An international experience in Hungary

On Rotation

American student pharmacists visit Pasarét Gyógyszertár in Budapest.

As our train pulled into the Budapest station, we were filled with excitement and anticipation for the month ahead. We were given the opportunity of a lifetime to spend a month on rotation in Hungary and learn about its pharmacy system and culture. 

Our trip began with a visit to Pasarét Gyógyszertár, a community pharmacy located outside of Budapest’s city center. Then we spent a day at Simmelweise University, the oldest medical school in Hungary, where we learned about the different faculties that make up the large university. We were thankful for our English-speaking host and Hungarian pharmacists who diligently explained how each facility worked. 

After spending time in Budapest, we made our way to Siófok for the largest Pharmacy Congress in Hungary. In between lectures and pharmacy updates on the newest and latest research ranging from 3D printing of medications to the medication therapy management practice model in the United States, we managed to sneak in a few kürtőskalács (pieces of grilled sweet dough).

Our journey continued on to Pécs, a melting pot of Hungarian, Croatian, and Swabian culture. We visited the University of Pécs, where we learned about their pharmacy curriculum and the university’s central pharmacy. We also visited Pécs Hospital and its clinical pharmacy facility, where pharmacists are responsible for dispensing, compounding, and answering clinical questions.

We then visited the University of Debrecen, which is known for its research advances. We toured the university’s central pharmacy, compounding lab, manufacturing lab, and the clinical pharmacy in the orthopedics clinic. 

Pharmacy education

After graduating high school, Hungarian students are required to determine their career choices. The profession in which students will practice is largely determined by their performance on an entrance exam and their ranking in the higher education bracket for each profession. Higher education is paid for by the government, therefore pharmacy school is free.

The PharmD training program lasts 5 years. The curriculum focuses heavily on chemistry, pharmaceutics, compounding, botany, and offers no APPE experiences. Recent pharmacy school graduates are more prepared for careers in research, pharmaceutical industry, and compounding than patient care. Residencies in Hungary are also heavily focused on research and industry, and residents do not have the option to specialize.

Comparing and contrasting 

In Hungary, community pharmacies are independently owned; by law, a pharmacist must hold the majority of ownership (at least 51%), and no one pharmacist may own more than four pharmacies. Every pharmacy has a compounding lab, and compounding is heavily emphasized as part of pharmacy practice. All medications, even OTCs, are kept behind the counter, which allows pharmacists to manage medication interactions and make appropriate recommendations. This was a major difference between the two systems that we truly admired.

While visiting hospital pharmacies in Pécs and Debrecen, it was clear that one central and a few satellite pharmacies may serve a 1,000-bed hospital. The patient-to-pharmacist ratio is very large. Although pharmacists make interventions, participation in collaborative activities such as interdisciplinary rounds is not a routine practice.

In terms of operations, the components are similar between the U.S and Hungarian systems, but Hungarian hospitals are less technologically advanced. Compounding was also a major component. Many medications are compounded on-site for patients, which is very cost-effective.

More culturally competent

The opportunity to travel abroad and experience the rich Hungarian culture raised our cultural sensitivity and enabled us to become more culturally competent, which is an integral component in all health professions. Total immersion in a country where we didn’t speak the language developed our cultural understanding in more ways than any didactic course ever could.

Seeing these differences between the pharmacy systems in the United States and Hungary gave us a greater appreciation for our program—a program that offers opportunities to experience various aspects of pharmacy ranging from research to clinical practice, and a greater appreciation for the option to specialize in a career that is best suited to our own needs and interests.