Why are APPEs unpaid?

[rxconquistador]

I fully understand why IPPEs are unpaid internships and are for the most part a good thing as long as it is a learning experience and not just an extra tech.

But, why are pharmacy students unpaid for their 4th year rotations?

I know the answer that school administrators will say: The schools of pharmacy follow the ACPE which says pharmacy students can't be paid.

Saying that it is the way things have always been done, is never an acceptable answer.

The bureau of labor is cracking down on unpaid internships.

I'm thinking that this is an illegal practice, and all current and past pharmacy students who did APPE rotations for free are entitled to be part of a class action lawsuit against the ACPE, boards of pharmacy & SOPs.

I don't believe that MD students do anything like this for free.

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[rxforlife2004]

I fully understand why IPPEs are unpaid internships and are for the most part a good thing as long as it is a learning experience and not just an extra tech.

But, why are pharmacy students unpaid for their 4th year rotations?

I know the answer that school administrators will say: The schools of pharmacy follow the ACPE which says pharmacy students can't be paid.

Saying that it is the way things have always been done, is never an acceptable answer.

The bureau of labor is cracking down on unpaid internships.

I'm thinking that this is an illegal practice, and all current and past pharmacy students who did APPE rotations for free are entitled to be part of a class action lawsuit against the ACPE, boards of pharmacy & SOPs.

I don't believe that MD students do anything like this for free.

not only that you are not paid during this 4th year clinical rotation, but you also have to pay the school tuition for the full year (30k-40K depending on your school's tuition).

No, MD students are not paid either during year 3 and 4. This is called "clinical clerkship". Until they are matched into residency, they will start to get paid.

 

[ucrx]

I think (I could be wrong) that med students on clinicals are not getting paid. Can anyone verify this or tell me if I'm wrong?

 

[rxforlife2004]

I think (I could be wrong) that med students on clinicals are not getting paid. Can anyone verify this or tell me if I'm wrong?

Residents get paid, MS-3 and MS-4 do not get paid.

 

[VancTheTank]

But, why are pharmacy students unpaid for their 4th year rotations?

Who would pay the student? What would they receive in return?

 

[rxconquistador]

I would argue that 3rd & 4th year Med Students are not doing the same tasks as a physician. They are certainly not prescribing or doing surgery. They are actually learning, not working.

This is often not the case in pharmacy. Work instead of learn. 4th year pharmacy students especially in retail, are acting as pharmacists - checking techs work & counseling.

Not sure if anyone ever wondered why the IPPE/APPE hours are less than 2,000 total. At 2,000 or more it is considered an apprenticeship.

The ACPE should reclassify our training as such.

In any case, the Obama administration has opened pandora's box with their focus on eliminating unpaid internships in the private sector.

Here is a snipet from a fact sheet the labor dept released in april of 2010.

Under these circumstances the intern does not perform the routine work of the business on a regular and recurring basis, and the business is not dependent upon the work of the intern. On the other hand, if the interns are engaged in the operations of the employer or are performing productive work (for example, filing, performing other clerical work, or assisting customers), then the fact that they may be receiving some benefits in the form of a new skill or improved work habits will not exclude them from the FLSA’s minimum wage and overtime requirements because the employer benefits from the interns’ work.

Where would the money come from? That is a separate issue. It would come from somewhere. Slave owners asked the same question many years ago: "Emancipation is great and all, but won't our profits go down?"

If pharmacists ever want to be paid for cognitive skills, it will begin with fixing our educational process.

As the Joker said: "If you're good at something, never do it for free"

 

[Quiksilver]

I would argue that 3rd & 4th year Med Students are not doing the same tasks as a physician. They are certainly not prescribing or doing surgery. They are actually learning, not working.

This is often not the case in pharmacy. Work instead of learn. 4th year pharmacy students especially in retail, are acting as pharmacists - checking techs work & counseling.

Not sure if anyone ever wondered why the IPPE/APPE hours are less than 2,000 total. At 2,000 or more it is considered an apprenticeship.

The ACPE should reclassify our training as such.

In any case, the Obama administration has opened pandora's box with their focus on eliminating unpaid internships in the private sector.

Here is a snipet from a fact sheet the labor dept released in april of 2010.

Under these circumstances the intern does not perform the routine work of the business on a regular and recurring basis, and the business is not dependent upon the work of the intern. On the other hand, if the interns are engaged in the operations of the employer or are performing productive work (for example, filing, performing other clerical work, or assisting customers), then the fact that they may be receiving some benefits in the form of a new skill or improved work habits will not exclude them from the FLSA’s minimum wage and overtime requirements because the employer benefits from the interns’ work.

