relocating to a progressive state

[kitkat06]

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Hi all,

If someone is interested in getting their Pharm.D education in a state that places much restrictions on pharmacists, and is thinking about relocating to a more progressive State, say practicing pharmacists there have the authority from the State Board of Pharmacy to administer vaccinations and allows pharmacists a more integrative role in the health care system, would it be hard to find/get a job in these areas since such progressive role/knowledge/mentality is not taught in the earlier state? Where can you learn such skills if your pharmacy school do not provide them?

thanks

 

[DownonthePharm]

For vaccination you can take certification classes even after you have graduated.

 

[sdn1977]

Hi all,

If someone is interested in getting their Pharm.D education in a state that places much restrictions on pharmacists, and is thinking about relocating to a more progressive State, say practicing pharmacists there have the authority from the State Board of Pharmacy to administer vaccinations and allows pharmacists a more integrative role in the health care system, would it be hard to find/get a job in these areas since such progressive role/knowledge/mentality is not taught in the earlier state? Where can you learn such skills if your pharmacy school do not provide them?

thanks

This is actually very easy. Your degree allows you to sit for the NAPLEX & any state law exam you want.

All the "extra" certifications are done independently of your school - immunizations, travel medications, MTM, EC....they're all courses you take - you get CE & also certification.

The certification is not state specific..in other words if CA for example allows immunizations via any method - collaborative practice agreement or whatever...the APhA/ASHP certification will qualify for participation. In my state - CA....the collaborative practice agreement is not usually for individuals - it covers qualified (certificated) employees of companies - Kaiser, Longs, XYZ pharmacies....etc.

Each expanded practice act will have training & certification thru an accepted & recognized authority - ASHP, APhA or private providers - HCET, Outcomes, individual state professional organizations, etc..

Some collaborative practice agreements may require a specific provider for certification, but its always easy to do.

Does that help answer your question?

 

[lord999]

Or to make it even easier, work for the feds, particularly their Commissioned Corps.

They have the most progressive practice regime for the last 50 years (and it doesn't look like they're slowing down).

USPHS Innovations:
Disease-state management clinics
Clinical pharmacist (yes, even prior to UCSF)
Rounding as a required part of a team (yes, even prior to UCSF)
Vaccinations
Therapeutic interchange
Pays for certifications, licenses, and pays differential for certifications.
and others...


If you have an idea that can change the practice, it's most likely to originate there if you want to try your hand at innovation.

 

[sdn1977]

Or to make it even easier, work for the feds, particularly their Commissioned Corps.

They have the most progressive practice regime for the last 50 years (and it doesn't look like they're slowing down).

USPHS Innovations:
Disease-state management clinics
Clinical pharmacist (yes, even prior to UCSF)
Rounding as a required part of a team (yes, even prior to UCSF)
Vaccinations
Therapeutic interchange
Pays for certifications, licenses, and pays differential for certifications.
and others...


If you have an idea that can change the practice, it's most likely to originate there if you want to try your hand at innovation.

I won't go into the specifics.....but honestly - this has not been the case - even prior to UCSF. I was an intern in the mid-70's at a VA Hospital - there was nothing clinical there -unless you'd call making vats & vats of coal tar ointment & packing it in pound jars clinical. They also had HORRIBLE allotment programs for drugs which would run out at the end of the fiscal year - we are talking 1976. There were NO pharmacists rounding anywhere & most of them were doing mail-order filling.

I've also spent 30+ years within 15 miles of the VA Palo Alto & when I was in SF, at Letterman Hospital (which is now closed, altho a rotation site when I was in school). You don't even want to know how backward they were at the time. They didn't institute clinical practice in the 70's!

ZPak might have a few things to say about VA-Los Angeles - which is where a lot of the work on the epidemiology of Legionaire's Disease took place - he would have been there at the time.

I admire the VA & the other federal programs.....but, their pay is lacking, they have a huge heirarchy & seniority system - although they have great benefits.

Most every employer of repute will pay for your certifications and CE - that's just part of the job, altho none paid for my license. I can imagine the federal govt would pay - you only need one to work in any facility - thus the low pay.

