Comparison of professional pharmacy degrees and health systems in United States, Canada, Spain and Mexico
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Rev. OFIL·ILAPHAR 2020 [first on line] / ARTÍCULO ESPECIAL / 1
Comparison of professional pharmacy
degrees and health systems in United
States, Canada, Spain and Mexico
HUERTA-OLVERA SG MD, PHD1, HAACK S PHARMD2, NAVARRO-RUÍZ A PHARMAD3, PATRICK VIET-QUOC NGUYEN B. PHARMD M. SC4
1 Medical and Life Sciences Department. Centro Universitario de la Ciénega. Universidad de Guadalajara. Jalisco (México)
2 Pharmacy Department. Drake University. Des Moines. Iowa (U.S.A.)
3 Pharmacy Service. Elche General University Hospital. Elche. Alicante (Spain)
4 Pharmacy Service. Montreal University Hospital Center (CHUM). Montreal (Canada)
Fecha de recepción: 04/10/2020 - Fecha de aceptación: 02/11/2020
SUMMARY Results: Pharmacy curricula in the United States and Canada
Introduction: It is known that in countries like United States, are very similar. They have many clinical pharmacy subjects,
Canada or Spain, pharmacists are well recognized as impor- such as pharmacotherapy, therapeutics, pharmaceutical care,
tant members of the healthcare team, in both community drug calculations and skills-based lab courses. In Spain and
and hospital settings, due to their vital role in caring for pa- Mexico, however, while some of the coursework is similar,
tients’ medication safety. In Mexico, just a short time ago, Spain has an experiential rotation program and Mexico does
pharmacists were recognized in this manner. The objective not. Mexican universities allow students practice in workshops
to this study is to compare professional pharmacy training to simulate pharmacy practice.
programs and healthcare systems in the United States, Ca- Conclusion: It will be important to develop pharmacist training
nada, Spain and Mexico. programs in Mexico (químico, farmacéutico biólogo), with more
Methods: A convenience sample of four universities were clinical pharmacy subjects as well as patient-centered commu-
selected due to the authors’ extensive knowledge of the nication skills to strengthen the profession and be able to con-
content and development of the profession. tribute within the health team and provide better patient care.
Key words: Health systems plans, clinical pharmacist, pharmacist, pharmacy, education.
Comparación del grado profesional de farmacia y con el paciente. España y México, va-
rias de sus materias son similares, con
los sistemas de salud en Estados Unidos, Canadá, la diferencia de que en España, como
España y México en los otros dos países ellos tienen pro-
gramas de rotaciones en farmacias co-
RESUMEN Métodos: Se tomó una muestra a con- munitarias u hospitalarias. En México,
Introducción: Es sabido que en países veniencia de cuatro universidades, las la mayoría de las universidades aborda
como Estados Unidos, Canadá o Es- cuales fueron seleccionadas por el am- por talleres en estos temas.
paña, el farmacéutico es reconocido plio conocimiento de los autores del con- Conclusión: Sería importante enriquecer
como un elemento importante en el tenido de los programas y el desarrollo los programas de químico, farmacéutico
equipo de salud, ya sea en la farmacia de la profesión. biólogo en México con un mayor nú-
comunitaria u hospitalaria, teniendo Resultados: La currícula de farmacia de mero de materias en el área de farmacia
un papel importante en la seguridad Estados Unidos y Canadá son muy si- clínica, así como habilidades de comu-
de la medicación del paciente. El obje- milares, sus programas contienen gran nicación con el paciente para fortalecer
tivo de este estudio fue comparar los cantidad de materias relacionadas a la profesión y tener la capacidad de par-
planes de estudio de farmacia y los sis- farmacia clínica como farmacoterapia, ticipar dentro del equipo de salud, así
temas de salud de Estados Unidos, Ca- terapéutica, cuidado farmacéutico, cál- como informar de una mejor manera al
nadá, España y México. culos de medicamentos y habilidades paciente sobre su medicación.
Palabras clave: Planes de sistemas de salud, farmacéuticos clínicos, farmacéutico, farmacia, educación.
