February 2024 Alumni Spotlight: Jocelyn McDougal

Tell me about your residency program.
My current PGY-2 residency in ambulatory care focuses on direct patient care. We cycle through various rotations in primary care and specialty outpatient clinics. Some disease states that we treat in our clinics include diabetes, heart failure, inflammatory bowel disease, chronic kidney disease, HIV, and cancer. This year is dedicated to residents getting exposure to managing various disease states. Pharmacists in these clinics work under collaborative practice agreements which allow them to review and order labs or initiate, discontinue, and titrate medications.
Last year, my PGY-1 in managed care involved some ambulatory care experiences, but it also included rotations in drug use management, drug information, and pharmacy benefits. As a part of these rotations we participated in the Pharmacy and Therapeutics committee meetings, created drug monographs, developed utilization management strategies, such as step therapy criteria and prior authorization criteria, and reviewed requests for non-formulary medications. These activities are a part of the process that ensures members receive quality, cost-effective care.

What do you like the most about your residency experience?
I get exposure to so many areas of pharmacy that I would not have experienced if I went straight to work after school! In PGY-1, I got to focus on managed care activities like writing or reviewing step therapy and prior authorization criteria. Now in PGY-2, I am independently managing patients with chronic conditions. Being a part of both residency programs has allowed me to understand how the formulary decisions made by the health plan actually affect the patients we see in the clinic. The benefit of working in an integrated delivery system is that you get to see everything come full circle.
Also, I appreciate that we have preceptors who genuinely wants to see us succeed in the program. Support was something they harped on during the initial interview process! We have preceptors for every project who are flexible, provide clear feedback, and are eager to help. It’s so nice to have someone to talk through clinical decisions with me. I also love having co-residents! It is reassuring to share the experience with other people who act as an additional support system.

What advice can you give to residency applicants that do not match?
If you are interested in managed care but do not match or do not choose to participate in the match process, I would recommend seeking out entry-level managed care jobs. Many of these positions will involve prior authorization review for Pharmacy Benefit Managers (PBMs) and health plans. Even if you do not get a managed care job right away, you can always transition into the industry later. I know multiple pharmacists that started out in community pharmacy, became pharmacy managers, and then later transitioned to working at a health plan. If residency is something that you truly want to pursue, then reflect on how you can become a stronger applicant and re-apply the following year. Also, there are many non-accredited managed care residencies that do not participate in the ASHP match process. These unique opportunities may be discoverable on Linkedin and other job listing websites.
Developing and connecting with your network can also be very important. Stay connected with classmates, mentors, and preceptors within your field of interest – as they could provide advice, direction, or even a recommendation. People are often willing to help students and recent grads, because someone likely helped them when they were starting off in their career. It’s the cycle of paying it forward. Remember that the most important thing is that you graduate and become licensed. Whether or not you match will not ultimately determine where you land. I think residency can accelerate your path, but it does not have to determine your path.

Tell me about your experience in pharmacy school.
When I initially began pharmacy school, I really thought I wanted to pursue community pharmacy. Prior to pharmacy school, I had experience as a pharmacy technician in a hospital and at a PBM, but I knew I enjoyed patient interaction and working in a fast-paced environment. However, I remained open-minded in pharmacy school to other opportunities and to potentially pursue a residency. I joined SNPhA early in pharmacy school because being service-oriented is a part of who I am and their mission to serve the underserved really resonated with me. I also joined some clinical organizations to experience different fields of pharmacy. Joining AMCP later in pharmacy school exposed me to the Pharmacy and Therapeutics Competition and led me to attend a managed care symposium that ultimately solidified my decision to pursue a managed care residency.
I recommend that current students get involved in the organizations they join to take advantage of the full experience. You get the most value when you are an active participant. Your exposure to pharmacy school can make a huge impact on your trajectory after graduation. So get involved early and make connections, but stay on top of your classwork! Additionally, I recommend getting an internship since they are excellent for learning and will help your CV to stand out. They are also a great way to determine what you like and don’t like. After my P2 year, I completed a summer internship with the North Georgia Rheumatology Group where I completed prior authorization requests, submitted appeals, and enrolled patients in patient assistance programs for high-cost biologic medications.

