How to Work as a Pharmacist in the United States: Full Guide for Domestic and International Graduate

Introduction

The United States is a land of opportunity, not only in terms of career advancement but also in terms of experiencing a diverse and vibrant culture. For pharmacists, the US offers a dynamic and rewarding environment with numerous pathways for professional growth. This guide provides a comprehensive overview for both domestic and international pharmacists, detailing the steps required to become licensed, find a job, and integrate into life in the US.

Characteristics of the US Healthcare System and Opportunities for Pharmacists

Unique Features of the US Healthcare System

The US healthcare system is renowned for its advanced medical technology, high standards of care, and significant investment in medical research. However, it is also complex, consisting of a mixture of public and private providers. The system is regulated at both the federal and state levels, leading to variations in practice standards and requirements across different states.

Opportunities for Pharmacists

Pharmacists in the US have a wide range of career opportunities:

• Community Pharmacies: Pharmacists in these settings are the most accessible healthcare professionals for the public. They provide medication dispensing, patient counseling, and health screenings. Major chains include CVS, Walgreens, and Rite Aid, as well as numerous independent pharmacies.
• Clinical Pharmacies: These pharmacists work in hospitals and healthcare facilities, collaborating with healthcare teams to manage patient medication therapy and improve outcomes. Roles include medication reconciliation, clinical consultations, and direct patient care.
• Specialty Pharmacies: Focused on managing chronic and complex conditions such as cancer, HIV, and rheumatoid arthritis. Pharmacists in these settings manage high-cost, high-touch medication therapies.
• Academic and Research Positions: Involves teaching at pharmacy schools or conducting pharmaceutical research. These roles contribute to the advancement of the pharmacy field through innovation and education.
• Pharmaceutical Industry: Opportunities include roles in drug development, regulatory affairs, medical science liaison, and sales. Pharmacists in the industry ensure the safety, efficacy, and regulatory compliance of new drugs.

Steps to Get Licensed as a Pharmacist in the United States

For Domestic Pharmacists

1. Obtain a Pharm.D. Degree: This is a four-year professional degree from a program accredited by the Accreditation Council for Pharmacy Education (ACPE). Admission to Pharm.D. programs typically requires completing prerequisite coursework and passing the Pharmacy College Admission Test (PCAT).
2. Complete Required Internships: States vary in their requirements, but internships typically involve several hundred hours of supervised practice in different pharmacy settings.
3. Pass the North American Pharmacist Licensure Examination (NAPLEX): This exam assesses pharmacy knowledge and skills. The fee for NAPLEX is $575. More information can be found at www.nabp.pharmacy.
4. Pass the Multistate Pharmacy Jurisprudence Examination (MPJE): This exam tests knowledge of federal and state laws governing pharmacy practice. The fee is $250. Each state has its own version of the MPJE. Details are available at www.nabp.pharmacy.
5. Apply for State Licensure: Each state has specific requirements and fees for licensure. It's important to check with the respective State Board of Pharmacy for detailed information.

For International Pharmacists

1. Credential Evaluation by the Foreign Pharmacy Graduate Examination Committee (FPGEC): This process evaluates your foreign pharmacy degree to ensure it meets US standards. The fee for this evaluation is $1,100. Visit www.nabp.pharmacy for more details.
2. Pass the Foreign Pharmacy Graduate Equivalency Examination (FPGEE): This exam assesses the equivalence of your foreign pharmacy education. The fee is $750. The FPGEE covers basic biomedical sciences, pharmaceutical sciences, social/behavioral/administrative pharmacy sciences, and clinical sciences.
3. Pass the Test of English as a Foreign Language (TOEFL): This exam demonstrates proficiency in English. The fee varies by location but is typically around $200. Minimum score requirements must be met in reading, listening, speaking, and writing sections.
4. Complete a Pharm.D. Bridge Program: Some states require completion of additional coursework to bridge the gap between foreign education and US standards. These programs are offered by various pharmacy schools.
5. Complete Required Internships: Similar to domestic requirements, internships provide valuable US practice experience and help in understanding the healthcare system.
6. Pass the NAPLEX and MPJE: Same as domestic pharmacists.
7. Apply for State Licensure: As with domestic pharmacists, each state has its own requirements.

Detailed Steps for Licensing Examinations

North American Pharmacist Licensure Examination (NAPLEX)

• Exam Content: The NAPLEX covers various topics including pharmacotherapy, disease management, and pharmacy practice. It consists of 225 questions, with a mix of multiple-choice and scenario-based questions.
• Study Resources: Recommended resources include the "RxPrep NAPLEX Course Book", "Kaplan NAPLEX Review", and "The APhA Complete Review for Pharmacy". Online courses and practice exams are also available.
• Pass Rate: Historically, the pass rate hovers around 85% to 90%. This indicates the exam's difficulty and the importance of thorough preparation.
• Fees: $575.

