Submitted by Lior, Jan 14, 2008 11:19

I have been reading hundreds of articles stating that the US is suffering from a nationwide shortage of pharmacists; some rural areas do not even have a pharmacy due to this problem and until 2020 you will be facing a shortage of 156,000 pharmacists. So what does the biggest power in the world doing about it? Seriously I am asking you! I am asking because I seen many countries in the world (like France and Germany) that faced the same problem and their government is actually doing something about it.

France and Germany had a similar problem 3 years ago. They were in a serious shortage of nurses. In order to resolve the issue they "imported" foreign Nurses from all over Europe, gave them a 6 month course of the French language and send them to work. Today, Europe is facing a shortage of computer analysts so they went ahead and created the "Blue card" which is like the Green card but much easier to get. This is what a country does when it actually cares.

In order to be a pharmacist in the US, a foreign pharmacist will need to fill applications to get his diploma approved. Then, he will need to pass two exams, the FPGEE exam and the TOEFL ibt. The FPGEE exam is conducted twice a year, cost 700$ and can only be passed in the US. That mean that, in addition to the 700$ admission, a pharmacist should get a plane ticket, hotel and pay for his stay.

In the TOEFL exam the examinee needs to achieve a total score of 89. This is divided in to; listening, reading, writing and speaking. In each portion, there is a minimum requirement for passing (writing – 24, Speaking – 26, Listening – 18 and Reading – 21). That means that the total score of the test is not important.

As mentioned he minimum requirement for the speaking portion is 26 out of a total of 30. According to ETS statistics, the US average in the speaking portion is 22; England is 23 and Canada 24. That means that the requirement of a non native English speaker is 3 point higher than the average of all the English speaking countries. This requirement is based on the ETS recommendation and not upon and actual interview of a person that got a lower score (for example 20 and above). There are no exceptions to this requirement for foreign pharmacists. Let me provide you with an example. My wife received a remarkable score of 113 out of 120 (30/30 in writing, 29/30 in reading, 30/30 in listening and 24/30 in speaking) only 2% of the population is getting higher scores. She overachieved in all areas except for the speaking portion. Although she overachieved and was off by only 2 points, the NABP would not accept her. On the same logic, one could get 30, 30, 30 and 25 in the speaking and still not pass. Nurses in the US are passing a separate exam for speaking; physicians need only 24 in speaking and I do not think that they lower the level of health care.

Now my wife will need to pass the TOEFL all over again. She cannot pass only the speaking portion; even though a minimum requirement for each part and the complete disregard of the total score turns this exam to 4 separate exams rather than one.

My wife lost 2 points based on the following information provided to her (by the ETS): "Your responses demonstrate that you are able to speak in English about academic reading and lecture material, with only minor communication problems. For the most part, your speech is clear and easy to understand. However, some problems with pronunciation and intonation may occasionally cause difficulty for the listener. Your use of grammar and vocabulary is adequate to talk about the topic, but some ideas are not fully developed or are inaccurate."

The speaking portion of the TOEFL is divided into 3 sections; each of them is being checked by another person. In 2 of these sections she was perfectly understood and had no intonation or pronunciation problems. Only one tester seemed to have a problem with her French accent. Moreover, she achieve a score of 30/30 in the writing part, that means that she know how to fully develop and idea.

After a rescoring of the speaking portion, she still got the same comments. What are the odds of that? It should be noted that the TOEFL (the F in TOEFL stands for foreign) exam asks questions that are somewhat American centric – for example: "what do you prefer, being in a fraternity or not". There are cases where the person may not have studied American English and some terms may not be as familiar to them as others. This fact alone is causing my wife to be terrified of passing the TOEFL again. My opinion is that NABP should at least, established an exception board that will handle situations such as my wife's. I would assume that this is a small group as how many test takers pass with a score of, for example, 108 (90% of 120)? From this group, how many have the intention of working as pharmacists? If we narrow this down further, how many of the original small group, who want to be pharmacists received a score of 108, but did not pass your stiff requirements? This is the number of exceptions the NABP should be looking in to. I am not hiding the fact that my wife and I will benefit from this, but she is an experienced doctor of Pharmacy who received an excellent score on her TOEFL exam. NABP states that its reasoning behind requiring such a high score on the TOEFL is due to their desire to maintain your high standards in healthcare. Do you think that 113 is a will lower the health care standards.

1. The NABP is basing their requirements upon the ETS recommendations.

2. The ETS is a non profit private organization that earned millions of USD only from the rescoring of the TOEFL. A law suit was filed against the ETS no this issue and at the end the ETS came to a settlement (I have the copy of the law suit).

3. The ETS do not give any feedback of what were the mistakes, so there is not possibility for the test taker to improve (at least not with a high score)

4. Based on BBB files, this company has an unsatisfactory rating with the BBB due to unanswered complaint(s) (http://trenton.e-asp.net/NIS4/bbbreportaccbuscontent.asp?ID=1&ComID=0221000009000267). In more than one occasion in happened that a test taker asked to be rescored and the ETS just cancel his request (usually they say that the credit card number was wrong). Also, in many cases, a test taker needed to travel 2 hours to take the exam, then he waited to hour in the exam room only to find out that the exam was canceled due to internet connection. One more example of the ETS incompetence is that, after contacting the NABP, we discover that the ETS never sent the results. After calling the ETS they told us that we never asked them to send them. Of course they never give a proof, they do not have to, and they are a monopole.

Given that there is a nationwide shortage of pharmacist problem, I would recommend that: Lower the speaking portion requirement to, let's say, 23. I do not think that the NABP should base it's decision on my word, I think that they should interview some pharmacists that got less than 26 and see if they are able to talk or not. For other foreign members of healthcare, like nurse, dentist and physicians, the requirements in speaking are lower and they do not lower the level of healthcare. Nurses for example have an interview in front of a living person. On the other hand, in the TOEFL the test taker record his answer to a computer, and do not get any feedback on the recording quality. Give incentive to foreign pharmacists to come and work in the places that suffer the most from the shortage. Like Germany did. Many of the pharmacists are not yet in the states and will be more than happy to save time if they were given to opportunity to arrive to rural area that suffers the most for the problem. Give the possibility to re-test only the one portion of the test. There are hundreds of pharmacists that are experiencing the same problem. The thing that all these stories have in common is that people (especially the older, baby boomer, population) are suffering from the problem and that, often, they arrive to a pharmacy and find it close. In all the articles the suggestion is to open a pharmacy school, which is a very good idea, but will start to be affective 6-7 years from now when the first class will end. Also after 6 years, supposed that today 100 new school opened, each class consist of 100 students, in the year 2020 you will not even have 80000 new pharmacists. The foreign pharmacists are not even mentioned and they are the immediate solution. If the NABP would take the time to interview a few test takers and see their level of English, I am sure that they will change the requirements. Seriously, I can think of 3 reasons for these requirements:

The NABP wants to maintain the very high salary of the pharmacists regardless of the fact that, soon, people will start to get sicker. The NABP is afraid to be sued in the case that a patient will not be understood.

That brings me to the 2 last requirements of a foreign pharmacist: 1500 hours internship in which their English will be "tested" daily and improve daily After the 1500 hours they will need to pass yet another exam. Maintain a high level of healthcare – This is not the role of NABP alone. There should be 1 standards for all healthcare professions. I am contacting you, since I was disappointed by all others and I do not know who else I can contact. My wife and I are even willing to meet with you and prove to you that here level of English is very high.

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