The Mix Tape: Ep. 9 — A Passion for Patients: The Crucial Role of an Infectious Disease Pharmacist

Natalie Taylor:

Welcome to the Mix Tape.

Valerie McCandlish:

Welcome to the Mix Tape.

Natalie Taylor:

I’m Natalie.

Valerie McCandlish:

And I’m Valerie. And today we’ve got a fun episode with one of our recruiters, Drew Leininger, who, fun fact, is our 100th employee. So, really cool to bring him onto the Mix Tape. He has joined us from, kind of a non-traditional background. I know that back in season one, we discussed how we have a really cool mix of people here that just really makes us stronger as a group, and we come from several different disciplines. But Drew, himself, comes from higher education and transitioned into recruiting this year, and has just been absolutely wonderful to join our team. And he is joined today by his girlfriend, Jessica Smith.

Natalie Taylor:

That’s right. And Drew, he’s an awesome teammate because he’s always just willing to jump in and do-

Valerie McCandlish:

Anything.

Natalie Taylor:

Do anything, and always helping out. So he brought his fabulous girlfriend, Jessica, onto the podcast and it’s a great discussion. She’s kind of talking about something that we’ve never… A topic we’ve never had on the podcast before. She is an infectious disease pharmacist, so she’s going to be talking about her career path and what took her to this field and just some tips and tricks for maybe people in a similar situation or who are in pharmacy school. I’m interested in learning from her.

Valerie McCandlish:

Did I ever tell you that I wanted to be a pharmacist?

Natalie Taylor:

No. You did not.

Valerie McCandlish:

When I was in high school, I was dead set on it. I thought, okay, I’m going to go to this school, I’m going to study this, I’m going to become a pharmacist. And then I had to take my first year of chemistry and that no longer became a-

Natalie Taylor:

Then you were out.

Valerie McCandlish:

A career path option for me. But that’s okay. Because, I’m kind of still adjacent to-

Natalie Taylor:

That’s right.

Valerie McCandlish:

To it all with what we do here at Mix, but-

Natalie Taylor:

Perfect.

Valerie McCandlish:

I’m excited.

Natalie Taylor:

You found a good match.

Valerie McCandlish:

Exactly.

Natalie Taylor:

For yourself.

Valerie McCandlish:

Exactly. So we’re really excited to have you listen to their discussion today and we will go ahead and turn it over to Drew and Jessica.

Drew Leininger:

All right. Welcome to the Mix Tape. My name is Drew Leininger. I’m a recruiter here at Mix Talents and I am here with Jessica Smith, who is an infectious disease pharmacist, and we are going to be talking a little bit more about the world of pharmacy. Welcome to the Mix Tape, Jessica.

Jessica Smith:

Thanks. I’m really happy to be here.

Drew Leininger:

All right, great. So to kind of start off, why don’t you tell us a little bit about what it is that you do in your role as an ID pharmacist?

Jessica Smith:

Yeah, so I am an infectious diseases pharmacist. I work for a large academic medical center, primarily on the inpatient side. So I actually work with a team of physicians, and pharmacists, and medical students, and residents to see patients in the hospital setting with complicated infections. And as the pharmacist on the team, I am considered the drug expert. So, my role is primarily to make recommendations about the best medications that patients should get to treat their infections. And that’s taking into consideration things like, how well their kidneys are working, the other medications that they’re taking, making sure that there’s not drug interactions as well as whether they can afford it when they go home, if it’s something that they have to take four times a day, whether that’s something that’s going to be feasible for the patient. So we really work as a team with me being, again, the drug expert, and then the physicians on the team being the ones making the diagnosis and driving a lot of the patients care.

But we work ultimately as a team to provide the best care that we can for the patients that we’re seeing on a daily basis. So that’s what I do for most of my time. But, another big part of my job in the hospital is working on what’s called an Antimicrobial Stewardship Program. That’s something that all hospitals have, and that they’re required to have actually. And that is essentially a program that is designed to ensure the most appropriate use of antimicrobials, so antibiotics, antifungals, antivirals in the hospital setting. And the reason that’s important is because, unlike almost any other area of medicine or pharmacy that you might work in, in infectious diseases, though drugs that we choose to treat one patient can actually have an impact on other patients because of things like bacterial resistance and other downstream effects. So that’s a really important thing for hospitals, and that’s basically the goal of our Antimicrobial Stewardship Program.

Drew Leininger:

So to ensure that you aren’t creating superbugs in essence?

