Category: Career spotlight

Could you tell us a little bit about your background and how you came to study pharmacy?

I have been a qualified nurse since 2002. I have worked mainly in critical care areas and, for 7 years prior to starting my MPharm, I was a clinical nurse specialist in pain management. I completed my non-medical prescribing course in 2013 and became interested in how drugs work. I enjoyed counselling patients on how to take their medications to achieve the best outcome for them so decided to take the plunge and study pharmacy. Having lived and worked in other parts of the UK and overseas for many years, I wanted to study in Scotland to be closer to my family. I got an unconditional offer from The Robert Gordon University (RGU) in Aberdeen and the rest is history.

Congratulations on your recent award. Could you tell us what you did to achieve this accolade?

Thank you! I honestly have no idea how I achieved the award. I was nominated for the volunteering I did at RGU, peer teaching and my work as a nurse during the pandemic while still studying for my MPharm. I was the academic rep for my year in 2nd year and am currently one of the two Student School Officers for the School of Pharmacy and Life Sciences. I feel honoured to have been nominated and over the moon to have won but basically, I just try to work hard, help others, be organised and lead by example.

How has the pandemic had an impact on you and your friends as pharmacy students?

The pandemic has impacted us as pharmacy students a lot. Everything is online now and most of us have not been on campus since March last year. We miss the social side of being at university and seeing our friends. It can be hard to motivate ourselves when we’re staring at a screen all day. I’ve been lucky and could still attend my experiential learning placement last year but many others couldn’t due to the travel restrictions.

What changes has the university made to your learning experience?

The university has been fantastic. All of the staff have worked so hard to ensure that our learning experience is the same high quality as it was before the pandemic. Everything is online now but the staff at RGU have gone over and above to make the transition to online learning as good as it can be. All of the support services at university are still available and the staff themselves have been exceptionally supportive.

What have you enjoyed so far in the undergraduate course?

I have enjoyed learning so many new things and making new friends up in Aberdeen. The placements I have had have been great and have given me an insight into many different aspects of the pharmacy profession.

The pandemic has in many ways been devastating for the UK but taking an optimistic stance do you see any benefits for pharmacy students and the profession more widely as a result?

The fact that we’ve all had to adapt the way we work (in uni, pharmacy roles or both), deal with the impact of all the restrictions and work a lot harder means that we’ve developed coping mechanisms that we perhaps didn’t have before and we’ve become more resilient. It’s been lovely to see how people have pulled together and I believe, in the vast majority of cases, it’s brought out the best in society.

Have you decided what pharmacy sector you would like to go into and why that area?

I honestly don’t know what sector I would like to go into yet. I have worked with so many inspirational pharmacists in many different places over the years. I started the course I thought that I’d become a hospital pharmacist as all of my nursing career has been in hospitals, then I got a community pharmacy job and did a summer placement with a great independent pharmacy chain. I’ve yet to have a placement in primary care so that may confuse matters even more.

Have you got any words of advice for pharmacy students coming behind you in years to come?

Make writing a to-do list a habit, start assignments and studying for exams early, and ask for advice if you need it. Help each other and share your knowledge and experience. I have lots of clinical experience that I use to help others yet I’m not the best at chemistry. Luckily, one of my best friends in my year is great at chemistry.

Sarah Cameron is an independent pharmacist prescriber and Director of Propharm Services and Superintendent Pharmacist at My Pharmacy 365. She took some time out to talk to us about her career progression, achievements and future plans.

How long have you been a pharmacist?

16 years

Why did you choose to become a pharmacist?

I wanted to interact with people and directly impact the application of science and medicine to patients. Even 20 years ago, the prospects and career development potential seemed exciting.

Where did you work on your first day as a pharmacist?

I worked as a rotational basic grade pharmacist in Princess Alexandra Hospital in Harlow, Essex. It was a great department, with pro-active staff who invested resources into technology and bringing care to the patient bedside.

What does your current role involve?