Multistate Pharmacy Jurisprudence Examination (MPJE)

• Exam Content: The MPJE focuses on federal and state-specific laws governing pharmacy practice. Each state's version of the exam includes questions tailored to its own laws.
• Study Resources: "Guide to Federal Pharmacy Law" by Reiss and Hall, state-specific law guides, and online resources from the National Association of Boards of Pharmacy (NABP).
• Pass Rate: Varies by state but generally around 80%. It's essential to understand both federal and state laws thoroughly.
• Fees: $250.

Foreign Pharmacy Graduate Equivalency Examination (FPGEE)

• Exam Content: The FPGEE tests four major areas: basic biomedical sciences, pharmaceutical sciences, social/behavioral/administrative pharmacy sciences, and clinical sciences.
• Study Resources: "FPGEE Secrets Study Guide", "The Comprehensive Pharmacy Review", and study materials from the NABP. Online forums and study groups can also provide support.
• Pass Rate: Approximately 60% to 70%. The exam is challenging, reflecting the rigorous standards of US pharmacy practice.
• Fees: $750.

Finding a Pharmacy Job in the United States

Clinical Pharmacy Jobs

• Networking: Attend conferences such as those hosted by the American Society of Health-System Pharmacists (ASHP) to network with potential employers. Joining professional organizations can also provide networking opportunities.
• Job Boards: Use job boards like www.indeed.com, www.glassdoor.com, and the ASHP CareerPharm (www.careerpharm.com). These platforms list a wide range of pharmacy positions across the country.
• Residencies: Completing a residency program can enhance job prospects. Residency programs provide advanced training in clinical pharmacy and can lead to specialized positions. Information on residencies can be found at www.ashp.org.

Community Pharmacy Jobs

• Large Chains: Apply directly to chain pharmacies like CVS (www.cvshealth.com) and Walgreens (www.walgreens.com). These companies offer numerous opportunities for pharmacists across the country.
• Independent Pharmacies: Networking and contacting local pharmacy associations can help. Independent pharmacies often value personalized service and strong community ties.

Specialty Pharmacy Jobs

• Specialty Pharmacies: Focus on managing medications for complex conditions. Employers include large healthcare systems and specialized pharmacy chains.
• Biopharmaceutical Companies: Positions in research, development, and patient support programs.

Average Salaries and Cost of Living

• Salaries: The average annual salary for pharmacists in the US is around $128,000, but this can vary significantly by location, experience, and type of pharmacy practice. Clinical pharmacists and those in specialized roles often earn higher salaries.
• Cost of Living: Major cities like New York, Los Angeles, and San Francisco have a higher cost of living compared to smaller cities and rural areas. Housing, transportation, and healthcare costs are significant factors to consider.

Life in the United States

Diversity

The US is a melting pot of cultures, offering a diverse and inclusive environment. This diversity is reflected in the healthcare system, where professionals from various backgrounds collaborate. The cultural richness provides opportunities for personal and professional growth.

Big Cities and Famous Hospitals

• New York City: Home to renowned institutions like NewYork-Presbyterian Hospital and Mount Sinai Hospital. The city offers a vibrant lifestyle and numerous cultural attractions.
• Boston: Known for Harvard Medical School and Massachusetts General Hospital. Boston is a hub for medical research and education.
• Los Angeles: UCLA Medical Center and Cedars-Sinai Medical Center are top employers. The city offers a mix of urban and suburban living with a mild climate.
• Houston: The Texas Medical Center is the largest medical complex in the world, providing numerous opportunities for pharmacists.

Public and Private Healthcare

The US healthcare system includes a mix of public and private providers. Public healthcare programs like Medicare and Medicaid provide coverage for specific populations, while private insurance is common for working individuals. Pharmacists play a key role in both settings, ensuring medication safety and efficacy.

Visa and Residency for Foreign Pharmacists

H-1B Visa

The H-1B visa is the most common visa for foreign professionals, including pharmacists. Employers must sponsor this visa, and there is an annual cap on the number of visas issued. More information can be found at www.uscis.gov.

Permanent Residency (Green Card)

After working in the US, foreign pharmacists can pursue permanent residency. The process involves employer sponsorship, filing labor certification, and meeting eligibility criteria. Details are available at www.uscis.gov.

Sponsorship

Many hospitals and large pharmacy chains sponsor visas for qualified candidates. It is important to inquire about sponsorship during the job application process.

Additional Resources and Support

Professional Organizations

Joining professional organizations such as the American Pharmacists Association (APhA), American Society of Health-System Pharmacists (ASHP), and National Community Pharmacists Association (NCPA) can provide valuable resources, networking opportunities, and continuing education.

Continuing Education

Pharmacists in the US are required to complete continuing education (CE) to maintain licensure. CE programs are available through professional organizations, online platforms, and universities.