The *Angriest* Pharmacist You want your prescription filled when? Eat shit…

Foreign Graduate Problem?

Posted on February 21, 2011

This was emailed too me and seemed quite compelling. I don't have much to add to it except my curiosity. I was hoping to present this to the community and see what your thoughts were. Please share them with me (and the author).

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From: leon <leonce1234@gmail.com>
Subject: too many incompetent foreign graduates
Title: Pharmacist

Message Body:
I am sorry to switch gears on you, but I felt the need to address another issue in the field of pharmacy. As most pharmacists already know, it is very tight job market out there. When I graduated, it was completely the opposite. Sign-on bonuses were common and hourly rates were very negotiable. Most employers were willing to train old and new pharmacists from the very beginning. Fast forward a few years later and all those jobs have practically vanished. Without networking, it is nearly impossible to get your foot into the door.

While I have been fortunate enough to find another job in pharmacy, I noticed a disturbing trend. Generally speaking, I will say most of my classmates were competent pharmacists. They were hardworking and eager to learn and keep up with the latest drug therapies. As I worked in the real world, I noticed some really ignorant and incompetent pharmacists. These pharmacists would not know the difference between Keppra and Keflex (no, I am not kidding). These pharmacists could not tell you the names of other drugs in the same family (ACE inhibitors, ARBs, Cephalosporins, Fluoroquinolones, etc). They could not even tell you the generic name of a drug, much less if there was even a generic on the market. Worse, I started catching their prescription errors on a regular basis and had to explain to customers why our pharmacy was making mistakes. My technicians would tell me, “That floater we had yesterday was dumb as hell. He was asking me questions about drugs.” My other regular pharmacists would shake their heads in disgust after seeing the kinds of mistakes that were being made.

Who are these pharmacists? Foreign graduates. I spent 6 years getting my Doctorate of Pharmacy degree. By contrast, most of these foreign graduates spend only 4 years in school. Unlike most medical schools in foreign countries, pharmacy schools outside the United States are basically looked down upon in their respective countries. Part of the reason is because the education is lacking and does not challenge the prospective student. A pharmacist in China, for example, would make little money and he or she would be working every day to make ends meet. As for a place on the healthcare team, you can forget about it. Pharmacists in other countries are poorly thought of and would not be considered true healthcare professionals. On the other hand, getting into a medical school in China is very difficult. After one enters and graduates from medical school, he or she would still be required to perform a residency in the United States for a minimum of 3 years. Despite all of this, it is apparently pretty easy for a foreign graduate to get a Pharmacy License in just about any state by taking a couple of simple exams such as the Foreign Pharmacy Graduate Equivalency Examination and a Test of Spoken English. Throw in a few hundred dollars and you basically have bought a Pharmacy License.

The biggest consequence in all of this is the rise in prescription errors. I have seen it over and over again at different pharmacies and settings. These pharmacists and pharmacies are a danger to public’s health and safety. Another effect these foreign pharmacists are having is that they are over saturating the job market. I can live with the fact that another pharmacist gets the job I was looking for. There are many competent and very good pharmacists out there in the marketplace. They are mentally very sharp and do their job very well. However, when I see a pharmacist make errors repeatedly, I start thinking to myself, “How can this person not know what they are doing? Where did this person even go to school?” And on most occasions, he or she did not attend a pharmacy school in the United States.

At the end of the day, this country needs to stop just handing out Pharmacy Licenses to anyone who claims to be a pharmacist. A pharmacy education in foreign countries is not equivalent to a pharmacy education in the United States. I am sure there are exceptions to the rule. I am certain there are some highly motivated foreign graduates who proved themselves over and over that they are more than qualified to handle the responsibilities of a pharmacist. I just have yet to see one such pharmacist. In my experience, some schools do a better job of putting capable pharmacists onto the marketplace (UCSF seems to do a good job, in my opinion). Personally, I think all foreign graduates should have to attend pharmacy school in the United States in order to acquire a Pharmacy License (a 3 year or 4 year Pharm.D program). Before someone thinks I am too eco-centric, I was actually born in another country, but I grew up here in America, and English is my primary language. And yes, I am a United States citizen. I just think our profession needs to have a serious discussion on what a pharmacy education in the Unites States is really worth before it is too late.


BEFORE COMMENTING READ THIS:

TheAngriestPharmacist did NOT write this post. He has not commented about the validity, certitude, or accuracy of anything written in the post or in ANY of the comments. Please stop submitting comments accusing TAestP of racism, discrimination, or having anything to do with this post. I only posted this because the author asked to use my site as a place to reach many pharmacists. I will not post accusatory comments about myself. I will delete them and ban the author from the site entirely. If you have an opinion, feel free to post it. Keep the other pointless shit off my site.

Pharmacy Class of Trade

Posted on January 26, 2011

I got the following message from Steve Moore, an independent Pharmacy owner. I wasn't sure what to do with it or how to share it with the world. Therefore, I'm just going to post it here for all to see. I'm not going to post his contact info, but he's welcome to post that in the comments section (as well as links and references).

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My name is Steve Moore and I am an independent pharmacy owner from New York.  I am wondering if you would consider sharing your thoughts on the following topic, one I think that most pharmacists would be interested in.

When it comes to business side of our profession, most pharmacists don't have a clue as to what is going on.  As an owner, it affects me more than most, and I don't comprehend all of the complexities.  After speaking to some other pharmacists in my area, I came to realize that they are under the impression that mail order pharmacies were simply discount pharmacies, that mail order just filled prescriptions at a lower price than retail pharmacies.  That may or not be true, the larger issue is that mail order pharmacies are able to offer deeply discounted medications because they are purchasing medication a better price than retail pharmacies.  PHARMA grants them a special class of trade (COT).  I attempted to find a law/rule/etc that grants mail order pharmacies these special buying privileges as a different COT and was unable to do so.  I wrote to consulting companies and wholesalers and I was told that there is no such list.  If there is no government approved or provided COT list, what makes mail order special other than the fact that PHARMA says so?

