...But the beginning of another.
(Originally posted 11/7/09 but re-dated to appear in the correct order on the blog site)
To cut a long story short, it has taken me four years, thousands of miles and thousands of Dollars, but I am now (well, in about a week) a US Registered Pharmacist. The story of how I got here is told in explicit detail, divided into three blogs:
1. How to pass the FPGEE®.
2. How to get an H1B-Visa.
3. How to pass the Naplex® and CPJE®.
Having got here, and done such hard work to realize my dreams, I have always felt an almost instinctive urge to help others do the same. In the process I have made many friends and well-wishers, and I thank you all so much both for your continued support of my blogs and for your concern and joy over my progress throughout the various requirements needed to get here.
However, as one side-effect of all this, I think I have become a little addicted to blogging, and so I have added one more blog to my list for a new purpose. This blog will be to continue to chart my progress to becoming an American citizen, and to also mention any ad-hoc pharmacy related issues that come to light that I feel may be worth sharing.
So welcome to episode 1 of the rest of my life, and together we will see where the adventure goes next.
Good luck to you all,
Steven C.
Sunday 8 February 2015
Saturday 7 February 2015
Day 1
The weather was truly horrendous as I drove to work for my first day as a US pharmacist. I just didn't want it to be my last day on Earth as Californians have no idea how to drive in the rain, and as it happens I saw one car skid completely out of control which really put the fear into me, but I made it to work alive and early.
Before clocking in I phoned the computer help desk and got my finger print bumped up to pharmacist class (we use biometrics for every stage of dispensing, so you can't get away with anything!).
Clocked in and started to feel the nerves mount. It wasn't that I didn't know how to be a pharmacist, it was that the QA station in the dispensary was a completely unknown area, and I had no idea what the QA window on the computer even looked like. Thankfully I was "Department 3" today, which means I was a spare pare of hands and there was another seasoned pharmacist there to help me along.
I would say it took about 2 hours to get used to the new screen, and to get an eye for what errors to look out for; and by the end of an altogether enjoyable day I have to say my wonderful techs had given me an opportunity to correct almost every conceivable error :-)
They had put the wrong Dr, the wrong patient, the wrong quantity, the wrong number of refills, the wrong dose, the right Dr but at the wrong address, they had forgotten to deduct some loaned tablets, they had filled too soon on controlled drugs, and they had somehow filled a rx that had no fills. And that was just the errors I can remember now - there were plenty more. The other pharmacist said some of the errors she had never even seen done wrong before, so I have to count myself especially fortunate to have come across them on day 1 of my professional career!!
The strange thing was, finding these errors was very enjoyable - even exciting. There were other issues which were more complicated, like whether or not to give a steroid cream to a 2 year old child when the book said it should not be used in under 18 year olds. And there was a prescription for someone on two SNRI's which didn't make sense. And how to decide what to do with a Rx for a strength of drug which didn't exist. And so many other interesting and stimulating scenarios. It was really great pharmacy.
i don't know what I would have done if I hadn't had 18 years of experience under my belt already - I can imagine that for a kid out of college it could be a very difference emotion come the end of the day. But for me, for whatever reason, I loved it. Really.
And on top of all that you have to manage the techs and clerks, answer the phones, fill prescriptions, send faxes and chit chat with customers as you get called to consult or answer questions - I'd have a 100-page entry if I tried to list all the interesting questions I answered today on top of QA'ing.
And instead of my 1 hour lunch break I now only get 30 minutes!
Well, tomorrow is my first 12 hour shift. That's a 12 and a half hour day with a 30 minute unpaid lunch and possibly, if customers permit it, another 30 minute paid break late in the day. That should send me to bed exhausted tomorrow night for sure.
But I'm looking forward to it. I've really missed being a proper pharmacist far more than I had realized until today. I enjoyed being a free and easy, care-free, Monday to Friday 8-hour day intern - but being a "proper" pharmacist is much more rewarding, and it feels damned good to be back.
Steven C.
Before clocking in I phoned the computer help desk and got my finger print bumped up to pharmacist class (we use biometrics for every stage of dispensing, so you can't get away with anything!).
