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davidtrump

Training and practice in United States

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United States

In 2014 the United States Bureau of Labor Statistics revealed that there were 297,100 American pharmacist jobs. By 2024 that number is projected to grow by 3%. The majority (65%) of those pharmacists work in retail settings, mostly as salaried employees but some as self-employed owners. About 22% work in hospitals, and the rest mainly in mail-order or Internet pharmacies, pharmaceutical wholesalers, practices of physicians, and the Federal Government.

All graduating pharmacists must now obtain the Doctor of Pharmacy (Pharm.D.) degree before they are eligible to sit for the North American Pharmacist Licensure Examination (NAPLEX) to enter into pharmacy practice.

Pharmacy School Accreditation
The Accreditation Council for Pharmacy Education (ACPE) was founded in 1932 as the accrediting body for schools of pharmacy in the United States. The mission of ACPE is “To assure and advance excellence in education for the profession of pharmacy.” ACPE is recognized for the accreditation of professional degree programs by the United States Department of Education (USDE) and the Council for Higher Education Accreditation (CHEA). Since 1975, ACPE has also been the accrediting body for continuing pharmacy education. The ACPE board of directors are appointed by the American Association of Colleges of Pharmacy (AACP), the American Pharmacists Association (APhA), the National Association of Boards of Pharmacy (NABP) (three appointments each), and the American Council on Education (one appointment). To obtain licensure in the United States, applicants for the North American Pharmacist Licensure Examination (NAPLEX) must graduate from an ACPE accredited school of pharmacy. ACPE publishes standards that schools of pharmacy must comply with to gain accreditation. A Pharmacy school pursuing accreditation must first apply and be granted Pre-candidate status. These schools have met all the requirements for accreditation, but have not yet enrolled any students. This status indicates that the school of pharmacy has developed its program in accordance with the ACPE standards and guidelines. Once a school has enrolled students, but has not yet had a graduating class, they may be granted Candidate status. The expectations of a Candidate program are that they continue to mature in accordance with stated plans. The graduates of a Candidate program are the same as those of fully accredited programs. Full accreditation is granted to a program once they have demonstrated they comply with the standards set forth by ACPE. The customary review cycle for established accredited programs is six years, whereas for programs achieving their initial accreditation this cycle is two years. These are comprehensive on-site evaluations of the programs. Additional evaluations may be conducted at the discretion of ACPE in the interim between comprehensive evaluations.

Education

Acceptance into a doctorate of pharmacy program depends upon completing specific prerequisites or obtaining a transferable bachelor's degree. Pharmacy school is four years of graduate school (accelerated Pharmacy Schools go January to January and are only 3 years), which include at least one year of practical experience. Graduates receive a Doctorate of Pharmacy (PharmD) upon graduation. Most schools require students to take a Pharmacy College Admissions Test PCAT and complete 90 credit hours of university coursework in the sciences, mathematics, composition, and humanities before entry into the PharmD program. Due to the large admittance requirements and highly competitive nature of the field, most pharmacy students complete a bachelor's degree before entry to pharmacy school.

Possible prerequisites:

Anatomy
Physiology
Biochemistry
Biology
Immunology
Chemical engineering
Economics
Pathophysiology
Physics
Humanities
Microbiology
Molecular biology
Organic chemistry
Physical chemistry
Statistics
Calculus

Besides taking classes, additional requirements before graduating may include a certain number of hours for community service, e.g., working in hospitals, clinics, and retail.

Estimated timeline: 4 years undergraduate + 4 years doctorate + 1–2 years residency + 1–3 years fellowship = 8–13 years

A doctorate of pharmacy (except non-traditional, i.e. transferring a license from another country) is the only degree accepted by the National Associate of Boards of Pharmacy NABP to be eligible to "sit" for the North American Pharmacist Licensure Examination (NAPLEX). Previously the United States had a 5-year bachelor's degree in pharmacy. For BS Pharmacy graduates currently licensed in US, there are 10 Universities offering non-traditional doctorate degree programs via part-time, weekend or on-line programs. These are programs fully accredited by Accreditation Council for Pharmacy Education (ACPE) but only available to current BS Pharmacy graduates with a license to practice pharmacy. Some institutions still offer 6 year accelerated PharmD programs (similar to 6 year MD programs), though in both cases the issuance of a doctoral degree in less than 8 years is controversial.