 

[All4MyDaughter]

VA pharmacists aren't part of the USPHS.

There is a lot of clinical pharmacy at the VAMC where I am employed. I work on the outpatient service but in one week will switch to the clinical service for a one month rotation. I'm excited because there is quite a bit going on: warfarin monitoring, diabetes clinic, hospice care, ID, etc. I'll have a lot more to report I'm sure after the rotation is over. Back on the outpatient dispensing side, the VA has a lot more mandatory counseling than I've observed in the retail settings I've experienced.

 

[AvocadoLover]

All4MyDaughter is correct. VA is not part of the USPHS. USPHS (commisioned corps) includes a number of different agencies such as indian health services, national institutes of health, agency for healthcare research and many many more.

Most ppl think of IHS when they think of USPHS. This is huge branch and many pharmacists work here. I did an IHS rotation and am now a resident. In my experience (although limited) IHS provides the most amount of patient contact for pharmacists. At my facility there are seven pharmacy managed (disease state management) clinics. ALL outpatients are counseled in private rooms when they pick up meds. On the inpatient side, pharmacists round every morning and patients cannot be discharged until the pharmacist counsels them and signs off on it.

 

[sdn1977]

Well - go to the USPHS website & check for yourself. In my state, most of the jobs are in BOP - the Board of Prisons. You can do all the discharge counseling you want - they'll still know more about drugs than you do. There may be rounds, but there are few teaching sites in CA unless they've been admitted to a county hospital, in which case, they are out of your care. The few which are actual "hospital" are for the mentally or criminally insane (the court description - not a medical description), in which case - they're not likely to be discharged anytime soon & the physicians on staff are mostly psychiatrists, IM or FM.

Then, look at the pay scales......not so high, at least compared to non federal positions.

Now - look at all the Chief Pharmacist positions open - gotta wonder why????

Finally, read the very, very small print - in your agreement & in the pay scale. You can be deployed if necessary...but, they'll give you combat pay🙄 Be very, very careful before you sign on that dotted line!

Just not for me. But - I had a tech who went back to school & became a pharmacist in the Indian Health Service in Kansas. Most of our Indian reservations have their own healthcare centers in CA - they are soverign nations & don't have to follow labor laws. They don't employ many pharmacists.

So - make your choice. The federal govt is not the only choice out there. Kaiser is a HUGE player in progressive health care, altho located in CA. The Asheville project I think now references many progrressive programs in NC. Actually, the state of WA is one of the most progressive in the nation. So - decide where you want to live...then seek out the kind of position you want.

 

[kitkat06]

thanks for all your responses, everyone 🙂 I originally thought that if you get your degree in one not as progressive state, you are pretty much limited to states with similar restrictions. I knew (very little, appearently) about CEs but thought that they are only taken so you could continue keeping your license and learn more (book material) about the field you are practicing in. I didn't know that you can learn more hands-on material after graduating from pharmacy school! thanks for the clarification! 🙂

another question, i heard from someone that you don't have to take the NAPLEX in the state that you graduate from. However, once you start the test, you have to finish there. Is there any truth in this? Does that mean even though someone didn't go to school in CA or FL, they can take the NAPLEX in CA or FL after relocating there? and once the NAPLEX is taken there, you are pretty much restricted from practicing in other states? Correct me if I am wrong, but as far as I know, CA and FL are the only two places that do not have reciprocity with many other states.

 

[sdn1977]

thanks for all your responses, everyone 🙂 I originally thought that if you get your degree in one not as progressive state, you are pretty much limited to states with similar restrictions. I knew (very little, appearently) about CEs but thought that they are only taken so you could continue keeping your license and learn more (book material) about the field you are practicing in. I didn't know that you can learn more hands-on material after graduating from pharmacy school! thanks for the clarification! 🙂

another question, i heard from someone that you don't have to take the NAPLEX in the state that you graduate from. However, once you start the test, you have to finish there. Is there any truth in this? Does that mean even though someone didn't go to school in CA or FL, they can take the NAPLEX in CA or FL after relocating there? and once the NAPLEX is taken there, you are pretty much restricted from practicing in other states? Correct me if I am wrong, but as far as I know, CA and FL are the only two places that do not have reciprocity with many other states.