Clocked in and started to feel the nerves mount. It wasn't that I didn't know how to be a pharmacist, it was that the QA station in the dispensary was a completely unknown area, and I had no idea what the QA window on the computer even looked like. Thankfully I was "Department 3" today, which means I was a spare pare of hands and there was another seasoned pharmacist there to help me along.
I would say it took about 2 hours to get used to the new screen, and to get an eye for what errors to look out for; and by the end of an altogether enjoyable day I have to say my wonderful techs had given me an opportunity to correct almost every conceivable error :-)
They had put the wrong Dr, the wrong patient, the wrong quantity, the wrong number of refills, the wrong dose, the right Dr but at the wrong address, they had forgotten to deduct some loaned tablets, they had filled too soon on controlled drugs, and they had somehow filled a rx that had no fills. And that was just the errors I can remember now - there were plenty more. The other pharmacist said some of the errors she had never even seen done wrong before, so I have to count myself especially fortunate to have come across them on day 1 of my professional career!!
The strange thing was, finding these errors was very enjoyable - even exciting. There were other issues which were more complicated, like whether or not to give a steroid cream to a 2 year old child when the book said it should not be used in under 18 year olds. And there was a prescription for someone on two SNRI's which didn't make sense. And how to decide what to do with a Rx for a strength of drug which didn't exist. And so many other interesting and stimulating scenarios. It was really great pharmacy.
i don't know what I would have done if I hadn't had 18 years of experience under my belt already - I can imagine that for a kid out of college it could be a very difference emotion come the end of the day. But for me, for whatever reason, I loved it. Really.
And on top of all that you have to manage the techs and clerks, answer the phones, fill prescriptions, send faxes and chit chat with customers as you get called to consult or answer questions - I'd have a 100-page entry if I tried to list all the interesting questions I answered today on top of QA'ing.
And instead of my 1 hour lunch break I now only get 30 minutes!
Well, tomorrow is my first 12 hour shift. That's a 12 and a half hour day with a 30 minute unpaid lunch and possibly, if customers permit it, another 30 minute paid break late in the day. That should send me to bed exhausted tomorrow night for sure.
But I'm looking forward to it. I've really missed being a proper pharmacist far more than I had realized until today. I enjoyed being a free and easy, care-free, Monday to Friday 8-hour day intern - but being a "proper" pharmacist is much more rewarding, and it feels damned good to be back.
Steven C.
Friday 6 February 2015
End of my first week...
Well, I have to say my first week was fantastic. It was also absolutely exhausting. Twice after work I came home, had some food, and fell straight to sleep watching the TV, something I haven't done for years. But I was tired from exhilaration, and excitement, and sheer pleasure of being what I was born to be.
But the week wasn't all filled with good news. I heard two good pharmacists I know and one good intern were "let go" by the company I work for. It is a sign of the times I guess. The two pharmacists were known to be on the slow side, but one of them had worked for the company for years, and was a really nice guy, whilst the other was a really sweet foreign graduate, who must be in the US on a visa related to working for the employer, so I really worry about what will happen now for her. I spoke with one person who believed that if that happens you have 30 days to find a new sponsor (very difficult in todays climate, but presumably even more so if you've just been fired) or your right to reside in the US is revoked. OMG, as the kids say. That means (if its true) then, since it can easily take 7 or 8 years (or more) to get your green card, you are technically on edge for all that time. I just hope that the economy doesn't get any worse (and of course I hope these good people find some good news quickly).
And then there's the intern who was let go. Apparently, and I didn't hear this first hand so its not absolutely true - meaning there may be something else I don't know - all he did wrong was fail his pharmacy law exam. I've got to say that I knew another intern who didn't pass earlier this year and that person was allowed to carry on (although the fact that it took nearly the three months one has to wait to be allowed to resit the CPJE® must leave one to question the story of why the result was delayed for so long) but that person wasn't dismissed for failing. But I did read the email I received before sitting the exams from my employer with dread, as it clearly said that failing to pass BOTH the Naplex® and the CPJE® first time and within 90 days of being eligible to sit (ie after completing the 1500 hour internship) might leave the company to reconsider the continued employment of the person with the company. But reading it as a threat isn't the same as believing that they would carry it out. But it seems that they have. Which means anyone who believes they have won the golden ticket when they get their visa stamped will have to think again, long and hard, until they have these two exams under their belt and they are fully-fledged US registered pharmacists. But even so, I can't believe they let this person go. I of course cannot go in to any details, but it is amazing what they did, absolutely amazing.
