DEVELOPMENT OF A PHARMACY RESIDENCY PROGRAM:
What is the value of a residency training program to your institution? Many authors have
already documented multiple advantages and value of providing residency training to
new pharmacy graduates. They include, and are not limited to:
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Positive impact on patient care, medication use safety, and quality within the
institution
Positive financial impact related to medication interventions and formulary
review services
Positive impact on departmental clinical practice and scope of services and
expansion of services
Positive impact on patient, departmental, interdisciplinary, and external
(pharmacy student) education
Positive impact on recruitment and retention
Institutions should start the investigative process, by asking and answering several
important questions including:
 Why should our pharmacy department start a residency training program?
 What will be the benefit to our department, our institution, and ultimately to our
patients if we have a pharmacy resident or residents training with us?
 What opportunities are unique to our institution and what do we have to offer a
potential resident training at our facility?
 What similarities do we have with other residency programs in our area? What
kind of programs do other local residency programs offer and how long have they
been in place and are they also accredited? Do we have a professional
relationship with these institutions for some collegial advice in planning for a
residency program at your site?
 Do we have the clinical and administrative talent in our department to support
residency training?
 Should we partner with a college of pharmacy?
 Are we financially able to support the residency training program and how can we
fund it with outside resources if necessary?
 Do we understand the value and need for ASHP accreditation of our program?
This process may take 3-6 months or longer meeting regularly with an exploratory
committee. Include your pharmacy director and one or two other pharmacy
administrators or clinicians if possible.
Preparation to turn your idea into reality requires the abilities of research and inspection
of your pharmacy practice site and services, your staff, and the mission and goals of the
department. Residency programs often support the mission, goals, and the vision for
your pharmacy department.
GETTING STARTED: THE BASICS
ASHP Resources
The following documents need to be thoroughly reviewed by members of the committee
and all are located on the ASHP website link for “Residency and Technician Program
Accreditation” located at www.ashp.org
“How to Start a Residency Program, What You Really Need to Know”
http://www.ashp.org/s_ashp/docs/files/RTP_HowStartResidencyPrgm.pdf
The ASHP Accreditation Standard for Postgraduate Year One (PGY 1) Pharmacy
Residency Programs
http://www.ashp.org/s_ashp/docs/files/RTP_PGY1AccredStandard.pdf
Or, if you feel your new program should be in a specialized area of practice, use
The ASHP Accreditation Standard for Postgraduate Year Two (PGY 2)
Pharmacy Residency Programs
http://www.ashp.org/s_ashp/docs/files/RTP_PGY2AccredStandard.pdf
If your practice site is located in a managed care or community setting, accreditation
standards for these practice sites are also available for review on the website:
Community Pharmacy Residency (PGY 1), prepared jointly by ASHP and American
Pharmacists Association (APhA),Managed Care Pharmacy (PGY 1), prepared jointly by
ASHP and The Academy of Managed Care Pharmacy (AMCP.
Additionally APhA, AMCP, and the American College of Clinical Pharmacists (ACCP)
have representation and are involved with the work of the ASHP accreditation
Commission on Credentialing that recommends new standards, recommends lengths of
accreditation and major changes in the accreditation process to ASHP.
Required and elective educational outcomes, goals, objectives and instructional
objectives for the residency programs are also posted on the website for each level of
PGY 1 or PGY 2 residency program training. These statements need to be reviewed
alongside the respective standard to understand the scope and magnitude of training that
is expected by your preceptors.
ASHP offers a new web based, on-line evaluation tracking system (ResiTrak™) for those
residency programs in the accreditation process to help track their evaluations and
completion of residency goals and objectives on-line.
Finally, review the sections in the appropriate standard related to pharmacy practice at
your site. Does the level of service described in the standard exist at your institution?