Where would the money come from? That is a separate issue. It would come from somewhere. Slave owners asked the same question many years ago: "Emancipation is great and all, but won't our profits go down?"

If pharmacists ever want to be paid for cognitive skills, it will begin with fixing our educational process.

As the Joker said: "If you're good at something, never do it for free"

You don't know what you are talking about. Med students DO do stuff on rotations including participating in surgical procedures and perhaps even performing minor ones such as bone marrow biopsies. They do also treat patients, albiet they don't actually write scripts but do offer their own opinions. My girlfriend on OB rotations delivered babies and did 24 hour shifts so I don't know if you would not consider that work.

 

[Charlottefromca]

I would say this depends on the pharmacy school you attend and the clerkships you select at the particular school. I think more established schools have APPEs that have over time been tweaked more finely to favor the pharmacy school student while newer schools (esp. in saturated areas) will have to take what they can. And also speaking to students in previous years which rotation sites are worth while and which ones are "free labor."

 

[ucrx]

You don't know what you are talking about. Med students DO do stuff on rotations including participating in surgical procedures and perhaps even performing minor ones such as bone marrow biopsies. They do also treat patients, albiet they don't actually write scripts but do offer their own opinions. My girlfriend on OB rotations delivered babies and did 24 hour shifts so I don't know if you would not consider that work.

Exactly. Med students I worked with performed physical exams, participated in diagnosis, and helped decide treatment with the assistance/supervision of residents and attendings.

Who would pay the student? Pharmacy schools already pay sites for taking their students on rotations.

 

[GreyFox2002]

Under absolutely no circumstance should any pharmacy student, medical student, nursing student, or anyone else should ever be paid for an academic internship. Ever.

You are an unlicensed student (an intern license is not equivalent to a professional license) who is working as an apprentice under the watchful eye of a preceptor. No intern should ever be performing final verification of a prescription at a pharmacy. If they are, that pharmacy/pharmacist/preceptor is breaking a lot of rules.

You are there to learn, that is it. You learn about pharmacology/pathophysiology/therapeutics for your first 3 years of pharmacy school. In year 4, you learn how to be a pharmacist. All of that clinical knowledge, aka book work, you gain in your didactic curriculum will contribute 0 % to your ability to perform as a clinician, whether it be retail, staff hospital, clinical, in the real world. This also includes technical work (aka work that is supposedly beneath the pharmacist). Every step of the work flow process when it comes to the dispensing of medications is under the responsibility of the pharmacist, no matter what technician is performing the role. You as an intern need to learn and master the role of the technician before you are even able to master the role of the pharmacist.

The same is true for medical students. You think all of that knowledge they get in MS1/MS2 is going to anything for them when it comes to delivering babies? Don't tell me they're delivering that baby with no resident and attending around, that's just crazy.

You are in school and are there to learn. Most preceptors don't get paid either unless they are full time faculty. That means preceptors at community sites are taking extra time to take students as a way to give back to the profession; they aren't getting paid for supervising you. Most non-faculty members in the hospital also do not get paid. So pay your tuition and when you're done you'll make your 6 figures + 🙂

 

[VancTheTank]

Where would the money come from? That is a separate issue. It would come from somewhere. Slave owners asked the same question many years ago: "Emancipation is great and all, but won't our profits go down?"

Not a separate issue. Where would the money come from? I am not asking in the "gosh, how could this possibly be funded?" sense. I am asking who you honestly believe should be signing the checks.

Comparing APPE to slavery is hyperbole bordering on the offensive. Actually, it is just plain offensive.

As the Joker said: "If you're good at something, never do it for free"

You're not good at it yet. At least not licensed. That is why you're still in school.

 

[rxconquistador]

I think all of you have made my main point collectively. Sorry for the trickery 🙂

No, pharmacy students should not be paid for APPE hours. There is no way to guarantee enough spots for current students without completely redoing the entire health care system. And that will never happen.

APPEs however do fall under the current unpaid internship rules set by the Bureau of Labor:

"If the interns are engaged in the operations of the employer or are performing productive work (for example, filing, performing other clerical work, or assisting customers), then the fact that they may be receiving some benefits in the form of a new skill or improved work habits will not exclude them from the FLSA's minimum wage and overtime requirements because the employer benefits from the interns' work."

It is ILLEGAL to replace a current employee's task with an unpaid intern. Or in other words, In the absence of an intern the company should be as productive or more productive.