From the point of view of the foreign pharmacist, it is a tragedy - you risk everything, and potentially it comes crumbling down in an instant, having worked SO hard for so long to get so far. But what about the investment from the employers point of view? Aren't they wasting money training foreign interns to the absolute edge of becoming pharmacists, totally stuck like glue to their visa sponsor for years and years, but then choosing to let them go when they are potentially just 3 more months away from resitting the exam and becoming registered? It's not logical. I just don't get it.
And just to finish off the gossip from the first two pharmacists. What I heard, second if not third or fourth hand, is that they weren't dismissed on grounds of being slow, but were caught on technicalities for having signed out too late, or something like that. Apparently the company fines the store and the pharmacist is given a warning or two, or three, or possibly let go. But I have to ask what can you do if at one minute to closing a new patient walks up to the counter with an urgent prescription - do you satisfy the patient or risk getting fired? I will have to find out what you should do in these instances.
And just to close this blog, I bloody well signed out late on my last shift, as I got my times all wrong and forgot what time I was supposed to clock out at. Well, lets see what happens about that (hopefully nothing, but if I do get "written up" I'll let you all know).
But apart from all that sad news, my week was great, really fun, and I'm looking forward to next week now. And hopefully I'll have a more positive blog entry for you.
Steven C
But the week wasn't all filled with good news. I heard two good pharmacists I know and one good intern were "let go" by the company I work for. It is a sign of the times I guess. The two pharmacists were known to be on the slow side, but one of them had worked for the company for years, and was a really nice guy, whilst the other was a really sweet foreign graduate, who must be in the US on a visa related to working for the employer, so I really worry about what will happen now for her. I spoke with one person who believed that if that happens you have 30 days to find a new sponsor (very difficult in todays climate, but presumably even more so if you've just been fired) or your right to reside in the US is revoked. OMG, as the kids say. That means (if its true) then, since it can easily take 7 or 8 years (or more) to get your green card, you are technically on edge for all that time. I just hope that the economy doesn't get any worse (and of course I hope these good people find some good news quickly).
And then there's the intern who was let go. Apparently, and I didn't hear this first hand so its not absolutely true - meaning there may be something else I don't know - all he did wrong was fail his pharmacy law exam. I've got to say that I knew another intern who didn't pass earlier this year and that person was allowed to carry on (although the fact that it took nearly the three months one has to wait to be allowed to resit the CPJE® must leave one to question the story of why the result was delayed for so long) but that person wasn't dismissed for failing. But I did read the email I received before sitting the exams from my employer with dread, as it clearly said that failing to pass BOTH the Naplex® and the CPJE® first time and within 90 days of being eligible to sit (ie after completing the 1500 hour internship) might leave the company to reconsider the continued employment of the person with the company. But reading it as a threat isn't the same as believing that they would carry it out. But it seems that they have. Which means anyone who believes they have won the golden ticket when they get their visa stamped will have to think again, long and hard, until they have these two exams under their belt and they are fully-fledged US registered pharmacists. But even so, I can't believe they let this person go. I of course cannot go in to any details, but it is amazing what they did, absolutely amazing.
From the point of view of the foreign pharmacist, it is a tragedy - you risk everything, and potentially it comes crumbling down in an instant, having worked SO hard for so long to get so far. But what about the investment from the employers point of view? Aren't they wasting money training foreign interns to the absolute edge of becoming pharmacists, totally stuck like glue to their visa sponsor for years and years, but then choosing to let them go when they are potentially just 3 more months away from resitting the exam and becoming registered? It's not logical. I just don't get it.
And just to finish off the gossip from the first two pharmacists. What I heard, second if not third or fourth hand, is that they weren't dismissed on grounds of being slow, but were caught on technicalities for having signed out too late, or something like that. Apparently the company fines the store and the pharmacist is given a warning or two, or three, or possibly let go. But I have to ask what can you do if at one minute to closing a new patient walks up to the counter with an urgent prescription - do you satisfy the patient or risk getting fired? I will have to find out what you should do in these instances.
