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Pharmacy practice — the American way!

Have you thought about living the American dream and experiencing pharmacy practice in the US? Quinn Bott discusses about the US pharmacy system and provides advice on how UK students can get involved in study or work

By Quinn BottIn the US, opportunities abound in the profession of pharmacy. Currently, there are about 243,000 pharmacist jobs nationwide. Job opportunities are predicted to grow 22 per cent between 2006 and 2016 as the older generation of pharmacists retire, and the demand for pharmacy services grows to meet the needs of an ageing population.

Foreign pharmacy students have excellent opportunities to practise in the US, both before and after graduation. A career as a pharmacist in the US offers excellent pay, workplace flexibility and an enriching professional environment. However, getting started is not without its challenges. Understanding US pharmacy is the first step.

The current state of pharmacy in the US

Community pharmacies employ approximately 62 per cent of pharmacists, most as salaried employees of a drugstore chain, but some are self-employed independent pharmacy owners.

About 23 per cent of pharmacists choose to work in hospitals or other institutional healthcare settings. A small proportion work for mail order and internet pharmacies, pharmaceutical companies, pharmaceutical wholesalers, offices of physicians and the federal government.

The average chain drugstore contains a large retail floor, the “front store”, much like a large convenience store or small grocery store. The pharmacy itself is located at the back of the store near the aisles that contain over-the-counter drug products. Only prescription medicines and, sometimes, medical devices or expensive OTC drugs are kept behind the counter.

Community pharmacies typically employ one pharmacy manager, who works for the entire time the store is open, supervising any relief pharmacists and several technicians. A chain drugstore is just one of many practice settings, which may vary substantially to serve a diverse population of patients. Pharmacy education, however, is standardised.

How to register as a pharmacist

There are over 100 accredited schools of pharmacy in the US, to which approximately 96,000 students apply and 50,000 are accepted each year.

Each school is a bit different, with some programmes that offer direct entry from secondary school and others that require prerequisite coursework or a bachelor’s degree. Some are private colleges with only a pharmacy school, others are part of a larger university that offers many undergraduate and graduate degrees.

Students enrolled in a school of pharmacy register with the state board of pharmacy and can work as pharmacy interns (preregistration trainees), typically paid incrementally with their year in school.

Companies often invest time and resources in recruiting pharmacy interns to entice them to work for the company on graduation. This may include extra training or opportunities to attend corporate functions and conferences. Students are considered pharmacy interns until they obtain their state pharmacist licence.

Pharmacists must be licensed by the board of pharmacy in the state they live and work. Before foreign pharmacy graduates can register as interns, they must first take the Foreign Pharmacy Graduate Equivalency Examination (FPGEE) and an English proficiency test (Test of English as a foreign language).

After obtaining the necessary internship hours, the student must pass the North American Pharmacist Licensure Examination (NAPLEX) and the Multistate Jurisprudence Examination (MSJE), a state-specific test of the laws governing pharmacy, insurance, and healthcare.

Each state requires a different number of intern hours (between 500 and 1,500) to qualify for the NAPLEX; some states use a sliding scale based on FPGEE scores. Usually, pharmacy schools implement these requirements into the curriculum with clinical rotations or experiential learning requirements.

The Doctor of Pharmacy degree is now the only degree conferred on students who graduate from an accredited school of pharmacy in the US. The suffix “RPh”, which stands for registered pharmacist, can be used by anyone who has completed the licensure requirements and is currently registered to practise.

The Board of Pharmaceutical Specialties certifies pharmacists in nuclear pharmacy, nutrition support pharmacy, oncology, psychiatric pharmacy and pharmacotherapy, with emphasis on cardiology or infectious diseases, typically after a one- to two-year residency experience in the field, and a specialty examination.

Other students elect to pursue competitive fellowships offered by pharmaceutical companies after graduation. A few students pursue professional degrees in law (Jurist doctor), business (master of business administration), public health (master of public health), or medicine (medical doctor), depending on their career goals.

The job market

Although there are some similarities between pharmacy practice in the UK and the US, there are also considerable differences. Primarily, these differences stem from the distinct differences between a national single payer healthcare system, such as the NHS, and the for-profit, insurance-based healthcare system of the US.

Salaries vary greatly due to the large number of different job settings and employers. They may range from $80,000 to $140,000 (about £54,000 – £95,000) or more per annum, but the higher paying jobs may require relocation, a busy work environment and long hours.

