A Circuitous Route to Oncology Pharmacy—Does It Matter How We Get There?
Joseph Bubalo, PharmD BCOP BCPS
Oncology Clinical Pharmacy Specialist
Assistant Professor of Medicine
Oregon Health and Science University Hospital and Clinics
Portland, OR
If asked to write about an “atypical” path to oncology pharmacy, I might reply, “Is there a normal one?” Prior to the advent of the PGY2 oncology residency, I am not sure that there was. Today, to move into a dedicated oncology position in a timely fashion, you would start a PGY1 residency after pharmacy school graduation, enroll next in a PGY2 oncology residency, and then come out looking for a job.
Briefly, my path was, and continues to be, a little different. I skipped the graduation ceremony for my bachelor’s degree in pharmacy and got married that day instead (best decision of my life), and I went to work as an assistant manager for Hook’s Drugs in Indianapolis. Six years later (by then I was manager of the Hook’s in Edinburgh, IN), I decided that I wanted to explore different clinical opportunities and left retail work for hospital pharmacy. On my last day in Indianapolis, we loaded up the Ryder truck, my wife went to her medical school graduation, I went to my graduation from the MBA program I had been attending in the evenings, we returned our gowns, and we drove to Oregon. My wife, Frances, started her medical residency, and I, after several months of looking and 14 interviews, was hired into a relief position at Oregon Health and Science University Hospital. Volunteering for any position needing coverage, I was trained in inpatient psychiatry, sterile products, medicine, surgery, and pediatrics, and I eventually procured a position as an ICU pharmacist.
About 6 months into my ICU pharmacy career, the oncology pharmacist needed vacation coverage, and with some trepidation, I agreed to do it. I had not been attracted to oncology during pharmacy school—having to deal with nausea and vomiting, alopecia, and worse did not hold great appeal—but I was surprised to find that rounding with the team, managing patient symptoms, and overseeing chemotherapy orders were both mentally stimulating and rewarding. The patient contact was among the things I had missed most from my retail days. From then on, I volunteered to do relief coverage for oncology, and in 1992, when the regular position opened up, I successfully bid for it. My practice has developed from that starting point, with time spent in many clinical endeavors, research in clinical and practical aspects of oncology, teaching and precepting, and a stint in management followed by a return to clinical practice and research. With additional study I received a postbaccalaureate PharmD degree as well as BCPS and BCOP certifications, among other things.
Perspectives on Taking an Indirect Route
No experience is wasted. Numerous aspects of my retail career and other work experiences have benefited me in my hospital-based practice. Experience working with people, skills in self-management and management of others, public speaking experience, work in sales and budgeting, and many other experieces continue to serve me well as a steward of oncology practice.
Put yourself outside of your comfort zone. Progress rarely occurs if you do not seek out new methods, look at new areas, and apply yourself in new ways. Though I often grumble about technology, when something really useful comes along, I try to be an early adopter. Use past experiences to gauge where your talents lie, and try not to repeat old mistakes in new ways as you take opportunities to develop your practice.
Be a team player. I learn continually from my coworkers and would never have had some of my practice opportunities without them. I encourage you to view the “team” as including those beyond your fellow pharmacists, though they are likely your closest team members and the ones you engage with most frequently. I have learned valuable life lessons, practices, and skills from nurses, physicians, nurse practitioners and physician assistants, sales representatives, medical science liaisons, and students—and frequently from patients. The peers whom I have watched and emulated during my work experience include those who follow the current template for oncology pharmacy practice and those who do not. Although I don’t enjoy every aspect of my daily practice, I try to participate fully in all of them and have found that this effort results in better patient care.
Change is the one constant. Whether driven by technology, new therapeutics, institutional growth, social or family pressures, or other forces, you should expect to remake yourself and possibly your practice about every 5 years. This path is challenging to predict, and the rate of change may be speeding up, but I can say that change has been my constant companion in my nearly 34 years of pharmacy practice.
Enjoy being outside of work. My spouse, my children, and my family have a tremendous influence on my life. I could not be where I am today without my spouse, and I look forward to seeing her every day. Together we have found a love of hiking and camping, board games, quirky movies, and a variety of other things that enrich our lives. I am admittedly a workaholic at times, but I try to give as much time to others and hope that I succeed. I also try to bring outside interests into work—ask me about growing tomatoes!
Whatever your path to oncology pharmacy, I cannot think of a career that provides more opportunities, professionally and in life. I would be happy to take comments at This email address is being protected from spambots. You need JavaScript enabled to view it.. Best of luck to you all.