Jessica Smith:

Yes, exactly. We try to avoid the superbugs and then when we see the superbugs, we make recommendations about how to treat them. So yeah, so I wear a lot of hats in addition to those two main responsibilities. I’m also involved in a lot of teaching and precepting. Because we’re a teaching hospital, I have students and residents that I take on rotation with me usually for about a month at a time. These are either people that are enrolled in the PharmD program, so pharmacy students or pharmacists who have graduated from pharmacy school, but are doing additional training in the form of a residency program to specialize in some sort of area like infectious diseases.

Drew Leininger:

Yeah, awesome. So I know when we first met, I truly had no idea about the pharmacy world, right?

Jessica Smith:

Yeah.

Drew Leininger:

Before when you said you were a pharmacist, I was like, “Oh, you work at CVS.” And you’re like, “No, I work at the hospital.” And I said, “Those exists?” So, talk to me a little bit about how did you end up where you’re at now? Why ID, what was your pathway there?

Jessica Smith:

Yeah, that’s a really good question. And it’s okay that you didn’t know that pharmacists worked outside of the retail setting, because actually as a junior in undergrad, I didn’t know that pharmacists worked outside the retail setting either. So, I’m not someone who grew up knowing that I wanted to be a pharmacist or really knowing everything that a pharmacist did. To me, a pharmacist was the person at your local pharmacy who counted pills and dispensed them to you. But what I learned as a junior and undergrad is that, there’s so much more to it and that there are so many more opportunities that I didn’t know even existed. So I guess my path to becoming an ID pharmacist really started when I was a junior in undergrad. I was on the pre-med track. I had completed most of my prerequisites at that point. I was signed up to take the MCAT.

I was trying to do shadowing at a local hospital so that I could put all of that on my application to med school. And as I was shadowing an internal medicine team at the hospital, which is basically just a team that cares for patients who were admitted to the general ward or the floor, I noticed that there was a pharmacist on the team. And I was like, “Wait, why is… I didn’t know there was a pharmacist on a hospital team. This is so cool. What do you do?” So I started asking questions to this pharmacist, “What do you do? What’s your role here?” And he explained to me that basically pharmacists can work in hospitals too. And they see patients in the clinical setting. They work with physicians to make recommendations about exactly what I talked about earlier, optimizing therapy, taking into account patient specific factors like drug interactions, like access to medications, like kidney function, because a lot of drugs, the dose changes depending on how well your kidneys work.

And basically they work with the rest of the team to come up with a plan for the patient. So I thought that was really cool, and that combined with the fact that I talked to a lot of physicians who actually discouraged me from going to medical school, encouraged me to explore other options, made me start exploring other options. I still wasn’t set on pharmacy, but it made me realize that there was a lot more that could be done with a PharmD, a Doctor of Pharmacy degree than just working in the retail setting. So after that, I did a little bit more research on things that a pharmacist could do, and decided that that was actually a really cool career path. I was a chemistry major in undergrad. I really liked chemistry, and there’s obviously a lot of chemistry that goes into pharmacy. I also have always loved math.

There’s a lot of math because of the pharmacy. So it kind of made sense that that would be a career that might fit with the things that I already enjoyed. So I actually applied for an internship at a college of pharmacy, and I did summer research, the summer between my junior and senior year of undergrad. And when I… Outside of just working in the research lab, I had the opportunity to shadow a clinical pharmacist that, who had this lab that I worked in, but also had a clinical role where she saw patients. So she worked in a warfarin clinic, which is basically a clinic that monitors patients who are on an anticoagulant called Warfarin. It’s a blood thinner. Patients take it for many different reasons, but basically it has what we call a narrow therapeutic window, meaning the dose can be really tricky to figure out, and if you’re off, then it can either be ineffective or it can be toxic, really quickly. So it requires a lot of close monitoring.

Drew Leininger:

Okay.

Jessica Smith:

And this pharmacist had her own clinic where she was independently managing Warfarin for a number of patients. And she showed me how, she let me shadow her as she did the patient interview, as she looked at the lab values that she had for that particular patient. And then she actually ran a drug interaction checker to run a new medication that the patient had just been started on against everything else that the patient was already taking, to make sure that there weren’t any adverse drug interactions that could potentially put that patient at risk. So I thought that was just the most amazing thing, and it kind of solidified the fact that I wanted to go to pharmacy school. So, I applied for pharmacy school. It turns out there are a lot more prerequisites for pharmacy school than there are for medical school.

Drew Leininger:

Really?

