*AJOC VERSION* Many Alaska pharmacies are understaffed, leading to sporadic hours and turned away patients

Signs of a worsening pharmacist shortage in Alaska are everywhere: reduced hours at Anchorage pharmacies. Significant signing bonuses and multiple job offers for freshly graduated pharmacy students. Patients are being told to come back the next day to pick up prescriptions due to understaffing.

It’s a problem that’s been brewing for years but crystallized during the pandemic in Alaska and across the country. Experts in Alaska say the reasons for the understaffing are complex and varied. They also said there were no easy fixes – and the problem could get worse before it gets better.

Meanwhile, Alaskans are already feeling the pinch.

In Valdez, the only pharmacist in town quit earlier this year. It took months to find a replacement, according to Valdez City Clerk Sheri Pierce. Pharmacy hours were cut short and temporary staff had to be flown in on a rotation basis while the search continued.

“We finally have a permanent 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 us.

Meanwhile, recruiter participation in an annual job fair for pharmacy students in Anchorage has grown over the past two years. Tom Wadsworth, dean of the pharmacy program at the University of Alaska in Anchorage, 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 promotion had several job offers, many with significant bonuses.

“I had a student sitting in my office last spring with a problem, and their problem was, do I take this job with a $150,000 signing bonus, or do I take this job with a $50 $000” they wanted to make more, he said.

UAA/Idaho State University Doctor of Pharmacy Program

Heavy work and hostile patients

Before the pandemic, Alaska was doing well in terms of pharmacists. There were jobs but not too many vacancies, Wadsworth said.

“The question everyone wants to know: why has the jobs index shifted so quickly to pharmacy?” he said.

One of the main reasons is that during the COVID-19 pandemic, pharmacies have become the main place for vaccinations. It’s a task they were set up to do, but not at the volume they were asked to take on, according to Wadsworth.

“Instead of just a few hundred people getting the flu shot, they had to get the whole freaking state vaccinated,” he said.

This rise in demand – and the stress and hostility many faced when vaccinations became a political flashpoint – caused many to retire early or quit as the need for more staff grew .

That’s been true nationwide, said Coleman Cutchins, a state pharmacist with the Alaska Department of Health.

“But it hits us a little harder because we didn’t have such a large squad. And we cannot 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 — intermediaries between insurance companies and pharmacies — that charge fees to independent pharmacies.

UAA/Idaho State University Doctor of Pharmacy Program

“They decide how much a patient pays for their medication over the counter at the pharmacy,” 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 their pharmacy of choice, or if they’ll even pay for a prescription at a local Alaskan pharmacy,” she said.

They also take a share of the salary that pharmacies would otherwise have received.

This caused most independent pharmacies to close, while larger chain stores with greater financial leeway remained.

“We’ve seen many, many local independent pharmacies in Alaska close because the reimbursements that PBMs pay for their prescription drugs are often less than what the pharmacy even buys for the drug,” Seignemartin said.

In Anchorage, the only remaining independent pharmacy is Bernie’s, a small shop on the second floor of a building on Lake Otis Parkway.

Those closures over the past decade have also made pharmacy a less attractive 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 had rarely been able to fill all the places – just a few years ago only five students were enrolled.

“We heard that the community pharmacy was suffering,” he said. “It cast a shadow over the pharmacy. And so we’ve seen a reduction in student demand.

Closures and staff shortages

Shrinking profit margins have caused additional problems for pharmacies, said Karen Miller, pharmacist in charge of Denali Pharmacy, a Fairbanks hospital facility operated by Foundation Health Partners. She has worked as a pharmacist in the state since the early 1990s.

At many retail pharmacies, low reimbursements from pharmacy benefit managers have caused companies to try to save money by cutting staff hours or increasing responsibilities in unsustainable ways, Miller said.

“The most expensive thing in pharmacy is pharmacists, so people are fighting that by limiting pharmacists’ hours and putting a lot of work on technicians, and that’s wearing people out,” she said. .

This causes harm to patients as well as staff.

Earlier this month in Anchorage, Tyra Blanchard, who had just had a hip replacement, sent her husband to his usual pharmacy – Walgreens – to fill a prescription for post-surgery painkiller. The technician he spoke to told him he was unable to access the vault where Blanchard’s drugs were stored – only pharmacists can – and that there were more than 100 patients who were also waiting for their prescriptions. He returned home empty-handed.

Jacquelyn May, pharmacist in charge of Bernie’s Pharmacy in Anchorage, thinks the shortage is particularly severe at pharmacies owned by larger companies.

“Pharmacists that I know who work for large chains, the amount of things they are asked to do, just their regular daily duties of filling prescriptions on top of all the metrics that the large corporate chains want they’re doing, on top of vaccinations and everything else, with less staff than they probably had last year – it’s becoming an untenable situation,” she said.

“A lot of these pharmacies don’t tell their patients when they will be closed on a specific day,” she said.

Representatives for Walgreens and Safeway did not respond to requests for comment on this story.

May said she wants Alaskans to know that pharmacies having to close early due to understaffing are also hard on pharmacists.

“They hate it to happen. But when your district manager calls you every day you’re supposed to be off after working 40 hours a week, after a while you have to start saying no, even if you really want to be there for your patients. . You also have to take care of yourself,” she said.

Miller, the pharmacist from Fairbanks, said recently that she has seen many job openings for pharmacists in community pharmacies, but not for other types of pharmacist roles, such as in hospitals or clinics.

His biggest challenge right now is finding and hiring pharmacy technicians, who are essential to operations but often underpaid and overworked.

“For three years, we haven’t found any technicians to hire,” Miller said.

UAA/Idaho State University Doctor of Pharmacy Program

Worse before it gets better

Back at the UAA pharmacy program, Wadsworth’s phone is still ringing these days.

“I’ve had people call me doing residencies or jobs to tell me that their application pools have dwindled dramatically and they want to know why,” he said.

He tells them it’s not them. There simply aren’t enough students to fill all their positions. And it’s a problem that will take at least four or five years to solve given the school’s chronic understaffing.

The problem is also bigger than Alaska.

“I have been contacted almost daily by employers outside of Alaska, about positions ranging from community pharmacy, to pharmacy managers to clinical pharmacists in primary care clinics,” he said. .

He tells these recruiters that he will do his best to pass on job opportunities to his future graduates, but the competition is fierce.

“I was like, ‘No problem, I’ll do it. However, know that we only got 12 degrees this year. And all 12 had multiple job opportunities.

Meanwhile, 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 town clerk. “It makes a huge difference.”

Wadsworth agreed.

“Think about what it does to the quality of your healthcare when you have healthcare workers who change every two or three years in a facility,” he said. “That means you lose institutional memory every two or three years. Patient care suffers from staff turnover.

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