Dr. Dillon explained to us the wide ranging opportunities for Pharmacy graduates, in addition to describing the somewhat convoluted path that lead to her current post, all peppered with a series of anecdotes and witticisms that made for an excellent breakfast talk.
Dr. Dillon is the B.Pharm Director and Pharmacy Practice Skills Co-ordinator at the School of Pharmacy here in Dunedin. As a Registered Pharmacist in New Zealand, she also acts as one of the Professional Practice Fellows in the Department.
“As you probably can tell by my accent, I am not from New Zealand. I’m actually from Canada and, specifically from Newfoundland.” This Province is of similar size to New Zealand but with a population of only half a million. Dr. Dillon’s home town is St. Johns, where the winters are long and cold, “We like to paint our houses with very bright colours to make us feel warm and cozy all year.”
It is the closest land mass to where the Titanic went down, and one of Dr. Dillon’s relatives actually received the first distress call from the Titanic. “And yes, there are a lot of icebergs. The part of the island I am from is also known as Iceberg alley. So how they did not know that there were going to be icebergs, I have no idea."
"When I first went to university, I had absolutely no idea what I wanted to do. In high school, I was really good at science and not very good at literature and things like that. So when I started my first year at university, I did a lot of maths and science courses, and started to work for a degree in chemistry."
"I did that for a couple of years and I got a scholarship to work in a research lab. And then I realised, ‘I'm really good at thinking about chemistry, but I'm not very good in the lab.’ I broke a lot of equipment, caused a few explosions - and this made me rethink my career path, that maybe chemistry wasn't perhaps for me."
"Some of my lab mates were applying for Pharmacy at that point. And I just decided to apply, too. I didn't really think I'd get in to the School I applied to, because they only took forty people. But I thought if I was unsuccessful, I would just finish chemistry and hope I didn't blow the building in. So thankfully - for my Chemistry supervisors - I got into Pharmacy. And I did it in my hometown and this is a picture of the campus. And that's a good day for snow. Good day? That's pretty mild . . . "
Carla finished her pharmacy degree there, and it was a really good experience because she had the opportunity to work in a variety of hospitals, including an overseas posting to a hospital just outside London, all as part of the training.
Her first job was as a Community pharmacist, working for a large group of pharmacies, and one of the things she learned about herself was that she is really good at thinking about things, but doing things fast was not her strength - “and community pharmacy is a very fast paced place, and to also give you context of how slow I am in life, my sister has a lot of tattoos and the one that represents me is a sloth, because I do things at slow, slow speeds.”
"So I'm thinking, well, I like pharmacy, and I like some of the experiences in pharmacy, but I'm way too slow for community pharmacy, so I saved up a bunch of money and decided to train a little bit more.” She moved to Hamilton, which is close to the US border, much further south, so with far less snow - and the home of the very large McMaster Hospital. There Carla did some specialist training, going through each of the departments, including cardiology, oncology, paediatric and mental health.
After that she took a job as an acute mental health pharmacist, working on floor X , “We called ourselves ‘The X Files’ because the patients rooms were arranged in a kind of square, with the professional staff offices in the middle part of the square."
Dr. Dillon spent some of her time in the dispensary in the hospital making medicines that went to the rest of the hospital, “but the majority of my time was on the ward, talking to the patients, talking to psychiatrists, and trying to figure out the right drug therapy for patients. And patients in mental health can be very complex . . . because they have a long history of different types of medicines. It takes a long time to find medicine that might work for them.” After a further two years working there, gaining some “really, really good experience” Carla began to feel really homesick. All her family were back home, and even though the weather in Hamilton was much better, the pull of family was stronger, and she went back to the same campus she had started at.
“The role I took there was in medicine information. When prescribers in different hospitals in the Province had questions about medicines and didn't have time to do the research themselves, I would do the research for them, call them back and make some recommendations and give them some rates of literature. This was before AI, so I was basically their AI.” Because of her experience, she was able to make recommendations based on medical experience.
