Pharmacy in the European Union

[Biomol]

Hi everyone.

I'm a Pharmacy student from the European Union (EU/Portugal). In Portugal the equivalent of the American PharmD program is a 5 year long Master of Pharmacy program (it was 6 years long before the uniformities in European Union's higher education network), being the last semester/period comprised of a (curricular) training period in community and hospital pharmacy. After graduation, to practice as a pharmacist, a registration in the profession's national regulatory body (called "Order of Pharmacists") is necessary and an admission exam may be requested.

In most EU countries there are no retail pharmacy chains (an exception being for instance the United Kingdom). Instead, pharmacies are often small business units frequently owned by a pharmacist which simultaneously owns the pharmacy and is its responsible pharmacist. In countries such as France, Italy, Spain or Germany, amongst others, by law pharmacies can only be owned by licensed pharmacists.

Also, here pharmacists are formally called Dr [Pharmacist] (this happens in most EU countries, an exception being again the United Kingdom, as far as I know). As such, the fact that in most "anglo-saxon" countries only physicians and PhDs get called Dr has really been intriguing me. Am I wrong or nowadays PharmDs in the United States also get called Dr such as a physician gets? If not, why? Is it cultural?

---

Members don't see this ad.

 

[Biomol]

Anyone? I would really like to know why pharmacists (and other professionals from other important areas) usually aren't called Dr in the Unites States (and, by extension, in other countries of anglo-saxon culture, as the United Kingdom) whilst physicians (and, of course, PhDs) are. As I said, in most European countries (France, Spain, Germany, Belgium, Italy, Portugal, Czech Republic, Switzerland, Austria, Netherlands, etc.) pharmacists are formally called Dr and in some of them it may even sound offensive not to call a pharmacist Dr.

 

[All4MyDaughter]

It's only been three hours. AND it's New Year's Day. Give people a little more time to respond.

 

[Pharmavixen]

In North America, pharmacists' training traditionally consisted of a bachelor of science in pharmacy. Most (if not all; I'm not sure) of the US now is entry-level PharmD, so they could be called dr, but it's still a new thing. Here in Canada, we will be going entry-level PharmD within the next decade, but most of us are still BscPhm; I'm currently studying to become a PharmD after twenty years as a BscPhm.

Judging from the comments in the physician forums, many MDs would object to pharmacists being called, Dr. Where I practice, PharmDs legally cannot call themselves Dr.

These things may change, however.

I honestly don't care if I get to call myself Dr. after I earn the PharmD. Any place I've worked, almost everybody calls each other by their first names, including the physicians.

Some of the older people I work with tend to be more meticulous about saying, "Doctor," even tacitly correcting me when I say, "Michael wants the chart for John Doe," and they'll reply, "Tell Doctor X it's already on his desk." Patients have always called me by my first name, and I'm not going to change that.

 

[Biomol]

In North America, pharmacists' training traditionally consisted of a bachelor of science in pharmacy. Most (if not all; I'm not sure) of the US now is entry-level PharmD, so they could be called dr, but it's still a new thing. Here in Canada, we will be going entry-level PharmD within the next decade, but most of us are still BscPhm; I'm currently studying to become a PharmD after twenty years as a BscPhm.

Judging from the comments in the physician forums, many MDs would object to pharmacists being called, Dr. Where I practice, PharmDs legally cannot call themselves Dr.

These things may change, however.

I honestly don't care if I get to call myself Dr. after I earn the PharmD. Any place I've worked, almost everybody calls each other by their first names, including the physicians.

Some of the older people I work with tend to be more meticulous about saying, "Doctor," even tacitly correcting me when I say, "Michael wants the chart for John Doe," and they'll reply, "Tell Doctor X it's already on his desk." Patients have always called me by my first name, and I'm not going to change that.

Thanks for your answer. It's really kinda strange for me to imagine a pharmacist not being addressed by Dr but rather by its name or surname as it happens there in North America (and in the United Kingdom)! That's almost unthinkable here in Portugal (and throughout most of continental Europe) especially if a pharmacist/patient connection is established (for instance, the eldery who regularly use community pharmacies for counseling, therapy management, etc.). Even the identification cards used by pharmacists in community and hospital pharmacies have a Dr before their names (such as "Dr X - Pharmacist"). And officially, in inter-professional relationships, the same "rule" applies: physicians formally address pharmacists as Dr and pharmacists officialy address physicians as Dr too. But if a PharmD is now required to be a pharmacist it would be fair for pharmacists to be called Dr. By the way, here in Portugal, France, Italy and other European countries there are no retail pharmacy chains: pharmacies are small individual (often familiar) business units. The variable is whether the owner has to be exclusively a pharmacist or not. In Portugal the law has been changed in 2007 and now anyone can own a pharmacy (this legislative change had strong opposition by pharmacists though, which claimed their professional independence and etics could be easily menaced in a pharmacy owned by a non-pharmacist looking only for profit). It is hard for me to imagine how it would be to work for a great retail pharmacy chain such as the ones in the US, Canada or UK. What model of community pharmacy do you think is the best? Large retail pharmacy chains or small independent pharmacies (owned by pharmacists - preferably - or others)?

