Differences Between US and International Pharmacy and its Impact on the Role of Pharmacists
Pharmacists’ roles and responsibilities differ between countries which leads to differences in expectations for pharmacists in each country. This can be attributed to the level of education and training or country laws and regulations. Inconsistencies in education and internship experiences between programs may result in pharmacists graduating with variable knowledge levels. In addition, many countries require pharmacists to take a licensing exam to determine their competency and eligibility to work although several do not. Some countries also require pharmacists to complete a certain number of internship hours prior to taking a licensing exam.
Even with these measures in place, pharmacy practice is still different between the US and other countries. In order to understand this, we need to first understand the difference in pharmacy education.
What pharmacy degrees are currently offered around the world?
While many countries use the Bachelor of Pharmacy (BPharm) as the standard pharmacy degree, other countries have moved to Doctor of Pharmacy (PharmD) or Master of Pharmacy (MPharm). These are considered the basic degrees to practice as a pharmacist. In the US, the PharmD degree is currently offered, whereas, in the UK, the MPharm is the standard pharmacy degree. Other countries have different BPharm, PharmD, and MPharm given at different universities.
This change in pharmacy education reflects on the more advanced roles that pharmacists have as clinicians and their roles in patient care. The program choices reflect local needs, the structure of pharmacy services, and the responsibilities placed on pharmacists.
What is the difference between pharmacy practice in the US and internationally?
In the US, pharmacist responsibility is broad and extends to many settings. Pharmacists are heavily involved in clinical practice and direct patient care as important members of the healthcare team. They can also have roles in academic settings, research, drug manufacturing, and other medication-related services. Pharmacist roles internationally vary based on the country but include, in part, hospital and community pharmacies, academia, and drug manufacturing. Out of these, the most common are community and hospital pharmacies.
Although the setting may be similar, the services pharmacists provide differs greatly compared to the US. For example, pharmacists can administer vaccinations in the US but they are not able to in other countries. In addition, hospital pharmacists can potentially order certain medications based on protocol depending on the institution and state. Conversely, medication ordering by pharmacists is not common outside the US. One exception is found in the UK where pharmacists can become independent prescribers after finishing specialized training.
How does this affect the pharmacy profession?
Different standards in pharmacy education and professional responsibility can negatively impact how pharmacists are viewed on a global scale. Think of a scenario where a physician practices in a hospital with a team that includes other physicians, a pharmacist, and a nurse. Now imagine this physician moving to a different setting abroad where he works with similar team members but no pharmacists.
Scenarios such as this can be applied across all pharmacy settings especially in areas where pharmacists work with other healthcare professionals. Pharmacists moving between countries may also have difficulty adjusting to new expectations and responsibilities. Overall, this may lead to lower expectations of pharmacists which in turn can lead to their utility being perceived in only its most basic form such as dispensing prescriptions.
How to Tackle this Problem?
Standardizing pharmacy competencies is one of the best ways to ensure that certain pharmacy services are maintained internationally. Pharmacy associations around the world play a major role in ensuring pharmacists are recognized as vital members of the healthcare team by making sure that even certain advanced pharmacy services become a standard competency globally.
For example, the international pharmacy Federation (FIP) has released a global competency framework for pharmacists. It helps to ensure that pharmacists meet the same standard competency levels. This competency is applicable in pharmacists in all aspects of pharmacy practice as described in the following quote:
applicability for leaders, educators, regulators, and practitioners who are working towards global harmonization of the practice-based expectations.
My personal thoughts
Pharmacy practice in the US is very advanced compared to most of the world with even some of the basic US pharmacy services still being considered advanced for other countries. Standard pharmacy services should be changed internationally to include additional advanced services such as clinical pharmacy. Such changes will lead to an improved perception of the pharmacist role on a global scale and lead to pharmacists being more recognized overall.