At this stage, wishing to progress in her work, Carla returned to Toronto where there was a part-time programme leading to a doctorate. The part-time nature allowed her to earn some money in between working at the course content. The research was not the usual type that most Ph.Ds have gone through, but “was all about patient care, so it was more a matter of expanding on some of the things that I've done in my hospital work. I got to spend time in various hospitals with things that I hadn't done before. So, for example, I spent some time with the HIV clinic, which is an area that I didn’t have a lot of experience with before. So it really expanded the type of patients and knowledge about medicines that I had at that point.”
After gaining her doctorate, she stayed with the university, but “I mixed it up a little bit” and also worked as clinical pharmacist to a GP clinic. “We had a lot of older patients. A lot of them had mobility issues, and I worked with a GP and a nurse, and we used to do a lot of home visits with the elderly. So we'd all have our little points of view - I would look at the medicine, make some recommendations that might be better for them. A lot of medicines tend to cause some problems, such as dizziness or sleepiness, which can cause falls. When someone is quite frail and they fall, that can be really difficult because they may have to leave their home and get some other type of care.“
A main aim was to make sure that the patient could stay home and have the quality of life that goes with that, exchanging medicines that did not work very well for them for more suitable ones. Still being primarily in the academic realm, Dr. Dillon became the assistant Dean of Pharmacy, and for a little while, the Dean of the school.
After many years of doing that, a colleague who had moved to New Zealand. called: ”We are revising our curriculum,. we could use your help.” “And I said ‘No! because, look how far away that is. I am not going that far away. I had been back and forth to Toronto, which was a four hour flight, but I always went home. . . .And he said, ‘Well, why don't you come for a year, help us get started, and then you can go back home. I said, 'I could probably do that.' So then I got on my four different planes to get to move to New Zealand. And then landed in the airport here and thought, ‘I’ve landed in a farm!’ - Maybe this was a really bad idea!”
She soon realised that she had a good deal to offer, however, redesigning the Practice Lab where students practiced some of their dispensing skills. The existing one at the time had probably been built in the 1970’s, and was “a little bit” outdated. “To go with a new lab, we needed a new way of teaching as well.” Dr. Dillon felt it was important to have a system that was more interactive, as an important skill is communication with patients and with other health professionals. Such skills are hard to develop, more so if teaching is primarily through lectures. “So I helped set up the lab, and helped set up the teaching. And that took more than a year. And now it's been seven years. And that's been my project for many years now."
"The way pharmacists practice in New Zealand is different to that in Canada, so I thought it was really important that I got licensed here and more experienced at the different challenges that New Zealand pharmacists have. So I did that process, and at the same time that I was getting licensed, we had a pandemic. And then I spent a lot of my time vaccinating!” Also, Dr. Dillon spent some time working in pharmacies to learn a little bit about the challenges in New Zealand to learn what to teach students to work in that environment.
“Over the last couple of years, I've become the programme director. So before my responsibility was about the teaching that happened in that lab. Now my responsibility is the whole programme, So I still spend a lot of time working on the lab content, but trying to bring together pieces from the other parts of the program. I meet regularly with our students Exec. to talk about their experience and what works for them and what doesn't. And then I try to work with all the other instructors to figure out ways that students learn what we think is important in the best way, listening to that feedback and continuously trying to improve what our programme does."
"Also as a city girl from all those little houses that were close together, now I have chickens and goats and sheep! And that was not what I was expecting! I also have cats. I don’t want to offend them in any way so I don’t have a picture of them. But they're part of the collection of animals that we have."
Question Time
Q. How would you describe the differences between Canada’s medical system and that of New Zealand?
A. "From a Pharmaceutical point of view, medicines are covered by the government, right? I suppose in the Canadian system, the majority of the medicines are covered by insurances. So when you go to an employer, all major employers would have insurance. As pharmacists you are dealing with ten plus different insurance companies to process the cost."