And just to close this blog, I bloody well signed out late on my last shift, as I got my times all wrong and forgot what time I was supposed to clock out at. Well, lets see what happens about that (hopefully nothing, but if I do get "written up" I'll let you all know).
But apart from all that sad news, my week was great, really fun, and I'm looking forward to next week now. And hopefully I'll have a more positive blog entry for you.
Steven C
Thursday 5 February 2015
I'm a seasoned pharmacist already!
Well, I feel like a seasoned pharmacist at least. I've been here, there, and everywhere, and I'm pretty sure none of the staff I worked with had any idea I am still as fresh as a daisy to the world as a US pharmacist.
I've increased in confidence on the QA screen of the computer system, and have been trying to work out why various things don't always add up. For example I often see prescription images that have zero refills dated 6 months ago, and yet the rx has been filled 6 times since then and still has further refills available. It's most often related to the correct info not being visible on the QA screen, and has to be searched out on the actual patients record. It's onerous enough to just assume that there was an e-script somewhere along the line, and that the refills are valid, they just aren't obviously valid. I'm still debating whether to search each one out or trust the system.
The other thing I've come across quite a bit is prescriptions where there's an annoying line something like "this prescription is not valid unless the number of items is included", and then the number of items is NOT included. Seems to get passed a lot of pharmacists, until it gets to me. I spoke with one seasoned pharmacist who takes the view that the responsibility for the correction is solely on the shoulders of the first pharmacist that QA'd it, and that subsequently it could be argued that there was the possibility that the correction was made but that no image was added. I'm of the view currently that seeing is believing, and I'm not happy with the possibility that the board of pharmacy grab only the first pharmacist and let the rest off just because, so I'm making phone calls for new presciptions (as phone rx's), and deleting any refills on the original, and leaving little notes in the computer in case any audit by the board pulls any of these out for check. At least I'd be confidant they can't find me at fault.
And the final common error I keep coming across is when there are mistakes on CIII, CIV or CV controlled drugs prescriptions. Errors come in many shapes and sizes, but they are more risky when on controlled medication prescriptions, so I'm chasing these more zealously. For example, if the "this prescription is not valid unless the number of items is included" is not included on a CII then of course the patient will have to take it back to the MD to be changed, as you can't currently make ANY changes to a CII rx, whatever, ever, ever - but on a CIII-CV rx, these can be changed by a phone call, even though it would be more pleasing to annoy the prescriber by repeatedly sending every patient back until they got the message that this is IMPORTANT! However, I sent one poor sod too many back this week, and he was sharp enough to call the Doctor first, who then phoned a new rx in, and then super sharp enough to realize that if it could be phoned in then the original could have been amended by phone (some people really are annoyingly clever), so I'm not taking the risk again - I'll just make the phone calls, and eat the annoyance.
Well, one day left before a well-deserved break for the holidays. I hope everyone has a wonderful and relaxed few days, and I'll be back for more updates in the new year.
Oh, and if you've noticed the new waiver at the bottom of every page of all of my blogs, that's because the good people at the NABP® have been following my various blogs too, and wanted to be sure to let everyone know they aren't sponsoring, endorsing or authorizing me - well, fair enough, I'm just proud to bits they've even noticed me :-)
Happy 2010 everyone.
Steven C
I've increased in confidence on the QA screen of the computer system, and have been trying to work out why various things don't always add up. For example I often see prescription images that have zero refills dated 6 months ago, and yet the rx has been filled 6 times since then and still has further refills available. It's most often related to the correct info not being visible on the QA screen, and has to be searched out on the actual patients record. It's onerous enough to just assume that there was an e-script somewhere along the line, and that the refills are valid, they just aren't obviously valid. I'm still debating whether to search each one out or trust the system.