EDIT - By the way, how are the other health professionals (besides physicians and pharmacists), such as dentists, nurses, veterinarians, psychologists, called? By Dr, Mr or directly by their names? In Portugal and Europe in general all get called by Dr (except nurses).

 

[PharmPrincess]

Generally, if one earns a Ph.D. (Doctor of Philosophy) or a Doctorate in their field of study (Pharm.D.= Doctor of Pharmacy, M.D.= Medical Doctor, D.D.S.= Doctor of Dental Surgery, D.V.M.= Doctor of Veterinary Medicine, J.D.= Juris Doctor, D.O.= Doctor of Osteopathic Medicine, O.D.= Doctor of Optometry, etc) earns the title of being called Doctor because their field requires specialization. *However, no one calls (JD) lawyers "Doctors"*

In addition, previous programs of study are currently also in the process of changing over to a Doctorate degree that I know of: Physical Therapy (P.T.), Occupational Therapy (O.T.), and Doctor of Chiropractic (D.C.)

There is something interesting to note too: Naturopathic Doctor (N.D.) are "holistic" doctors. They do not go through medical school, but have a 4-5 year program in medical education. I believe that only 12 states allow them to prescribe as well, but I'm not sure on what exactly.

side note:
-psychologists practice in the field of psychology(i.e. cannot prescribe, but can hold a doctorate but did not go to medical school, rather a graduate program)
-psychiatrists are medical doctors that specialize and diagnose in the field of psychiatry (i.e. can prescribe meds because they attended medical school)

Most nurse positions/titles still retain the title "Nurse": LPN (Licensed Practical Nurse), RN (Registered Nurse), DNP (Doctor of Nursing Practice), even though a doctorate is available.

whew, as far as calling someone "doctor", i believe its just something that's been around. People in the U.S. generally never called pharmacists "Doctors", so a recent change to this as a norm probably won't happen until the younger generations accept this (for any field that is).


I hope this clarifies any questions you have. I like the idea by law,only pharmacies can be owned and operated by licensed pharmacist. We should do away with corporate companies (Chain drug companies) because they are ruining the profession of pharmacy!! Now wouldn't that be something In answering your question, smaller independent pharmacies would be better to catering to the public (proven) than for-profit pharmacy retail stores.

 

[cdpiano27]

I don't know about Portugal but I was in Paris, France. And there were many, many pharmacies that were all over the city. They each at a green cross sign (neon) with the word pharmacie, but I found out they were not owned by a company at all, but rather were independently owned. The negative with that is that you are not guaranteed a salary, and the amount of money that one would make depends upon how well your store does, almost like owning a small business. However, I still think this is better for the profession overall, but could be bad when someone has hundreds of thousands of dollars in student loans to pay back.

In France, the fee for a EU citizen to go to pharmacy school is only about 250 euros (about 380 US dollars), and the curriculum appears to be very similar to a US school. So, there is not the pressure over there to pay back such a large amount of money, which I think is much better.

Overall, I believe that the US should switch to a more "European" system in the future. I was in France and I really thought that everything they did there should be done here. Small fees for education, almost free health care, etc. The taxes are of course much higher, but you are getting REAL services for those taxes. I think the high taxes there are definitely worth the benefits.

One negative: I heard that college graduates had difficulty finding a job because in many companies, it was very difficult to get rid of workers, creating very few positions. Don't know if this is quite true though or pertains only to certain fields.

Again, I don't know anything about Portugal, but I am curious.

 

[Biomol]

Thanks for your post PharmPrincess. Very clarifying.

I don't know about Portugal but I was in Paris, France. And there were many, many pharmacies that were all over the city. They each at a green cross sign (neon) with the word pharmacie, but I found out they were not owned by a company at all, but rather were independently owned. The negative with that is that you are not guaranteed a salary, and the amount of money that one would make depends upon how well your store does, almost like owning a small business. However, I still think this is better for the profession overall, but could be bad when someone has hundreds of thousands of dollars in student loans to pay back.

In France, the fee for a EU citizen to go to pharmacy school is only about 250 euros (about 380 US dollars), and the curriculum appears to be very similar to a US school. So, there is not the pressure over there to pay back such a large amount of money, which I think is much better.

Overall, I believe that the US should switch to a more "European" system in the future. I was in France and I really thought that everything they did there should be done here. Small fees for education, almost free health care, etc. The taxes are of course much higher, but you are getting REAL services for those taxes. I think the high taxes there are definitely worth the benefits.