"A very small amount is covered by government. Here you're just dealing with one insurer, which is the government, so that has good and bad points. The good is that it gives more access to medicine in New Zealand than in Canada. So in Canada, people can fall through the cracks. When I was a resident, one of the first ones that stood out to me was an immigrant. He was a taxi driver, so they are more of an independent, and they don't have insurance. Then he had a heart attack. He made enough money that he didn't qualify for a government plan, but he didn't have private insurance, so his medicines weren’t covered. That happens less in the New Zealand system. The pitfall of the New Zealand system is that, in order to have enough money to cover everyone, you only can fund a limited amount of medicines. So we tend to be a little bit behind in therapy because it takes us a while to be able to afford new therapy. In Canada, with the private insurance, we had all the bells and whistles, though some of the bells and whistles were just more complicated and didn't actually give you more benefit. From a pharmacy point of view, that's the big difference."
"The other is a more kind of global medical system difference There is no private healthcare in Canada, as opposed to New Zealand, where you have some private and some public."
Q. Can we hear a bit about the American system?
A. {This was answered by the poser of the previous question}.
"I have a kind of myopic view of the American system as the place I am from has one of the biggest hospitals in the world, and my mother worked there. So anything I have is not representative of America as a whole. My mother works in oncology, and any experimental drugs she wants to try she can get, just like that. Medicine is certainly very expensive. However, what you get for having such high cost is access that is unparalleled. As long as you can afford it you can have anything you want.”
Dr. Dillon remarked that, with such a large population you've got more experts. As opposed to New Zealand, where we have a limited amount of expertise. “For example, my mother has a myeloma affecting her eyes, and goes to Toronto frequently for health care. Because, although Canada is not quite as large as us, there's expertise in that type of oncology. There will be no equivalent to that in New Zealand. “
There was further discussion on the issue of access in New Zealand. Because it is a small country, while most standard therapy is available to anyone, the trade-off is that less standard therapies are not. There are challenges in trying to find a balance for the greater good, with costs involved.
Q. How do you feel about AI and the healthcare workplace?
A. "I think it's really interesting. I remember when we just first got Google. In some ways, I see it as similar to that, where it's a transform of how we do things. And just like anything else, it has its strengths and its limitations. I think its a really interesting time, because it’s just unfolding. If it saves us time, that usually means we can provide better healthcare."
"I have talked to some of my student groups about what is it useful for right now. It's useful for idea generation, but sometimes it steers you in the wrong path, so not having a closed mind is important. And the other thing, when it's mining data from just the general ether of the internet, it can have a lot of bias. And so, you have to approach it realising that it doesn't really represent some populations as well, so it gives you a skewed angle. But I think if it’s harnessed appropriately, it can actually be really useful in healthcare. It's just doing it cautiously, so we don't end up using it in a way where it actually doesn't help us and causes more problems.”
Q. Do you think it would be useful to the extent of replacing some of the healthcare workers in some settings, or do you think that’s too far a reach?
A. “I think because of the complexity of people, that it would be hard to completely replace an actual person. But I do think it could take some tasks that we currently do away, and then we can focus on the things that you really need a human being to do. So I think it could make our jobs much more efficient and focused. It could also add some standardisation, because obviously the other problems with humans as healthcare professionals is that we all come with our own bias and perspectives and that sort of thing. It might help standardise some parts of the system that are skewed because of that. So I think that it's replacing some tasks, but that then health professionals will move to do what the AI can’t do.”
Q. What advice would you give your younger self?
A. “No, I don't think I've ever thought about it! . . . I don't know, because I've done things that I didn't expect to do, and when an opportunity came, I said, why not? So I would kind of suggest that if opportunity presents itself, to always say, well, just give it a go - see what happens . . . it's a learning experience.” [Several past speakers have said that if there's an opportunity, have a good look at it, and probably take it up.]