As an independent pharmacist prescriber, I manage acute prescription requests, which often involves (at the moment) telephone appointments with patients. I am a member of the diabetes management team within one GP Practice, undertaking annual reviews of patients living with diabetes. I have had fantastic clinician support to enable the development of this role, including undertaking clinical assessments. Working within primary care enables me to autonomously manage a wide variety of patients living with long term conditions and implement medication changes or clinical assessment and follow up. I try to minimise the need for further unnecessary practitioner appointments, including being able to take blood at the point of consultation. As a vaccinator, I administer annual influenza vaccines on an ad-hoc or sessional basis and have recently undertaken Covid-19 vaccination training.

In the current unprecedented circumstances, it is vital to continually strive to expand clinical experience and abilities. This enables our front-line clinicians to direct their time and skillset where they are most needed.

What do you love about your job?

Building relationships with patients and instilling confidence in the pharmacist as one of their clinical care providers. Being a consistent part of the patient journey and liaising with other services to manage any disease changes or progression creates a very person-centred approach and supports cross-sector communication.

Any aspects you dislike?

Like most healthcare workers, time and resource limitations can be frustrating, but I generally find that individuals within the health care sector strive as far as possible to do their best for their patients.

What previous roles have you undertaken as a pharmacist?

I have worked previously as a community pharmacist which has given me an insight into the pressures the sector faces.

As a locum hospital pharmacist for a number of years, I had fantastic learning opportunities working within hospital dispensaries, respiratory wards, cardiovascular care, emergency medicine, surgical admissions, paediatric speciality wards and oncology.

Looking to build my future as an experienced clinician, I took every opportunity to become involved in direct patient care to continually develop my knowledge base and learn from experienced practitioners.

Which role did you find most challenging and why?

Within emergency medical admissions wards, the pace and urgency of care could be a challenge. Adapting work planning, care plans and complex medication calculations to a changing clinical picture at any given time provided me with resilience and the ability to access resources and evidence quickly and efficiently. This is a skill I still use on a daily basis.

Do you think all pharmacists should be independent prescribers?

I think that all pharmacists should have the opportunity to access training and support to become independent prescribers. For some, their career pathway does not include the need to prescribe medication, and resources may be better directed to provide training in other areas to support career development. However, the independent prescriber training curriculum provides a valuable perspective on the realistic application of medicine. This can greatly influence how we work with our prescribing colleagues and clinicians.

What was the toughest lesson you had to learn as a pharmacist?

My own limitations, and as an independent practitioner, having the confidence and knowledge to be responsible for your own decisions. Once you expect to be working with patients to manage conditions, you have to be prepared to be accountable.

Has the pharmacists working in general practice initiative been a success in recent years?

I do think it is a success, but only where we integrate as part of the General Practice team and are provided with GP support to develop the role. In Scotland, the pharmacotherapy aspect of the GP contract provides clear direction for the general practice pharmacist role, and the ongoing developments in training and accreditation will serve to strengthen this.

Are you optimistic about the future of pharmacy?

Absolutely! As a workforce, we have shown that we can step up and develop our skills as necessary. Registered pharmacy technicians are now routinely undertaking tasks that were traditionally performed by pharmacists; as a profession, we are striding forward with career development. By continuing to undertake our work and improve communication we can enable other medical professionals to understand the support we can provide.

What’s next for you?

Imminently, participating in the national COVID vaccination scheme.

Within Propharm Services, we are currently working to provide further GP practices with the opportunity to obtain sessional pharmacist support. Many prescribing pharmacists are flexible, adaptable and keen to provide a few hours or a few days to practices, enabling effective bespoke resource management for GP practices. We are always looking to build our pharmacist team across the Central Belt.

Sarah has teamed up with Pharmacy in Practice to conduct a survey to find out how the working lives of pharmacists across the UK had been impacted on throughout the pandemic and explore the support that they may need this year and beyond. 

Click here to take part in the survey

You can contact Sarah by email here.

Where did you study?

I studied at the University of Strathclyde and graduated in 2010.

What additional qualifications have you achieved post-qualification?

I completed the Pharmacist Independent Prescribing course at Strathclyde in 2016, and of course, I have now achieved my California Pharmacist licence.