The other thing I've come across quite a bit is prescriptions where there's an annoying line something like "this prescription is not valid unless the number of items is included", and then the number of items is NOT included. Seems to get passed a lot of pharmacists, until it gets to me. I spoke with one seasoned pharmacist who takes the view that the responsibility for the correction is solely on the shoulders of the first pharmacist that QA'd it, and that subsequently it could be argued that there was the possibility that the correction was made but that no image was added. I'm of the view currently that seeing is believing, and I'm not happy with the possibility that the board of pharmacy grab only the first pharmacist and let the rest off just because, so I'm making phone calls for new presciptions (as phone rx's), and deleting any refills on the original, and leaving little notes in the computer in case any audit by the board pulls any of these out for check. At least I'd be confidant they can't find me at fault.
And the final common error I keep coming across is when there are mistakes on CIII, CIV or CV controlled drugs prescriptions. Errors come in many shapes and sizes, but they are more risky when on controlled medication prescriptions, so I'm chasing these more zealously. For example, if the "this prescription is not valid unless the number of items is included" is not included on a CII then of course the patient will have to take it back to the MD to be changed, as you can't currently make ANY changes to a CII rx, whatever, ever, ever - but on a CIII-CV rx, these can be changed by a phone call, even though it would be more pleasing to annoy the prescriber by repeatedly sending every patient back until they got the message that this is IMPORTANT! However, I sent one poor sod too many back this week, and he was sharp enough to call the Doctor first, who then phoned a new rx in, and then super sharp enough to realize that if it could be phoned in then the original could have been amended by phone (some people really are annoyingly clever), so I'm not taking the risk again - I'll just make the phone calls, and eat the annoyance.
Well, one day left before a well-deserved break for the holidays. I hope everyone has a wonderful and relaxed few days, and I'll be back for more updates in the new year.
Oh, and if you've noticed the new waiver at the bottom of every page of all of my blogs, that's because the good people at the NABP® have been following my various blogs too, and wanted to be sure to let everyone know they aren't sponsoring, endorsing or authorizing me - well, fair enough, I'm just proud to bits they've even noticed me :-)
Happy 2010 everyone.
Steven C
Wednesday 4 February 2015
And after 5 months...
Well, its been an education almost every day, working as a floater pharmacist, and I think that's probably why I enjoy floating so much. I'm never bored, and I love going to new stores, and meeting new staff, and if I'm really lucky I get to add another store fridge-magnet to my growing collection! (I'm up to 12 although I think I've been to 18 different stores now).
Since most of the time any insurance related issues are dealt with by others (thankfully), most of the issues I have to deal with are one's of a legal or quasi-legal nature. However, recently there has been a real clamp-down on processing rx's through insurance with much greater care, mostly related to COB's (when patients have more than one insurer) and also in regard to Medicare Part B issues, where patients have to be informed of any potential reasons for not being provided with their medication, resulting in streams of new paperwork. All very ugly and time-consuming, but I guess we'll get used to it.
However, on a day-to-basis I don't really find those issues very interesting, or not as interesting as I find the legal issues which crop up every so often. And on that basis, I'd like to share two issues today which any aspiring pharmacists should really learn like the back of their hand, and not have to think about.
1. CII's are often written without the patients address on, and that is OK as long as the patients address is already stored on the computer. However, there is an interesting situation which crops up in particular in one location locally where the residents, for some strange reason, do not use street addresses but only use P.O. Box numbers - it is ILLEGAL to supply a CII without a patients physical street address - a PO Box # is not sufficient.
The first time I came across such a rx I phoned the pharmacy help desk to double check and they confirmed that the rx needed a physical address. So I phoned the prescriber who said that (for patients in that area who only ever used PO Box #'s) he had always written PO Box #'s o the rx, and in all the many years he had been writing these rx's I was the first pharmacist to ever tell him that this was illegal and he was very interested to know why nobody had told him before. So I went back to the pharmacy's legal department and asked them if we were able to write the patients address on a CII rx - yes - it is the ONLY thing you can add to a CII rx. So that's fine and dandy, but I would bet you a large sum of money that almost every previous rx for a CII written in that area has NOT had the patients physical street address added to their computer records, and that if the Board of Pharmacy fancied, they could get a lot of pharmacists in a lot of legal trouble. You have been warned!
2. The other legal issue, I may have already mentioned, but I will mention again. Controlled meds CIII thru CV's are allowed refills - either to a maximum of 120 days supply or 5 refills. So if a script comes through (I wont start the discussion on what is or is not an electronic signature but that is another valid discussion point) as follows:
Temazepam 30mg i qd #10 + 5RF
It would be OK to fill all 6 times, since the total would only be a 60 day supply.