+ Selene G. Huerta-Olvera MD, PhD w Medical and Life Sciences Department. Centro Universitario de la Ciénega. Universidad de Guadalajara w 1115 Universidad
Av. Zipe Code 47820, Ocotlán, Jalisco (México)
8 selene.huerta@academicos.udg.mx2 / ARTÍCULO ESPECIAL / Rev. OFIL·ILAPHAR 2020 [first on line]
Huerta-Olvera SG MD, PhD, Haack S PharmD, Navarro-Ruíz A PharmaD, Patrick Viet-Quoc Nguyen B. PharmD M. Sc
INTRODUCTION RESULTS
While for over 50 years, pharmacists have been recognized The first program reviewed is the Drake University Doctor of
as healthcare professionals in countries such as the United Pharmacy (PharmD) program in the United States. The curri-
States, Canada, and Spain, this has not been the case for culum requires 2 years of pre-pharmacy coursework, which
Mexican pharmacists. Some information has been published includes courses such as chemistry, biology, calculus, micro-
on the best pharmacy schools in the world and the coun- biology, statistics, and Career Academic and Professional Suc-
tries with the best preparation in the training of pharma- cess. Following completion of the pre-pharmacy classes,
cists, mainly highlighting several universities in the United successful students are admitted into a four-year professional
States, such as University of California in San Francisco, as program3. The first three years of the PharmD degree program
well as several universities in the United Kingdom, such as are completed on campus and include the courses shown in
the University of Cambridge, Oxford and others. Australia table 1. The final year of the curriculum is completed off cam-
has also been mentioned as a leader in pharmacy educa- pus. Students are assigned to Advanced Pharmacy Practice
tion, as well as some universities in Sweden and Spain1. Experiences, where they spend eight, 5-week rotations explo-
Mexican pharmacists are recognized as chemists or ring different types of pharmacy practice. These include four
scientists, due to their primary forms of employment in hos- “core” rotations (ambulatory, acute, community and hospital)
pitals, clinical laboratories and blood banks. Community along with four “elective” rotations. The degree focuses on
pharmacies are not required to employ pharmacists, so drug clinical application of pharmacy topics which prepares gra-
dispensing is entrusted to non-pharmacist personnel. Phar- duates to improve health outcomes in the patients they serve.
macists are not accountable for patient’s safety and well- Following graduation with the Doctor of Pharmacy de-
being. Finally, last January 24th, 2020, the Mexican law gree, students are required to pass two exams to be licensed
approved the pharmacist as part of the healthcare team2. In to practice pharmacy in the United States. One of these
Mexico, pharmacists graduate from a Chemistry-Pharmacy- exams is called the NAPLEX (National Association of Boards
Biology (químico, farmacéutico biólogo) university program. of Pharmacy)4 Exam and includes questions related to me-
As graduates, they can work in a variety of areas, including: dications. The other exam focuses on pharmacy law, from
quality control (food or pharmacy industry), clinical labora- both a national and state perspective5. A majority of phar-
tories, blood banks, immunology, research, genetics, tequila macists in the United States work in community pharmacies.
industry, meat industry, microbiology, hospital pharmacy or Many new graduates also apply for competitive post-graduate
community pharmacy. The advantage of the Chemist-Phar- training programs, such as research fellowships or 1-2 years
macy-Biology program is the large variety of job opportuni- clinical residency training programs. Residencies help pharma-
ties. On the downside, the degree program has no equivalent cists specialize in areas like infectious disease, emergency me-
in other countries, so graduates are not recognized as phar- dicine or oncology in a hospital setting.
macists outside of Mexico. This may pose challenges for stu- In the United States, there are both public and private
dents who would like to pursue a Masters or PhD degree in options for medical insurance. For those over 65 years of age,
a foreign university, especially in this area. We believe that the government-funded Medicare system provides health in-
there are some reasons for the lack of recognition of the Me- surance. For those under 65 years of age, there are three
xican pharmacist as a healthcare professional and one of main categories. A majority of working people in this group
these could be the Chemistry-Pharmacy-Biology (CPB) curri- have insurance benefits that are provided by their employer.
