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Clinical career ladders: Jewish Hospital of St. Louis.

The clinical career ladder program developed for pharmacists at Jewish Hospital, a 500-bed tertiary-care teaching institution, is described. In 1983 the hospital's salary structure was re-evaluated. The pharmacy department seized this opportunity to create a clinical career ladder program that would accommodate the changing nature of the profession. Management informally interviewed staff members and developed their opinions into a proposal, which was accepted by the job evaluation committee. The career ladder has three levels. Level I pharmacists carry out basic practice duties. Level II pharmacists have additional responsibilities, notably maintaining a procedure manual, training, and performing an advanced clinical function. At level III, pharmacists develop, implement, and manage a clinical program. Pharmacists are promoted for having achieved a certain level of practice. They are not given new duties upon promotion; rather, they have already taken them on. Advancement can occur at any speed, and it is possible to voluntarily step back to a previous level. The novelty of the program, design flaws, and a series of modifications have created some frustration and confusion among the staff, but the career ladder is otherwise a success. Recruitment has improved, the department's organizational chart is aligned more horizontally, and the pharmacists are being trained for nondistributive roles. In retrospect, management would not have based the program on staff interviews but would have established a formal committee. The effort needed to establish and adjust to a clinical career ladder is great but so is the potential payoff.