Meeting with NABP: Are you ready to talk to NABP?

[knok]

Discussion:

If you have 15 seconds to speak to NABP, what do you want to say?

You have plenty of time to think and have 40 seconds to type. (beep) Go..

1. Get rid of TOEFL iBT.

..What's next? ....

2.....

[PTS]

In my opinion, NABP should eliminate Toefl iBT, but if they are not ready to do that, than atleast they should relax the score requirement- especially speaking. Also to get particular score in all four sections is not easy. Before iBT and at the time of CBT + TSE - they didn't require particular score in grammar, in reading, in essay or in listening section. So why now?? If they consider TSE 50 score equivalent to iBT 26 then, why the requirements for other sections? This is the only case with pharmacists. Even physiotherapists don't require particular score in each section except speaking. I suffered recently from this trauma. In my third attempt I scored 27 in speaking. Total score 103. Reading 29, listening 25 and writing 22. No change in writing in rescoring too. In my first attempt I scored 27 in writing...now how someone's writing can degrade so fast? I think we should also present this view too in NABP meeting.

[knok]

Are you saying that, "TOEFL score is invalid."

If the test score is valid, the scores of test takers should be similar in different tests. The test measures test takers' ability under time limit, rather than language ability.

Therefore, it can be concluded that:

"TOEFL is an integrated test, requiring scores by section is flawed."

[said123]

Hi knock and everybody,
I really appreciate all you guys effort to solve this problem not only for yourself but for all foreign pharmacists. I took toefl many times but the most i got on speaking was 24. I have been in the U.S for almost 10 years and working as a pharmacy technician. I passed the fpgee last june but struggling to pass the toefl ibt. I got informed from yashak about this effort which I really appreciate. He is one of my friend which I met him in the library while I was preparing for fpgee last year. I hope it works out for all of us and I am with you guys and I know other people too. I will let them know that there is an effort to solve this problem and hopefully they will join us too.

[knok]

Hi Said,

Welcome to the group!

Every effort is cooperative. We need more perspectives and more people.

[knok]

Fact about TOEFL iBT:

The average number of times candidates take the TOEFL iBT before passing the speaking section = 100/11 = 9.09 times

According to ETS score summary, data collected between January 2007-December 2007, a score of 26 of the speaking section is at 89 percentile. Only 11 out of 100 candidates can pass the speaking section.

[knok]

Hi folks,

I received a phone call from Carla, a member who met with NABP 3 years ago discussing about getting rid of the two year requirement, reducing the TSE score, or replacing TSE with IELTS. She told me that the other two friends who came with her could not pass the TOEFL iBT- speaking.

She passed the last TSE with luck. Now, she is working at the hospital every single day with no break every 2 weeks because there is not enough pharmacists. Hospital is waiting for new graduates. Pharmacists at her hospital cannot understand why the board does not want foreign pharmacists to get licenses while all of pharmacists are overworked.

She will have a day off on May 13. I hope that I can talk to her in details.

I guess that everything is just a miscommunication between us and the board. ETS presents to the board that it offers a good test while not many candidates get together to explain to the board that it is not true. We need to present the facts that cause pain to us and the nation.

Please sign in and click private message. I sent private messages to some of us. I expect to receive some feedback. Thank you for all your support.
Good luck.

Knok

[knok]

Alleviation of Pharmacist shortages

Pharmacists’ roles

• Play a crucial role in patient safety.
• There has been a drastic change in levels of staffing over the years. Every week, some chain pharmacies are cutting their tech hours, despite record sales, and exceeding budget sales volume.
• The job is so stressful, so hectic, so unfulfilling and mindless at times.
• Many pharmacists have left the industry in recent years because of mounting pressure to do more in less time. (Ethan Asedo, owner of Miller Pharmacy)
• Working 12 hours without getting time to eat or use a bathroom, dealing with a queue of demanding customers and spending hours on the phone.
• The tremendous amount of stress and pressure and constant interruptions that we pharmacists are constantly exposed to “contributed to the error.”
• 91% pharmacists are experiencing a shortage in their region of the country (student pharmacist.com.)
• 67% Pharmacists believe that the shortage is somewhat severe (student pharmacist.com.)
• 24% pharmacists believe that shortage is extremely severe (student pharmacist.com.)