cular program. The employees pay some of the cost and the employer pays
the remainder of the insurance premium. A second group of
OBJECTIVE this population, often unemployed, qualify for state-govern-
Due to the recent recognition of pharmacists as health pro- ment funded insurance, called Medicaid. The Affordable Care
fessionals in Mexico and the documented importance of Act, which was signed into law by former President Obama
pharmacists in the healthcare system, we decided to com- in 2010, extended health-insurance coverage to millions of
pare the pharmacy degree programs of four international uninsured Americans. Finally, there are also people in the Uni-
universities, as well as a brief review of their corresponding ted States who are still uninsured.
healthcare systems. In Canada, we compared two Pharmacy Doctorate pro-
We will highlight these differences by comparing the grams. In the Montreal University Pharmacy Faculty, the phar-
pharmacy curricula of four academic institutions in Mexico, macy doctorate is a four-year program. In the first year, the
the United States, Canada and Spain. pharmacy students learn mainly general knowledge on
human anatomy, physiology and pathology. They also learn
METHODS about physical chemistry and pharmacology. In the second
Despite the fact that the best universities for the training of and third year, the students concentrate their learning in
pharmacists stand out in the United States and the United pharmacotherapy and pharmaceutical care6. They go through
Kingdom, we compared the plans of the following coun- a wide variety of subjects related to clinical pharmacy that
tries: United States, Canada, Spain and Mexico. These coun- are shown in table 1.
tries were selected since the authors have collaborated in During the three first years, the students have manda-
other projects together, in addition to belonging to coun- tory laboratory practice where they learn and apply patient
tries where the figure of the pharmacist is widely recogni- care skills in community and hospital settings. Every sum-
zed, with the exception of Mexico. The comparative degree mer, students complete an internship in a community or a
programs belong to the universities where the authors hospital pharmacy. The fourth year of the pharmacy pro-
work, which allows for each author to share their experien- gram is entirely dedicated to internships in community and
ces from a teaching, research and clinical pharmacy practice hospital pharmacy. Another program in Canada, at Alberta
perspective. University, requires the students to take 10 subjects calledRev. OFIL·ILAPHAR 2020 [first on line] / ARTÍCULO ESPECIAL / 3
Comparison of professional pharmacy degrees and health systems in United States, Canada, Spain and Mexico
Table 1. Sample curricula from pharmacy programs. Focus on subjects related to clinical Pharmacy
United States of America (Drake University) Canada (Montreal University)
Biochemistry The Pharmacist Health Professional
Health Care Systems and Policies Pharmacy and the Law
Pharmacy Skills and Applications Normal Functioning of the Human Body I, II, III, IV
Principles of Drug Actions I, II, III Single Dose Medications
Drug Calculations Multiple Dose Medications
Therapeutics I, II, III Drugs and Interactions
Therapeutic Drug Monitoring Pharmacy and the Patient
Physiology Community Pharmaceutical Practice
Pathophysiology The Pharmacist and Scientific Knowledge
Management in Pharmacy Pharmaceutical Care: Cardiology I, II, III, Immunology,
Nonprescription Therapies Hematology, Nephrology, Infectious Diseases I, II,
Kinetics Gastroenterology and Endocrinology Pharmaceutical
Pharmaceutical Sciences Advice
Pharmaceutics I, II
Literature Evaluation Methods
Immunizations
Pharmacy Law and Ethics
Social and Administrative Pharmacy
Spain (Universidad Miguel Hernández) Mexico (Universidad de Guadalajara)
Clinical Pharmacy Bioethics and Deontology
Pharmacology and Pharmacotherapy I, II, III Health Regulations and Legislation
Pharmaceutical Care Pharmacology I, II
Biopharmacy y Pharmacokinetics I, II Physiology and Fundamentals of Pathophysiology
Legislation and Social Pharmacy Health Regulations and Legislation
Genetics Applied to Pharmacy Community and Hospital Pharmacy
Pharmacognosy and Phytotherapy Hospital Pharmaceutical Services
Human Physiology Biopharmacy and Pharmacokinetics
Clinical Pathology I, II Pharmacognosy
Pharmacotherapy 1-10. The program includes the study of Pharmacy and others. The students interested in those special-
chronic diseases, different patient care scenarios, immuni- ties then have to take the FIR National Exam (Pharmaceutic In-
zations, nephrology and others systems7. The students in- ternal Resident). The duration of the residency is four years and
corporate principles of evidence-based therapeutics to make there is also a theoretical-practical. See Reference 9 for more
patient-centered treatment decisions. Other subjects are Pa- information. In Spain there is a public health system that covers
tient Care Skills, which develops patient communication the full scope of healthcare for the population. There are few
skills and interprofessional communication skills, Advanced people covered by private healthcare.