I cannot speak about Fl. There used to be several states without reciprocity - CA, TX, NY to name a few.

We still don't have reciprocity, per se. However, when you take your NAPLEX, you can list the states that you want your scores sent - each one costs a bit - I can't tell you how much.

Each state will require you to take its own individual jurisprudence exam. In CA - its hard - not just jurisprudence - also clinical situations.

So - as long as you have passed your NAPLEX (& have graduated after 2005 or some such year....) you just have to take the jurisprudence exam to become licensed in any state you want. Now....each state will require you to pay them to stay licensed.

I just met 2 pharmacists - one had 6 active licenses & 2 inactive - another...a young man, had 4 licenses - he skis in CO in the winter. The first one does flu shots in HI - go figure!!!!

 

[AvocadoLover]

Well - go to the USPHS website & check for yourself. In my state, most of the jobs are in BOP - the Board of Prisons. You can do all the discharge counseling you want - they'll still know more about drugs than you do. There may be rounds, but there are few teaching sites in CA unless they've been admitted to a county hospital, in which case, they are out of your care.

I cannot comment much on the clinical involvement of pharmacist at BOP since I work for IHS, but I know all of the agencies are VERY different so its good that you get to choose. I am sure there are many great programs in CA, WA and I actually applied to Mission Hosp in Asheville but was accepted to IHS first before the match. (I love Asheville!)

Now - look at all the Chief Pharmacist positions open - gotta wonder why????

I am not 100% sure about this but I think one reason ppl leave (at least IHS) when they're older (and more prepared for these types of positions) is bc they have kids or get married and want to move closer to their family or there spouse can't find a job in such remote rural areas.

In terms of the pay, I think with all the benefits, including tax free housing stipends, tuition reimburstment, free health care, etc... It really does add up to the pay of pharmacists in the private sector.

Finally, read the very, very small print - in your agreement & in the pay scale. You can be deployed if necessary...but, they'll give you combat pay🙄 Be very, very careful before you sign on that dotted line!

Too late for that- I am already a resident! You are correct thought, pharmacists can get deployed. HOWEVER, USPHS is nonmilitary. Therefore we cannot be sent overseas or into places of combat. The sole purpose of deployment is to help during natural disasters that occur in the US. In fact a few of the pharmacists I work with were deployed during Katrina. Those who didnt get to go are very jealous! If deployment means lending a hand to those who need it, then I hope I one day get the opportunity to go.

 

[kitkat06]

hm... I guess I am still confused. I am probably not interpreting your response in the intended manner. Do you mean
for instance if someone who earned the Pharm.D in a state that does not have reciprocity with a state this person wants to relocate to, all he has to do is pass the NAPLEX exam, have his scores sent do this more restrictive state, pass the jurisprudence exam to bypass the reciprocity issue? How would it be different if you are moving between mutually accepting states with no license reciprocity concern, if you also have to do well on your NAPLEX, send your score to the appropriate places and pass the law exam?

Thanks sdn!

 

[kitkat06]

AvocadoLover,

Since you are in USPHS, have you actually met Pharm.Ds placed in FDA or more rarely CDC under the same program? It seems like most of assigned to IHS and BOP. Since it is my understanding that the USPHS Commissioned Corps is quite selective, would you know what sorts of qualifications they are looking for in about-to-graduate applicants (aside from grades)? Would they take people who are not from a public health infused pharmacy curriculum? I would imagine that experiences in the public health area would be essential.

Gracias!

 

[sdn1977]

hm... I guess I am still confused. I am probably not interpreting your response in the intended manner. Do you mean
for instance if someone who earned the Pharm.D in a state that does not have reciprocity with a state this person wants to relocate to, all he has to do is pass the NAPLEX exam, have his scores sent do this more restrictive state, pass the jurisprudence exam to bypass the reciprocity issue? How would it be different if you are moving between mutually accepting states with no license reciprocity concern, if you also have to do well on your NAPLEX, send your score to the appropriate places and pass the law exam?

