Nuclear Pharmacy
Typical Day at a Nuclear Pharmacy
Most pharmacies will typically have between 1 – 3 set “runs”. I’ll explain a typical day at a pharmacy, just so you get an idea of how the process goes. The night pharmacist comes in at around midnight and takes any new orders off of the recording. They will then begin to hit the generators and start compounding the first run. Technicians and drivers will begin to trickle in; doses are drawn (including FDG brought in from a cyclotron) and packed up. First run is out the door and on its way to customers between 03:00 – 05:00. The pharmacist and technicians then have some down time to clean up, log all of the kits prepared during the run into the computer, grab a bite to eat, etc. 2nd run then starts at around 06:00; a second pharmacist arrives at around 07:00 as this is when the phones start to pick up with same day add-ons from the customers. 2nd run is out the door by 08:00. A third and fourth pharmacist arrive at 08:30. One of them will generally be designated to work on the bloods; another will help answer the phone, take orders, deal with customer service issues, etc. 3rd run compounding (which is usually pretty light), begins at 10:00 and is out the door by 11:30. I-131 capsules will need to be compounded at some point as well. Throughout the day, we’ll field phone calls ranging from STAT add-ons to clinical questions (i.e. pediatric dosing, altered biodistribution, questions about drug selection, etc.). The rest of the day is generally spent setting up for the next night: order entry, drawing any doses (i.e. Thallium, which has a long half-life) that can be drawn the day prior. Scripts are printed, double-checked and any products needed for the next day are ordered. So, as you can see, the daytime hours are generally spent getting ready for the following night. The last pharmacist locks up sometime around 17:00 and is on call for the remainder of the night.
Radiation Safety
This is always one of the main concerns/questions people ask me about nuclear pharmacy (and rightly so). Radiation safety and proper handling of all RAM is at the forefront of the training you receive. Employees are required to wear ring badges on each hand (to monitor extremity exposure) as well as a body badge at collar/thyroid level (to monitor whole body exposure). Rings are monitored weekly, and badges monthly, to assess each employee’s radiation exposure. The US government has set limits (i.e. 5 REM/year for whole body exposure, 50 REM/year for extremities, etc.). In addition, companies will oftentimes have even stricter limits than these, and will assess each individual as necessary if their exposure approaches action levels. Most of the times, this will entail adjusting ones compounding techniques to ensure practice of “ALARA” principles. Each pharmacy will also have a “Radiation safety officer” (who may or may not be a pharmacist), and they are responsible for overall safety at the pharmacy: monitoring air concentrations, training personnel, and keeping employees under all federal/company radiation guidelines. Pregnant women can officially declare their pregnancy to the company as well, and will receive an additional fetal badge to be worn near the belly. She will have even stricter limitations to restrict the amount of radiation exposed to the child.
Advantages of Becoming a Nuclear Pharmacist:
It’s a very specialized field and there’s a general appreciation for the training/education that you’ve put in. Salary is very good (generally comparable to retail). There’s no insurance to deal with, since the hospital/clinic is responsible for billing the patient. As you saw in my description of a typical day, (barring any problems), the pace is generally pretty relaxed and you’ve got some lag time, especially at night. There’s no dealing with the general public (although this can also be seen as a disadvantage to some people). You become very close with your staff (technicians, drivers, admins). You also get to know your customers very well over the phone; I’ve become good friends with many of the nuclear pharmacy techs and physicians too. You are treated as a professional and they value your input and services. After you’ve gotten enough hours under your belt, you’re also able to become board certified (BCNP) if you so desire; nuclear pharmacy was the first specialty area established by the BPS. There’s definitely opportunity for job growth through management, etc. Nuclear is a neat balance between clinical pharmacy, physics, chemistry, math, management, business/sales, customer service, issues like <797>; there’s a little bit of everything for everyone.
Disadvantages of Becoming a Nuclear Pharmacist:
The reality is, you are dealing with radiation and biohazardous material (i.e. blood). You are however, provided with the training for how to deal with this properly, and it’s in your own interest to do things by the book. Over-night hours are another stickler for some people. A fully staffed pharmacy though, will permit pharmacists to rotate their hours. It may be possible that you will only have to work the opening shift one week out of every two? four? six weeks?..depending on the needs of the pharmacy. Specializing in nuclear also requires you to keep up with “regular” pharmacy. Hospital/retail pharmacists don’t exactly know what Cardiolite® is, but nuclear pharmacists rarely talk about the new factor Xa inhibitor anticoagulant either. I’ve also been asked whether it’s difficult to find a job as a nuclear pharmacist. The answer is: no…it’s not hard to find “a” job; you’re a well-trained specialist and there will always be a demand for you...however, unlike retail pharmacies, you’re not exactly going to find a nuclear pharmacy on every corner. As a result, it may take a little longer to find “the” opening you want, in the specific city/state you’re interested in.
So…if you’ve actually gotten through all of this, I’m highly impressed! And you’ll have a better understanding of what nuclear pharmacy is relative to 99.9% of the general public...because if I tell anyone that I’m a nuclear pharmacist, I generally just get a blank stare of bewilderment. If you’re even remotely interested in the field, I highly suggest taking an elective at your school if one’s offered, sign up for a nuclear rotation, or even contact a nearby pharmacy to shadow someone for a day. I know the ID guys are going to jump on me for this one, but generally speaking...and excluding empiric therapy, you can’t treat a patient unless you know what you have on your hands. I love that nuclear medicine is able to provide some of those answers, and provide some interesting treatment options to patients. It’s an exciting area to practice in!
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