Facts and Incidents

• Unexpected growth in medication use has increased demand for pharmacists that has outpaced supply.
• The profession is realizing an acute pharmacist shortage, and it is expected to persist for some time. (HHS & HRSA)
• There is a major problem with a shortage of pharmacists in the nation (Officials at Gifford.)
• Media are bombarding the public about pharmacist shortage.
• Educators, pharmacists, patients are shouting for help about the crisis for decade.
• By 2015, the estimate is that we are going to be over 40,000 pharmacists short nationally, and 157,000 short by 2020. (HRSA)
• 41 percent of all male pharmacists are age 55 or older, nearing retirement.
• 48% of pharmacists reported that there were unable to take breaks, 36% had fewer opportunities to reduce errors, 35% spent less time with patients, and 33% had less ability to solve drug therapy problems. (HRSA survey, 2002-2004)
• The demand for pharmacists is growing at a much faster rate than the number of pharmacy graduates each year.
• An increase in prescriptions and aging baby boomers also exacerbate the situation. (2006 ASHP)
• A machine cannot always substitute for a person. (NABP Newsletter 2/2007)
• Pharmacists was in top of the list of five most difficult positions to fill because the exploding demand for pharmacists in retail outlets and the utilization of prescription drugs increased 71% from 1994-2005.(WHA)
• More states are at the “4” (high demand) level, up from 40 in 2006 to 46 in 2007. (ADI Data, 2007)
• 54 percent of all pharmacists reported their workload as “high” or “excessively high.” (HRSA)
• 58 percent said that their workload had “increase” or “increased greatly” compared to one year ago. (HRSA)
• In 2006, there was a 21 percent nationwide vacancy rate for pharmacists. (AHA)
• Hiring and retaining pharmacists is a growing challenge for drugstores.
• Workload conditions in the pharmacy are a problem that impacts the public health and safety.(Task Force)
• Older men will be lost from the pharmacist workforce due to death or retirement, while younger women entering the profession will tend to choose part-time work.
• Four of every five visits to a doctor results in a prescription.
• People over 65 use three times the number of medications as younger Americans.
• Vacancy length of time required to fill a vacant pharmacist position remains approximately 6 months.
• 2007 total retail Rx volume 3.52 scripts, up 3.42 scripts in 2006. (NACDS)
• Between 2004 and 2010 the supply of all community pharmacists is expected to increase only 7.8% vs. an estimated 27% increase in number of prescriptions dispensed, going from 3.27 billion in 2003 to over 4.1 billion in 2010. (HRSA)
• 3,904 open chain pharmacist positions as of January 1, 2007 (NACDS).

Actions
• Pharmacy schools have been built but the seats of pharmacy schools are limited. Some pharmacy schools received about 500-1,700 applications but they could admit only 50-80 seats.
• An increase in technology and the use of pharmacy technicians.
• Hire from overseas pools of younger workers and sponsor their green cards but there is setback.

Causes of the shortage
• The shortage is resulted from a greater need for pharmacists’ services
• The increased demand for prescriptions by an aging population and coverage of drugs by managed care organizations.
• A sharp increase in prescription drugs dispensed annually at a rate that greatly outpaces the increase in pharmacist supply.
• Higher educational standards for pharmacists have added to the shortage.
• Due in part to the unprecedented growth in new types of employment opportunities.
• Attractive careers in areas other than pharmacy, and a movement toward managed care.
• The growing biotechnology industry requires pharmacists’ knowledge base.
• Limited uses of automation and pharmacy technicians. Greater number of female pharmacists, who prefer to work part time.
• There has been a rapid growth of 24-hour community and retail chain pharmacies.
• Changes in insurance policies and federal pharmaceutical regulations which made drugs available to more people.
• An aging population and more drugs being manufactured and advertised to the public.
• A sharp increase in utilization of prescription drugs and more pharmacist retiring than joining the field are dueling a severe shortage of pharmacists in the state.(WHA)

Impact of Pharmacist shortages

Patient Safety

• The current shortage is restricted pharmacists’ ability in maintaining safe, accurate, and efficient medication distribution systems.
• The burden of more prescriptions dispensed per pharmacist may contribute to medication errors.
• The lack of qualified workers, along with a greater reliance on lesser-trained pharmacy technicians to fill the gaps, is one reason a large number of prescriptions are misfilled.
• Lessening the number of opportunities for pharmacists to interact with patients and perform managed care activities.
• Some pharmacists filled 500 prescriptions a day; they could spend only 10 seconds with each patient.
• There was an increase in the risk of dispensing potential drug-drug interactions with higher pharmacist and pharmacy workload. (Lippincott Williams & Wilkins)
• Potentially increasing the risk of dispensing errors. (HRSA)
• The media highlights those items when pharmacists do make errors.
• There is a strong correlation between pharmacist shortages and patient safety.
• Reasons for errors include pharmacy workplace noise levels, number of interruptions, the differences in the amount of staffing available, and the extreme workload placed.