Thanks sdn!

Reciprocity is an "older" term. Its one that used to be used when each state had its own state board exam (or for those states without a pharmacy school - they used a qualifying exam from a neighboring state). The purpose of this was for a number of reasons - first, decades ago (think the 1950-60's) the practice of pharmacy was very, very different geographically. Some here might remember compounding or a "wet" lab on their state board exam. That particular part of pharmacy became less significant here in the 60's & was dropped off. Likewise, about that same time, some states changed their education to become more patient care oriented - separate & apart from the Pharm D.

Here, in CA, for example, the state board exam was a very clinically oriented examination when I took it, however - there were only 3 schools of pharmacy here: mine (UCSF) & USC both offered the PharmD and UOP which was still offering the BS. We all took the same examination.

Now you understand that there were at least 40 or so examinations. Reciprocity is a concept to facilitate licensure between states so pharmacists (dentists, physicians, etc..) could become more mobile & live where they wanted. It was a very honest fact that there were some states in the "sun belt" - CA, TX, FL who wanted to limit the number of pharmacists licensed because there weren't jobs. NY was also one of these states.

Now....much, much later - a push started for a national licensure examination - about the time the discussions took place for having the sole entry level degree be a PharmD. This was the late 80's & 90's. This was a difficult & really divisive time in the field. However, it was ultimately decided on the standard degree, however, it took many more years before a national examination could be hammered out. After all - by this time there was the NAPLEX (in a very easy format, btw) & still other individual state exams. The whole NAPLEX had to be rewritten & a few states had significant input into the content. Additionally, the provider of the exam changed a few times. A new exam now had to be written for each state - a state juripurdence exam, which at least in CA, was incorportated into the original state board.

So...now we have NAPLEX, which is the licensing examination for all states. It is cheaper for you to tell NAPLEX where you want your scores sent at the time you take it, however, you can always get them sent after the fact. You will still have to take a jurisprudence examination.

So - you see....there really is no reciprocity like we used to know it - meaning an Idaho license could practice in Utah as well. Now...when you pass the NAPLEX, you get your scores sent to Idaho, Utah, CA, Nebrasak - whereever, take your law exam, pay your money & ......there you go!

Its expensive to maintain lots of licenses, but most allow for inactive status.

 

[no-see-um]

AvocadoLover,

Since you are in USPHS, have you actually met Pharm.Ds placed in FDA or more rarely CDC under the same program? It seems like most of assigned to IHS and BOP. Since it is my understanding that the USPHS Commissioned Corps is quite selective, would you know what sorts of qualifications they are looking for in about-to-graduate applicants (aside from grades)? Would they take people who are not from a public health infused pharmacy curriculum? I would imagine that experiences in the public health area would be essential.

Gracias!

I know pharmacists who work for the FDA. A lot of them got their start in the USPHS and began with IHS. Not many go DIRECTLY into the CDC or FDA without serving in some regions where pharmacists are needed (unless they have other degrees, for instance, if they're public health scientists, as well). They usually want someone who is willing to work in many aspects of pharmacy to fulfill the public health ideals of the country.

 

[sdn1977]

Avocado - its great you like what you're doing.

But, in CA - the pay absolutely stinks - even with the benefits. The pt population is awful as well, but to each his own.

As for USPHS - you may not get deployed to a combat zone....but, I have known folks who have been sent to take over the military positions for those folks who've been sent to a combat zone. If I were to work for BOP in CA - I'd HATE to be sent to a ship off the coast of the middle east (classified non-combat - wth??) which is what occurred to a friend of mine. He left USPHS soon thereafter!

You & I will have to disagree on the # of dop positions. We don't have many real "rural" places in CA, so location is not such a priority. The fact is - just like the private sector - there are some hospitals that are known for being terrible places to work, not supported by adminstration, etc..

