The most recent study published by the Center for Disease Control (CDC) in 2010 presented inspirational data for individuals interested in a career as a pharmacist. Statistics showed in the past decade, the number of Americans who needed at least 1 prescription medication rose from 44%-48%. For patients requiring between 2 and 5 prescriptions, the increase was 25%-31%. For those who required 5+ medications, the increase was nearly double–6%-11%.
For the time period of 2007-2008 the data revealed that for 1 in 5 children and 9 in 10 adults, each had used a prescribed medication in the 30 days preceding the study. These 2007-2008 percentages translate into billions of dollars spent on prescription medications–all of which required the work of highly trained and educated pharmacists. The United States spending totaled $234.1 billion; a number which had doubled in only 8 years.
“As new drugs are introduced and new uses for old drugs are found, more patients can have improved health and quality of life with the appropriate use of prescription drugs.” Center for Disease Control
Janelle Mann, Pharm.D., BCOP is a Board Certified Oncology Pharmacist who earned her Doctor of Pharmacy at St. Louis College of Pharmacy. She also completed a PGY-1 Residency at Froedtert Hospital, Milwaukee, Wisconsin as well as a PGY-2 Oncology Residency at Froedtert. Dr. Mann is an Assistant Professor of Pharmacy Practice (St. Louis College of Pharmacy) and is a Clinical Pharmacist in Oncology at the Siteman Cancer Center in St. Louis.
Dr. Mann, how many hours do you work each week?
It’s hard to quantify because there is a lot of overlapping time. I do a lot of reading related to my patient’s medical conditions. I’m really interested and passionate about learning oncology, so I don’t really count that as work time. In terms of hours, it flexes. My lowest is 45 hours a week. During my busy time of the year if I’m coordinating a course, or lecturing, the number gets pretty high. Fortunately my husband is aware of the demands I have with my jobs and is very supportive.
Are you able to spend with your family, friends?
I try to be balanced now that I have a little one. It’s important to me that my home time is focused on my daughter and my husband. Of course there are days where after she goes to bed I have to pull out my computer and finish a few things. I’ve really attempted to have work-life balance where I can come home and devote time to my family but also keep up to date in my area of practice and roles at the college.
Do you have time for hobbies/recreational activities? If yes, how much time?
I enjoy cooking, baking, and being in the kitchen. My neighbors and I do meal prep workshops. We get together for a couple of hours to put together meals for our families and at the same time catch up on each other’s lives. I value this time to catch up with friends, but also make delicious meals for the coming month that can be made quickly.
My days are always changing. Right now, Mondays and Thursdays are spent full time at my clinical practice at Siteman Cancer Center. I won’t get to campus often, and if I do it’s after 5 o’clock when our clinic closes. I might work from home those evenings on my College duties. Tuesdays are primarily spent in the clinic, but I get some time in the afternoon to work on College projects or schedule/attend meetings. On Wednesdays I’m mostly at the College except for one meeting with my team of providers at the clinic where we prep for the coming clinic days and discuss new patients. Fridays are split evenly between my two offices. In all honesty there is never one day that is the exact same, and each day can be shorter or longer depending on the case load. I try to be a team player. Even though my primary role is at the College and I provide a service for the clinic, I feel it’s important to participate as a full member of the team and that means staying late sometimes to help with patient care.
Why did you want to enter your field?
I found when I was in middle school and high school I liked chemistry and anatomy. I had a friend who was pursuing pharmacy, and I was very close to her. Through conversations with her I started to consider the field. I found out I could learn about drugs, the body, and how they worked together. Through these process conversations and shadowing different pharmacy positions in the summer months, I was able to learn more about the career.
Did you have a mentor, a person who inspired you or an experience which led you to your career field?
My mom worked in a hospital, so it really helped me navigate medical field pretty easily. I really got into science in high school (Nashville Community High School in Nashville, IL). My chemistry teacher, Mr. Meyer, had several students go on to pharmacy careers. He interjected some pharmacy themes and talked about past students who were currently attending pharmacy school into his course. It’s unique. Not a lot of teachers would do that. I think because he had so many prior graduates pursue pharmacy careers, he thought the community could benefit from it.