Q. Did you ever find it overwhelming?
A. “A little bit. Going somewhere different, even when I just first moved to Hamilton, I moved in with some roommate somewhere that I never knew before. I moved to New Zealand with a roommate I never knew before. She's the one here that has a goat. I've never been near a goat before. So some of those experiences and moments were a little overwhelming, but I think overall why I haven't felt overwhelmed in general is because I have a very strong anchor about where I'm from. And in my head, I can always just go home, and then it'll be fine. My immediate family is really small, but my extended family is quite large. And so the next question back home that people ask you is, ‘Who knit you?’ And what that means is ‘Who's your family?’ Because I come from a small place, everybody knows everybody, and someone is related to someone. So coming from a very interconnected community, I always felt very grounded in that whatever little adventure I went on, if it didn't work out, I'd just come home. So it doesn't feel that scary when you know there's people who can help you out."
Q. Do you think you will stay in New Zealand, or will you return to home eventually?
A. "It will depend. I mentioned my Mom has myeloma in her eye, so it may be at some point she needs some extra care, and if that happens, then I'll go home. So because you're rooted there, you have responsibilities. And then, you know, I have to get quality care for all my animals and stuff. They have routines. They get treats in the morning!”
Q. If someone wants to go into Pharmacy, what advice would you give them?
A. “Are you thinking more from an academic point of view? Well, there's two parts to look at . . . You need to have the requirements, to pass your courses and that sort of thing. Then the other thing with pharmacy, be open to the pathways that pharmacy could bring you. So for me, I've worked in community, I've worked in hospital, I've worked in GP clinic, I've worked in medicine information, I've worked at the University. So even though a lot of times people think of pharmacy as community pharmacy, it's actually quite a large field. One of the reasons I like the career is that if one part of pharmacy is not quite the right fit for you, then there's probably another piece that would be better. So a Pharmacy degree gives you a lot of mobility to try different things. “
Q. How hard did you find it to get registered as a pharmacist here in New Zealand? How difficult or different did you find it transitioning from being a pharmacist in Canada?
A.”I felt the process was a little tougher than it needs to be. And it felt a little unfair because if I was from the UK, I would only have to do a month of practice, but because I'm from Canada, I would have to do three months of practice. And I'm like, but we have a longer degree, so how does that make any sense? So it was a bit frustrating because I couldn't find logic in the system."
"Once I brushed that aside, I had to do a written multiple-choice test, which I hadn't done in a long time. But it did make me think about my students a lot more. And I'm thinking, I hope I never give them these awful types of multiple-choice questions. But that wasn't too bad because I didn't need to study. But then I was looking at it from a teacher point of view. I’m thinking, ‘This is a poorly-constructed multiple-choice question. It could be this one or this one. This is unfair!"
"And then I found, although I think it's changing a little bit from when I first came, that there is a narrow view in pharmacy, that you're either a community pharmacist or a hospital pharmacist, and you have to choose one or the other. Actually, I've been a GP pharmacist. So I guess I'm closer to a community one. And so I spent three months working in a community pharmacy, which was really helpful for me to understand the system. But it did take a lot of effort and time to go through all the processes. So there was a written exam with a three-month practice, and there was an ethics exam, which again, I found really weird, because I've never had an exam like this, where someone just sat next to me and quizzed me. And I'm just like, why? And again, from a teacher point of view, I'm thinking, ‘This is a poorly constructed examination.’ So some of the barriers had to do with the fact that I'm a teacher, and I've been designing the curriculum for a fair amount of the last decade. So some of the hurdles were in my mind.”
Q. If you were given one million dollars, what would you spend it on?
[Much laughter from both guest and audience!)
A. “That's a really good question. I think I would probably, because my Mom is so anxious, I'd just put it in an account and say, Mom, you don't need to worry about money.”
(At present Dr. Dillon’s mother worries a lot about the cost of her treatments, and by putting the million dollars into an account and telling her mother she now has plenty of money for treatments, she would worry less.)
Q. As you showed in the photo earlier you worked at a Drug Mart. What's your concern if you've got Chemistry Warehouse, compared to a family pharmacist? I feel like they're slowly taking over the Family Pharmacy.
