Tomorrow's Pharmacist
2007:36-39
January 2007

This article
Reprint   Photocopy

PDF 60K, Acrobat Reader

Living the American dream

After you have registered in Britain you may like to travel and work in other parts of the world. Registering as a pharmacist in the US is not an easy task but it is possible. Sara Barrow outlines the steps involved and the challenges she faced along the way

Pharmacy around the world

Pharmacists working in the US must have a pharmacist licence issued by the state in which they wish to practise (except, for example, if they are working in the pharmaceutical industry). Although each state has its own procedure, they generally all require foreign-trained pharmacists to pass the Foreign Pharmacy Graduate Equivalency Examination (FPGEE) and be certified by the Foreign Pharmacy Graduate Examination Committee (FPGEC) before undertaking practical experience as an intern.

The applicant must then pass the North American Pharmacy Licensure Examination (NAPLEX), which is common to all states, and the Multistate Pharmacy Jurisprudence Examination (MPJE), which is tailored to meet individual state requirements. The final step is then the pharmacist licence application. The FPGEC requires candidates who graduated before 1 January 2003 to have completed at least a four-year pharmacy course and candidates who graduated after this date to have completed at least a five-year pharmacy course. Either A-level studies or preregistration training can be included as part of the pharmacy curriculum requirement, so British graduates meet this criterion.

FPGEE application

Application packs for the FPGEE, containing forms and instructions, are available from the National Association of Boards of Pharmacy. A number of items in addition to the completed forms are required, as listed in the first panel (below). Any documents that are not in English must be accompanied by an official certified translation. Since I was including my A-level studies as part of the four year requirement, I also included a transcript from my secondary school. The FPGEC then requested a letter from my university stating that A-levels were a requirement for the pharmacy degree. This letter was duly sent and my application was approved. I was then able to register to sit the FPGEE, which is currently a pencil and paper examination (rather than a computer-based test) held twice a year, at two or three locations in the US (including one in New York City).

Language competency

The FPGEC requires all foreign applicants to demonstrate competency in the English language. At the time of my application, I had to achieve a specified score in both the Test of English as a Foreign Language (TOEFL) and the Test of Spoken English, within two years of taking the FPGEE. I believe that this has now changed, so that the language test can now be taken at any time in relation to the FPGEC. I also understand that there will be a change to a single internet-based TOEFL in which candidates will have to achieve specific scores for reading, writing, speaking and listening.

Preparing for the FPGEE

The FPGEC issues a syllabus to help candidates prepare for the FPGEE. Applicants are also provided with a list of textbooks that are used by pharmacy schools in the US. Some of the books will already be used in the British system, whereas others are specifically concerned with pharmacy practice in the US. Good places to source these include hospital or university libraries and the library service at the Royal Pharmaceutical Society. If books are bought, I have been advised that the cost can be claimed against US income tax because they count as “continuing education expenses”.

One book not on the FPGEC list which I found particularly useful is the Comprehensive Pharmacy Review.¹ This is written for US students preparing for the pharmacist licensing exam and includes a number of practice questions. A companion book of additional questions is also available.² Another useful book is the Drug Information Handbook,³ which is the US equivalent of the British National Formulary. It should be noted that, while generic drug names are mostly the same as in the UK many brand names are different, as are some dosage forms. For example, aspirin tablets are available in 81mg and 325mg strengths and are generally enteric coated. Abbreviations used on prescriptions also differ from those used in the UK, for example “o.d.” means “right eye”, “q.d.” means “each day”, and “h.s.” tends to be used instead of “o.n.” for doses taken at night. Clinical laboratory tests do not always use SI units — the first time I saw a television commercial for a cholesterol-lowering drug I was horrified to hear about cholesterol levels of 200!

Pre-FPGEE

The FPGEE is a multiple-choice examination and the FPGEC brochure includes some practice questions. The pre-FPGEE is an internet-based practice examination that anyone may do, although there is a $50 (approximately £28) fee. This involves answering 66 questions in 85 minutes and it may only be attempted once. All the questions must be answered in order to generate a score report. Although the questions are real examination questions, I did not find the pre-FPGEE truly representative of the FPGEE because it was not possible to skip questions and return to them later or to go back and amend answers. Also, some questions do not count towards the score but are being tested for their suitability as future examination questions. Scores for both the pre-FPGEE and FPGEE are scaled rather than given as a percentage, with a score of 75 out of a maximum possible score of 150 being required to pass the examination. I finally summoned up the courage to do the pre-FPGEE two weeks before the actual FPGEE, and achieved a score of 119, which was a great confidence boost.

