What I Wish I Knew: Tips and Tricks for Starting a New Practice

The “What I Wish I Knew” series of articles is a service of AAPP’s Resident and New Practitioner Committee. Articles are intended to provide advice from experts for students, residents, and new practitioners. Articles are not intended to provide in-depth disease state or pharmacotherapy information nor replace any peer-reviewed educational materials. We hope you benefit from this “field guide” discussing approaches to unique problems and situations.

Kelly N. Gable, PharmD, BCPP
Professor and Director of Well-being and Resilience
SIUE School of Pharmacy

Dr. Kelly Gable is a Professor in the Department of Pharmacy Practice at SIUE School of Pharmacy. She received her Pharm.D. from the University of Mississippi, and subsequently completed a specialty residency in psychiatric pharmacy practice at the University of Southern California. Dr. Gable has worked as a psychiatric pharmacist within the state psychiatric hospital system and has created clinical services within primary care and community mental health settings. She is the first psychiatric clinical pharmacist to be recognized as a provider by the Missouri Department of Mental Health. After spending years working as a psychiatric care provider on Assertive Community Treatment (ACT) teams, she shifted her clinical focus to a collaboration with psychiatry, offering integrated behavioral health services within a family medicine clinic. She routinely provides trainings in Motivational Interviewing, mental health well-being, and harm reduction in her community.

Are you exploring the development of a new clinical practice? This concise review will provide you with a few considerations as you address the “where, when, and how” surrounding setting up a new practice. As you navigate challenges and successes during this exciting process, you may find yourself exploring the following questions:

1. What practice environment gives me the most job satisfaction? Below is a list of potential new psychiatric pharmacy practice environments. Consider which of the following descriptions matches your personal and professional interests best.

2. Do I have a physician champion? While this is not a necessity for all practice settings, if you plan to have some level of prescriptive authority and pursue the development of a collaborative practice agreement, you will need to identify a physician partner. A physician champion can serve as an advocate for psychiatric pharmacy services and help others (healthcare providers, patients, administration) understand your valuable role on a treatment team. If your focus and interest is the treatment of psychiatric disorders, your collaboration should be with a board-certified psychiatrist. Be sure to review your specific state guidelines regarding collaborative practice agreement development, as this will dictate the level of autonomy you will have in your partnership. Be aware of the number of advanced level practitioners that a physician can enter into a collaborative practice with in your state. Be cognizant of how often your agreement must be renewed or updated (often annually) per state guidelines as well.
3. Will teaching be a part of my new practice site? If teaching is important to you as you develop your practice, seek out sites that have partnerships with pharmacy,nursing, social work, and medical schools, residency programs, or other experiential learning programs. If you hope to integrate advanced practice pharmacy students into your practice site, ensure that there is room for student involvement. When feasible, request an identified space for you at the practice site and an established and separate space for your students. Determine how many students per rotation and per year that the practice site, and you, can comfortably welcome for a learning experience and what the orientation process entails. If you hope to also serve as a learning resource for other healthcare students, residents, and providers, ensure that there is opportunity for interprofessional integration. Try to be respectful of patient needs as you navigate experiential teaching, as too many student learners at once can be overwhelming and even triggering to patients within behavioral health care settings.
4. Who are the administrators that I need to connect with at the potential practice site? ?” Prior to making final decisions, ensure that there is time allocated to meet with administrative staff and/or clinical and medical directors. A good working relationship and partnership with administrative personnel can dramatically enhance your job satisfaction and personal investment in your clinical service. From the start of the collaboration, begin to explore financial compensation and reimbursement opportunities for your service at the site. Clearly determine and define who will fund your position (e.g.- University/college, federal or local grant funding, provider-service reimbursement system). If you have an interest in grant writing, explore opportunities within the practice site structure that would allow for integration of your clinical pharmacy service into current or future funding sources. For administrators who are less familiar with specialized pharmacy roles, take time to provide education on the process of becoming a Board-Certified Psychiatric Pharmacist.
5. How will I document my new service? No matter the practice location, take the time to determine the most effective and efficient method of documentation. Most practice sites will utilize an electronic health record (EHR). Learn what credentialing process is necessary to allow for a clinical pharmacist to document within their system. You may be tasked with developing your own documentation template, or you may have the opportunity to integrate into an already established system. In a widely utilized system such as Epic, ensure that you are credentialed to function and document as a clinical psychiatric pharmacist, and not a dispensing pharmacist. As you learn the electronic database, determine if the system will allow for a more global evaluation of the treatment interventions you provide. An ongoing review of your interventions will provide you the opportunity to assess your clinical impact at the new site.
6. How am I performing at my new practice site? Once you become established in your new role, ensure that there is opportunity for routine peer and performance assessment. In some practice settings, this process may be led by a pharmacy director or clinical program director. For practice sites without a significant pharmacy presence, clinical review may be conducted by your collaborating physician or medical director. If time allows, request a direct observation and evaluation of your clinical service with patients. This encourages professional clinical growth and demonstrates overall personal investment in the quality of care you provide. A quarterly to yearly peer evaluation of your documentation of patient care within the EHR can also be requested and is encouraged.
7. I’ve started at my new practice site, now what? Always take the time to reflect upon what aspects are working well at the site and what feels less professionally rewarding. In many practice settings, non-pharmacy clinicians may be less familiar with the role and function of a psychiatric pharmacist. Remember, you bring a unique and wonderful clinical perspective to your new colleagues that is of great value to overall patient care. Try not to get bogged down with tasks that may not be within your scope of practice as a psychiatric pharmacist. In an inviting and engaging manner, take the time to educate others on your extensive training and expertise. Throughout the exploration of your new practice setting, try to maintain a level of creative energy, innovation, and passion for what you do!