Very simple solution: Make a 9-12 month paid residency a requirement to become licensed. Force retail companies to create residencies to allow pharmacists to get experience counseling and do quality control (make sure the techs didn't screw up). This will also weed out the incompetent pharmacy students who can't communicate with others despite their 4.0 gpa. Companies will have to replace that "free" labor with a $40K residency position to do the grunt work.

 

[rph3664]

B.Sc.Pharm. people like myself did their rotations during the last semester only, and my liberal arts roommate thought I was nuts to go to New Mexico for 2 months without being paid (although my site did provide free housing). Yes, I nearly maxed out a couple of credit cards but it was totally worth it!

 

[penguin85]

I'm not sure which I am more appalled by - the fact that you think you should be paid to learn, or the fact that you think you have a level of expertise which deserves compensation. Wow... back in my day (2 years ago), this was never even a question. 😉

 

[bacillus1]

We are learning, so fine, make it unpaid. However, paying 1.3 years worth of tuition (or even a year's worth) to do rotations is ridiculous. Someone out there, please audit the schools and see where the money is going, and then act accordingly! I would do something, but I don't want to piss people off and end up jobless. I once threatened to call the health inspector on my school during my undergrad years, and that in my opinion cost me an RA job. Now, if I piss off ACPE, the school and rotation sites, that would cost me a pharmacist job. But, if you're already an established pharmacist, please do something to force schools reconsider their shady business practices!

 

[Quiksilver]

We are learning, so fine, make it unpaid. However, paying 1.3 years worth of tuition (or even a year's worth) to do rotations is ridiculous. Someone out there, please audit the schools and see where the money is going, and then act accordingly! I would do something, but I don't want to piss people off and end up jobless. I once threatened to call the health inspector on my school during my undergrad years, and that in my opinion cost me an RA job. Now, if I piss off ACPE, the school and rotation sites, that would cost me a pharmacist job. But, if you're already an established pharmacist, please do something to force schools reconsider their shady business practices!

I agree with this. I do think they should give students a slight break on tuition in your fourth year considering the other expenses of the fourth year including travel for conferences and residency interviews, costs of prepping for residencies as well as licensing costs. It really adds up.

As far as getting paid though, it just sounds dumb.

 

[Sparda29]

I don't think we should be paid for rotations, however tuition and fees should be much lower for students on rotations. Especially for those of us at schools like Touro where we have TWO years of rotations, not ONE.

Does the pharmacy school pay sites to take in their students for rotations?

 

[Soonersyko]

Comparing APPE to slavery is hyperbole bordering on the offensive. Actually, it is just plain offensive.

Ugh, I can't stand it when you try to compare two processes that occur during an event and people think you're comparing the event. Next time please look at the processes he is comparing. Reminds me of the time that I said we should cut funding to Israel like we cut funding to North Korea and someone said "you think North Korea and Israel are on the same playing field?". Jeez, some people need to get a grip.

You're not good at it yet. At least not licensed. That is why you're still in school.

But you DO have something to offer which is why you ARE licensed...as an intern. Health science majors are not allowed to work in a pharmacy as an intern, right? Pre-med students are now allowed to work in a pharmacy as an intern, right?

 

[Sparda29]

But you DO have something to offer which is why you ARE licensed...as an intern. Health science majors are not allowed to work in a pharmacy as an intern, right? Pre-med students are now allowed to work in a pharmacy as an intern, right?

Pre-meds and other health science students can work in a pharmacy, but with the title of pharmacy technician.

A pharmacy intern with a permit, is allowed to practice pharmacy under the supervision of a licensed pharmacist.

 

[pharm B]

Very simple solution: Make a 9-12 month paid residency a requirement to become licensed. Force retail companies to create residencies to allow pharmacists to get experience counseling and do quality control (make sure the techs didn't screw up).

I think most retail companies do this via internships worked over the course of school or baptism by fire training after you're hired with as a licensed pharmacist. If you want to make paid retail residencies mandatory, don't you think new grads would scream at the thought of doing pharmacists' work for half pay?

I don't see a need for retail residencies. A pharmacist in retail is essentially a new component in a well-tested, well-developed business machine. Target teaches you the Target way, and if you're re-hired elsewhere, the new company will teach you their methodology, and that's that.

This will also weed out the incompetent pharmacy students who can't communicate with others despite their 4.0 gpa. Companies will have to replace that "free" labor with a $40K residency position to do the grunt work.

Residencies don't have to be what eliminates these people from retail. Interviews and annual reviews should do that.

 

[FarscapeGirl]

I get paid as a pharmacy intern. But, I work in a setting that offered me the position with the idea that I would be working there the whole four years of school. Therefore, all that training my bosses do, all that time and effort they put in, is worth it, because they have someone who most likely will be around for four years and getting more and more independent as time goes on. Most places that hire interns seem to function this way.

