What is it like to be a Pharmacist in the United States of America?

By Christina Cao (Cao Xuan Thanh Ngoc)
Corporate Director of Pharmaceutical Services
Prime Healthcare Management Inc.

My name is Christina Cao and I have been working in healthcare as a Pharmacist for 10 years now. I would like to take the opportunity to share with you some of the milestones of Pharmacy profession in the United States (US). I will focus on the steps on howto prepare for Pharmacy School, the degree that associated with this profession as well as the many options that Pharmacists can do after they officially become Pharmacists!

Becoming a pharmacist requires years of education and training to obtain the necessary knowledge, skills and certifications. When one decide to pursue a career in pharmacy will affect his/her education path. Prospective pharmacists can spend between six years to thirteen years completing pre-requisites, Pharm.D (Doctor of Pharmacy) courses, clinical rotations and national exams.

The pre-requisite courses for future pharmacists mainly focus in biology and chemistry. At the undergraduate level, these help lay the foundation for advanced pharmacological study. Students working toward entry to a Pharm.D program have a few options when it comes to science-related courses. There are 2 major options to prepare for the Pharm.D program: first option is a 2 years non-degree courses where students can focus on their Pharm.D pre-requisites in a targeted, two-year timeframe and the courses are science-heavy to facilitate readiness for the Pharmacy College Admission Test (PCAT). Secondly, a bachelor’s degree in science-related fields (biology, chemistry) before making the transition to a Pharm.D program. This option allows for more flexibility upon graduation should a student decide to explore other options in addition to a career in pharmacy. Some students decide to choose this route because this will allow them more time to study for the PCAT.

The Pharm.D degree is the first professional step toward practicing as a pharmacist. As of July 2015, there are 132 U.S.-based colleges and schools of pharmacy with full accreditation. Completion of a Pharm.D degree usually takes four years of study. During these four years, the students will receive extensive studies focusing on pathophysiology, pharmacotherapy, health management and clinical rotations where the students will be able to select different rotation sites such as hospital, community or management care pharmacies to practice. These rotations really help future pharmacists to choose their career paths after they pass their national and State Board of Pharmacy licensure examinations! There are 2 examinations that future pharmacists must pass in order for them to practice as pharmacists in the US. The NAPLEX-North American Pharmacist Licensure Examination-this exam measures a candidate’s knowledge of the practice of pharmacy. The State Boards of Pharmacy used this exam as their assessment of a candidate’s competence to practice as a pharmacist. The second examination is the MPJE-Multistate Pharmacy Jurisprudence Examination and it combines federal and state-specific questions to test the pharmacy jurisprudence knowledge of prospective pharmacists. It serves as the pharmacy law examination in practicing jurisdictions.

For me, after I finished my Pharm.D program and received my license to practice in Florida, I chose to do 1 year of residency in Pharmacy Practice to strengthen my knowledge in the hospital setting. After I did my clinical rotations at different hospitals during my last year of Pharm.D program, I knew that hospital pharmacy was the place where I wanted to practice as a pharmacist. The residency program allowed me to practice as a pharmacist as well as to continue with my learning process! After 1 year of doing residency, I decided to move back to California where all of my relatives lived, therefore, I had to obtain my CA pharmacist license (each State has its own MPJE exam that a pharmacist must take). As a pharmacist, there are so many career options that one can choose such as health system pharmacy-inpatient pharmacist; community pharmacist; long-term care pharmacist; academia; ambulatory care; nuclear pharmacy; corporate management…the list goes on and on (www.pharmacist.com/career-option-profiles for more details)

Health system pharmacy-inpatient pharmacists work very closely with nurses and physicians to care for the patients in the hospitals. Most of the time, they do not interact directly with the patients, but they help to optimize the patient’s drug therapy. The inpatient pharmacists may have exposure to oncology, intravenous (IV) medication therapy, neonatal care, nutrition, pain therapy management, geriatrics, and much more. Health system pharmacists have many responsibilities such as dispensing medications, monitoring drug therapy, preparing IV medication, and overseeing drug administration.

Community pharmacists play a personal role within the community by ensuring that the patients receive the medications and care that they need. They provide consultations to customers who have questions about their medications including drug-food interaction; drug-drug interaction and simply how to take their medications to maximize the effects of the drugs!

As Americans live longer, the need for long-term care pharmacists grows stronger each day. They practice in a variety of settings such as hospitals that own skilled nursing facilities, long-term care pharmacies, nursing homes and rehabilitation facilities. These pharmacists are responsible for the residents’ drug therapy regimens, medication dosage requirements, and formulary decisions.

There are many pharmacists enjoy working with students while engaging in clinical practice and/or clinical research. These pharmacists have both a direct and an indirect impact on patient care as many are involved with medication therapy management programs and services. Their job responsibilities include administrative activities, scientific research, teaching professional student pharmacists, student counseling and teaching student pharmacists during their rotations.

My career path leads me to be in the corporate management position. After I finished my residency program, I started to work as clinical pharmacist in hospital setting. I only practiced for 3 years when the opportunity presented to me with a job offer to be a Pharmacy Director for my hospital. At the time, I had no management experience at all, but I accepted it with the willingness to learn! I have worked as Pharmacy Director for many hospitals ever since. My career continued to grow when I was offered a Corporate Manager position with my current company. At the time, I was in charge for 28 hospital pharmacy operations across the country. After 1 year of being a Corporate Manager, I got promoted to become a Corporate Director to oversee 40 hospital pharmacy operations at the age of 40! To this time, there is no one in my profession who holds this title at such a young age!

My daily operation responsibilities include coordinating and supervising 40 hospital pharmacy accounts nationwide; maintaining and revising policies/procedures to ensure safe administration, control; storage and use of medications at all locations throughout the system; optimal management of the pharmacy operations, including staffing, financial decisions in inventory control and the budgeting process; managing $200 million dollars pharmacy budget across the system; working closely with the Vice President (VP) of Clinical Operations in evaluating and assessing new acquisitions; determining required level of services for Pharmacy departments, and conducting mock surveys for all Prime hospitals; working with the Corporate Chief Medical Officer (CMO) and the VP of Clinical Operations to monitor budgets, and implement appropriate Plan of Corrections to improve pharmaceutical cost throughout the system; serving as Subject Matter Expert (SME) for the design, standardization and implementation of Epic Willow application and other pharmacy IT applications; formulary and pharmacy products standardization; ensuring compliance focusing in patient care and operations of the Pharmacy-consistent with policies and procedures of the health system and regulatory agencies.
Christina Cao (Cao Xuan Thanh Ngoc)