However, if it had read:
Temazepam 30mg i qd #30 + 5RF
Then legally, you could only supply for a maximum number of refills to cover 120 days - that's the original rx plus 4 x 30 days of refills - so the 5th refill must be cancelled.
I cancel these every now and again, but the computer system we use doesn't automatically catch this error by itself (it does catch some errors - say if someone brings in a rx for temazepam which was written over 6 months ago it will not let you fill it). But this error on the 5th refill it does NOT catch, and if you give it out you are breaking the law people. Once again, don't say I didn't tell you :-P
Well, that's the legal update for this post. The only other thing I wanted to add, much in the manner of my entire blog series, is once again I have hit another problem in my paperwork. This time its my employer deciding not to post my application for permanent residency, as written in stone in my contract. They have a fairly good reason for saying they can't sponsor me at this time as there are now a sufficient number of pharmacists in the area, and that I should check back with them in 6 months to a year to see how the situation may have changed by then. I'm not worried about it much at this time, as they have just put in the papers to extend my H1B visa, but even so, it does add to the almost never-ending list of things that haven't gone quite according to plan for me in my journey to becoming not just an American pharmacist, but an actual American (or at least a green card holder).
As always I will update when I have more to say, but until then good luck to you all,
Steven C
Since most of the time any insurance related issues are dealt with by others (thankfully), most of the issues I have to deal with are one's of a legal or quasi-legal nature. However, recently there has been a real clamp-down on processing rx's through insurance with much greater care, mostly related to COB's (when patients have more than one insurer) and also in regard to Medicare Part B issues, where patients have to be informed of any potential reasons for not being provided with their medication, resulting in streams of new paperwork. All very ugly and time-consuming, but I guess we'll get used to it.
However, on a day-to-basis I don't really find those issues very interesting, or not as interesting as I find the legal issues which crop up every so often. And on that basis, I'd like to share two issues today which any aspiring pharmacists should really learn like the back of their hand, and not have to think about.
1. CII's are often written without the patients address on, and that is OK as long as the patients address is already stored on the computer. However, there is an interesting situation which crops up in particular in one location locally where the residents, for some strange reason, do not use street addresses but only use P.O. Box numbers - it is ILLEGAL to supply a CII without a patients physical street address - a PO Box # is not sufficient.
The first time I came across such a rx I phoned the pharmacy help desk to double check and they confirmed that the rx needed a physical address. So I phoned the prescriber who said that (for patients in that area who only ever used PO Box #'s) he had always written PO Box #'s o the rx, and in all the many years he had been writing these rx's I was the first pharmacist to ever tell him that this was illegal and he was very interested to know why nobody had told him before. So I went back to the pharmacy's legal department and asked them if we were able to write the patients address on a CII rx - yes - it is the ONLY thing you can add to a CII rx. So that's fine and dandy, but I would bet you a large sum of money that almost every previous rx for a CII written in that area has NOT had the patients physical street address added to their computer records, and that if the Board of Pharmacy fancied, they could get a lot of pharmacists in a lot of legal trouble. You have been warned!
2. The other legal issue, I may have already mentioned, but I will mention again. Controlled meds CIII thru CV's are allowed refills - either to a maximum of 120 days supply or 5 refills. So if a script comes through (I wont start the discussion on what is or is not an electronic signature but that is another valid discussion point) as follows:
Temazepam 30mg i qd #10 + 5RF
It would be OK to fill all 6 times, since the total would only be a 60 day supply.
However, if it had read:
Temazepam 30mg i qd #30 + 5RF
Then legally, you could only supply for a maximum number of refills to cover 120 days - that's the original rx plus 4 x 30 days of refills - so the 5th refill must be cancelled.