A.“That kind of shift happened in Canada many years ago, and it really depends on how it's regulated. Even if you worked for a big chain there, if you thought something wasn't right, you just said, ‘I'm not doing that. Because I have a professional license, so it will come back on me personally, not you as a corporate, if something is wrong.’ And our colleges or our regulators really backed us in making those judgment calls. So I also always felt secure in saying no. That said, in the years that I've been here, there has been some more pressure from those corporates on their pharmacists to reach some quotas and that sort of thing, and that's not really anything to do with providing good health care, right? You really need to work in a system that allows you to make some professional judgment. These things can be okay as long as the pharmacists at these places are all practicing with the same autonomy and can say, in response to something the corporate wants them to do, “No, we think that affects patient care, or it's going to make things less safe,” and the corporates accept that, then it will work. But if the corporate comes with a mandate and the pharmacists feel the pressure to do whatever the corporates want, then it's shifting between patient care and the bottom line, and that's where things go wrong."
"So I don't have a problem so much with the big business models, because some pharmacists don't want to have a lot to do with the business side, so that frees you up from that part. But when they start taking away your ability to make decisions in the day-to-day about what is safe and what is not, then that's where things go wrong."
Q. Have you ever thought of working in a different province? Like, it's very random just to go to New Zealand, you know?
A. “No, that was random. That was never a plan. Like, I never, I barely knew where New Zealand was, and I didn't even know it was two islands! But I knew it wasn't part of Australia. That's all I actually knew. But other than that, all I knew that, like, it was way over there and there were a lot of sheep. And the only reason is because my previous boss had come here. He's obviously also Canadian. I have no idea why he decided to go to New Zealand. No idea. But he was like, he was just nagging. ‘I could really use your help. Come on, it'll be fine. We'll work together again. It'll only be a short time.’ I'm like, oh, all right. That's how it happened. And now he's moved to Australia! “
Q. You indicated earlier that, when you wanted to register as a Pharmacist here, there were just two options, hospital or community Pharmacist, but from other things you have told us, there do seem to be other options.
A. “There's definitely other career paths. There are GP pharmacists here as well. It's just from the regulatory point of view, for a Pharmacist from abroad to obtain a New Zealand licence those are the only two paths that they have a programme for - because there are fewer pharmacists in those roles currently. There are pharmacists that work with the Ministry of Health. There's some pharmacists that work with the New Zealand formulary - that's all the online information. So there's lots of different roles. But the ones that have the most pharmacists are community and hospital."
Q. What are the working hours for a pharmacist?
A. "It depends on the type of job that you do. So if you are at a smaller pharmacy, you might have a lot of hours because there's not a lot of you. But on the flip side, for example, in community, you could locum - that’s where you just fill in for other pharmacists when they're on vacation or whatever. So then you just set your own hours. You work as much or as little as you want. When I went back to NewFoundland over Christmas, I met up with one of my former students, and that's what he was currently doing . . . so that he could take time off to pursue his interests."
Q. What qualities do you think you have or experiences that enabled you to become the Programme Director of Pharmacy?
A. “I’m very interested in how students learn. So that's a little different from a lot of my other colleagues who have researched particular drugs or diseases. I was supposed to establish a research field, but that didn’t really interest me a whole lot. And so I just spent my time working at the curriculum and how it was organised and how it fit together. And how the students saw it and how I saw it and how it sometimes interacts. And people just let me go on and do that, and never really interrupted that pathway. And I also get uber, uber focused on something. So if you're watching a Netflix series and it's super good and you're like, one more episode, one more episode. Well, I'm like that with curriculum. I'm like, I'll just stay in for another 30 minutes or so - and then it’s three hours later. I've been like that the whole time. So because I put so much work into it and there seemed to be improvements, then I think I just carved out a niche because it was my interest and no one else was really doing it in my area. Because everybody was focused on the traditional career path. And I'm like, I don't really care about that. I'm just very interested in these pieces. Let's put these pieces together. So I think that's how it kind of evolved. And then I just became known for a thing. “
Q. What do you think is like the best part of being the Programme Director?
“ It isn't the emails. There's a gazillion emails. That's the not good thing."