What characteristics do you think allow someone to thrive in this career field?
A pharmacist needs to be a career learner. I’ve learned so much since I’ve graduated. There are always new medications, new recommendations, and new studies to stay on top of in the field. There is something always happening, so it is exciting.
Many pharmacists enjoy direct patient interaction. It’s a chance to help the patient understand their diagnosis, and the role the medication will play in their treatment. Pharmacists have a wealth of knowledge about medication and how it will affect the body. Letting patients know about what to expect, and what they may encounter in the days and weeks ahead, is an important part of my job. It’s also incredibly fulfilling to know I helped a patient gain a level of understanding about their diagnosis, treatment, and adverse effects.
What have been the characteristics that have allowed you to be successful?
The pharmacists I’ve seen who are the most successful at their jobs are always looking for ways to improve. That drive for improvement touches on all aspects of their career. They want to know about the latest studies and research to help their patients, whether they give patients the information directly or talk with their prescribing physician about treatment. I’ve found physicians often seek out pharmacists for their knowledge of medications.
That spirit of improvement also has a direct impact on patient treatment. Pharmacists regularly review patient medication lists, and armed with the latest knowledge, look for ways to improve treatment plans. It may take the form of combining medications to reduce the number of pills a person takes on a daily basis, or reduce a side effect the patient is experiencing.
What gets you excited about your job and why?
In the classroom, I enjoy bringing the latest information and patient cases (without patient names to protect their privacy) into the students to discuss. The students have an incredible opportunity to discuss real people and real cases and make treatment recommendations based on their knowledge. I’ll also take them through my recommendations and explain my thought processes. The questions the students ask definitely help me stay on top of my game! I also enjoy seeing the spark of understanding in the student’s eyes when they make new connections by combining concepts they’ve learned separately over the past several years.
My work at my practice site at Siteman Cancer Center is very exciting, but very daunting at the same time. We are changing the way we think about cancer treatment. When patients come to be treated their tumor may under additional genetic testing which can possibly hold the key to understanding how their cancer may be treated. As part of an interdisciplinary medical team of oncologists, nurses and social workers, it is my job as the medication expert to explore treatment options. I take the genetic information from the tumor and see what medication may work best. In some cases I’ve used medication initially developed for breast cancer to treat a patient’s lung cancer. I also take a lot of time looking for the data to support my thought process and then advocating for my patients with their insurance providers to help pay for treatment. The likelihood is we can’t totally get away from the traditional chemotherapy treatments. These new cancer medications are in addition to, or overlapping, treatments. In addition I also look at medications they’re taking for other health conditions the patient may have, like diabetes or high blood pressure which aren’t related to their cancer. There’s a good possibility of drug interactions between our recommended treatment of their cancer and the continued management of their prior medical conditions. Staying up to date and abreast of all the new medical and pharmaceutical breakthroughs keeps my area of practice ever evolving and exciting to apply and manage.
On a scale from 1-10 how hard was it to get where you are now? Was it worth the hard work and expense?
I have worked very hard to get where I am today, and am very lucky to have the complete support of my family as I pursue my dual careers of a clinical pharmacist and educator. I enjoy the direct patient interaction at my practice site because I see the impact I make in people’s lives. I am passionate about figuring out these complex puzzles, and I hope that enthusiasm comes through in my teaching as well. There’s been a boom in the number of cancer medications available in the last several years. I also enjoy being able to bring the latest information and treatment methods into the classroom to prepare future pharmacists. This is information to new for textbooks. It may seem difficult at the time when students start to learn the information, but when they graduate I hope they feel the same as I did. The professors that taught me in school brought forward the most current information and made me successful at delivering and practicing evidence based medicine and taught me how to be a successful lifelong learner. I would not change my experience during pharmacy school, even though it was difficult and challenging at times. All of the hard work and focus placed on my education has been worth the positive of getting to love my job and practice in an area that keeps me excited.