I cancel these every now and again, but the computer system we use doesn't automatically catch this error by itself (it does catch some errors - say if someone brings in a rx for temazepam which was written over 6 months ago it will not let you fill it). But this error on the 5th refill it does NOT catch, and if you give it out you are breaking the law people. Once again, don't say I didn't tell you :-P
Well, that's the legal update for this post. The only other thing I wanted to add, much in the manner of my entire blog series, is once again I have hit another problem in my paperwork. This time its my employer deciding not to post my application for permanent residency, as written in stone in my contract. They have a fairly good reason for saying they can't sponsor me at this time as there are now a sufficient number of pharmacists in the area, and that I should check back with them in 6 months to a year to see how the situation may have changed by then. I'm not worried about it much at this time, as they have just put in the papers to extend my H1B visa, but even so, it does add to the almost never-ending list of things that haven't gone quite according to plan for me in my journey to becoming not just an American pharmacist, but an actual American (or at least a green card holder).
As always I will update when I have more to say, but until then good luck to you all,
Steven C
Tuesday 3 February 2015
All Change...
Exactly 6 months after registering in the US, and exactly 23 months after leaving the UK, I started my new position as a pharmacy manager in one of the stores for my sponsor. It's all happened rather suddenly, and has of course been very exciting, taking on the role of PIC - Person In Charge - of a US pharmacy, with all the responsibilities that go with that position, as well as the functions of a pharmacy manager in terms of staff, audit, customer service, loss prevention, interaction with the store manager/book-keeper/scheduler and so on. It has been a bit of a steep and sudden learning curve, but thankfully my district manager doesn't expect me to master the role in a day, so I have the chance to learn the finer functions over a period of time, including attending two training days, whilst I simply get on with the job itself, and find out how to do the job to the best of my abilities over the next few weeks and months.
I have also been trained to give immunizations and CPR (including use of an ECD), but more of that in another entry, as it will be a while before I get all the correct documentation to actually start stabbing patients.
There have been, as there always seems to be with my story, problems. The main two issues I have currently hit relate to the new position being in a slightly different location than my original position, and therefore not strictly within the terms of my H1B. So apart from issues regarding my sign-on bonus, which I wont go in to, but seem to have been resolved now, the issue of my visa is still ongoing. As it happens I am currently waiting for my 2nd extension to come back from USCIS, and when it does I will raise the matter with my sponsor, but I'm not mentioning it currently. There were other issues arising too, but I can't go in to those here, but let me assure you that you really need to make sure every i has a dot, and every t has been crossed, or the results can be a seriously ugly mess!
It always seems to be such a difficult learning curve, and I am sure there are easier ways to learn how to do everything right, but it seems no one helps you until everything goes wrong, rather than help you before they go wrong. For example no one explains how to get a smog check on your car, or how to file your tax return, or how to manage your bank account or apply for Medicaid or get your kids shots done or apply for schools for the kids, or a million other small issues that have cropped up and each proved to be a small nightmare until the lessons were learned the hard way. I could make a whole blog just about arguing over one false parking ticket, for a completely different person with a completely different car, in a place I have never been on a date I was no one near the alleged parking violation took place, and which took about 5 letters, two on-line claims and about 6 months of worry to get cleared off the system. Crazy.
Anyway, back to the job, and it really is all going well thank goodness. There are the usual legal updates to note (CII's can now be sent by electronic means, under certain circumstances) and I should really explain more about what a Person-in-charge means in greater detail, but for now I just wanted to share with you that I was now a pharmacy manager, and that (apart from the usual problems I get) all is going well.
Good luck to you all,
Steven C
I have also been trained to give immunizations and CPR (including use of an ECD), but more of that in another entry, as it will be a while before I get all the correct documentation to actually start stabbing patients.
There have been, as there always seems to be with my story, problems. The main two issues I have currently hit relate to the new position being in a slightly different location than my original position, and therefore not strictly within the terms of my H1B. So apart from issues regarding my sign-on bonus, which I wont go in to, but seem to have been resolved now, the issue of my visa is still ongoing. As it happens I am currently waiting for my 2nd extension to come back from USCIS, and when it does I will raise the matter with my sponsor, but I'm not mentioning it currently. There were other issues arising too, but I can't go in to those here, but let me assure you that you really need to make sure every i has a dot, and every t has been crossed, or the results can be a seriously ugly mess!
