Pharmacy practice the American way!

In 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 for important deadlines and obtain all the necessary information for international travel, study, work, and residency. Being well prepared means 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 but persistent with your calls and e-mails (and remember the time zone differences).
  •   Eight to 10 months ahead: submit applications Finalise all paperwork, applications and dates of travel. Confirm and double-check all the plans you have made. Ask your friends, professors and academic advisers to look over your plan and confirm your goals with them. Take time to reflect on your plans and be certain that you have 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 your destination. Continue to make regular contact with the relevant agencies to have your questions answered. And, of course, enjoy your experience!

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 programme provides detailed information and resources specifically for students in the UK interested in coming to the US. It also provides scholarships and subject-specific programmes in undergraduate and graduate study.

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

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

International Pharmaceutical Students Federation
The IPSF is the leading international advocacy organisation of pharmacy students promoting improved public health through provision of information, education, networking and a range of professional activities. It provides a well organised summer student exchange programme to many countries each year.

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

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

Department of Health and Human Services This branch of the government is responsible for the regulation of pharmaceuticals and employs many pharmacists in the public health service. 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

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