Quality of life of pharmacists

• Longer working hours and decreased quality of life for pharmacists.
• A new system of improving efficacy has been used to increase speed of dispensing medication.
• All methods have been used to utilize limited resources, which put pressure on pharmacists.
• Pharmacists are stress and strain with work overload, with not enough technician help.
• They don’t get any lunch breaks; they just have way too many prescriptions to do all day, every day.
• It is a bad working environment.
• Approximately half of pharmacists complained that their workload was high. (31)
• Job-related stress and longer work hours led to in-the job fatigue. (HRSA)


Profession

• Constraining community pharmacists to the role of dispensing high-volume prescriptions represents a step backwards for the pharmacy profession
• Workload is one downside to the profession.
• The pharmacy closures would “create significant barriers” for patients. It’s critical, especially in rural areas (McConnell.)
• Insufficient staffing and interruptions were the biggest stress producers. (31)
• Drugstores in rural areas are struggling to attract pharmacists (B. of America Research)
• A shortage in good pharmacists hurt both the retailer and the consumer. A good pharmacist is one that interacts with customers, establishes trust and answers questions.
• We are healthcare professionals trained in collecting information, counseling patients and caring for patients. Everyone thinks that the pharmacy is a drug store, retail store but it is a practice. This is a barrier that needs to be addressed. The shortage of pharmacists makes this barrier difficult to break.
• Customers suffer either by pharmacists having less time to spend with them or, in the worst case, by prescriptions filled incorrectly. "It's a great deal of pressure and a lot of people are leaving because of it. They're sick and tired of it, burned out.”
• Fewer opportunities for patient care as a result of understaffed work shifts and an increase in individual workers' duration and volume of work.
Consumers
• The shortage means an inconvenience and no one answer their questions.
• The age wave is coming. To meet demand, a few strategic routes need to be taken.
• Patients waiting longer to have prescriptions filled. (KFOX News)
• Workload pressures reduced pharmacists’ time available to counsel patients (HRSA)
• Staffing limitations may force the store to close on occasion. It is certainly causing a great deal of anxiety. The last thing in the world seniors need is to have their pharmacy close.

Economy

• The average length of time to hire a pharmacist has continued to rise. (ASHP)
• The nationwide shortage of pharmacists has prompted fierce competition between employers for new pharmacy graduates.
• Drugstores are competing with hospitals and retail chain stores over the limited supply of pharmacists, despite an increase in the number of pharmacy graduates.
• As great demand for pharmacists continues, pharmacy chains and health systems bid against one another to staff their expanding facilities.
• Drugstores can’t maintain a retail, 24 –hour pharmacy because there aren’t enough pharmacists.”
• The pharmacy attributes the recent closing to a lack of pharmacists.
• The shortage of pharmacists is one of the factors holding back the roll-out of pharmacies.
• Despite high wages, when pharmacists reduce their hours or quit because of the stressed out work atmosphere, clearly it’s not “all about money.”
• In addition to the risk for errors, not having enough pharmacists can lead to shorter pharmacy business hours.

Trends

• The industry is under stress – stacks of unfilled prescriptions, a rushed staff, a schedule board showing extra-long shifts and, in the worst cases, pharmacy shutdowns.
• The number of prescriptions written and dispensed has increased significantly, creating greater demand for pharmacists.
• More and more conditions and diseases can be effectively treated and managed by medication, decreasing the need for surgery and hospitalization.
• Pharmaceuticals will play a major role in the future of health care treatment.
• These demographic trends show that even if the workforce is sustained at current levels, not enough health care workers will be available to provide care.
• If actions are not taken to develop a solid health care workforce, the healthcare delivery system will be imperiled, particularly for most vulnerable citizens, seniors. ( Health Workforce Institute, 2006)
• The shortage of pharmacists will become more acute as our aging population explodes. The U.S. Census Bureau reports that today’s 35 million citizens age over 65 will jump to 40 million by 2010.
• Our growth out here for the future is just going to be so high because of the new stores that we constantly open. It just creates a constant need for us. (Walgreens)
• The American Society of Health-System Pharmacists estimates a moderate to severe shortage of staff at 90 percent of its hospital pharmacies.

