank them according to their preference. Directors of residency programs also rank the candidates according to their program’s preference. Both lists are entered into a computer, and an algorithm creates a "match" that pairs candidates with programs.

In 2016, 43 out of 48 graduates from the UI College of Pharmacy who applied for a residency matched with their choice of program. Among them was Alyssa Cosnek, who landed one of six residencies through the Community Pharmacy Residency Program offered by the Department of Pharmacy Practice and Science at the UI College of Pharmacy.

Established in 1997, the community residency program at the UI is the longest-running accredited community residency in the nation. These residencies, which are open to any pharmacy graduate around the world, are offered at six community pharmacies in Iowa, including Towncrest Pharmacy in Iowa City, where Cosnek will be working for the next 12 months.

Randy McDonough, co-owner and director of clinical services at Towncrest and Solon Towncrest Pharmacy, has trained more than 20 residents in his career and says he believes residencies eventually will be required for all graduating students.

"Pharmacy is changing dramatically," says McDonough, who also is an adjunct professor at the UI College of Pharmacy. "Community pharmacists are being held responsible for achieving therapeutic outcomes and safe and effective care. Pharmacists, like other health professionals, are being evaluated based on clinical outcomes."

Residents in the UI Community Residency Program do more than dispense medication. Cosnek and others work to become experienced clinical providers who can manage patients' drug therapies, regardless of the clinical complexity or situation.

Stevie Veach, a clinical assistant professor and director of the Community Residency Program at the UI College of Pharmacy, says that one year of residency training is worth three to five years of on-the-job training.

"Residencies give residents the opportunity to further apply their clinical knowledge with consistent and regular oversight and feedback," she says, adding that 40 percent of graduates from the UI Community Residency Program still practice in Iowa.  

Paul Abramowitz, chief executive officer for the American Association of Health-System Pharmacists in Bethesda, Maryland, says he believes the growing interest in residency training and the demand for residency-trained pharmacists is a reflection of the changing role of the pharmacist.

"Residency training has been a powerful way to help position pharmacists as knowledgeable and credible leaders on the patientcare team," Abramowitz wrote in March in a blog on ASHP Connect. "It has also helped pharmacists take on even greater responsibility for medication therapy management and overall patient care."

The UI College of Pharmacy also is affiliated with nine other residency programs in Iowa, which are offered through UI Hospitals and Clinics, Iowa City Veterans' Affairs Health Care System, UnityPoint Health-Allen Hospital in Waterloo, Covenant Medical Center in Waterloo, Northeast Iowa Medical Education Foundation in Waterloo, and Waverly Health Center. Many of these residencies are multi-year posts in specialty areas such as pediatrics, oncology, psychiatry, and internal medicine.

Letendre says that in the case of large acute-care facilities such as UIHC, it is almost unheard of for pharmacists to be hired without residency training.

"That has become commonplace in acute-care facilities across the United States," he says.

"They have become very selective. As a consequence, they have become much more competitive because the number of applicants has increased and because the demands for residencies have increased by virtue of employment requirements."

Letendre is actively working with other health care organizations across the state to establish more residency programs. He also wants to develop incentives, such as student loan forgiveness, to encourage UI pharmacy graduates to practice in Iowa.

"We've already made a huge investment in their education," he says. "Why not make additional investments in their training so, at the end of the day, we hire them and they stay here?"