Clinical career ladders: Thomas Jefferson University Hospital.

The clinical career ladder program developed for pharmacists at Thomas Jefferson University Hospital, a 700-bed teaching hospital, is described. A task force was assembled to develop a clinical career ladder that would parallel the managerial advancement track in terms of rewards and recognition. The task force created separate lists of competencies for staff and clinical pharmacists and ranked the competencies according to their complexity and the number of years most pharmacists would need to achieve them. Separate pathways were established for staff and clinical pharmacists: staff pharmacist I, II, and III and clinical pharmacist I, II, and III. A salary scale designed to provide meaningful salary increases between levels was established. Nearly all pharmacists who are hired begin at level I and are allowed to apply for promotion to level II within six months. Opportunities for promotion occur twice annually. Pharmacists who have received an overall rating of effective or outstanding at the most recent performance appraisal may submit documented evidence that they have gained the knowledge and skills required at the higher level. A promotions review board evaluates each application and informs the director of pharmacy as to whether the applicant meets the criteria for promotion. Response to the program has been favorable, as indicated by the number of pharmacists who have applied for promotion and the quality of their applications. A carefully planned clinical career ladder program was well received by pharmacists, who responded by acquiring the knowledge and skills necessary for promotion.