What compelled you to consider a career in managed care pharmacy?
My first exposure to managed care was working at a PBM before starting pharmacy school. We helped pharmacies adjudicate claims, discussed benefits with members, triaged prior authorizations to the pharmacists for review, and set up peer-to-peer meetings in case that the provider needed to speak to the pharmacist. What I liked about that position was being a part of the patient access process. It felt satisfying helping patients get access to the medications they needed, making sure their therapy was appropriate, and ensuring safety and cost-effectiveness for the patient and company.
My internship at the North Georgia Rheumatology Group and the direct patient care experience I had during my Ambulatory Care APPE rotation steered me to consider a residency program at Kaiser Permanente Georgia, where I would get both managed care and ambulatory care experiences all in one program. In the future, I hope to integrate my passion for both managed care and ambulatory care into my professional pharmacist career. I see myself working within a managed care organization completing clinical tasks that provide value-based care to all patients.

What are you most surprised about now that you are working in the industry?
My residency experience has taught me the importance of drug utilization management strategies. Just because a medication is indicated to treat a certain condition, doesn’t mean it is necessarily the best option. Drug utilization management strategies not only help keep overall healthcare expenditures down by ensuring medications are cost-effective, but they also help ensure patient safety which I think is often times underrated.
When developing and reviewing criteria we consider clinical guidelines and best practices. Now I have a better understanding of why denials have to happen, why they can be good in some cases, and why certain criteria exist. You have to remember that the decisions you make and the criteria that you create affect not just one patient, but an entire population!

Are there any opportunities for pharmacy students to complete an internship, volunteer opportunity, or rotation with Kaiser Permanente?
Kaiser has multiple regions throughout the country, so the opportunities for student involvement may vary per region. Kaiser Permanente Georgia allows shadowing to provide students with insight into our residency programs. We also host IPPE students and offer clinical pharmacy internships! Unfortunately, we do not offer APPE rotations in our region at this time but hopefully, we will in the future! APPE rotations are offered in some other Kaiser regions. So, if you are interested and open to travel then they are a unique experience to consider!

What advice would you give to fourth-year pharmacy students who are interested in managed care residencies?
If you’re reading this prior to your P4 year, I would recommend seeking out managed care-related internships and trying to schedule a managed care APPE rotation experience. If you’re reading this as a P4, you probably already have your APPE schedule solidified. So, if you were not able to schedule a managed care APPE, then I would recommend getting involved in your school’s AMCP chapter, attending conferences and webinars, and attending residency program information sessions. These events are a great way to meet current residents and program directors, as well as learn about the details of these programs ahead of time so you can know what will be the best fit for you.
When it comes to applying, start researching programs and preparing yourself early! ACCP has sample letters of intent to guide you in writing yours. AMCP also does mock residency and fellowship interviews – which were extremely helpful for me! Decide which professors and preceptors will be writing your letters of recommendation and begin to form solid relationships with them by helping with projects and getting research experience. Most of them have likely completed a residency and can provide relevant experiences that will help prepare you for residency. Be able to speak to your experiences listed on your CV and in PHORCAS, the residency application system. Remember that no experience or accomplishment is too small! Most residency programs use a rubric to objectively score applicants, so try to list a relevant experience/accomplishment in every single category on PHORCAS so you do not miss out on potential points! But even if you don’t have something for every category, that is okay. Remember that all skills are transferable, and if you are strong in one category, you can always speak to your strength in that area (for example, you may have much more work experience than research experience).
The entire objective of residency is to give new professionals the space to build professional confidence in their specialty. A strong candidate who is likely to be successful will have experiences that provide them the confidence to dive into a project independently, but also remain open and receptive to feedback and collaboration. It is important that you stay organized and disciplined because residency is a lot of work! And when times get tough, keep going and never forget your “why”!