But, the APPEs at our school are 9 rotations of a month each. Basically, by the time you're done with the training aspect, it's time to go on to the next one. It'd not be worth it to pay someone for that time period. No one would want someone to be there for only a month and shell out even minimum wage. And, these rotations do 'pay off' in one sense: you may very likely get a job from one of your rotation sites, if not now then in the future.

I do have an issue with the IPPEs at our school. It's frustrating that we have to work at a different community site (or possibly the same one if we're employed by a hospital) and not get paid. I think as long as you're doing valid intern work, you should only have to do the IPPE unpaid that's most unlike your current position (so if you're retail, only inpatient IPPE should be unpaid and vice versa).

 

[FarscapeGirl]

I think most retail companies do this via internships worked over the course of school or baptism by fire training after you're hired with as a licensed pharmacist. If you want to make paid retail residencies mandatory, don't you think new grads would scream at the thought of doing pharmacists' work for half pay?

I don't see a need for retail residencies. A pharmacist in retail is essentially a new component in a well-tested, well-developed business machine. Target teaches you the Target way, and if you're re-hired elsewhere, the new company will teach you their methodology, and that's that.



Residencies don't have to be what eliminates these people from retail. Interviews and annual reviews should do that.

Seriously. Just what I'd want is to work for half pay and do more than full work while answering such thought-provoking questions as where the toilet paper is. I work in outpatient hospital right now and am considering doing community, and I think a community residency is ridiculous.

Now a class on how to bill insurance would be very useful...

 

[FarscapeGirl]

I don't think we should be paid for rotations, however tuition and fees should be much lower for students on rotations. Especially for those of us at schools like Touro where we have TWO years of rotations, not ONE.

Does the pharmacy school pay sites to take in their students for rotations?

While it's annoying that we pay full tuition our year(s) of rotations, I imagine if we paid less tuition our fourth year, then we'd just have to pay more our first three years.

I don't think sites are paid, but it's hard to convince a site to do all the work of taking in an unknown pharmacy student whose abilities may not be all that great to train them for just one month.

 

[Sparda29]

While it's annoying that we pay full tuition our year(s) of rotations, I imagine if we paid less tuition our fourth year, then we'd just have to pay more our first three years.

I don't think sites are paid, but it's hard to convince a site to do all the work of taking in an unknown pharmacy student whose abilities may not be all that great to train them for just one month.

I guess free valet parking is good enough payment for those on rotations. 🙄

I heard that back in the day (1980s-1990s), students and residents in hospitals would not have to pay anything for breakfast and lunch, but some people starting hording food to take home, or brought their families in and fed the whole family, thus the hospitals starting to charge for food.

 

[Soonersyko]

Pre-meds and other health science students can work in a pharmacy, but with the title of pharmacy technician.

A pharmacy intern with a permit, is allowed to practice pharmacy under the supervision of a licensed pharmacist.

I can't speak for everyone and every pharmacy but for the short time I worked at a retail pharmacy I was paid more than the techs. Just saying.

 

[psychoandy]

I completely disagree. I think students should get paid for IPPEs, but not for APPEs...with a few exceptions. IPPEs are tech work basically, and I think that should be paid for, unless you really are shadowing someone and standing around...if you handle meds, you should be paid.

I'm a 4th year, I've done 2 hospital, 1 amcare, and 1 retail so far. In the hospital ones, I've made many interventions, but in terms of a floor pharmacist, the only result they care about is who owns the orders. Not to discount clinical ability, but the bottom line that matters is that there's an rph verifying the orders. As a student, you don't do this...plus I spent over 50% of my time on pubmed/uptodate or doing projects, and I really don't think anyone should be paying me for that. Now, if they had me checking meds and filling omnicells or operational stuff like that, we'd be having a totally different conversation.

In my AmCare, I talked to a lot of patients and did med rec and counseling, but it wasn't by any means necessary for the clinic to function.

Finally, where I kinda agree with you...I was placed in an awful store for my retail APPE, and did 5 weeks straight of tech work, scanning rx's and filling. The last week I got to try my hand at checking scans and rx's (wooo exciting), until they kicked me out because I wasn't fast enough amd had me try and sell flu shots. I can hold my own on the bench, but the whole point of an APPE is learning, not filling and scanning and typing as fast as possible with no pay.

