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Pharmacist of the Month:
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Dr. Kirby Lee is an Assistant Professor of Clinical Pharmacy at UCSF's Department of Clinical Pharmacy. He was more than happy to share his thoughts and experiences about pharmacy. He went to University of California, Santa Barbara for his undergraduate education and then attended University of California, San Francisco for pharmacy school.
Q: What made you decide to go into Academia?
I like a variety of activities. I am passionate about research, I like to see and take care of patients, and I also like teaching. There are very few careers where you can do all three. The best fit for me was a career in Academia, especially in UCSF where they do a lot of research, clinical, and teaching. Some schools are focus more on clinical and no so much on research, and I wanted a position where I had all three activities. It’s a little bit hard because you have to balance all three and succeed in all three… but it’s very rewarding if you can pull it off.
Q: What kind of research did you do?
After I finished residency, I did two years in fellowship (research-type training) in health policy research with the School of Medicine in UCSF. During my fellowship, I did a lot of research looking at how journal editors decide what kind of research papers to publish in their journals. These are major biomedical journals. We really wanted to see if editors are biased, if they selectively publish certain types of research on their journals, what not. This is actually a big deal right now regarding clinical research, because when we make health care decisions on how best to see a patient, or when health policy makers want to make decisions, we go straight to the medical literature. If the medical literature is inaccurate or incomplete, we won’t have the right sources to make a balanced, accurate decision in health care. We scrutinize editors to see if they are biased. To make a long story short, they actually do a good job and we didn’t find any bad bias. They do high quality research, randomized controlled trials, and report conflict of interests in funding sources. Now that I am faculty, I’m doing more research on geriatrics (health care of older adults). That’s my focus now.
Q: What is your role on your geriatrics research?
I’m part of the academic geriatric resource center in UCSF, an interdisciplinary collaboration that includes physicians, nurses, dentists, physical therapists, and pharmacists. We actually work together as a team and see patients at home-- elderly patients that are homebound, that aren’t sick enough to be admitted at the hospital and not seen at a nursing home. So we make house calls and see them for their medical needs. It’s great because we work in an interdisciplinary environment. I actually work with the physicians, nurses, dentists, and physical therapists, and we work together to provide the best confidential care to the patient. It's different from traditional pharmacy, where the pharmacists usually work with one other health care provider (physician, nurse, etc) and are cut off on their own. The pharmacists have their own role, the physicians have their own role. I work closely with my team to work together to help the patient. We also bring in some students from Medicine, Nursing, Pharmacy, and Physical Therapy, and we pair them up with another student from a different discipline. So how does a physical therapist access an elderly patient? What concerns do they have? Gait, mobility, worrying about falls?
From a pharmacist standpoint: we might help them with their medications that might affect their balance, their gait, that might cause them to fall, whether it’s from blood pressure medications that might lower their blood pressure so much (orthostatic hypotension) or they may be taking too many medications that cause dizziness or make them delirious that make them prone to falling or experience lightheadedness. What are ways we can actually improve their drug regiments that they minimize their risk of falls? We then with the physical therapist to physically help the patient minimize their risk of falling.
Furthermore, we’re trying to do research that shows that these teams are actually more effective. We can actually provide more comprehensive care, and it's easier than for one person such as a physician to be responsible for everything. Nowadays older adults have a lot of health care issues, not just medical issues, but also health care and insurance issues. When we work as a team, it easier to provide this level of care than with just one provider doing it all. It’s a model that hopefully we can do research that shows better intervention and better health care. One nice thing about being a pharmacist is that drugs affect all these disciplines. So they have questions for all of us: drugs affect the oral cavity for dentist, physical therapists as I mentioned, and clearly in nursing and physician interventions for diagnosing and treating diseases. It keeps us busy.
Q: What are some of things you like and dislike about your job?