You were a locum in Scotland for some years. What were the pros and cons of this role in your experience?

Being a locum was great for getting experience in a wide range of settings, meeting lots of new people and learning how to adapt quickly to new situations. It also allowed me flexibility in choosing my own working days. On the other hand, sometimes there might not be much work available, and the resources for professional development such as training and networking might be more limited when you aren’t employed by a single company.

Could you describe the highlights of working for NHS Scotland?

I worked in three different NHS Scotland roles – as a Pharmacy Advisor for NHS 24, a Prescribing Support Pharmacist and General Practice Clinical Pharmacist for NHS Lanarkshire and as a hospital Clinical Pharmacist, also with NHS Lanarkshire. Although these positions were different from each other in many ways, they all allowed me to feel the satisfaction of using my experience and training to help patients. Being a welcomed part of a multidisciplinary team was always a highlight, and I enjoyed learning from my colleagues in other professions and demonstrating the value that I could bring as a pharmacist. At NHS 24 I had the challenge of assessing and advising patients from all over Scotland by telephone. It was always a highlight when I could help a patient to understand their medication, provide reassurance to a worried caller, or recognise a high urgency situation and get the appropriate help in time. In primary care, I was able to review patients’ medicines and make sure they were getting the most from their treatment. Getting patients engaged with their medication, making clinical decisions based on risk and benefit and coming to a mutual agreement on the treatment plan were highlights for me. In the hospital, I saw patients admitted while seriously unwell, participated in their care throughout their journey until they improved and saw them go home looking like a new person. To see the difference I can make as a pharmacist is the greatest highlight of all.

During the course of your work in Scotland did you manage to apply your independent prescribing qualification?

I did. I used it as a General Practice Clinical Pharmacist to prescribe for patients requesting acute prescriptions, then even more extensively as a Clinical Pharmacist on the surgical wards at University Hospital Wishaw.

Why did you decide to move to the USA to practise as a pharmacist?

My wife is from Los Angeles and was offered a great job opportunity back in the US. We decided to move over and so my journey began.

Could you describe the registration requirements and process for pharmacists who may wish to work in the US?

The first requirement for working here is employment authorization from US immigration. I am able to work here as the spouse of a US citizen, but it would otherwise be very unlikely that a US company would successfully sponsor a work visa for a foreign pharmacist.

The next requirement was the Foreign Pharmacy Graduate Examination Committee (FPGEC) Certification. This program evaluated my Scottish degree to certify that it is equivalent to a US pharmacy degree. The requirement for graduates after 2003 is a 5-year pharmacy program, but they consider Highers/Advanced Highers equivalent to a year of US undergraduate study, so my 4-year Scottish MPharm was accepted. Once my SQA Certificate, MPharm transcripts, GPhC letter and other supporting documents were sent in and I passed the Test of English as a Foreign Language (required even as a native speaker), I could sit the Foreign Pharmacy Graduate Equivalency Exam (FPGEE). This is held every October in test centres across the US, comprises 200 questions over 4.5 hours and tests all the knowledge from your pharmacy degree from organic chemistry to biostats to pharmacokinetics and therapeutics. After passing I received my FPGEC certificate and could move on to the next stage.

Pharmacy in the US is regulated by the individual states rather than nationally, so I then applied to the California Board of pharmacy for a license to complete the required intern hours (similar to a pre-reg). The intern hours required vary from state to state, but in California, I had to complete 1500. I was fortunate to find a paid hospital pharmacy position quickly after arriving, but it can be very challenging to get an internship as a foreign grad. Once my intern hours were complete, I then had to pass the national clinical exam sat by all pharmacy graduates – the NAPLEX – and the California exam testing further clinical knowledge, state pharmacy law and practice standards – the CPJE. Other states use a different exam for state law – the MPJE. This was the final step in a long process to gaining my California pharmacist license, and I would certainly advise anyone making the move to start gathering the required documents for FPGEC as soon as possible, as this was the longest part of the process and unexplained delays in processing are frequent.

