On a scale of 1-10, 10 being the worst pain you can imagine…

June 14, 2008 at 8:48 pm | Posted in pharmacy | Leave a comment

JP has an interesting post over on his blog, about foreigners with H1B visas practicing pharmacy in the US, and how they often don’t quite grasp the social niceties of dealing with other pharmacists. In Texas there weren’t many foreigners practicing pharmacy. And most that did practice were either immigrants from Nigeria or were second-generation Mexican-Americans.

I worked with a Nigerian pharmacist once. At the time, I was the pharmacist in charge, and she was the other full-time pharmacist. My main memory was that she was incredibly slow and disorganized. The techs all hated working with her. Things got progressively worse as cold and flu season rolled around, so that whenever I came to work there were always hordes of angry customers to placate. Which was bad, because as a new store we were trying to build volume. And pissing off customers tends to do the opposite.

Anyway, just as December was approaching, and it was time to draw up the holiday schedule, her husband’s father died, back in Nigeria. She said she would need to be gone for an entire month, because apparently he was some bigwig and there were lots of family gatherings and functions involved in his funeral. Also it was apparently in the middle of nowhere and would require extensive travel time both ways.

It was awfully convenient timing, and my district manager was as skeptical as I was about the whole thing. Plus, it being cold and flu season, there was no coverage for such extended vacation time. I would have to cover the store from open to close, seven days a week. That meant six 14-hour days, and one 9-hour day, with maybe an occasional half-day off when there was someone extra to cover. So my manager basically left it up to me to approve the vacation or not.

So I told her that if she was willing to approve that much overtime for me, I honestly thought the store would be better off.

It was a couple of weeks before she could find any coverage at all. The store was open 93 hours a week, and after 40 hours I got paid time and a half. My salary was somewhere around $30 an hour, so I was making roughly $3500 a week.

As a side note, all that the ACGME would have to do to ensure work hour compliance is force the hospitals receiving Medicare payments for training residents to pay us time and a half for anything beyond 80 hours. We don’t make a whole lot, but it would still provide a strong financial incentive to hospitals to streamline our work and reduce the bureaucracy we have to navigate. Which is what’s making compliance without compromising education so difficult for programs–the people in charge of regulating our hours aren’t the people determining how much paperwork we have to do to get our jobs done.

The problem is that the ACGME is run by doctors, who’ve probably never held a “full time job,” in the same sense that the rest of U.S. workforce understands the term. They understand well how to obtain compliance from their fellow physicians, but they don’t seem to understand where the problem really lies, or how to manipulate financial incentives and disincentives to force hospitals to make the needed changes.

Anyway, I survived the month, and in fact was transferred to be in charge of a higher volume store with bigger personnel problems before the month was out. That was apparently my role: I got sent wherever there were problems, and my job was basically to make happen whatever it was the staff there balked at doing. That last situation was particularly thorny, as I had been sent there as pharmacist in charge, and my colleague would be the pharmacist just demoted, and not voluntarily, after many years in that position. Looking back, I find it pretty surprising how those people ended up liking me despite that.

But that month also put to rest my last reservation about medicine, which was whether I had the stamina to survive a residency. I figured it couldn’t be a whole lot worse. And actually, it’s been better most of the time.