The current Pharm.D. degree curriculum is considerably different from that of the prior BS in pharmacy. It now includes extensive didactic clinical preparation, a full year of hands-on practice experience in a wider array of healthcare settings, and a greater emphasis on clinical pharmacy practice pertaining to pharmacotherapy optimization. Legal requirements in the US to becoming a pharmacist include: graduating from an accredited PharmD program, conducting a specified number of internship hours under a licensed pharmacist (i.e. 1800 hours in some states), passing the NAPLEX, and passing a Multi-state Pharmacy Jurisprudence Exam MPJE. Arkansas, California, and Virginia have their own exams instead of the MPJE and pharmacists must pass the Arkansas Jurisprudence Exam, California Jurisprudence Exam, and Virginia Law Exam, respectively.

Residency is an option for post-graduates that is typically 1–2 years in length. A residency gives licensed pharmacists decades of clinical experience in an extremely condensed timeframe of only a few short years. In order for new graduates to remain competitive, employers generally favor residency trained applicants for clinical positions. The profession is moving toward resident-trained pharmacists who wish to provide direct patient care clinical services. In 1990, the American Association of Colleges of Pharmacy (AACP) required the new professional degree. Graduates from a PharmD program may also elect to do a fellowship that is geared toward research. Fellowships can varying in length but last 1–3 years depending on the program and usually require 1 year of residency at minimum.

Specialization and credentialing

American pharmacists can become certified in recognized specialty practice areas by passing an examination administered by one of several credentialing boards.

The Board of Pharmaceutical Specialties certifies pharmacists in thirteen specialties:

Ambulatory care pharmacy
Cardiology pharmacy
Compounded sterile preparations pharmacy
Critical care pharmacy
Geriatric pharmacy
Infectious diseases pharmacy
Nuclear pharmacy
Nutrition support pharmacy
Oncology pharmacy
Pediatric pharmacy
Pharmacotherapy
Psychiatric pharmacy
Solid organ transplant pharmacy

The Commission for Certification in Geriatric Pharmacy certifies pharmacists in geriatrics specialty practice.
The American Board of Applied Toxicology certifies pharmacists and other medical professionals in applied toxicology.

Advanced Practice Pharmacist


California pharmacists can apply for Advanced Practice Pharmacist (APh) licenses from the California State Board of Pharmacy. Senate Bill 493, written by Senator Ed Hernandez, established a section on the Advanced Practice Pharmacist and outlines the definition, scope of practice, qualifications, and regulations of those holding this license.

An APh can:

Perform patient assessments
Order and interpret drug therapy related tests
Refer patients to other healthcare providers
Participate in the evaluation and management of diseases and health conditions in collaboration with other health care providers
Initiate, adjust, or discontinue therapy pursuant to the regulations outlined in the bill 

Qualifications:

To qualify for an advanced practice pharmacist license in California, the following requirements must be met

Hold an active pharmacist license in good standing with the California State Board of Pharmacy
Meet two of these three criteria
Possess a current certification in relevant area of practice
Completed a postgraduate residency earned in the United States through an accredited postgraduate institution
Provided 1,500 hours of clinical experience under a collaborative practice agreement or protocol to patients within 10 years of application, where clinical experience includes initiating, adjusting, modifying or discontinuing drug therapy of patients 
The APh applying for renewal must complete 10 hours of continuing education in 1 or more areas relevant to their clinical practice.

Earnings and wages

The American Pharmacy Journal of Education in 2014 reported the average salary around $112,160.

According to the 2010 "Pharmacy Compensation Survey":

Directors of Pharmacy $125,200
Retail Staff Pharmacists $113,600
Hospital Staff Pharmacists $111,700
Mail Order Staff Pharmacists $109,300
Clinical Pharmacists $113,400

According to the US Bureau of Labor Statistics – Occupational Outlook Handbook, 2016–17 Edition, Median annual wages of wage and salary pharmacists in May 2015 were $121,500.

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