In my area, there are many more opportunities for growth & independence outside USHPS than in it. As for experiences like Katrina - I think there were more private retail pharmacists who went voluntarily & worked without pay or licensure than military or USHPS supported - but that is a whole other tragedy & embarrassment for a different thread...

But, I appreciate your enthusiasm. I hope you learn a lot & perhaps you will stay with them & be a positive force for change!

 

[no-see-um]

Just not for me. But - I had a tech who went back to school & became a pharmacist in the Indian Health Service in Kansas. Most of our Indian reservations have their own healthcare centers in CA - they are soverign nations & don't have to follow labor laws. They don't employ many pharmacists.

Although there's a lot that could be debated with regards to US Labor laws for Federal workers with regards to tribally-run clinics and hospitals and the legal aspects, thereof, I will, rather, suggest that the Federally run Indian clinics strictly adhere to these laws. It sounds like your friend just ended up in a crappy area. There's a lot of choice that goes into where you are placed- and Kansas doesn't exactly have the same set-up as the Aberdeens or the Southwest.

 

[no-see-um]

As for USPHS - you may not get deployed to a combat zone....but, I have known folks who have been sent to take over the military positions for those folks who've been sent to a combat zone. If I were to work for BOP in CA - I'd HATE to be sent to a ship off the coast of the middle east (classified non-combat - wth??) which is what occurred to a friend of mine. He left USPHS soon thereafter!

Depends on the person. I would, actually, welcome the change and feel like I've done something to serve. This, however, is an extremely rare scenario.

 

[no-see-um]

In my area, there are many more opportunities for growth & independence outside USHPS than in it. As for experiences like Katrina - I think there were more private retail pharmacists who went voluntarily & worked without pay or licensure than military or USHPS supported - but that is a whole other tragedy & embarrassment for a different thread...

It's not about quantity. It's about emergency support, and training personnel and working with them to support those functions.

For instance, in a disaster you could have doctors of all sorts trying to offer their services (which is a good, humanitarian, thing to do), but without prior training in disaster response, it may actually weaken a triage system in some respects!

It's not always a question of the numbers, it's a question of coordination, and the Federal Response Plan, and ESF-8, particularly, serves to alert, organize and deploy management support to disaster areas to liason with field resources. Much more than the numbers are the ideals of, operations, administration, logistics, planning and communications. And pharmacists in Federal units could play major roles in these aspects.

And this isn't a contest of who are trained to perform these functions. Federal health professionals are mandatorily trained in these aspects, and public sector pharmacists can be trained, as well, should they elect to- or if they work for employers who mandate training. And I'd stipulate that the community pharmacists of America outnumber the public health pharmacists of America, but that's not the point! It's not a contest- there is a system to response. And that leads to the debate about execution of standards (not exactly at the level of pharmacy!), but I would agree, that's for a different thread.

 

[ZpackSux]

Progressiveness of pharmacy practice is not dependent upon states. It's based on progressiveness of each hospital and their protocols.

 

[kitkat06]

Hmm... I have been looking at this in the wrong way then. Thanks for the clarification!

 

[All4MyDaughter]

I'm confused about one thing - one poster said USPHS pharmacists can't be deployed overseas. Another said that a USPHS pharmacist was sent to a ship docked in the middle east. Isn't that considered overseas?

I thought that when there were military pharmacy vacancies, they called up reserve and National Guard pharmacists to fill them.

My (outpatient) supervisor at the VA is currently activated and being the acting pharmacy chief at Fort Knox. But he is a member of the Army Reserve so that makes sense.

 

[sdn1977]

They'll take anyone who can fog a mirror!

 

[tussionex]

if you want to reciprocate into NY [ we still use the term reciprocity]...you have to have passed the NAPLEX, practiced in another state for a specified period of time [ it used to be a year] and then take the NY law exam.

i have many friends who did this....went to neighboring states like CT and MA for a year, then came back to NY to avoid having to take the wet lab [part III]

in my eyes, and i know this is a bit elitist, we make the test hard for a reason in NY and doing it this way just to skip part III seems like one is exploiting a loophole [one that i hope the board closes!]