The thing I like about my job is the diversity. I was talking about teaching, research, and patient care. These are all rewarding in their own way. When it comes to teaching students, when you get that light bulb to flash in their heads and get them to say “hey I got that. Now I can solve the problem on my own and take what I’ve learn and apply it on my setting where I want to go." For me, that’s extremely rewarding. Same thing with patients, if you get them to take their medications or improve their health outcomes. Same thing with research, if you can research a problem and come up with a solution or shed more light on how a process works and then publish that paper and share your ideas to people outside of UCSF. And I get to go conferences and attending meetings which allows me to travel like Australia. All aspects combined satisfy my interests and a job that feeds my soul.
As for dislike, it's not so much as things I don’t like but the processes. There’s so many administrative work. We have to make sure the grades are right for the students, make sure the speakers come (it’s sometimes difficult to schedule different speakers), deal with students disgruntled with grades, and make sure the syllabus is right. And in clinical intervention we make sure the administrative policies are in place. There’s a lot of confidentiality dealing with treating patients at home. Same thing in research: there’s a lot of bureaucracy--obtaining approval from an institutional board and obtaining funding. Funding is a big deal, you can spend months writing grants that may or may not get funded. Luckily for me I try to be savvy.. I try to do research that don’t require funding. But it’s always better to get funding because it helps support your salary and helps bring in money for the department and your school.
Q: Where do you see pharmacy going into the future?
From my perspective, clearly there’s an aging baby-boomer population. For pharmacists, the types of patients we are starting to see more of are older adults. They have a lot of health care needs. Right now with the new programs such as Medicare Part D, they are going to need help and education understanding not only the health insurance/policy issues, but also their multiple-disease states. People are living longer and often times living longer with chronic illnesses such as diabetes, hypertension, congestive heart failure, asthma, etc. Since they’re living longer, they are going to be on chronic medications… they are more prone to drug interactions, more prone to difficulties to adherence in certain medications, side effects.. So for pharmacists, there’s going to be a huge need in actually helping manage these people, treat them, not only as providers of information and dispensing medication but also really trying to work with other health care providers to create comprehensive care. The way health care is going now, not one provider can do it all. It’s starting to become integrated. Pharmacists should start working closely with other providers. With older adults, this will be common in this type of practice.
Q: What do you do for fun?
Biggest thing I do is surf. I’ve been surfing for a long time, something that is good for my soul, my body, and helps me stay in shape. One of the funnest sports I’ve ever done, nothing like getting barreled by waves of water. So I’ll spend my time trying to coordinate when I go to professional meetings or conferences to try to plan a surf trip around that.
Q: Any words of wisdom for pre-pharmacy students?
Don’t put so much pressure on yourself to be the prefect student and the perfect future pharmacist. Do the best you can. Do the best you can on your grades. If the best grade you got is 3.0 or 3.7, then that’s what you got. I think the most important thing is that you're well-rounded, you have a balance. You’re involve in extracurricular activities, you have leadership in other organizations or activities you do whether you work or not. There are actually people who work full time while they are in school to support themselves. And that’s actually not a hindrance to get into pharmacy school. And also, don’t work so much and being in school so much that you forget to have fun. You have relationships with friends and family. And it’s important to have a healthy balance of school, work, personal interest and personal life. Definitely get experience in a health care setting like shadowing a pharmacist. Understand the health care system in general: what’s managed care, Medical, Medicare. Know a little bit of different types of pharmacy settings: what’s it like in a hospital vs community. You may not have to volunteer there but at least have a sense of what it is, so when you’re in a pharmacy school interview, you’re not completely lost. Really sit down and gather information on what career is right for you.
The beauty with pharmacy is that once you get your pharmacy degree there’s so much opportunity for you. You can work full time or part time, in academia, government, industry, retail, clinical, consulting from your own home, working with medical information, research: basic and health policy, etc. Getting into pharmacy school is one thing, but when you come to pharmacy school, still come in with an open mind because there are so many different opportunities available for you.