Could you describe your current role and perhaps what a typical day working in the US as a pharmacist is like?

I work as a Clinical Pharmacist in a community hospital, which is similar in many ways to hospital pharmacy in Scotland. Some duties include medication reconciliation, therapeutic drug monitoring, TPN formulation, advising medical and nursing colleagues, and ensuring safe medicines use. One significant difference when compared to Scotland is that non-emergency inpatient medicines must be screened and approved by a pharmacist before the first dose can be given, so this is a significant part of our role. Dispensing discharge prescriptions is not done by our pharmacy department; patients going home instead receive a prescription to be filled by a community pharmacy. We do however check medicines filled for inpatients, which are supplied in single unit-dose packages and labelled for a specific patient. Even the liquids come packaged as single doses in little cups (which look more like dipping sauce than medicine). Unit doses are often stocked in automated dispensing cabinets on the ward, so we also check the medicines for the cabinet refill. Almost all IV infusions are made in the aseptic room by pharmacy rather than by the nurses, so pharmacists must also check these before they are sent to the ward. These are all tasks that might all be done in any one shift, but at the core of it the purpose is the same in both countries, to make sure medicines are being used in the best way to benefit patients.

What do you now recognise to be the key differences in pharmacy practice in Scotland versus the US?

The biggest difference here is the insurance system. In Scotland, we have universal healthcare which is free at the point of use. Prescriptions are free, hospital treatment is free, GP visits are free. In the United States, healthcare is expensive and the cost can be a barrier to care. Patients are covered by a wide range of insurance plans with different costs and coverages and can easily be surprised with bills for thousands of dollars if part of their care wasn’t fully covered. As a hospital pharmacist, my interaction with insurance is minimal, but a lot of community pharmacists’ time is taken up by trying to navigate the system.

A difference in hospital is that all but the smallest hospital pharmacies tend to be 24 hours a day, 7 days a week, so there is always a pharmacist on site. Another difference is that the IT systems here are a lot more integrated; all of the prescribing, clinical notes, lab tests, outside medical history, pharmacy dispensing records and previous admissions are contained in a single system at my hospital. This means that more tasks can be carried out without being physically located in the ward. Pharmacist independent prescribing does not exist in California, but prescribing responsibility is often delegated to hospital pharmacists for certain drugs. For example, when a hospital doctor orders a drug like vancomycin or warfarin, they will often prescribe “per pharmacy”. The pharmacist then assumes responsibility for monitoring and adjusting the dose without requiring the prescriber to sign off each dose. This is in contrast to Scotland where a practitioner with prescribing authority is required to sign every time. There are differences in pharmacy education too here. Pharmacy is a 4-year doctorate program which generally requires an undergraduate degree for admission, so it takes 8 years at university (and a few hundred thousand dollars) to become a pharmacist. Clinical rotations are a lot more established as part of the pharmacy degree and students spend a significant proportion of their time on placements. I’m sure I could keep thinking of differences but this answer would soon turn into an essay!

Would you recommend the move to the US to others considering it and if so why?

It’s a long, difficult and expensive process, and opportunities here are often contingent on knowing the right people. However, I have learned so much through this process. I had to go back to basics and revise everything from university, but now with the practice experience to put it into context. I have seen new ways of working, been forced out of my comfort zone and confronted with different perspectives. I have met some amazing people and learned from them. If there was any experience in my career so far to make me a better and stronger pharmacist, this was it.

As I previously mentioned, getting a work visa through sponsorship here is basically impossible and there are other countries where it is much easier to do so. But if you are authorized to work in the United States, have the means to do it and the motivating reason I did, then it is possible.

What does the future hold for you now?

If there’s one thing this year has taught us, it’s that we can never predict the future! COVID-19 has reduced staffing and hiring at many hospitals due to elective procedures being cancelled and patient numbers decreasing. I’m currently working on a part-time as-needed basis but I’m hoping for the chance to increase my hours either at my current job or by taking on a second position once hiring picks up. I’m also looking at becoming a Board Certified Pharmacotherapy Specialist, which is a clinical pharmacy certification often sought by employers.