Finding a Reception: Elderly Pharmacists Leaving an Empty Pharmacy in Rural America

Ted Billinger Jr likes to joke that he will work until he dies. That turned out to be prophecy.

When Billinger died of a heart attack in 2019 at the age of 71, he was still running Teddy B’s, the pharmacy his father had founded more than 65 years earlier in Cheyenne Wells, Colorado. With no other pharmacists working at the store, pre-counted prescriptions and bottles were suddenly locked in a pharmacy where no one could enter. And less than 800 residents of Cheyenne Wells suddenly left without a pharmacy.

Pharmacies used to be regularly passed down from generation to generation, however, in interviews with more than a dozen pharmacists, many said the pressures of running an independent pharmacy had made they push their descendants to other occupations. And when they look for buyers, they often find that attracting new pharmacists, especially to rural settings, is difficult. With a large group of pharmacists nearing retirement age, more communities could lose their sole pharmacy.

“It will be harder to attract people and pay them,” says David Kreling, a professor emeritus at the University of Wisconsin-Madison School of Pharmacy. “If there isn’t a certain generation where someone can sit down with their son or daughter and say they can take over the store, chances are the pharmacy will evaporate.”

Tom Davis, Billinger’s friend and co-owner of Kiowa Drugs in Eads, Colorado, joined in to solve the mayhem in Cheyenne Wells. With permission from the State Board of Pharmacy, the county sheriff sent Davis to Teddy B’s in the eastern town of Colorado to take stock of the remaining drugs. Customers who dropped their prescriptions prior to Billinger’s death can pick up their medication.

Davis later acquired the pharmacy from the Billinger estate. He runs it like a convenience store and delivers prescriptions for it six days a week from Eads, 44 miles away.

“By the time you pay a pharmacist, the position there is already unprofitable,” says Davis.

Davis and his brother co-own seven pharmacies and have begun planning for retirement by hiring five young pharmacists and allowing them to buy ownership stakes in those pharmacies over time.(Rachel Woolf for KHN)

He’s received numerous requests to open pharmacies in other eastern Colorado towns, but doing so will be financially difficult. Reimbursements from insurance plans have been steadily decreasing, and customer bases have eroded as health insurers push patients to mail-order deliveries.

“I fill my prescription every day and my reimbursement is less than the drug,” says Davis. “In other contexts, you might say to the patient, ‘We don’t have that in stock,’ or ‘Why don’t you go down the street to the chain store?’ But down here, we just take care of the patients, and we just get tit for tat.”

He can survive, he said, because, after 48 years, he has no business debt.

“I look at my bottom line,” Davis said. “Given the interest I have at the end of the year, it won’t be enough if I have to pay off a mortgage.”

A woman walks into Teddy B’s home in Cheyenne Wells, Colorado. (Rachel Woolf for KHN)

Dia Giron, manager at Teddy B’s convenience store, transfers prescriptions to a locked box after Kiowa Drug delivers them. (Rachel Woolf for KHN)

Learn found the number of pharmacists nationwide to be enough, even more than enough, to meet current demand, even though supply and demand do not always line up. It’s harder to find a pharmacist than in the countryside.

“Once they get to enjoy the big city,” says Kreling, “it’s very difficult to get them back on the farm.”

Workforce data also showed worrying trends. Concerns about a shortage of pharmacists led the federal government to pour money into pharmacy schools in the 1970s, providing a temporary boost in graduate numbers. Those in that bloated group of pharmacists have reached retirement age.

“Many of them own independent pharmacies and they are working in rural communities,” said the University of Minnesota pharmacy professor. Jon Schommer, who studies workforce issues.

Now, as demand for pharmacists providing testing and vaccination services during the covid-19 pandemic increases, drugstore chains are offering incentives – such as high pay, signing bonuses and help pay off school loans – often more attractive than any rural pharmacy. can be gathered.

Pharmacy technician Jess Sierra prepares prescriptions at Kiowa Drug in Eads, Colorado.

The way graduates envision their careers has also changed. According to some pharmacy school professors, many people no longer want to own a pharmacy and prefer to work at pharmacy chains or other healthcare organizations. As of 2018, there are only about half of the pharmacists worked in traditional retail pharmacies.

That makes it more difficult to recruit workers in the countryside.

Denise Robins worked at R&R Family Pharmacy in Springfield, Colorado, for 18 years when the owner retired. She and three family members acquired the pharmacy in a last-ditch effort to keep it open.

“None of us are pharmacists, so that makes it a bit more difficult,” says Robins. “We just know that it’s going to be really difficult for people here if they have to take an hour to get to the pharmacy.”

But finding a pharmacist who works in this southeastern Colorado town of less than 1,400 people is a challenge. The first pharmacist Robins found traveled 48 miles from Lamar. But after a year and a half, the trip became too much.

Then she hired someone who only wanted to work for a year, to earn enough money to travel. Robins then interviewed two graduate students from the University of Colorado’s pharmacy school. She hired one, but that didn’t work out. So she called back the second candidate, who still hadn’t found a permanent job. He has two young children, and he and his wife are working against schedule. He took the job two years ago and has remained there ever since.

I fill my prescription every day and my reimbursement is less than the drug.

Tom Davis

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 recently passed away. But when making a profit with Battletown proved a struggle, White decided to retire.

She lined up two potential buyers, but neither of them made a purchase. Later, she hopes to pass a career in pharmacy to a recent graduate but doesn’t want to push him into the failed business.

“I told him he couldn’t make any money, and he said, ‘Thanks for being honest,'” White recalls.

Closing seems to be the only sensible option. Battletown shut down at the end of August. “I don’t want to sell out to a chain,” she said. “That’s always been my mentality.”

When a chain buys a pharmacy, it doesn’t always decide to run. Instead, it could close the pharmacy and transfer the pharmacy’s prescription records to one of its stores. Retired pharmacists who have spent decades serving the community often don’t want to see that happen. David Zgarrick, a professor of pharmacy at Northeastern University.

“They want to sell their pharmacy to another pharmacist who will continue to run the pharmacy in the same way,” he said.

Some plan ahead, hire another pharmacist, and offer that person a stake in the business. Over time, the new apothecary can buy the owner outright. Many independent pharmacist owners plan to live off the profits from the sale of their pharmacy, their inventory, and their prescription records.

“Their pharmacy is a retirement savings,” says Zgarrick.

However, Zgarrick said, increased pressure from the pandemic could push more pharmacists to retire. And a prolonged bull market could mean that some pharmacists have enough in their retirement portfolio to call it out of business without selling.

Davis talks to pharmacy technician Jess Sierra at Kiowa Drug. (Rachel Woolf for KHN)

In Eads, Davis, 70, still enjoys working as a pharmacist. He and his brother co-own seven pharmacies and have begun planning for retirement by hiring five young pharmacists and allowing them to buy ownership stakes in those pharmacies over time.

However, he wondered how long he could keep Kiowa pharmacy open. With less than 700 residents, Eads is possibly the smallest town in Colorado with a pharmacy. Combining ‘Davis customer base with Cheyenne Wells’ could have saved pharmacy access for both communities.

“So maybe where we could lose two pharmacies in the area, we were able to survive. We are stronger now than before,” Davis said. “That was not the original plan. We care about those people and just want to take care of them.”

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