"I would put it in a couple of different parts. Obviously having a good outcome when, for example, students do better and you get positive feedback from the profession about the student body, that always feels good. But also the process of getting to that is also equally good. It is really helpful to work with a team of instructors who have different points of view, but also have the same goal, and just working together, problem solving, working with the student's input, trying to figure out something that works. That process of exploring and also working as a team, which I really like. Sometimes in academia we tend to be really siloed because we have our particular field of research, so that is your niche, but my niche is how do we all work together to produce a good program. That involves all these people working together. Someone comes in to me and says, ‘John has got that now, and do you know, he got 100% on that test’, and I'm like, ‘Good day, good day!’
Q. What do you think makes a good pharmacist? What qualities do you think they should have?
A. “There’s lots of different qualities:
- You need someone who is adaptable, because things often do not go as planned, so you've got to be flexible to the situation.
- It’s helpful to be very patient focussed, because that helps you prioritize and determine what to do.
- If you're really interested in helping other people, (which is something that gets said a lot about health professionals), then it can help guide you into good decision making.
- Someone who works well in that team environment.
Again, these are a lot of things that are probably generic to a lot of different jobs, but definitely essential in the pharmacy world, because you don't work solo, ever, really."
Q. How about in terms of, since you're living in New Zealand now, with living costs, and also do you find anything beneficial in that do you get paid more?
A. "Not as a pharmacist as such. At first Canadian pharmacists would have been paid more than those in New Zealand, but more recently there's been higher demand here, because there's been fewer pharmacists. Like a lot of job markets, increased demand just brings up the prices a little bit, so the pay in some places would be probably fairly equivalent. There's obviously differences between Canadian dollars stronger but they're getting close to being similar."
Q. What do you think is the biggest problem with the healthcare system?
"Well, where do we even start? One, when all healthcare is dictated by policies, so depending on the government of the day, they have different perspectives of how much money to put into the system and how to do that. So sometimes it's really annoying when you have a big political shift, and then you have a completely different priority. Then you thought you were on track to go here, and now you've had to readjust. That can be annoying because you thought you were going to build a program and have funding and so on. So that's why even though politics is very annoying, politics is actually quite important. Other things include when there's big policy changes made, and they haven't really consulted enough with frontline healthcare workers."
"So, for example, like they made some changes to the controlled drug laws a couple years ago, and everybody was like, well, this makes no sense, and then they just rolled it out. So there have been changes to the controlled drug laws about every year for the last few years because there was a mistake in the first one, and then they had to fix it, and then it wasn't quite right, and then they had to fix it again. And I'm thinking, why did you not consult people who actually do this every single day?"
"So I think overall, the system could better communicate because I think we spend a lot of time doing unnecessary work. If we actually spent more time communicating and consulting the right people, we wouldn't be backtracking and fixing parts of the system. That's annoying. If you just do things a little slower, take a little bit more time, then in the long term, you would save some time.“
Q. What do you think are the pros and cons of being a pharmacist?
A. “I think it just depends on the area that you're in. So community pharmacy is probably one of the hardest parts of pharmacy because you're public facing, and sometimes the public may not be so nice. And in the context of that, you take it with a grain of salt because people are coming to the pharmacy and sometimes they're not feeling well. But the other side is they approach it way more as a service than like a GP. But you're not really there to hand them over some fries, right? If you hand them over the wrong pills, it's a lot different than you put too much salt on their fries. Sometimes they can be treated not as respectfully as they should be, and people don't understand that it's not as simple as like putting a label on a box and then handing it over to you. It's that every time I hand over a box to you, I have to make sure that it's the right one, and that's not something that's going to harm you. So I think there's a lot of challenges in community pharmacy because of that kind of service model. But at the same time, some of the best rewards come out of community pharmacy because you make these longer term relationships with people, and you can give them access to services that might be more difficult for them to get access otherwise. So every facet of pharmacy has that, where there's some parts that are challenging and some parts that are rewarding. But community pharmacy, I think, has the most challenges.”
