The signs of a worsening pharmacist shortage in Alaska are everywhere: reduced hours at Anchorage pharmacies. Significant signing bonuses and multiple job offers for new pharmacy graduates. Patients are told to return the next day to pick up prescriptions due to staff shortages.
It’s a problem that’s been brewing for years, but it crystallized during the pandemic in Alaska and across the country. Alaska experts say the reasons for the staffing shortage are complex and varied. They also said there are no easy solutions — and that the problem could get worse before it gets better.
Meanwhile, Alaskans are already feeling the pinch.
In Valdez, the town’s only pharmacist resigned earlier this year. It took months to find a replacement, according to Valdez City Clerk Sherry Pierce. Pharmacy hours were cut and temporary staff had to be brought in on a rotating basis while the search continued.
“Now we finally have a full-time pharmacist and we’re very, very grateful for that,” Pierce said. “People had to try to adapt. It’s worrying when you only have one pharmacy in town like we do.”
Meanwhile, recruiters’ participation in an annual pharmacy student job fair in Anchorage has grown in size over the past two years. Tom Wadsworth, dean of the pharmacy program at the University of Alaska Anchorage, said in an interview that it went from asking employers to attend the fair to charging $500 per booth because of increased demand.
Every member of the last graduating class had multiple job offers, many with significant bonuses.
“I had a student sitting in my office last spring with a problem, and their problem was should I take this job with a $150,000 sign-on bonus or should I take this job with a $50,000 sign-on bonus,” which they wanted to do more of, said he.
Tiring work and hostile patients
Before the pandemic, Alaska was doing well in terms of pharmacists. There were jobs, but not too many open, Wadsworth said.
“The question everyone wants to know: Why did the pharmacy jobs index turn around so quickly?” he said.
One big reason is that during the COVID-19 pandemic, pharmacies have become a prime location for vaccinations. It’s a task they were built for, but not to the extent they were asked to take on, according to Wadsworth.
“Instead of just a few hundred people getting a flu shot, they had to vaccinate the whole fucking country,” he said.
This increase demand — and the stress and hostility many faced when vaccinations became a political flashpoint — led many to retire early or leave at the same time as the need for more staff grew.
[Previous coverage: Alaska’s pharmacies struggle to keep workers amid low pay and customer hostility]
That’s true across the state, said Coleman Cutchins, state pharmacist for the Alaska Department of Health.
“But it hits us a little bit harder because we didn’t have that big of a workforce. And we cannot share resources with other countries,” he said.
The closing of pharmacies meant fewer prospects
Other conditions that led to the shortage started years before COVID-19, Wadsworth said.
It began with the rise of wealthy corporations acting as pharmacy benefit managers — middlemen between insurance companies and pharmacies — that imposed fees on independent pharmacies.
“They decide how much the patient pays for their medication at the pharmacy counter,” said Brandi Segnemartin, executive director of the Alaska Pharmacists Association.
“They decide if the patient is even eligible to pick up a prescription at the pharmacy of the patient’s choice, or if they’re even going to pay for a prescription at a local pharmacy in Alaska,” she said.
They also take a cut of the pay that pharmacies would otherwise receive.
This led to the closure of most independent pharmacies, while the larger chain stores with a greater financial buffer remained.
“We’ve seen many, many local independent pharmacies in Alaska that have had to close because the reimbursements that PBMs pay for their prescription drugs are often times less than what the pharmacy even buys the drug for,” Seignemartin said.
In Anchorage, the only remaining independent pharmacy is Bernie’s, a small store on the second floor of a building on Lake Otis Parkway.
Those closings over the past decade have also made pharmacy seem a less attractive option for young people considering a career in health care, according to Wadsworth.
There are 15 positions available at UAA each year for the four-year pharmacy program. Wadsworth said he’s rarely been able to fill all the spots — just a few years ago, only five students were enrolled.
“The word got out that the community pharmacy was suffering,” he said. “It cast a shadow over pharmacy. And so we saw a decrease in student demand.”
Closures and staff shortages
Shrinking profit margins have caused additional problems for pharmacies, said Karen Miller, chief pharmacist at Denali Pharmacy, a Fairbanks hospital facility operated by Foundation Health Partners. She has worked as a pharmacist in the state since the early 1990s.
In many retail pharmacies, low reimbursements from pharmacy benefit managers have led businesses to try to save money by reducing staff hours or increasing responsibilities in a way that is unsustainable, Miller said.
“The most expensive thing in a pharmacy is the pharmacists, so people are fighting that by limiting the pharmacists’ hours and putting a lot of work on the technicians, and that’s burning people out,” she said.
This causes harm to both patients and staff.
Earlier this month in Anchorage, Tyra Blanchard, who had just had a hip replacement, sent her husband to her regular drug store — Walgreens — to fill a prescription for post-op pain medication. The technician he spoke to told him that he was unable to access the vault where Blanchard’s medication was kept – only pharmacists could – and that there were more than 100 patients also waiting for their prescriptions. He went home empty-handed.
Jacqueline May, chief pharmacist at Bernie’s Pharmacy in Anchorage, believes the shortage is particularly bad at pharmacies owned by larger corporations.
“The pharmacists I know who work for big chains, the amount of things they’re asked to do, just their regular day-to-day duties of dispensing prescriptions on top of all the metrics that the big corporate chains want from them, the most vaccinations and all that , with less staff than they probably had last year — it becomes an untenable situation,” she said.
“A lot of these pharmacies don’t let their patients know when they’re going to be closed on a particular day,” she said.
Representatives for Walgreens and Safeway did not respond to requests for comment for this story.
May said she wants Alaskans to know that pharmacies having to close early due to staff shortages is hard on pharmacists, too.
“They hate it to happen. But when your regional manager calls you every day when you should be off after a 40-hour work week, after a while you have to start saying no, even though you really want to be there for your patients. You have to take care of yourself, too,” she said.
Miller, the Fairbanks pharmacist, said she’s seen a lot of openings for community pharmacy pharmacists recently, but not for other types of pharmacist roles, such as in hospitals or clinics.
Her biggest challenge right now is finding and hiring pharmacy technicians, who are essential to operations but are often underpaid and overworked.
“For the last three years, we haven’t been able to find technicians to hire,” Miller said.
Worse before it gets better
Back at UAA’s pharmacy program, Wadsworth’s phone is always ringing these days.
“I’ve had people calling me who are resident or working saying that their applicant pool has dropped significantly and they want to know why,” he said.
He tells them it’s not them. There simply aren’t enough students to fill all the vacancies. And it’s a problem that will take at least four or five years to resolve, given how chronically underenrolled the school is.
The problem is bigger than Alaska.
“I am contacted almost daily by Alaskan employers for positions ranging from community pharmacies all the way to pharmacy directors to clinical pharmacists in primary care clinics,” he said.
He tells these employees that he will do his best to pass on job opportunities to his soon-to-be graduates, but that the competition is fierce.
“I was like, ‘No problem, I’ll do it. You should know though: we only graduated 12 this year. And all 12 of them had multiple job opportunities.
Meanwhile, communities in Alaska, especially smaller ones, have less of a buffer.
For months, Valdez had to rely on a series of temporary pharmacists to keep the city’s only pharmacy open while Safeway searched for a replacement. It was a tense period.
“Having somebody who knows the people in the community — that’s really, really important,” said Pierce, the city clerk. “It makes a huge difference.”
“Think about what it does to the quality of your health care when you have health workers who are turning over every two or three years in an institution,” he said. “That means you lose institutional memory every two or three years. Patient care suffers because of turnover.”
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