In your opinion, what have been the 4 most exciting breakthroughs in your career field within the last 5 years?
-Interdisciplinary care. Physicians lead the team, but there are so many additional players in the process. It’s about treating not only the cancer but the patient as well. We have social workers come in to help arrange rides to the center for treatment and help answer questions about insurance or financial assistance forms. The nursing staff and higher level practitioners provide personalized care and management to the patients through daily phone conversations and routine office visits they truly are the glue that keeps the team performing at a high level. I enjoy my ability to provide support to the team through medication recommendations and patient education. I am very fortunate to work with a great group of providers and support staff. We have the patient in the front of our mind and together we can provide enhanced patient care.
– Growth of cancer treatment options. With the growth of options we have the ability to talk with the patient and discuss how aggressive of a treatment option they want to pursue. Most patients have perceived options about chemotherapy and they’re understandably afraid. Depending on what stage of cancer they have, there are multiple treatment options including surgery and chemotherapy. Further development of tumor genomics has changed the landscape in oncology and continues to push the development of novel drug therapies and treatment approaches. I’m fortunate to be part of the team that takes these new drugs that are coming from bench research and being involved in their first human trials. It’s incredibly exciting. We’re seeing what happens with the patient, and managing these toxicities. When a new drug comes to us we have a good idea on what will happen based on similar drugs which are already on the market. Having the drugs come to us in the trial phase, and seeing it progress onto the market, we’ve almost managed to develop a protocol to manage side effects.
– Pharmacy education. Looking at the many fields of medicine students can pursue following high school graduation it can be overwhelming. I think the ability for pharmacy to have so many flavors and options makes it a great opportunity for tailoring ones interest within a great profession. Historically, I feel that pharmacy was seen as a community role with a strong dispensing emphasis, but this is changing. We are training students in pharmacy to provide medication recommendations directly with the healthcare team. We have new opportunities for pharmacists to work under collaborative practice agreements expanding the scope of practice. Community pharmacists are not only providing direct instructions to patients, but also monitoring and intervening on patients with several comorbidities. In addition to this the growth of pharmacy into the management field, pharmaceutical industry, and information technologies is very exciting. Pharmacy education is changing along with the many opportunities and tracks students can take. Preparing the future of pharmacy with sound clinical knowledge as well as professional and passionate clinicians, we can make great strides within the healthcare field.
-Evolving role of the pharmacy in oncology. I’ve seen the need for a pharmacist to knowing a lot about the drugs to treat the patient’s oncology medication and integrating that with their medication for other diseases like high blood pressure, heart disease, or diabetes. It puts pharmacists in a good position to recommend therapies that will help reduce side effects or drug interactions. Pharmacists can help coordinate care and management amongst the patient’s numerous specialty physicians and the primary care provider. Being up to date on pharmacotherapy and disease state management along with a knowledge of oncology pharmacology helps to bridge the specialty arena with primary care.
What one thing would you like to see changed in your field?
I would like to see some standardization of medical records. There are numerous systems out there. Some are home-grown within a hospital system, and there are several companies offering similar services. Translating across systems, and learning new systems, takes time. A standardized electronic medical record can could hopefully improve transitions of care for patients.
What do you hope to have accomplished by the end of your career?
I hope to continue to make a mark at my practice site. I’m optimistic I can grow the perception of what pharmacists can offer to the group there. There’s a great group of pharmacists working there to make the drugs and doing patient reviews, but they’re not interacting with the patients in the clinic. There’s a lot of opportunity for pharmacy to grow in that setting.
What advice would you give someone who wanted to follow in your footsteps?
Oncology pharmacy can be very intimidating. I didn’t understand it initially when I was in school. Having good patient interaction and good preceptors, I realized it was something I could pursue. It’s a rewarding career and I would not change my decision at all.
Thank you Dr. Mann!
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