Trouble at the Neighborhood Pharmacy

By SAM URETSKY

In 1347, the Black Plague was first reported in England. It reached London by November of that year. It was the worst pandemic in human history and the mortality rate has been variously estimated at anything from 20% to 50%. There were many responses to the plague. The best-known were the flagellants. These were religious zealots who demonstrated their religious fervor and sought atonement for their sins by vigorously whipping themselves in public displays of penance. The more common approach was to flee the affected towns for places deemed safer. Those who could afford to, nobles, wealthy merchants and physicians, did leave the plague areas, but others, including apothecaries, feared to leave their shops, and stayed. There were no effective treatments, but people who lacked access to a physician got used to getting their care from the druggist, and this remained common practice for centuries.

As late as the 1960s, independent pharmacies were common. Every small town, every neighborhood in major cities, had a local drug store. According to the National Community Pharmacists Association, in 1965 there were approximately 50,000 independent pharmacies in the United States and 10,000 chain stores. By 2020 the number of independent pharmacies had dropped to about 20,00 while chain stores had increased to 60,000.

According to chaindrugreview.com “By store count, Walgreens … was the largest drug chain, with 8,221 drug stores, followed by CVS Caremark (7,660), Rite Aid (4,587), Health Mart (3,246) and McKesson Canada (1,650) in the top five. … Walgreens (+144 stores), CVS (+202) and Health Mart (+169) had sizable net gains in stores year over year. Rite Aid (-34 stores) has continued to close underperforming stores and locations coming off lease …”

In August 2022, the New York Times published a report, “How Pharmacy Work Stopped Being So Great,” describing the deterioration of pharmacy practice during the shutdown. While independent stores were essentially stable, stores owned by major corporations could close if they were not generating enough profit, or the landlord wanted an increase in the lease. Stores that offered 24-hour service might require 12-hour shifts. When pharmacists were allowed to give immunizations, to reduce the work load of nurses, the corporations prioritized the injections over prescription filling, since it was more profitable – while patients whose Rx wasn’t ready became justifiably more hostile.

It made the papers when pharmacists in Kansas City, Mo., walked off the job forcing 22 stores to close. The local ABC channel reported, “Around 32 pharmacists employed by CVS stores in the Kansas City metro area staged a walkout to protest working conditions they say put the safety of employees and patients at significant risk.” Drug Topics (a trade journal) reported, “Those walkouts mostly impacted CVS locations inside Target retail stores, but a few stand-alone CVS stores were also forced to close after employees called in sick.”

“These stores are open but are functioning with extremely limited resources in the majority of the impacted stores, with many only having one Pharmacist and one or even zero technicians for support,” a pharmacist associated with the walkout told KCTV 5 News 2. “There are stores with 140+ vaccination appointments, with only one Pharmacist on duty, there are stores 1700+ scripts behind and only one Pharmacist on duty to meet that demand.”

This was followed by a similar strike at Walgreens. This has a real impact on public health, since Wolters Kluwer’s Pharmacy Next survey shows 58% of Americans likely to first seek non-emergency healthcare at pharmacies – “As we saw in last year’s survey, primary care decentralization is continuing – the traditional one doctor-one patient, single point of coordination is vanishing, and this is especially evident in younger generations.”

The pharmacy colleges have essentially prepared their students for this by having required training in pathology and human anatomy as well as therapeutics and drug interactions, and waiting on the phone for a call from an MD or insurance company, but the CEOs and CFOs of the major chains haven’t been paying attention, and pharmacists in general are not unionized. The walk-outs were largely organized through postings on social media. The CEO of CVS took over a week to respond to the Kansas City walk-out.

Chain stores are not inherently bad, but, like the time it takes for a giant tanker shape to change direction, the heads of giant chains are too far from the stores to respond to changing trends. The owners of Mom and Pop stores can spot trends and respond to them. It matters.

Sam Uretsky is a writer and pharmacist living in Louisville, Ky. Email sam.uretsky@gmail.com

From The Progressive Populist, November 15, 2023

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