Finding

• English is not an official language of America.
• For instance, 25% of New York State residents, and 50% of New York City residents, speaks a language other than English at home. In the city, 1.7 million residents—one in four—are not proficient in English. 88 % of city pharmacies in New York said they served limited English proficiency patients daily. (New York Academy of Medicine)
• The New York State Department of Health has adopted regulations setting basic standards for hospitals’ communications with patients who speak limited or no English.(Into effect on September 13, 2006)
• The hospital must offer and provide communication assistance from fully-bilingual staff in a language that is understandable to the patient during the entire medical visit.
• Existing federal, state, and local laws require hospitals to avoid discrimination and provide meaningful access to health care, regardless of a patient’s national origin or the languages he or she speaks.
• For the first time, hospitals have clear standards they must meet to ensure that the health and safety of patients will not be compromised by language barriers.

Setback - hindering one potentially beneficial response to the pharmacist shortage

International pharmacy graduates are currently presented with significant barriers to achieving licensure

• TOEFL iBT: a score of 26 on the speaking section is very high. The average score of American candidates and candidates from English speaking countries was only 22 in 2007 but the requirement for foreign pharmacists is 26. 89 out of 100 candidates failed this section each time.

• In addition, the format, testing administration, test scoring process, and access to the TOEFL iBT are problematic. International pharmacists are in huge stress because of this TOEFL iBT. The average number of attempts candidates take before achieving a score of 26 is 9 times. The abusive monopoly, ETS, receives benefits from NABP's setting high score of the language requirement. The conflict of interest causes frustrations to candidates who keep failing this test and have no clue how to improve.

• Physician board developed its own communication skills.
• Nurses are allowed to take IELTS and other English tests. CGFNS approved that IELTS met statutory. Nurses and doctors are in the same healthcare system as pharmacists.
• Alternative English proficiency tests should be used to increase fairness and competition. In other words, getting rid of the monopoly will solve the shortage.
• Immigration process (H-1B cap)- After foreign pharmacist have passed all rigid requirements in the FPGEE certificate program, those who do not have work authorization and want to work must file H-1B petitions. They have to go through the lottery system of INS. In 2007-2008, the H-1B cap closed early in April after opening only a few days.
• INS has done its job by limiting the number of foreign workers. Shutting the doors to foreign pharmacists by setting language requirement at very high level seems to exacerbate the problem of pharmacist shortage.

The nation’s health care delivery system will suffer from the shortage unless the problem is addressed immediately. The current shortage of pharmacists exists and will not be quickly resolved. Overworked pharmacists are choosing to leave their profession because of intolerable stress levels due to inadequate staffing.

Pharmacist couldn’t stand the strain, not the work, but of the mistakes she was making. People are overworked and overstressed. It is the best interest of all stakeholders and profession, that we should be adequately staffed at all times.

The pharmacy schools have been trying to expand the pharmacists’ roles from providing products to providing services. But we never get there until we are willing to recognize that we have a major problem with inadequate staffing and willing to come together as a profession to figure out how to fix it.

Please ask yourself, what have you done for the profession? If your answer is “nothing”, then you have only yourself to blame.

“In the end, it’s necessary for pharmacists to have a unified voice.”

Sincerely,

[knok]

Dear all,

This is our PowerPoint Slides:

YouTube - Shortage of pharmacists/uptapped resource-foreign pharmacist

Thanks, bigmoonstar for converting it to the video in YouTube.

Please give your feedbacks for improvement.

[peeintira]

Dear All,

Thank you for doing a good job for all of us. I am far away, but I give you full support.
ETS has asked me to complet its survey so I did. I am not sure if you received the same survey, but this is the first time ETS tries to do something about its service. This is the link they gave me.

http://surveys1013.websurveyor.net/l.dll/JGsA5C7D7E8lyaD9U1364815J.htm

P