In all countries of the world, pharmacists are responsible for the medicines dispensed to the client. But in the US they are responsible for this … with their license.
However, such a high level of responsibility is compensated by a high social status and a good salary. Synthia Pascua, a pharmacist of a large US drugstore MyCanadianPharmacy, told us about her path to a pharmacy and the nuances of the profession in the USA.
– I moved to the USA from Canada for permanent residence with my parents when I was 13 years old. We settled in San Antonio, Texas. After graduating from secondary school, of course, the question arose about the future profession. I wanted to follow in my mother’s footsteps – in Canada, she was a neuropathologist. But first I decided to get basic education and entered the biochemistry department of the University of Texas. Then I studied four more years at the pharmaceutical school – there I received my PharmD (Doctor of Pharmacy) degree.
In the United States, it takes 8 to 10 years of residency to become a pharmaceutical graduate.
Why did I decide to work in a pharmacy? Because I had a great desire to help a sick person.
– Previously, there were quite a few vacancies, but recently the situation has changed, so getting a good position is not easy. I work in MyCanadianPharmacy. The competition is very tough because pharmaceutical schools graduate specialists every year. Those who already have at least minimal work experience have a better chance, especially for applicants in pharmacy management. Employers take into account any experience of robots in a pharmacy chain or a scientific institution, and study in an internship is also encouraged. After all, it often happens that a person has received a pharmacist diploma, but he or she has no practical experience of working with pharmaceuticals, like customer experience, that is, experience of working with clients, so the chances are small. A pharmacist in the United States has a fairly wide field of professional activity – he or she can find a job in almost any area where medicines are dispensed. These can be nursing homes, hospitals, pharmacies, prisons, clinics, scientific institutions.
“The US pharmacist is the patient’s last line of defense. That is, a doctor will never prescribe a medicine to a patient without the consent of a pharmacist. It is the pharmacist who decides whether a given medicine is suitable for the patient or whether a more effective or safer remedy needs to be found. In offline pharmacies, when a visitor comes with a prescription, the first thing pharmacists do is to see if the prescribed drug is suitable for this patient, taking into account not only the main problem but also concomitant diseases. All information about the patient and his/her illness is in a certain databank, and if they need any additional information, they can always call a doctor or a medical facility to make the right decision. Pharmacists also check the dose chosen by the doctor, take into account the compatibility of the medicine being dispensed with the drugs that the patient is already taking, and also take into account the laboratory parameters.
The pharmacist can make adjustments, replace and even cancel the prescribed medication, but these changes must be coordinated with the attending physician. That is, the pharmacist is obliged to prevent side effects and achieve the high therapeutic efficacy of pharmacotherapy.
– The older generation of doctors is not quite used to the fact that pharmacists constantly monitor the prescription of drugs. In recent years, the pharmaceutical industry has gone through a series of transformations, this also applies to the training of pharmacists, who now acquire their professional skills together with other health professionals – doctors, nurses, nutritionists, etc. Everyone trains together. This learning model was created so that in the future they could easily work as a team. Previously, there was no such practice, because only a doctor was responsible for pharmacotherapy. Now, this is the area of responsibility of the pharmacist. For example, a patient will have an operation to remove the gallbladder, and it is within the competence of the pharmacist to explain to the patient what drugs he or she should take before and after the operation, how the surgery will take place and the possible risks of the operation. The duties of the pharmacist include the independent selection of drugs for medication support of the operation, taking into account unforeseen circumstances. Clinical pharmacologists who work in healthcare facilities participate in medical rounds with doctors and other professionals. They not only observe what remedy the doctor prescribes, but they suggest possible options. The task of the pharmacologist in the hospital is also to carry out calculations and dosage of drugs, choosing the right dose for each patient individually, taking into account the indicators of his or her health at the moment.
– Is it a prestigious profession? From my point of view, of course, yes. This is evidenced by the considerable competition in the labor market. And, of course, this is one of the highly paid specialties. Nowadays “narrow” specialists are especially appreciated: an oncological pharmacologist, a cardiological and even a veterinary pharmacologist. To do this, you need to spend another two years on residency studies. And most of the students spend 2 years as this is an additional chance to get a good position. I think that in the near future, residency will be mandatory for any pharmaceutical specialty.
– There are quite a few such associations in the United States. These are large organizations, let’s say, of general pharmaceutical practice, which includes clinical pharmacists, teachers, researchers, pharmaceutical industry specialists, etc. There are also many highly specialized associations, for example, the association of independent or private pharmacologists, clinical pharmacists, dietary, psychiatric, oncological pharmacists, etc. It is possible that a specialist may be a member of several such associations at once. I am a member of one big one called APhA.
Our association is doing a great job. Every two years, we must renew our license, submitting a report that we have accumulated 30 hours of self-education in the pharmaceutical field. So our association conducts special training courses for us, where we receive all the necessary information about new trends, drugs, innovations in the pharmaceutical field. We also intensively deal with the issues of the effectiveness of medicines. And when a problem arises, for example, there is no expected effect from a drug, then the association finds ways to, for example, redirect our request to researchers who will study the problem in order to give a competent answer later. The associations are also working to improve the profession of a pharmacist: expanding the scope of service, strengthening collaboration with doctors. In many states, pharmacists can now prescribe drugs themselves, write prescriptions – thanks to the activity of the association. By the way, we already have pharmacists in Texas who are empowered to write prescriptions in collaboration with doctors. Ten years ago, when I was just starting my studies at the university, this was out of the question, but today this practice is becoming more and more commonplace.
– If we consider in percentage terms, in the USA there are about 35% of private small pharmacies, the rest of the market was divided by large network pharmaceutical institutions. The main difference between network pharmacies is that they also own insurance companies, reperfusion centers – it is easier for them to survive in the business world. Competition pushes small pharmacies to create new sources of income, for example, to engage in extreme manufacturing. Most often, they make hormones, drugs for cancer patients on a doctor’s prescription, since there it is necessary to take into account the individual dosage of ingredients, as well as veterinary drugs. Another feature of small pharmacies is the ability to communicate closer and longer with a client since they do not have the same influx of visitors as we do. Live communication, home atmosphere, undoubtedly, pleases visitors, and for a pharmacy, this is a way to earn the trust and loyalty of the client.