THE BOTTOM LINE: “SHOW ME THE MONEY”
Administrators in your institution will want three things from you when reviewing your
proposal. They want a concise summary of why you should implement a residency
program at your institution, the benefits of the program to the institution and pharmacy
department, and the bottom line, how much will it cost? The summary of the residency
program proposal and the list of benefits to the department and institution will be
generated from the introspective analysis you have performed with the assistance of your
committee.
RESIDENCY PROGRAM COSTS
Direct Costs
Salary and Benefits
Use your Human Resources Department to determine a stipend commensurate with other
residency programs in your area. Consider doing a salary analysis of what local residents
earn. What are the typical benefits that can be offered to this type of “short time” or
“contract” employee? Determine a travel budget amount that the resident can be
provided to be able to attend the ASHP Midyear Clinical Meeting and the regional
residency conference. Consider conference registration fees as part of the overall
amount.
Other direct costs associated with the program include ASHP fees for accreditation
(application fee and annual accreditation fee) and recruitment fees such as the annual
Residency Showcase and CareerPharm’s Personal Placement Service (PPS) during the
MCM to advertise and interview for your new program. The residency program director
and perhaps several preceptors in addition to the residents will be required to attend these
events and their costs should be taken into consideration.
Indirect Costs
Factor in the amount of time that preceptors and the residency program director will need
to set aside from their daily functions to focus on teaching the resident and performing
duties related to the administrative tasks of the residency program. This can be quite
substantial in beginning a new program.
FUNDING THE RESIDENCY PROGRAM
Reimbursement may be available to institutions via CMS (Medicare Graduate Medical
Education (GME) Pass-through Funding) for accredited PGY 1 pharmacy residency
programs. A full review of this topic is also located on the website:
http://www.ashp.org/s_ashp/cat1c.asp?CID=3567&DID=5667
Does your institution train medical residents and does it care for Medicare patients? You
may be eligible for this funding for your PGY 1 residency program. Consult your finance
office and human resources department. They may be aware of the process to file for this
type of funding for the department.
Pharmacy Pass-Through in Brief ( )
 Reimbursement available to hospitals for share of certain expenses associated
with accredited first year pharmacy residency programs
 Itemization and documentation of approved expenses required
 Reimbursement varies; approximately equivalent to percent of hospital’s
Medicare patients
 Details available in Federal register sections 412, 413
What if your pharmacy department does not qualify for Medicare Graduate Medical
Education Pass-through funding? Will you be able to incorporate one or more residents
based on your current FTE budget? Should you consider converting unfilled pharmacist
or tech positions to cover the salaries? If you are in the Veteran’s Administration you
have different sources of funding offered for programs in the accreditation process. Some
states or grants may also exist in your area to be considered for start up costs for a
residency.
Starting a residency is a major commitment for the long term of your organization.
Evaluate all the critical decisions above when considering discussions with your
administrator. Create your financial chart and set off on your new adventure.
Literature Search and information adapted from
‘HOW TO START A RESIDENCY PROGRAM”
Ross, Swanson, Bott, 1995 Update, Nelson 2005
“Developing an Approved Residency Program” Janet Teeters, presentation
VHA Leadership Conference 2006
Funding of pharmacy residency programs 1996, AJHP Vol 55 Aug 1 1998, p.1618-1619
Annecchini and Letendre
Understanding reimbursement for pharmacy residents, AJHP vol 55 Aug 1 1998, p.
1620-1623, Miller and Woller
Justifying pharmacy staffing by presenting pharmacists as investments through return on
investment analysis, AJHP vol 56 Nov 1, p. 2230-2234, McDaniel and DeJong
Pharmacy residency training in the future: a stakeholder’s roundtable discussion, AJHP
vol 62 Sep 1 2005, ASHP report
2003 ASHP Leadership Conference on Pharmacy Practice management executive
summary, Looking to the future: leading and managing change, AJHP Vol 61 May 15
2004, ASHP report
Advisory Board documents:
HR Investment Center interviews and analysis. PG 77
University of Utah University Health Care PowerPoint presentation
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