The real issue that I have, that you'll probably agree with, is why we pay so much for our 4th year APPEs. Now, I know the school needs to get paid, and I can't really speak for other schools, but at mine, all of the non-faculty preceptors don't get paid, and I don't think the sites get paid. So the school/faculty make an absurd amount of money (at my school, comes out to 40 faculty members at 100k a year, assuming 0 overhead)...for classroom education I'd pay, but for clinicals at sites where most preceptors volunteer? Not a huge fan...but it it what it is i guess.

 

[VancTheTank]

Ugh, I can't stand it when you try to compare two processes that occur during an event and people think you're comparing the event. Next time please look at the processes he is comparing. Reminds me of the time that I said we should cut funding to Israel like we cut funding to North Korea and someone said "you think North Korea and Israel are on the same playing field?". Jeez, some people need to get a grip.

OK. Perhaps if you find others consistently misinterpret your comparisons, you should reconsider how you construct arguments. Try dumbing it down for those of us who don't read Time and The Economist.

By your logic, if I am unable to find an open Starbucks, should I wonder aloud "No coffee...what is this, 9/11?, the holocaust?" I think most reasonable people would find such a comparison offensive, and daftly miss your point about the process of finding coffee.

/internet sarcasm.

But you DO have something to offer which is why you ARE licensed...as an intern. Health science majors are not allowed to work in a pharmacy as an intern, right? Pre-med students are now allowed to work in a pharmacy as an intern, right?

Sort of. Other posters have already pointed out the value of an employed intern vs. an APPE student. It is difficult to provide significant value if you are only at a site for 4-6 weeks. Non-pharmacy students cannot work as licensed interns.

Being licensed as an intern allows a pharmacy student to earn intern hours. In the states I am familiar with, you need a certain number of intern hours to graduate. You need to be a graduate of an accredited program to apply for a license. Your application for a license will require verfiication of your internship hours. The number of hours required during APPE rotations is designed to make sure all students satisfy these requirements. So, while you may have something to offer, you are already getting something in return.

 

[WVUPharm2007]

Who the hell would pay for some useless hop-a-long to come in and be confused for a month?

 

[All4MyDaughter]

It costs money for schools to administer rotations. It is time consuming for sites to TAKE students. If we required sites to pay students, we'd have no APPE sites.

 

[bacillus1]

By the way, for current P1s my school started charging extra for IPPEs (2 credits worth of summer tuition). That comes out to about 1500 bucks. Not a huge amount compared to our giant tuition, but I don't know where this 1500 bucks is going, especially that I believe it's for hospital IPPE. The hospital where I did my P1 IPPE said they only got about 80 bucks for me. Thankfully us P3s didn't get charged when we were P1s, but this is getting out of hand.

 

[rxlea]

What do pharm students know by the time their IPPE rolls around that could possibly demand payment? Sure, if you have worked as a tech then you already know the pouring, counting, licking, sticking that comes along with the production line of retail or you know how to make IVs for hospital. But, remember that many, many students don't have that experience. IPPE is where they learn about it. Is it annoying to do "tech work" when the techs are making money as they work alongside you and you're not? Sure. But, I just don't see how some pharm student who doesn't necessarily know much about the process of pharmacy quite yet can demand payment. Then, with APPE, the students are there to learn, not work as a tech. I work at an institution that used to take a lot of students for their rotations. IT IS A LOT OF WORK. The students don't know nearly enough yet about the operation of that specific site (like knowing how to use the computer system, for example) to even THINK about getting paid (as an intern pharmacist or whatever) for that. The pharmacists that precept the pharm students put in a lot of extra effort to teach and, at least at our institution, they don't get paid extra aside from maybe accruing a little bit of overtime. Why should they pay students to learn? It's not like they are supposed to be working and, if they are working only as techs (say filling pyxis or typing up scripts) for APPE, then that is a ****ty rotation site IMO and that's on your school for keeping it.

 

[ucrx]

As I said earlier and others have said, it costs the school money to send students out on rotations. Schools pay the sites (the preceptors are being taken away from their usual work/do extra work). They also pay salary for faculty that have outside sites; these faculty are often entirely paid by the school (sometimes this is shared).

I also don't think that most students on APPE are doing the work for the preceptor. Anything the student does should be double-checked or supervised by the preceptor, so they still are putting the time in.

Sorry if this makes no sense, I just had a 13 hour day and am a bit jumbled.

 

[confettiflyer]

IPPEs are tech work basically, and I think that should be paid for, unless you really are shadowing someone and standing around...if you handle meds, you should be paid.

This means your IPPE's weren't precepted/handled properly...I've done neither tech work nor *substantial* amounts of shadowing (ie just standing/sitting there observing).