Introduction
Dr. Nicole Alvey, Pharm.D., is a an associate professor of clinical sciences and Director of Academic Fellowship at Roosevelt University College of Science, Health and Pharmacy. She is an acute care transplant pharmacist specializing in post-op kidney transplant pharmacology, providing inpatient and outpatient medication management, discharge counseling, and multidisciplinary support. Dr. Alvey has been a Board Certified Pharmacotherapy Specialist since 2008, with an emphasis on transplant research.
Why Pharmacy
I started working in retail pharmacy in high school because I loved chemistry and was told that pharmacy may be a good profession for me. However, I also had a passion for teaching because I come from a family of educators. After several years in retail pharmacy, I realized that this path was not aligned with my true aspirations.
My perspective shifted dramatically when my father was diagnosed with kidney disease and underwent his first kidney transplant. During his hospitalization, the transplant pharmacist provided invaluable education about his new medications, including dosing and potential adverse effects. Witnessing this interaction solidified my desire to pursue a career that combined my love for science and chemistry with my passion for teaching and patient care. I recognized that this was the perfect path for me.
Motivated by this experience, I sought out information on applying to pharmacy school at St. Louis College of Pharmacy (STLCOP) and began my studies there within two years. My personal connection to the patient population has fueled my commitment to the field of solid organ transplant pharmacy, which has seen significant advancements over the past decade. Being a part of this growth has been incredibly rewarding, and I am now eager to inspire future pharmacists to explore similar career opportunities in this vital area of healthcare.
Career Journey
I completed two years of undergraduate education and then transferred to St. Louis College of Pharmacy to complete my Doctor of Pharmacy degree. Since I decided to pursue pharmacy as a result of my dad's illness and transplant, I knew from the first day of pharmacy school that I was on a clinical path with my goal to complete post-graduate residency training. After graduation from STLCOP in 2006, I completed a PGY1 Pharmacy Practice Residency at Rush University Medical Center in Chicago, IL followed by a PGY2 Solid Organ Transplant Residency at Barnes-Jewish Hospital in St. Louis, MO. This was a full circle moment for me because I was the first PGY2 Transplant resident at Barnes, and this also happened to be the hospital where my dad has his kidney transplant; the hospital where my pharmacy dream began. After completing my PGY2 residency, I took a position as a clinical pharmacy specialist in solid organ transplantation at Rush University Medical Center. Over the course of my 11 years there, I was able to build the transplant pharmacy services and oversaw the expansion of the transplant pharmacy team from 1 pharmacist to 3 and developed the PGY2 Solid Organ Transplant Residency for which I served as Director for 10 years. Approximately 5 years ago, I took a position as an Associate Professor of Clinical Sciences at Roosevelt University College of Science, Health, and Pharmacy and was able to keep my clinical site as a transplant pharmacy specialist at Rush. This position has allowed me to truly merge my passion for education and clinical pharmacy, as well as, allowing me to influence students earlier on in their career path. My goal with this career transition was to encourage and inspire our younger pharmacy generation to consider clinical pharmacy, specifically in the solid organ transplant specialty.
Current Role and Responsibilities
Thankfully, there is no typical workday! Every single day is different, which keeps things exciting! My role allows me to rotate between the inpatient transplant service and caring for patients in the outpatient clinic setting. A typical day on the inpatient service includes rounds with the transplant team in the hospital, reviewing patient cases, discussing medication regimens, and providing recommendations to optimize immunosuppressive therapy. I conduct medication reconciliation, assess for potential drug interactions, and educate patients about their transplant medications to prepare them for hospital discharge. In the clinic setting, I meet with transplant recipients for follow-up visits where I monitor medication adherence, address concerns regarding side effects of medications, and provide therapeutic recommendations for common comorbid disease states seen in the transplant population. I am also part of the multi-discipline team that evaluates patients for transplant candidacy. This dual role not only enhances patient outcomes but also fosters a comprehensive understanding of the transplant process from pre- to post-transplant care.
Challenges
For my clinical role, the most challenging aspect is needing to accept that we can't save everyone, and that sometimes there are negative outcomes for our patients. This is especially hard for patients with whom I have developed a longstanding relationship. COVID brought these challenges to the forefront in the minds of every healthcare professional, and I think many of us are still grappling with the loss of our patient lives during that time period.
My biggest challenge in my role as a professor is seeing a student give up on themselves and helping them see their potential through their weakest moments. My students are like my children. I will support them unconditionally, but it is sometimes difficult to help a student see and achieve their true potential when they don't believe in themself. So, my job as a Professor is to help them through these difficult moments and come out stronger no the other side.
Also, time management! Over the course of my career, I have struggled to maintain a work/life balance, as most people do. I have shifted my perspective over the last several years to one of work/life integration. I keep a detailed calendar that includes important events and deadlines for both my professional life and personal life all in one place. This allows me to see what is coming and recognize that some days are more professional life heavy and others are more personal life heavy. I find that if I am very mindful and intentional with my planning and scheduling, I am able to integrate my work and personal life pretty well.
Rewards
Anytime you get to see your impact on the life of a patient and their family is rewarding. This can be something as simple as watching your patient who came into the hospital prior to transplant gravely ill just walk into clinic on their own. It is not uncommon for patients to come to follow-up visits with pictures of their experiences with their kids, grandkids, vacations, etc. When they say to you, "you helped make this happen," it makes your heart swell.
I saw a kidney transplant patient as part of his pre-transplant evaluation and was very firm with him about the importance of medication compliance post-transplant after he was dismissive of my comments in a previous visit. He eventually realized that he would not receive his transplant unless he became serious about learning his medications, and he eventually did. After his kidney transplant, he came to clinic for his first post-operative visit. When I walked in the room, he said "Oh, I remember you. You were the one who yelled at me about not taking my medications. But thanks to you, I realized how important medication understanding is in this whole process which allowed me to be listed for kidney transplant." I did not, in fact "yell" at him, but I was firm because he needed to realize how important these medications were after transplant. It was so rewarding to see him come to that first post-transplant visit with a complete medication list and a pillbox filled 100% correctly! He did not have any problems with medication compliance after transplant. Sometimes tough love is just what a patient needs!
The most rewarding aspects of my career as a professor are similar. When a student comes into my office with a beaming smile on their face because they aced an exam or they got the residency position they were after, and they thank you for your role in helping them get there, it fills my cup. Every "aha moment" I watch a student experience is rewarding. So, in short, the most rewarding aspects of both components of my career involve making a difference and seeing that difference be appreciated by the individual impacted. Even more rewarding is watching that individual I impacted continue on to do amazing things in life and make a difference for others. Its the ripple effect of my interactions that are the most rewarding.
Advice for Students and Aspiring Professionals
Don't give up on yourself! Even when times get tough, keep your eye on what motivated you to start this journey to begin with. Pursuing a career in clinical pharmacy is challenging, but along with some of the toughest challenges in life some the biggest rewards. If a student is interested in pursuing a career in transplant pharmacy, they should get involved and learn more about the profession. There are so many ways to do this, but the one I recommend the most is to become involved in some of the national transplant pharmacy organizations, such as the ACCP Transplant PRN and American Society of Transplantation Transplant Pharmacy Community of Practice. These organizations will help connect you with transplant pharmacists in your area and will increase your exposure to the profession! If you are at a pharmacy school that has transplant clinical faculty, reach out! Get involved! We are a close knit group of pharmacists always looking for the next student and resident to mentor!