Pharmacy Practice Experiences and others. To work as a pharmacist in hospitals, the title of Hospital
To get the professional pharmacy doctorate degree and Pharmacist is required. This title is obtained, as is the case of
the right to practice the profession, students must complete medical professionals, through the residency system which
the pharmacy program as established by the Canadian is available after a selective examination. This system has
pharmacy program at the university. The provincial govern- been in place since the mid-1980s. The residency program
ments publicly fund the Canadian health care system. Ca- lasts for four years. The current training plan was created in
nadian people do not have to pay for physician consultations 1999 and is pending the approval of a new, updated plan.
or hospitalizations. Some provinces also cover medication ex- Hospitals and Hospital Pharmacy services must be accredited
penses. Even though each university in Canada and the United to participate in the residency training programs.
States offers slightly different pharmacy programs, most of Finally, in Mexico, the pharmacy curricula are similar to
their subjects are related to patient care and appropriate me- the programs in Spain. Even though the pharmacy career
dication safety and use. exists in Mexico, most of the pharmacy professionals who
In Spain, the pharmacy degree program is different than work in hospital or community pharmacy settings have a
those found in the United States and Canada, because students Chemistry-Pharmacy-Biology degree (químico, farmacéutico
must take courses such as physics, psychology, chemistry, mi- biólogo, QFB). For this reason, we will discuss this degree
crobiology, pharmacology, pharmacotherapy, management, program instead of the pharmacy program. The QFB degree
plant biotechnology, pharmaceutical care, clinic analysis and la- has subjects related to chemistry, like organic chemistry,
boratory diagnosis. They can also take some elective subjects analytical chemistry and biochemistry. Students have a com-
like hospital pharmacy, Galenic medicine and others8. Subjects bination of required courses along with four elective cour-
related to clinical pharmacy are shown in table 1. ses. Some subjects in the degree program are: general and
To obtain the degree, students must have to present a the- applied toxicology, bioethics and healthcare ethics (deonto-
sis or have three publications in a high level (Q1) journal. Al- logy), pathophysiology, biotechnology, microbiology, para-
ternatively, students can choose specialty areas in Microbiology sitology, immunology, lab analysis, and others10. Subjects
and Parasitology, Clinical Laboratory, Immunology, Hospital related to clinical pharmacy are mentioned in table 1.4 / ARTÍCULO ESPECIAL / Rev. OFIL·ILAPHAR 2020 [first on line]
Huerta-Olvera SG MD, PhD, Haack S PharmD, Navarro-Ruíz A PharmaD, Patrick Viet-Quoc Nguyen B. PharmD M. Sc
Table 2. Comparison of clinical pharmacy core subjects
Pharmacy Pharmaceutical Pharmacy
Pharmacology Pathophysiology Therapeutics Pharmacokinetics
Law care skills
USA X X X X X X X
Canada X - X X X X X
Spain X X X X X X X
Mexico X X - X X - -
Table 3. Experiential Education in Clinical Pharmacy
USA Canada Spain Mexico
Required Yes Yes Yes No
Timing in curriculum All 4 years Since 1nd year Final year --
1st year = 70 h
1st year = 160 h
2nd year = 100 h
Number of hours 2nd year = 160 h P4 year = 900 h
3rd year = 160 h
4th year = 1120 h
4th year = 1600 h
Coordinated by University University University --
Students have multiple options to acquire the QFB: 1) medication regimens, communications skills, and practice
achieve an average score of 90 in their credits (evaluation in a variety of pharmacy settings, including hospital and
scale: 0-100), 2) passing a national exam called CENEVAL community practice, table 3. On the other hand, pharmacy
or 3) by writing a thesis. Also, students must finish 300 programs in Spain and Mexico have several similar courses.