Jessica Smith:

So, well, different ones. There’s a lot of overlap, but there’s also additional ones. So I had to overload my senior year to get all of my prereqs in for pharmacy school. But I did it and I got in, and once I got to pharmacy school, it was like, okay, great. But I still had no idea what I wanted to do other than I knew I wanted to be in the clinical setting, either in a hospital or in a clinic, like I’d seen with the pharmacist that I shadowed at my internship. So I knew at this point that that would mean I would need to do a residency. And for pharmacists, a residency is still optional. It’s something that is highly encouraged if you want to work in a hospital, but you don’t necessarily have to do residency training to get a job as a pharmacist. But knowing that I wanted to be in a hospital and ideally in a large academic medical center, a teaching hospital that also had research opportunities, I knew that I probably needed to do a residency.

So that was my mindset going into pharmacy school. And I knew that there were different specialties that I could go into, including things like cardiology, infectious diseases, pain and palliative care, drug information, critical care, emergency medicine, just about anything you can think of, there’s probably some sort of residency program for it. But I really liked everything when I first got to pharmacy school. So it was hard for me to narrow down one specialty that I would want to go into. And actually the first time that I learned infectious diseases in pharmacy school, I absolutely hated it.

Drew Leininger:

Of course, now you do it all the time, right?

Jessica Smith:

I know. Yeah. So that’s usually how things work out. I was a first year pharmacy student, and in my pharmacology class we learned about ID and I just thought to myself, how in the world could anyone ever learn all of these drugs and all of these bugs, and which bugs are covered by which drugs and what dose you use?

Drew Leininger:

Literally me, every time you talk about your work, how do you know all this stuff?

Jessica Smith:

Yeah. It was so incredibly complicated that I just kind of wrote it off as something that I would memorize for the exam and move on. But then as life tends to do, it laughed in my face. And the next time I learned about infectious diseases in pharmacy school, I actually was kind of like, huh, okay, this is kind of fun actually. I started to see that there was a lot of value in knowing about bugs and drugs, because regardless of what specialty you go into or what kind of patients you see, infections touch everyone. So it’s important to have at least some sort of baseline knowledge of how to treat those in order to be responsible to our patients. So, I kind of liked ID the second time I learned it, and then actually, when I got to my clinical rotations, priority picked infectious diseases as a rotation, that would be my first choice if I could choose any rotation.

And that’s when I really solidified my interest in infectious diseases, because I wasn’t just learning about them in a textbook or a lecture anymore. I was actually applying my knowledge to patients that I was seeing. And I thought it was really interesting. And the more that I have practiced in infectious diseases, it’s funny because those things that initially made ID so overwhelming and so complex, the fact that not only do you have to worry about the patient and the drug and how those two things interact, which is usually what you have to worry about as a pharmacist. There’s this whole other living, evolving, mutating organism that is thrown into the mix, and you kind of have to chase what that’s doing as well when you’re making your decisions. So that’s initially what was so overwhelming about ID, but that’s what keeps it interesting for me now. And I can truly say there is never a dull moment at my job.

Drew Leininger:

So you talked a little bit about, when you were first introduced into the infectious disease world, you were worried about how do you keep track of all the drugs and all the infections and stuff. And so, how do you understand… Working in the life science field like I do, there are constantly new drugs being introduced every single year and every single month. How do you keep track of all those and how those new drugs could interact with these infections and with these antibiotics or whatever drugs that you want to give to your patients to fight infections?

Jessica Smith:

Yeah, that’s a really great question. And the short answer is, it’s hard to keep up with everything new that’s coming out. But that’s one thing that I love about where I work is, it is a teaching and research institution. So it’s highly encouraged to stay on top of new things that are coming out. The patient populations that we see are also, they tend to be complex, and we get to see some of the weird things where you really have to dig into the published literature about an infection that might not be well described and isn’t common by any means. So in addition to just doing my own research as new things come up as I’m seeing patients, I also am a member of several different pharmacy organizations, including specific infectious diseases pharmacy organizations. And these organizations do a great job of hosting webinars with informational material or updates on new things that are coming out, new practices.

They also have newsletters as well as invited speakers who are experts in certain areas to come and talk about ongoing research or new data that’s coming out. So that’s one way to stay up to date. There are also several medical journals that focus on infectious diseases that I subscribe to, their tables of content. So I basically skim as new articles are coming out, if there’s anything that might be applicable to my own personal practice. And then of course, learning information from colleagues in the ID world. Social media is really big, and a lot of people use social media as a platform to share new information. So that’s actually become a new thing that I’ve tried to dive into a little bit more just because it is a good way to stay up to date with people all around the world and what they’re doing and new information as it’s coming out.