One negative: I heard that college graduates had difficulty finding a job because in many companies, it was very difficult to get rid of workers, creating very few positions. Don't know if this is quite true though or pertains only to certain fields.

Again, I don't know anything about Portugal, but I am curious.

Very similarly to France, Portuguese community pharmacies also have the neon green cross outside simbolizing there's a pharmacy there. They're also independently owned and are owned by licensed pharmacists who besisdes property also are their responsible pharmacists/directors. Besides the responsible pharmacist it is also mandatory for all pharmacies to have an "associated" pharmacist who substitutes the responsible/director when needed. There's no retail chains here. Until the last year only a pharmacist could own a pharmacy, but the Government insisted in changing the law, permitting anyone (except prescriptors, that is, physicians) to own a pharmacy. Portuguese pharmacists strongly opposed this though as a non-pharmacist doesn't have a deontological code to respect and may easily put profit frist rather than public health. The opening of a pharmacy is also regulated by the State through a periodic "public competition" held by the national drug authority (the Infarmed - it's the FDA's Portuguese homologous) in which various concurrents propose to own and open the pharmacy. The opening of a pharmacy depends on the number of inhabitants per pharmacy (the required minimum to open a pharmacy is 3500 inhabitants/pharmacy) and distance between pharmacies (a distance of 300 meters, at least, is mandatory - that is, one cannot open a pharmacy in front of another pharmacy, for instance). I really like this system though I do not know - in depth - how the retail chain system works. Anyway, the idea I have of it is of a system very prone to profit only, very "commercial" and thusly - perhaps! - disregarding a bit a truly independent practice by the pharmacist even if less profit is to be made if necessary... That's just the idea I got by reading, it may be nothing more than a myth I've made. I'm currently studying Pharmacy here in Portugal (Faculty of Pharmacy/University of Lisbon) and I pay about 900 EUR per year to study (that is about 1.300 USD). A little more than a French pharmaceutical student then. Anyway, taxes are also relatively high here for the State to be able to support publicly-funded education (including higher education), health, social security, etc. Yes, in general I think it is harder for a corporation to get rid of a worker here in Europe (exception to the United Kingdom, again) as labor laws are less flexible than those in the US.

EDIT - Portuguese pharmacists (as well as French and Spanish pharmacists, as far as I know) can also run a pathology laboratory (and be responsible for it) through a specialization. Is that possible for a pharmacist in the US?

EDIT 2 - By the way, why aren't there any Pharmacy programs in the Ivy League universities (Harvard, Columbia, Penn, Yale...)? I read Dr. Louis Ignarro (Nobel Prize in Medicine or Physiology for its works on nitric oxide pharmacology) got a BSc in Pharmacy at Columbia University's Pharmacy School in the 60's though when I google it that pharmacy school doesn't seem to exist anymore (I also visisted Columbia University website). Do you know anything about this?

 

[cdpiano27]

RESPONSE TO EDIT 1: I don't think that pharmacists have this role in the US, but I may be wrong. Sounds very interesting though!

RESPONSE TO EDIT 2: I am not sure, why there is no PharmD at Ivy League schools. Perhaps the pharmacy field is still not viewed with the same prestige that medicine is (I may get flamed for this!), but unfortunately that is probably true. The doctors have lobbying organizations to protect their interests in the US, while I do not believe that pharmacists have this. However, at some of the better public schools (UNC-Chapel Hill, Michigan, etc.) there are pharmacy programs.

I believe that it is around 250 euros per semester, making it 500 euros for the year. No school would ever be this inexpensive in the US. The better state, public schools (such as UNC-Chapel Hill) still have tuition set at around $10-15K, and that is the cheapest you will find here. And some private schools charge even $40K per year. I believe that such a high tuition is probably not worth it. That person is under much pressure to pay off $160K in debt (with interest!). That would limit them to working for the big chains in order to make the money to pay that off. Under that debt load, the student would be less inclined to go into certain clinical routes that may not pay as much, simply because of the debt.

Hence, I believe there is not as much pressure for the pharmacy graduates in Europe to make $100K (or 70,000 euros) per year to come out to pay back the tuition!

I am studying towards PhD so I have stipend for living expenses and only have to pay the student fees at my university of around $725 per semester ($1550 per year).

I think the US can learn a lot from the EU, especially in regards to health care and education.

 

[twester]

We are much more informal here in the United States. In the academic setting, Doctor is the form of address for anyone with a doctorate of any kind. Outside of that, we tend to use first names. I've had faculty members chastise me for using Doctor outside of a professional setting.

I don't call my pharmacist, Dr. Blythe, I call her Debbie. To further throw a wrench in the works, I don't call my physician, Dr. Mohr. I call him Mike (although I'll generally throw in a "Thanks Doctor" at the end of the visit).