Signs of a worsening pharmacist shortage in Alaska are everywhere: reduced hours at Anchorage pharmacies. Significant signing bonuses and multiple job offers for newly graduated pharmacy students. Patients being told to come back the next day to pick up prescriptions due to short staffing.
It’s an issue that has been brewing for years but crystallized during the pandemic in Alaska, and nationwide. Experts in Alaska say the reasons for the understaffing are complex and varied. They also said there are no easy solutions — and that the problem may get worse before it gets better.
Meanwhile, Alaskans are already feeling the pinch.
In Valdez, the town’s sole pharmacist resigned earlier this year. It took months to find a replacement, according to Valdez City Clerk Sheri Pierce. The pharmacy’s hours were cut short, and temporary staff had to be flown in on a rotating basis while the search continued.
“We do now finally have a permanent pharmacist and we are very, very thankful for that,” said Pierce. “People had to try to adapt. It is concerning when you only have one pharmacy in town like we do.”
Meanwhile, recruiters’ participation in an annual job fair for pharmacy students in Anchorage has swelled in size over the last two years. Tom Wadsworth, dean of the University of Alaska Anchorage’s pharmacy program, said in an interview that he went from begging employers to attend the fair to charging $500 per booth due to increased demand.
Each member of the most recent graduating class had multiple job offers, many with significant bonuses.
“I had a student sitting in my office this last spring with a problem, and their problem was, should I accept this job with a $150,000 sign-on bonus, or shall I accept this job with a $50,000 bonus” that they wanted to do more, he said.
Daunting work and hostile patients
Pre-pandemic, Alaska was doing OK in terms of pharmacists. There were jobs but not too many vacancies, Wadsworth said.
“The question that everybody wants to know: Why did the job index flip so quickly in pharmacy?” he said.
One big reason is that during the COVID-19 pandemic, pharmacies became a primary location for vaccinations. It’s a task they were set up for, but not at the volume that they were being asked to take on, according to Wadsworth.
“Instead of just a couple hundred people who would trickle in for a flu shot, they had to vaccinate the whole freaking state,” he said.
That rise in demand — and the stress and hostility that many faced as vaccinations became a political flashpoint — pushed many to retire early or quit at the same time that the need for more employees was increasing.
[Previous coverage: Alaska’s pharmacies struggle to keep workers amid low pay and customer hostility]
This has been true nationwide, said Coleman Cutchins, state pharmacist with the Alaska Department of Health.
“But it’s hitting us a little harder because we didn’t have as big of a workforce. And we can’t share resources with other states,” he said.
Pharmacy closures meant fewer prospects
Other conditions that led to the shortage began years before COVID-19, Wadsworth said.
It started with the rise of wealthy corporations acting as pharmacy benefit managers — middlemen between insurance companies and pharmacies — who impose fees on independent pharmacies.
“They decide how much a patient pays for their drugs at the pharmacy counter,” said Brandy Seignemartin, executive director of the Alaska Pharmacist Association.
“They decide whether or not a patient is even allowed to pick up a prescription at the pharmacy of the patient’s choice, or whether they’ll even pay for a prescription at a local Alaskan pharmacy,” she said.
They also take a cut of the pay that pharmacies otherwise would have received.
That’s resulted in the closures of most independently owned pharmacies while larger chain stores with more of a financial buffer remained.
“We’ve seen many, many locally owned independent pharmacies in Alaska have to close because the reimbursements that the PBMs pay for their prescription drugs are often times less than what the pharmacy is even buying the drug for,” Seignemartin said.
In Anchorage, the only independent pharmacy left is Bernie’s, a small shop on the second floor of a building on Lake Otis Parkway.
Those closures over the last decade also made pharmacy seem like less of an appealing option for young people considering a career in health care, according to Wadsworth.
At UAA, there are 15 openings each year for the four-year pharmacy program. Wadsworth said he’s rarely been able to fill all spots — just a few years ago, only five students enrolled.
“Word was out that community pharmacy was suffering,” he said. “It cast a shadow over over pharmacy. And so we’ve seen a reduction in student demand.”
Closures and short staffing
Diminishing profit margins have caused additional problems for pharmacies, said Karen Miller, pharmacist-in-charge at Denali Pharmacy, a hospital-based facility in Fairbanks run by Foundation Health Partners. She’s been working as a pharmacist in the state since the early 1990s.
At many retail pharmacies, low reimbursements from pharmacy benefit managers has caused businesses to try to save money by cutting down on staff hours or increasing responsibilities in a way that’s unsustainable, Miller said.
“The most expensive thing in the pharmacy is the pharmacists, so people are combating this by limiting pharmacist hours and putting a lot of work on the techs, and it’s burning people out,” she said.
That’s causing harms to patients as well as staff.
Earlier this month in Anchorage, Tyra Blanchard, who’d just received a hip replacement, sent her husband to her regular pharmacy — Walgreens — to fill a prescription for post-surgery pain medicine. The technician he spoke to told him he wasn’t able to access the vault where Blanchard’s medication was stored — only pharmacists can — and that there were more than 100 patients also waiting for their prescriptions. He went home empty-handed.
Jacquelyn May, pharmacist-in-charge at Bernie’s Pharmacy in Anchorage, thinks the shortage is particularly bad at pharmacies owned by bigger corporations.
“The pharmacists that I know who work for large chains, the amount of things they’re being asked to do, just their regular daily duties of filling prescriptions on top of all of the metrics that the big corporate chains want them to do, on top of vaccinations and everything else, with less staffing than they probably had last year — it becomes an untenable situation,” she said.
“A lot of these pharmacies don’t notify their patients when they’re going to be closed on a specific day,” she said.
Representatives from 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 being short-staffed is hard on pharmacists too.
“They hate that it happens. But when your district manager calls you on every single day that you’re supposed to be off after having worked a 40-hour week, after a while you have to start to say 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 lately she’s seen high vacancies for pharmacists at community pharmacies but not for other types of pharmacist roles, like at hospitals or clinics.
Her biggest challenge right now is finding and hiring pharmacy techs, who are essential to operations but often underpaid and overworked.
“For the last three years, we cannot 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 call me who are doing residencies or employments telling me that their application pools have dropped significantly and they want to know why,” he said.
He tells them it’s not them. There are just not enough students to fill all their openings. And it’s a problem that will take at least four or five years to resolve given how chronically under-enrolled the school has been.
The problem is also bigger than Alaska.
“I’ve been contacted almost daily by employers out of Alaska, about positions ranging from community pharmacy, all the way up to directors of pharmacy to clinical pharmacists inside primary care clinics,” he said.
He tells those recruiters that he’ll do his best to pass along the job opportunities to his soon-to-be-graduates, but that the competition is fierce.
“I was like, ‘No problem, I will. However, you should know: We only graduated 12 this year. And all 12 of them had multiple job opportunities.”
In the meantime, communities in Alaska, especially smaller ones, have less of a buffer.
For months, Valdez had to rely on a string of temporary pharmacists to keep the only pharmacy in town open while Safeway searched for a replacement for a replacement. It was a stressful time.
“Having someone 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 that does to the quality of your health care when you have health care workers turning over every two or three years at an institution,” he said. “That means you lose institutional memory every two or three years. Patient care suffers because of turnover.”