It always seems to be such a difficult learning curve, and I am sure there are easier ways to learn how to do everything right, but it seems no one helps you until everything goes wrong, rather than help you before they go wrong. For example no one explains how to get a smog check on your car, or how to file your tax return, or how to manage your bank account or apply for Medicaid or get your kids shots done or apply for schools for the kids, or a million other small issues that have cropped up and each proved to be a small nightmare until the lessons were learned the hard way. I could make a whole blog just about arguing over one false parking ticket, for a completely different person with a completely different car, in a place I have never been on a date I was no one near the alleged parking violation took place, and which took about 5 letters, two on-line claims and about 6 months of worry to get cleared off the system. Crazy.
Anyway, back to the job, and it really is all going well thank goodness. There are the usual legal updates to note (CII's can now be sent by electronic means, under certain circumstances) and I should really explain more about what a Person-in-charge means in greater detail, but for now I just wanted to share with you that I was now a pharmacy manager, and that (apart from the usual problems I get) all is going well.
Good luck to you all,
Steven C
Monday 2 February 2015
And finally...
Final final last final updates!
I spent about 3-4 months asking everyone I knew for help. I spoke to a dozen immigration lawyers. I contacted every lead and left no stone unturned. I put a tremendous amount of energy in to finding a solution to the problem, as I was not about to get kicked out of the country and have to face going back home after 6 years in the promised land.
I cannot begin to tell you what I had to go through. Let me just say that if you think this blog has been hard work, eventful, painful and scary to get my H1b, then to navigate the task of trying to get a green card makes getting an H1b look like a walk in the park.
I will not share what I went through, but I will say that I personally don't know a single other foreign pharmacist from my year of entry that made the process successfully without their H1b sponsor doing it for them (actually I know 2 people that did, one a year ahead of me who had a PhD and self-sponsored themselves, and one from my year who I think managed it, but she hasn't confirmed it to me yet - dammit, she just told me she went back to South Korea). However, I do know numerous foreign pharmacists that after six years of living the dream did go back to their homelands. It is such a pity. I cannot blame my sponsor at all, it was just business. They started to process green cards applications around the end of 2008 (just as I arrived and just as the economy died and every chain store put a freeze on new jobs) and when they came to advertizing the positions hoping no one would apply, which would block the green card application, instead of getting no response as they had in the past, suddenly dozens of people were applying for the jobs advertized. And since it literally costs thousands of dollars to place each ad, it is not surprising they took the sensible (but life-changing) decision to stop wasting their money. They were kind enough to continue to sponsor the H1b's through to the maximum 6 years, but they were neither able nor willing to attempt to sponsor the applicants for residency.
So I found another way. Instead of my company paying all the legal fees and me just getting through at no cost, this way cost me a small fortune. And I was in no way guaranteed success throughout the process. I found an awesome immigration lawyer who totally empathized with my families situation (she was also foreign) and we went through each stage together in hope. I had to learn a lot of knew legal mumbo-jumbo to understand what was happening, and what the next stages would be along the way. And it was a long journey. So, from around mid-2010 when we started the ball rolling until this very week, I have never felt secure with my long term residency here, but I am finally, gratefully and with much relief, able to share that I have now received my green card, and am a delighted permanent resident of the United States.
I now have to wait 4 years and 9 months before I can apply for citizenship.
I have been through so much, and for me I can say it was totally worth the effort. But it was just so complicated the whole way through. Nothing was simple, nothing was easy, nothing was smooth or without effort or expense. Since way before 2008 when I arrived I have been dreaming of this moment, and when it finally came it was 100% relief, not joy or excitement. I feel so badly for my friends who didn't or couldn't find their way around the problem, but I had a mission, and I was NOT going to miss the target. My kids have now grown up here, I love every minute of being here, and not that there was anything at all wrong with lovely (cold, wet and miserable) England, but California is just SO much better!
So that ends this blog. Thanks for following me to the bitter end. It has been an amazing journey and ultimately a successful one (thank G-d), and I wish you all the very best in your dreams, wherever they may take you.
All the best,
Steven C.
This NOW is the final, really final, last ever entry! As of March 30th 2021 I am now an actual US citizen. Of course it was another ordeal, what with covid and everything going on; but it has all been worth it, to reach this moment of joy. May all your dreams come true too, and may the process be smooth and stress free for you.
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