Drew Leininger:

Yeah, absolutely. So, talk to me a little bit about the patients that you see, because as an ID pharmacist, I would assume that you see patients across the spectrum. So, where some pharmacists might only focus on oncology or emergency room, you, I’m assuming, get a wide breadth of patients here. What does your patient population look like?

Jessica Smith:

Yeah, absolutely, it’s a little bit of everything. So, whenever… I just had a new student and a new resident start on rotation with me this week, and whenever I have new learners start on their ID rotations, I always tell them, “Make sure you bring comfortable shoes because we’re going to do a lot of walking.” And that’s because we do see patients from all over. We see patients from the ICU, patients from our heart hospital, patients in the cancer center, patients in brain and spine hospital, patients who are just on regular medical wards, patients in the emergency department, patients in the psych hospital. You see where I’m going?

Drew Leininger:

Yeah. Yeah.

Jessica Smith:

Infections don’t discriminate. And anyone, of course there are certain patients who are at higher risk for infections than others, but it’s something that can impact anyone. And I think that’s another thing that I really love about my job is that, while it is very focused, in the sense that I just have to know about the patient’s infectious problems, I don’t really have to worry about their diabetes management or anything like that.

It’s also very broad in the sense that, we see patients who are coming from all walks of life, all ages, all sorts of past medical histories, including no past medical history, or someone who has 18 different things on their problem list. And, all of those things can impact the decisions that we make for a patient’s antibiotics or their care. And, I think that that’s also where as a pharmacist, we can add a lot of value, because the patients that we see can range from the very simple to the very complex, but we can help navigate some of those things like drug interactions or potential side effects, or whether the patient is able to be adherent to the prescribed therapy. Like I said, if it’s four times a day, that might be difficult for someone. So, I think that the variety in the patients that we see keeps us on our toes, but it’s also one of my favorite parts of my job.

Drew Leininger:

Yeah, that’s great. So you talked a little bit about, when you were looking at where you wanted to come out of residency, you wanted to be at a research institution. So, do you get an opportunity to do research then, in addition to that teaching piece with the precepting and the patient care?

Jessica Smith:

Yeah, that’s a great question. And fortunately I do. And it’s working primarily in retrospective research, meaning that we’re taking things that have already happened and looking back to see if one particular therapy, for example, worked better for a certain disease state than another one. So I work primarily with pharmacy residents as well as infectious diseases fellows. So those are physicians who have gone through four years of medical school, three years of internal medicine residency, or board certified internal medicine physicians, but are doing two additional years of infectious diseases fellowship, so that they can then become board certified infectious diseases physicians.

And as part of that fellowship program, they have to do a research project. So as an infectious diseases division or department, we’re very close knit and the pharmacists and the physicians all work very closely together. And that includes on research projects. So right now I’m involved in three different research projects, and that’s pretty on par with my usual load per academic year. But something else that’s great is that, you don’t have to be involved in research. That’s something that I choose to do, something that’s encouraged by the organization where I work, but there are plenty of opportunities for pharmacists who aren’t interested in research to still be able to provide excellent patient care, but not have to worry about being involved in all these other projects.

Drew Leininger:

Yeah, that’s great. One question that I always like to ask in interviews is, if you were to give a new pharmacist coming into the field, one piece of advice prior to them starting out either in infectious diseases or even general pharmacy, what would that one piece of advice be?

Jessica Smith:

That’s a really good question. And, just thinking back to where I was many years ago now, as someone who was trying to figure out what I wanted to do with my life, I think my biggest piece of advice would be to find what you’re passionate about and stick with it. Because pharmacy as a field, you might hear that it’s very saturated. There are more candidates than there are jobs, and that can be discouraging. But I think if you’re truly passionate and know what you want to do and are willing to put in the work to get there, then don’t sell yourself short. I never thought that I would end up being an infectious diseases pharmacist practicing at a large academic medical center, but I continued to pursue the things that I enjoyed, and that led me to where I am today. And I think on the flip side of that, if you choose to do something because it’s easy or you think that it’s not going to put as many barriers in your path to where you want to be, then that’s great.

Sometimes it works out, but when it doesn’t, if you’re not truly passionate about what you’re doing and what you’re pursuing, then you’re probably not going to land in a place where you’re as happy as you would’ve been, if you would’ve just stuck it out and pursued the things that you’re passionate about. So, I think it can be hard to figure out what you’re passionate about, but once you do find it, it kind of hits you in the face. And then, if you just keep pursuing it, then you can truly end up where you never thought you would be.

Drew Leininger:

That’s great. With this being the Mix Tape podcast and us being in the people world, we always like to ask our guests, what is your favorite interview question that you’ve ever asked or have been asked in an interview?

