August 13, 2021
In this alum spotlight, we chat with Irene Park Ulrich, Pharm.D., BCACP, clinical pharmacist in the Mountain Area Heath Education Center’s Department of Family Medicine, and associate professor of clinical education at the UNC Eshelman School of Pharmacy.
Please describe your novel practice setting. What makes your career path unique?
MAHEC is a multidisciplinary health care institution in Western North Carolina. I work in the Family Medicine Department and practice at 2 of the MAHEC satellite practices alongside family medicine physicians. I practice under a collaborative practice agreement, and have my clinical pharmacist practitioner (CPP) designation in North Carolina. In both my practice sites, I have developed a co-visit patient care model in which I see patients in real time alongside the provider, which has been shown to have financial benefit for the practice.
I am also adjunct faculty with the UNC Eshelman School of Pharmacy and precept 8-10 fourth year pharmacy students each year.
My career path is unique is because I started pharmacy school with no intentions of pursuing residency. I felt sure that I would go into community pharmacy and was comfortable with that. However, as I learned more about clinical pharmacy, I began to consider pursuing community pharmacy residency. It was not until I completed by ambulatory care rotation during my fourth year of pharmacy school that it became clear to me that was the path I wanted to take. I decided in the fall of my PY4 year to pursue ambulatory care PGY1 residencies. I was very fortunate to match with Mission/MAHEC in 2012, and ultimately was able to stay on at MAHEC.
What led you to this career path? What steps did you take?
My ambulatory care clinical rotation in the fall of my PY4 year convinced me that this was the route I wanted to take. This rotation was in a diabetes clinic, and I loved that in the process of gathering information for clinical decision making, I would have to learn about the patient’s lifestyle and values. I loved being able to focus on the patient in front of me. I also loved practicing under a CPP where I could make adjustments to medications right then, rather than having to draft a recommendation that may or may not be taken.
Following this rotation, I requested a change in my rotation schedule that would allow me to have one more ambulatory care rotation before ASHP Midyear Clinical Meeting. This solidified my interest in ambulatory care.
What does a typical workday look like for you?
I typically have clinic for at least half of the day. Pre-COVID, I would arrive in clinic and huddle with my physician partners and clinical staff to talk about patients for the day. We would see patients together or sequentially and share documentation responsibilities. If clinic is light, I respond to drug information and med access questions that come to my inbox, or make follow-up phone calls as needed to patients. I also help with insurance communications re: medication recommendations for patients. The other half of the day is often administrative time. In this time, I work on a variety of tasks including but not limited to teaching time with students and residents, scholarly activity including manuscript writing, other initiatives including transgender care work.
Describe the most exciting or rewarding aspect of your (novel) practice role?
Working so closely with my physician colleagues who value and respect my role as a pharmacist is the best aspect. I also love my institution because I have the ability to take on and champion issues that are important not only to me but to our community. The best example of this is my work leading a transgender equity work group that includes representation across our entire organization.
Describe the most challenging aspect of your role?
It is very easy to overcommit. Because anyone can take on new initiatives that they are passionate about, there is often a lot to get involved in.
How can someone learn more about this unique practice setting and the career opportunities it presents for pharmacists?
There are wonderful resources about ambulatory care practice from large pharmacy organizations including ASHP and APhA.
What advice would you give to a current student pharmacist who is interested in pursuing a similar type of practice role in the future?
Shadow a pharmacist in this setting. The bulk of the work is in face-to-face patient encounters. Those who are excited and energized by this would do well in ambulatory care.
What general advice would you give to a high school or college student who is interested in pursuing a pharmacy career?
Shadowing is so important to understanding what this might look like as a career. No matter how detailed a description, nothing can prepare you more than an in person shadowing experience.
Can you share a brief story about a time you had a positive impact on a patient, population, or community in your role as a pharmacist?
Within the first few weeks of starting at one of my satellite clinic sites, I saw a patient with diabetes who had just obtained private insurance and was referred to me to help her switch from 70/30 insulin to a basal-bolus regimen. We discussed the patterns of her blood sugars, and her desire to lose weight. Based on our discussion, we decided to change to a long-acting insulin analogue and rather than doing bolus insulin, we started a GLP-1 agonist. On follow-up 1 month later, she had lost quite a bit of weight, had not had any low blood sugars and her A1c had gone from 8.5 to 6.5. I continued to check on her in the following years and she lost a total of 30 lbs and her A1c remained in the 6s without requiring any additional changes to her diabetes medications!
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