Aging pharmacists leave pharmacies vacant in rural Colorado
By Markian Hawryluk, Kaiser Santé news
Ted Billinger Jr. liked to joke that he would work until he died. It turned out to be prophetic.
When Billinger died of a heart attack in 2019 at the age of 71, he still ran Teddy B’s, the pharmacy his father had founded over 65 years earlier in Cheyenne Wells, Colorado. With no other pharmacist to work in the store, prescriptions already counted and sealed in bottles were suddenly locked in a pharmacy where no one could enter. And fewer than 800 residents of Cheyenne Wells suddenly found themselves without a pharmacy.
Pharmacies were once routinely passed down from generation to generation, but, in interviews with more than a dozen pharmacists, many said the pressure of running an independent pharmacy was pushing them to push their boundaries. offspring to other careers. And when looking for a buyer, they often find that it is difficult to attract new pharmacists, especially in rural areas. With a large group of pharmacists approaching retirement age, more communities could lose their only pharmacy.
“It’s going to be harder to attract people and pay them,” said David Kreling, professor emeritus in the University of Wisconsin-Madison School of Pharmacy. “If there isn’t a generational thing where someone can sit down with their son or daughter and say they could take over the store, there’s a good chance the pharmacy will evaporate.”
Tom Davis, Billinger’s friend and co-owner of Kiowa Drug in Eads, stepped in to sort out the issue at Cheyenne Wells. With permission from the State Board of Pharmacy, the county sheriff let Davis enter Teddy B’s home in the eastern Colorado town to take an inventory of the remaining drugs. Customers who had deposited their prescriptions before Billinger’s death were able to collect their medications.
Davis then purchased the drugstore from Billinger’s estate. He runs it like a convenience store and delivers prescriptions six days a week from Eads, 70 kilometers away.
“By the time you paid a pharmacist, the location was bordering on unprofitable,” Davis said.
He has received many requests to open pharmacies in other towns in eastern Colorado, but it would be difficult to make this work financially. Insurance plan reimbursements have declined and customer bases have eroded as health insurers push patients toward mail order deliveries.
“I fill prescriptions every day when my reimbursement is less than the cost of the drug,” Davis said. “In other contexts you might say to a patient, ‘We don’t have this in stock’ or ‘Why don’t you take the streets to the chain?’ But here on earth we just take care of our patients and we eat it. “
He can survive, he said, because after 48 years he no longer has any trade debt.
“I’m looking at my results,” Davis said. “With the amount of profit I had at the end of the year, it wouldn’t have been enough if I had to pay a mortgage.”
Studies have shown that the number of pharmacists nationwide is sufficient, if not more than sufficient, to meet current needs, although supply and demand do not always match. Finding pharmacists is more difficult in rural areas.
“Once they’ve tasted the big city,” Kreling said, “it’s hard to bring them back to the farm.”
Labor force data also shows worrying trends. Concerns about a shortage of pharmacists led the federal government to pour money into pharmacy schools in the 1970s, creating a temporary increase in the number of graduates. The people in that bulge in the pharmacist pipeline have reached retirement age.
“Many of them owned independent pharmacies and worked in rural communities,” said Jon Schommer, professor of pharmacy at the University of Minnesota, who studies workforce issues.
Now, as the demand for pharmacists to perform tests and vaccinations during the COVID-19 pandemic increases, drugstore chains are offering incentives – such as hefty salaries, signing bonuses, and help repaying loans school – which are often more attractive than anything a rural pharmacy could put together.
The way pharmacy graduates view their careers has also changed. Many no longer want to own a pharmacy and are content to work in drugstore chains or other healthcare organizations, according to several professors at pharmacy schools. In 2018, only about half of pharmacists worked in traditional retail pharmacies.
This makes rural recruitment more difficult.
Denise Robins had been with R&R Family Pharmacy in Springfield, Colorado for 18 years when the owner retired. She and three members of her family bought the pharmacy in a last ditch effort to keep it open.
“None of us are pharmacists, which made it a bit more difficult,” Robins said. “We just knew it was going to make it really difficult for people here if they had to travel an hour to get to a pharmacy. “
But finding a pharmacist to work in the southeast Colorado city of less than 1,400 was a challenge. The first pharmacist Robins found was driving 48 miles one way from Lamar. But after a year and a half, the journey became too long.
She then hired someone who wanted to work for only a year, to earn enough money to travel. Next, Robins interviewed two graduates of the University of Colorado School of Pharmacy. She hired one, but it didn’t work. She therefore called back the second candidate, who had still not found a permanent job. He had two young children, and he and his wife worked different hours. He took the job two years ago and has remained there ever since.
In Berryville, Virginia, pharmacist Patricia White opened Battletown Pharmacy in 2011 because she wanted to continue the family business. Her father owned a local pharmacy and had recently passed away. But when it became difficult to make a profit with Battletown, White decided to retire.
She lined up two potential buyers, but neither closed the sale. She hoped then to transfer the pharmacy to a young graduate but did not want to give him a bankrupt business.
“I told him he couldn’t make any money, and he said ‘Thanks for being honest,'” White recalls.
Closure seemed to be the only acceptable option. Battletown closed at the end of August. “I didn’t want to sell to a chain,” she said. “It’s always been my mentality.”
When a chain buys a pharmacy, it doesn’t always decide to operate it. Instead, he could shut down the pharmacy and move the pharmacy’s prescription records to one of his outlets. Retired pharmacists who have spent decades serving a community usually don’t want this to happen, said David Zgarrick, professor of pharmacy at Northeastern University.
“They would like to sell their pharmacy to another pharmacist who would continue to run it in much the same way,” he said.
Some plan ahead, hire another pharmacist, and offer that person a stake in the business. Over time, the new pharmacist can redeem the owner. Many independent pharmacist-owners plan to live off the profits from the sale of their pharmacy, inventory and prescription books.
“Their pharmacy is their retirement savings,” Zgarrick said.
But, Zgarrick said, the added pressure from the pandemic could push more pharmacists into retirement. And a long-standing bullish stock market may mean that some pharmacists have enough in their retirement portfolios to quit without a sale.
At Eads, Davis, 70, still enjoys being a pharmacist. He and his brother co-own seven pharmacies and began planning for retirement by hiring five young pharmacists and allowing them to purchase ownership shares in those pharmacies over time.
However, he had wondered how long he could keep the Kiowa Pharmacy running. With less than 700 residents, Eads is perhaps the smallest town in Colorado with a pharmacy. The combination of Davis’ clientele with that of Cheyenne Wells may have saved pharmacy access for both communities.
“So maybe where we could have lost two pharmacies in the region, we could have existed. We’re stronger now than we’ve ever been, ”said Davis. “It was not the original plan. We care about these people and just wanted to take care of them.
Kaiser Health News is a national health policy information service. This is an independent editorial program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
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