The FPGEE

Candidates taking the FPGEE examination are responsible for making their own arrangements for travel and accommodation. The examination locations are close to major airports, making travel from both within and outside the US relatively easy. It is worth considering the effects of jet lag when making travel arrangements.

The exam day itself consisted of morning registration and a three-hour exam, followed by a lunch break, then afternoon registration and another three-hour exam. “Top tips” include reading the exam rules carefully, and not arriving with prohibited items (ie, bags, books, calculators, mobile phones, etc) and bringing a jumper, even if the weather outside is hot, because air-conditioning in examination rooms can make them cold. Bringing lunch might also be recommended — when I sat the exam only one sandwich bar was open to provide lunch for around 700 people.

Internship and licensure

Each state has its own requirements for pharmacist interns. My understanding is that most states require 1,500 intern hours, although only 500 hours are required in Florida. The state of Washington varies the number of hours required according to the score obtained in the FPGEE. My score of 133 means that I will only have to complete 300 intern hours before I am eligible to take the final licence examinations.

Challenges

There are a number of costs involved in achieving FPGEC certification. First there is the $700 (approximately £400) FPGEE fee, which must be paid in the form of a certified cheque, cashier’s cheque or money order through a US bank. Those without a US bank account will probably incur bank charges to arrange this. There is no charge for the “letter of good standing” from the Royal Pharmaceutical Society, but my school charged £20 for providing an A-level transcript and my university charged £10 for a degree transcript. The TOEFL fee was $130 (approximately £72) and the TSE fee was $125 (approximately £71). I understand that National Association of Boards of Pharmacy will be using an external agency in the future to undertake the educational assessment of clients, which will incur an additional charge of $85 (approximately £47). Other costs, such as travel to and from the US in order to take the FPGEE and any visa costs, will depend on individual circumstances. There will also be fees for an intern licence, taking the NAPLEX and the MPJE, and, finally, for the pharmacist licence itself.

Immigration

After passing the FPGEE, a work permit is required to work as a pharmacist intern. Individual circumstances vary, but most pharmacists would probably need an “H-1B” visa. This is a temporary visa which lasts for three years, although I understand it can usually be renewed for a further three years. It should be noted that it is the prospective employer, not the employee, who must file the immigration petition, so an employer who is willing to sponsor the visa application will need to be found. My impression is that this is not too difficult — for example, one pharmacy chain had representatives handing out recruitment fliers at the examination centre. The number of “H-1B” visas available each year (1 October to 30 September) is limited and there seems to be no fast-track system for professionals, such as pharmacists, who are in demand. Early filing is essential. By the time I received my FPGEC certificate in October 2005, all the “H-1B” visas available for that year had been issued and so I had to wait until 2006 for my application to be filed, for a visa that was not valid until October. I have now been able to start my internship and hope to obtain my licence early this year.

Conclusion

The process for a foreign-trained pharmacist to obtain a US pharmacist licence is lengthy, relatively expensive and not something to be undertaken lightly. Clearly, this article can only give an overview of my experiences in obtaining a pharmacist licence for the state of Washington and does not provide an official guide. Anyone thinking about applying to work as a pharmacist in the US is advised to contact the appropriate state board for current requirements and information. Websites for these can be accessed via the National Association of Boards of Pharmacy website, the address of which is set out in the second panel (below), together with those for other organisations.

References

1. Shargel L, Mutnick A, Souney P, Swanson L. Comprehensive pharmacy review. 5th edition. Baltmore, Maryland: Lippincott Williams & Wilkins; 2004

2. Mutnick A, Souney P, Swanson L, Shargel L. Comprehensive pharmacy review practice exams. 5th edition. Baltimore, Maryland: Lippincott Williams & Wilkins; 2004

3. Lacey C, Armstrong L, Goldman P, Lance L. Drug information handbook. 12th edition. Hudson, Ohio: Lexi-Comp; 2004