Reading various blogs and web forums can give an insight to the complaints and daily stresses a pharmacist in the US faces, but their content cannot be taken too seriously given their context. It is true that pharmacists in the US must often resolve patient’s insurance claims, navigating systems over which they have little control. This conflict between profit and the best interest of the patient often creates difficult situations. However, progress is being made to address issues of cost, quality and access in pharmacies nationwide.

Recently, community pharmacies have been creating in-store clinics where patients can see a doctor or nurse practitioner for minor illnesses and injuries, and receive prescriptions. Pharmacists advocate for permission to give immunisations, to support and reward medication therapy management and collaborative drug therapy management, and promote other issues that establish the pharmacist as an important player in the healthcare field.

Ready to make the move?

So, how can pharmacy students in the UK get involved in pharmacy in the States? The most important thing is to start early. Make a plan (see Panel 1). Do you want to practise in the US permanently or just try it out? Can you afford to spend a year or more abroad, or will you seek an inexpensive summer programme? Whatever you decide on, you will want to leave enough time to make contacts, set up your study or work plans, obtain the necessary permits and visas, find housing and make travel arrangements.

 

 Panel 1: Planning timeline

Here is a simple timeline that may assist you in preparation of experiencing pharmacy practice in the US.

 

  • One year (or more) ahead: make a plan and learn all you can Learn about the laws in the state you wish to travel, plan forimportant deadlines and obtain all the necessary information forinternational travel, study, work, and residency. Being well preparedmeans being as knowledgeable as you can.

 

  •  One year ahead: contact people, ask questions and find your direction Contact people who can help you make decisions and find the job,internship, or applications that you need. Be accommodating butpersistent with your calls and e-mails (and remember the time zonedifferences).

 

  •  Eight to 10 months ahead: submit applications Finalise all paperwork, applications and dates of travel. Confirm anddouble-check all the plans you have made. Ask your friends, professorsand academic advisers to look over your plan and confirm your goalswith them. Take time to reflect on your plans and be certain that youhave everything in order to ensure an easy and trouble-free experience(do not forget about visa applications).

 

  • Six months to one month ahead: final preparations It would be useful to research the area and universities near yourdestination. Continue to make regular contact with the relevantagencies to have your questions answered. And, of course, enjoy yourexperience!

 

 

Consider the many costs and fees that you may incur when travelling abroad and deciding your length of stay. Learn about the laws and requirements of the state you wish to go to.

Once you know about the costs and have decided on a goal, begin to reach out to people who can help you. Schools of pharmacy, pharmacy organisations, government organisations and pharmaceutical companies will be your best resources for assistance in finding a job, internship, classes and other resources to help you achieve your goals (see Panel 2).

 

Panel 2: Helpful resources

The Fulbright Commission The US-UK branch of the prestigious international exchange programmeprovides detailed information and resources specifically for studentsin the UK interested in coming to the US. It also provides scholarshipsand subject-specific programmes in undergraduate and graduate study.

 

Student Doctor Network A diverse online community for every kind of allied health studentand recent graduate. They may be able to answer questions or offerinsight and advice, but be wary of anecdotal claims.

 

American Pharmacists Association A huge organisation of pharmacists that provides many resources andinternships. They can put you in direct contact with programmes andpharmacists.


International Pharmaceutical Students Federation
The IPSF is the leading international advocacy organisation ofpharmacy students promoting improved public health through provision ofinformation, education, networking and a range of professionalactivities. It provides a well organised summer student exchangeprogramme to many countries each year.

 

American Association of Colleges of Pharmacy It contains links and contact information for every accreditedcollege of pharmacy in the US and Canada. Contact an institution nearwhere you hope to live and study for more information about theirpharmacy programme or other advanced degree programmes.

 

National Association of Boards of Pharmacy This organisation is responsible for the administration of alllicensure exams and should be your first point of contact regarding theForeign Pharmacy Graduate Equivalency Examination.


Department of Health and Human Services This branch of the government is responsible for the regulation ofpharmaceuticals and employs many pharmacists in the public healthservice. It also offers internship opportunities and resources.

 

Be sure to confirm that the credits or preregistration hours you hope to obtain will transfer to your institution. Because of the wide variety of institutions that grant academic credit and monitor internship hours in the US, one university may not recognise credits obtained from other institutions. Likewise, pharmacy boards may not recognise hours that were completed in certain settings.

Contact the US Embassy and inform it of your plans and ensure that your student or work permit and passport visas are in order. Although it is possible to arrange your own trip, consider seeking the help of a reputable agency, seeking sponsorship from a business, or applying for a prearranged programme.