practice hours and 480 social service hours in order to ob- Experiential learning is different between programs, though,
tain the degree. with the United States, Canada, and Spain offering expe-
Most student look for employment upon graduation, riential learning for students, while Mexico focuses primarily
while some choose post-graduate training in different fields on practice-based skills in lab settings. The advantage of
of study. A small percentage of graduates chose post-gra- comparing the coursework of these universities is that the
duate pharmacy training. In Mexico, we can divide the me- authors were able to comment on their programs in detail,
dical system in a general way into public or private attention, both in theory and in practice. This allows a discussion of
although there is a minority that can be served by the mili- the subject within the team and the ability to capture more
tary. In figure 1 we summarize the health system in Mexico11. accurate information, since sometimes, when making com-
IMMS or ISSSTE are the health plans provided to emplo- parisons or compilations of information only through web
yees of the majority of companies in Mexico, along with people pages, it is not possible to know the reality in detail.
who work in industry or University workers. The second health It is expected that little by little, any type of hospital will
plan is called Seguro Popular, which is being evaluated for be hiring pharmacists as a part of its health team to carry
changes, specifically called INSABI (Wellness Health Institute). medication-related functions. Along with hospitals, com-
The final option for patients is represented by private health- munity pharmacies should also expand their scope of prac-
care and is less common in Mexico. IMMS, ISSSTE, and Seguro tice to emphasize more patient care activities. It will be
Popular are not required to be certified or accredited by a go- important for the pharmacy education programs in Mexico
verning organization. That means that in Mexico there are not to emphasize the importance of hospital practice in each
any public hospitals that are certified and only few private hos- semester of the curriculum, as well as to constantly focus
pitals that are. There may be some specialty areas that follow on patient care skills, therapeutics, and clinical decision-ma-
quality control guidance from the International Organization king skills which mimic clinical pharmacy practice situations.
for Standardization (ISO), but not all of them. And finally, the The pharmacy programs which include experiential learning
hospital is required to be certified in order to have the emplo- opportunities and strong theoretical pharmacy fundaments,
yer pay or to have individual patients pay for private health along with communications skills, are very important in pre-
care The Hospital Certification system was implemented in paring students to be active clinical pharmacy practitioners
Mexico in 200912, which allows hospitals to accept patients and assets to the healthcare team. It may be challenging to
with private insurance. In these kinds of hospitals, pharmacists change the pharmacy curricula in Mexico, but universities
are required as part of the health team. In the remainder of could provide degrees that include rotation periods in dif-
the hospitals, pharmacists regrettably find it challenging to se- ferent hospitals and intensive clinical training for at least
cure employment. two years when pharmacy students finish their degree and
are interested in working as pharmacist. Some of the limi-
DISCUSSION tations of this study were not having any comparison with
Pharmacy programs in the United States and Canada are si- other countries in Latin America or with countries like the
milar; they have many courses related to pharmacotherapy, United Kingdom or Australia. The authors are not experts
specifically focusing on each organ system, table 2. These in evaluating credits by theoretical or practical subjects that
programs are strong in skills related to managing patients’ could contribute to discussion.Rev. OFIL·ILAPHAR 2020 [first on line] / ORIGINAL / 5
Comparison of professional pharmacy degrees and health systems in United States, Canada, Spain and Mexico
Figure 1. Health System in Mexico
Health System in
Mexico
Public Private
Private insurances
Social Security Health Secretary
IMSS INSABI
ISSSTE
SEDENA
MARINA
PEMEX
IMSS: Instituto Mexicano del Seguro Social (Mexican Institute of Social Security); ISSSTE: Instituto de Seguridad Social para
los Trabajadores del Estado; (Institute of Social Security of State Workers); SEDENA: Secretaría de la Defensa Nacional (Se-
retary of National Defense); MARINA: (Marine); PEMEX: Petróleos Mexicanos (Mexican oil); INSABI: Instituto de Salud para
el Bienestar (Wellness Institute of Health).
This is one of the few studies we are aware of in the edu- BIBLIOGRAPHY
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conflict of interest. areas/.You can also read