Jessica Smith:

Yeah, that’s a great question. There are a lot that I’ve been asked over the years, and have also asked candidates at this point, but I think the questions that I tend to like the most are the ones that really get at who a person is, the ones that they can’t really maybe prepare for as much. And I think the one that I was actually asked during my interview for my current job, and that stuck with me is, tell me about a time when you fell flat on your face and how you reacted to it. And the reason I like that question is because, like I said, I think it really gets at who a person is. It can be really difficult to admit when you were wrong or when you fell flat on your face, but I think you can learn a lot about a person, A, by what they admit to and the story that they choose to tell, and B, how they reacted to it. So that’s one that, like I said, I was asked during an interview and one that has really stuck with me.

Drew Leininger:

Yeah, absolutely. I think it gets to the point where a mentor once told me, “It’s okay to make a mistake, but the worst mistake you can make is a mistake you make twice.” So it’s a great way to see, okay, can you be vulnerable and talk about a time you made a mistake, but also how do you learn from that, grow from that and be a better worker, colleague, whatever, because of that mistake.

Jessica Smith:

Exactly.

Drew Leininger:

Awesome. And then also, since this is the Mix Tape, we always like to ask our guests, what is your song of choice? We always take a song from each of our guests here and we do add it to our playlist on Spotify. And so, what would be the song that you would like to add to our playlist?

Jessica Smith:

That’s another great question. So, I guess the song that comes to mind is one that, well, I guess I should back up. In a former life, I played soccer for basically my entire life all the way through college. And when I was playing in college, I was a goalkeeper. That was my position. And when I would prepare for games, I would always listen to music. And a lot of times the songs that I was listening to were really upbeat and getting me in the zone. But for whatever reason, well, I’ll tell you the reason, but when I was in college, the last song that I would always listen to right before I walked out on the field to play my game was, the Travis Tritt hit, It’s a Great Day to be Alive.

And that’s a country song that was on the radio when I grew up, but in college I kept coming back to it. I think because it was something that really grounded me. Right before I went on the field, I was usually feeling a lot of stress and excitement, but at the end of the day, just reminding myself that no matter what’s going on, and no matter what happens, it’s a great day to be alive. So, that is one of my favorite songs and one that meant a lot to me during that time of my life.

Drew Leininger:

Yeah, that’s awesome. Thank you for sharing. And-

Jessica Smith:

Yeah.

Drew Leininger:

Thank you so much for coming on to the Mix Tape today.

Jessica Smith:

Thanks for having me.

Valerie McCandlish:

Wow. Thanks so much to Drew and Jessica for joining us today. I just love listening to them. They’re wonderful. And I think Natalie, I can speak for us both, that we love Jessica’s sage wisdom on following your passion, even when it’s hard, even if it’s the more difficult option, because it’s always going to be far more fulfilling for you in the end, and going to be worth it over picking perhaps the easy option.

Natalie Taylor:

I agree. I loved what Jessica said about that, and I think that’s kind of a common thread that we hear a lot here on the Mix Tape. Just hearing from our guests who followed their passion, maybe where they started out in their career wasn’t where they ended up, or their journey took them on twists and turns. But ultimately, I think a lot of our guests do follow their passion and follow what they’re really interested in, and they have these wonderful, fulfilling careers.

So, I think that’s what is unique about the Mix Tape that we get to listen to people from all different backgrounds, like Jessica, a pharmacist who we’ve never had on the podcast before. And I think that’s another cool thing about Mix, like you alluded to in the intro. We even have a pharmacist on our team who works on the [inaudible 00:29:55] team, recruiting. So that diverse background of experience is just something that I think is really valuable to us at Mix.

Valerie McCandlish:

Absolutely. And it’s a great day to be alive because we’ve got another great song to add to the playlist.

Natalie Taylor:

That’s right.

Valerie McCandlish:

So-

Natalie Taylor:

That is a jam, that also was playing a lot in my-

Valerie McCandlish:

Seriously.

Natalie Taylor:

In my youth.

Valerie McCandlish:

It reminds me of dancing around my living room with my parents back when I used to listen to country music.

Natalie Taylor:

Oh. I still do. So I’ll represent for Jessica. But that’s a great addition to the playlist.

Valerie McCandlish:

And speaking of the playlist, if you hadn’t had a chance to check it out, it’s got a feature of all of our guests favorite songs from this season as well as from seasons past. And today is our second to last episode of this season. So stay tuned for next week for our finale, and thanks for being in the Mix. We’ll see you next week!