Be polite but persistent in getting what you hope to get out of the experience. You may have a much greater chance of success if you can offer to arrange an exchange with a US student interested in pharmacy in the UK.

If it is realistic and affordable for you, consider coming to the US to pursue an additional degree or residency. The student visa may be easier to obtain than a work permit and, as you navigate the process of not only getting your US licensure, you will be able to come away with an advanced qualification.

If you decide you do not want to stay in the US, you at least have the additional experience and if you do wish to stay, you already have at least two years of residency, and a head start on the immigration and licensure procedures.

Do not be discouraged if you are met with some difficulties. Seek additional help if you need it. We welcome all our colleagues from around the world to come and experience pharmacy in the US, and hope that you decide to join us in practice sometime.

 

Quinn Bott is a second year pharmacy student at Northeastern University in Boston, Massachusetts

Citation: Tomorrow's Pharmacist URI: 10975851

Readers' comments (5)

  • This article is most helpful. I am a hospital pharmacist in Cambridge, UK and my husband is a medical Dr. doing research. I have been practising for 7 years and have obtained a postgraduate Diploma. My husband is moving to Boston in April to do research for 18 months and I will come over and apply for a work permit then with a view to move over when (hopefully!) that comes through. Hence I will probably only be there for 1 year to 13 months and am unsure (have probably left it a bit late to apply to practice as pharmacist) as exactly what I will do- I am toying with the idea of practicising to be a technician and doing a course or applying to sit the FPGEE in November although I appreciate I need to get my skates on with this. Basically the information you have provided is great as it consolidates and clarifies information from a variety of sources I have been looking at. I don't suppose you know the no. of intern hours required in Boston as I note you are from there? Many thanks

    Unsuitable or offensive? Report this comment


  • Dear Hannah,


    Please see below a response to your query from Quinn Bott, the author of the article.


    Benedict Lam


    Editor - Tomorrow's Pharmacist


     


    The number of internship hours required for pharmacist licensure in the state of Massachusetts is 1,500, but can vary from 1,000 to 2,150 depending on the state. Applicants must be FPGEC certified and complete an affidavit to confirm their work visa if they do not have a Social Security Number. A detailed timeline of this process can be found here:


    http://www.nabp.net/programs/examination/fpgec/


    The telephone number for the Massachusetts State Board of Pharmacy is +1-617-727-9953, they would be happy to answer your case-specific questions. Their website is http://www.mass.gov/dph/boards/pharmacy, but little information for foreign pharmacy graduates is available there.
    This information and Board of Pharmacy contacts for each state are summarised here: www.visalaw.com/IMG/pharmacistchart.pdf


    Thank you for your enquiry, and good luck!


    Quinn Bott


    Doctor of Pharmacy Candidate
    Northeastern University | Bouvé College of Health Sciences
    Boston, Massachusetts


    bott.q@husky.neu.edu

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  • Thank you for your article, it has been very helpful. I have seriously considering moving to the United States to practise as a pharmacist. But I have not had much luck in finding a company to sponsor me for a work permit. I notice you did mention trying to seek the help of professional agencies or applying for a pre-arranged programme. Do you know of any agencies? And how do I go about applying for a pre-arranged programme?

    Unsuitable or offensive? Report this comment

  • Hello
    My name is Harleen Khaira. I am a fourth year pharmacy student in Liverpool, UK. I have done my bachelors of science in biological sciences at University of the Pacific, in Stockon California. I am a US citizen. I have lived and studied in the United States my whole life.

    Is it necessary for me to do my pre-registration year in the UK before heading back to the US to take the exams? Or once I finished my degree can I start the examinations?

    Additionally, if I am required to be licensed in the UK before heading over, can I take my FPGEE before I am licensed? Basically they offer it in April and I was hoping to fly back to the states to take the FPGEE in July. Otherwise I would have to wait a couple months after I finish in the UK before being able to take the FPGEE.

    Thank you for your time and effort!

    Sincerely
    Harleen Khaira

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  • Hi

    I'm a student in Cambridge, and I'll be finishing my 4-year course in Master of Pharmacy soon. After graduation, I would to move to America and get a job there, I'm thinking of New York. However what I have to do is still kind of fuzzy to me because I have read a lot of website and got many difference information. For instance one of them said that I need a PhD degree.

    I am really confused if pre-registration in UK is necessary in my case or I should go ahead with all the tests required in the States?

    Thank you for your help in advance,

    dangminhtu0709@gmail.com

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