My question is, if mail order can do it, why can't community pharmacy designate itself as a special COT?  Mail order promotes safety and accuracy, we have a robots and workflow too.  We can fill antibiotics and pain meds, mail order cannot.  We can deliver meds the same day, mail order cannot.  Mail order simply cannot meet 100% of our pharmaceutical needs.  If any group deserves a price break from PHARMA, shouldn't it be the group that can meet more needs?

There is a federal law known as the Robinson-Patman Act which specifically prohibits companies from selling the same products to competitors at different prices (order of magnitude wise).  Exemptions to this act exist to allow nonprofits (such as hospitals) to purchase medication for their own use at a discounted price.  In addition to the hospital COT, there is a 340b class (for now), a long term care class, and depending upon who you ask, anywhere from 7 - 23 classes.  The one constant is that the retail pharmacy COT pays the most for medications.  COT designations have been challenged in the past but were usually lost on the basis of own use.  That meaning, the nonprofit was purchasing medications to use for its patients/employees/etc and was not in competition with retail pharmacies.  Mail order pharmacies are for profit and are clearly competing with retail pharmacies, so in my mind a Robinson-Patman exemption should not apply.  I understand supply and demand and that some people can pay more than others for the same product, but we are not talking about a few bucks here and there, rather exponential differences.  The local hospital pays about $9 for 100 tablets of brand name Coumadin, what does the price sticker on the bottle in your store read?

The fact that mail order pharmacies are buying  medications at a lower price than retail pharmacies has an impact on every pharmacist filling 90 day prescriptions at retail for mail order rates.  I am not saying that if reimbursement improves, working conditions will improve, but it can't hurt to make pharmacists aware of what is going on.  I have contacted our trade associations and industry publications but am also reaching out to bloggers such as yourself.  If you feel that this may be something you would like to blog or post about, I can provide some links and references.

Thanks for your time.

Requirements versus Services

Posted on January 8, 2011

The smart alecks that post wise guy comments on my, and other pharmacist websites, usually only have one or two things they say regarding the worth of pharmacists. The root of their hatred for the profession that does so much for the common citizen is seeded in their jealousy of the wages paid to such highly trained professionals. Along the same lines, they only see pieces of paper (money and prescriptions) coming in and bottles filled with 30 pills each going out. Haters see it as overly simplified. Exoterically, from the outside looking in, it is, but for those of us that spent 6 to 8 years getting a doctorate, we don't agree. Compared to backbreaking labor outside in the hot sun, I can at least understand.

I've also had a recent brash of problems with patients being rude/uncaring about the difference between requirements of a pharmacist versus services provided by a pharmacy. Some things we do are required by laws, federal or state, while some things are done to ensure patients have a good pharmacy experience and return with more pieces of paper.

Requirements:

1. I take the prescription from you. I ensure it meets all legal requirements (Name, Date, Drug name, directions, quantity, refills, doctor signature, and in my state, the Rx symbol on the face of the prescription).
2. I input in the computer (the computer system is not required. I could use a typewriter or even hand write the labels).
3. A prospective DUR (Drug Utilization Review) is performed by either the pharmacist manually and/or the computer system automatically ensuring that there are no drug-drug, drug-disease, or drug-patient interactions requiring concern. If there is, the physician in contacted. The patient is educated or the drug is changed to an alternative at this point. If there is no problems, we move on:
4. A label is generated and placed on an amber bottle.
5. The appropriate drug is counted and placed into the bottle.
6. Final check is performed by pharmacist and all aspects of the process is verified again. Finalized product is bagged and put into the pharmacy's WCB (Will Call Bin).
7. Patient picks up medicine. Patient is provided the opportunity to ask a pharmacist any questions concerning the medicine with the magic question, "Do you have any questions for the pharmacist?" -- this requirement not being added until 1990.

Services:

1. Billing your prescription insurance (or Medicaid) for the cost of your medicine (I don't have to take any insurance - let alone YOUR insurance). Some compounding pharmacies refuse to accept insurance and are cash-only.
2. Calling your insurance if their is a problem such as them not wanting to pay for the expensive name-brand drug your doctor wrote for, the quantity he wrote for, or for any of millions of other reasons they could dream up. Perhaps you remember when CVS made the decision to not call your insurance for problems any more. They accomplished this by placing a phone in the waiting room. It didn't go over well, but it proves my point.
3. Calling your doctor for refills when your prescription runs out. This is the job of the PATIENT that has been performed by pharmacy's striving to merely keep patients from having the opportunity to take their pieces of paper elsewhere if they are forced to visit the doctor for refills.
4. An easy open lid is placed on your bottle instead of the safety lid which is the legal requirement. (Screw your arthritis - I don't have to cater to you!)
5. Paging your name overhead when your prescription is ready -- that's all southern hospitality, buddy!
6. Taking checks or credit cards is also optional. Cash is the only requirement -- read the dollar bill. Does your credit card or check say that I *have* to take it? Nope.
7. Flavoring your child's antibiotic with out FlavorRx system.
8. Anything or everything related to having a drive-thru or providing services through it.
9. Being nice to you in any way, shape, or form. I just have to be there and be sober...I don't have to be my normally delightful self...

I'm sure this second list has a BUNCH more items on it. Fill in the holes for me...I'll add them to the list.

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