Interns. At one time—for some of us a long, long time ago—we were all pharmacy interns. Working for pitiful wages back in my day, but hourly rates that jumped considerably when the shortage got significantly worse, gathering hours necessary for licensure, developing relationships that led to opportunities, jobs and lifelong friendships.
Today, internship requirements have evolved form they were back in my school days. Some duties and restrictions created by the Boards of Pharmacy have come and gone while others remain in effect. The end result is that interns, like their pharmacist preceptors, in the face of expanding duties and responsibilities, also face increasing liabilities.
The legal doctrine towards professional students in the experiential part of their education is that these persons are expected to make mistakes. Errors are part of the learning process, and thus the patient who consents to be treated, diagnosed, or counseled by a student is usually assuming a risk not taken with the licensed professional. However, there are a growing number of exceptions to this philosophy, the main one being the corresponding responsibility rule.
But first let’s remind the person seeking to become a pharmacy intern of his/her responsibility. In most states, you must be actively enrolled or have been accepted to a college of pharmacy (CoP) before you can become an intern. Contact the state Board of Pharmacy or look on their website to see what the requirements are for becoming an intern. Depending on the state where you seek to be an intern, the CoP must be either approved, accredited or—in at least one state—“recognized” by the state Board of Pharmacy; check with the Board to make sure your CoP is acknowledged by the Board. An application must be filled out and filed with the Board. Some of these will require a background check and drug test.
When you get your intern registration, keep in mind how often it must be renewed. File your collected intern hours in a timely manner—some states require monthly, others longer periods of time. Also review the intern rules to see when your registration is good: for most states it is good while you are enrolled in a CoP, on a scheduled break from school, awaiting licensure exam and awaiting licensure results (the latter two are called “graduate intern” in most states but there is usually no difference in status or duties you can perform). There may be circumstances where you will need to contact the Board to continue active registration. For example, a CoP student leaves early in the semester due to the death of a parent. Usually, contacting the Board and assuring them you will return to school the following semester or academic year suffices to continue active status.
Finally, make sure your pharmacist is a registered preceptor. Having a non-preceptor sign papers that you worked 200 hours of internship and seeing those hours lost is something I see a little too often and nothing I can do about. Those hours are lost. At the beginning of your internship, preceptor and intern need to discuss fully those duties the intern may perform, both as seen by the Board and the pharmacist-preceptor. Employers and preceptors may further limit what the law allows but the intern should question this when the limitations get to the point of negating the educational experience. I have heard stories of pharmacists who hire interns but then do not let them do anything delegable, instead turning them into cashiers. That is not learning how to be a pharmacist.
Pharmacists, if you are not a preceptor, become one the minute your state permits you to do so. We need you to help provide the experiential part of the pharmacy student’s education, as important as any class that student has sat or slept through. Most states will require an association as a community based faculty member and this means some extra training. Usually this is accredited and can fulfill continuing education requirements. Make sure you are acquainted with the CoP’s experiential goals.
- Time to move on to legal issues. Interns can and do have legal issues. Quite often, this is when they step over a line.
Performing a duty that is not recognized as a pharmacist delegable duty, even if the preceptor tells the student to perform the duty, is acting outside the scope of the pharmacy intern. This is why most CoPs have students take their pharmacy law class before they embark on rotations—they have a knowledge of what the law permits. Acting without authority opens up the student to liability and sanction by the Board. Do not perform the final verification of a prescription. Depending on whether your state allows it, do not counsel a patient or do not counsel a patient outside the range of the preceptor.
Ignoring a duty is also actionable. Refusing an order from a preceptor or refusing to perform a delegated duty provides a basis for ending the internship at the pharmacy level and possibly open the student to Board and CoP sanctions.
One duty that some pharmacy students ignore raises the ire of state Boards. And that is reporting the preceptor for acts that are illegal. Even in the 21st century, some pharmacists will tell the intern to fill prescriptions, even doing the final verification. After this, some pharmacists actually leave the pharmacy—go to lunch, get a haircut, go check on the husband, etc. Hard to believe this still occurs today, and the number of incidents is decreasing, but it does. The preceptor who does this usually intimates the student with fear of failing the rotation (if a rotation student) or ruining their school career.
Another example here is when the pharmacy intern, again out of fear, does not report an impaired preceptor. The pharmacist who takes advantage of having an intern or rotation student to drink or take drugs is also a dying, but not quite dead yet, breed. Patient lives are at stake; act accordingly for them.
In both of the above, the intern should report the preceptor to the director of intern rotations at the CoP and to the Board of Pharmacy. Do not be in fear. Report it. Having dealt with these issues, I can pretty much categorically state both entities will rally round the intern. And keep in mind that permitting these acts to occur and not reporting them places the intern in peril. Should a Board discover that a pharmacist left an intern alone at a pharmacy or that the preceptor was impaired AND the intern did not report—that is likely to be the end of the intern’s career.
Other issues that some interns still face, despite our being such an advanced society:
–discrimination. Whether gender, sexual orientation, race, religion, or national origin, you do not have to put up with acts or words that insult your status. In the pharmacy, we are expected to work and act together as a team for the betterment of the patients. Intolerance of any sort should be quickly reported.
–sexual harassment. This is hard to believe but it still exists in the workplace where the personnel are mainly licensed professionals. Inappropriate language and/or touching, demands for sexual favors—whether for a good grade, a passing grade, or not—should be immediately reported to the CoP, the Board, and, if appropriate, to the next highest official at the place of employment or rotation.
Finally, the question: “Should I, as an intern, get malpractice insurance?” Especially before fourth year rotations, my answer is “yes.” Under the corresponding responsibility rule, interns can be included as a party to liability where the intern’s action contributed to the harm to a patient or a violation of pharmacy law. Besides, it is pretty cheap.
Becoming a pharmacist is a daunting task, a challenging curriculum in a CoP, and internship that can be as tasking as it is rewarding. Interns should make themselves aware of the requirements, find a good preceptor, and acquaint themselves with the possible pitfalls.