As the most accessible healthcare providers, community pharmacists play an important role in the healthcare system and the lives of their patients. This American Pharmacists Month, we’re celebrating their contributions by highlighting a few pharmacists making a difference in their communities.
Read the other Q&As in this series with:
Name: Liz Altmiller
Pharmacy: Your Drug Store in Bakersfield, California
Q. How long have you been a pharmacist and at your current pharmacy?
A. I received my PharmD in 2013 and became licensed by 2014. However, I started working for Your Drug Store in Bakersfield, California when I was 13 years old for $5.25 an hour. I started with refilling the vials, cleaning bathrooms, and taking out the trash, and now I’m an owner and the pharmacy manager. I’m a third-generation pharmacist and one of five in my family.
Q. Why did you choose this career path?
A. When I was younger, I tried to get far away from pharmacy because I wanted to be different, and growing up around so many healthcare professionals can be a little intimidating as a kid thinking that you might not measure up. However, after a few years at university jumping from major to major, I kept enjoying a constant theme of the arts and sciences and helping others. I've always wanted to improve lives and, with science as a strong point, I creatively circled back to pharmacy. Now I have the freedom to innovate new processes and help others improve their health and wellbeing.
Q. What is your favorite part of your job?
A. There are so many favorites, but if I had to pick one, I would say it is seeing first-hand that we make a difference in the lives of our patients. When you have a client who comes in with uncontrolled blood sugars, blood pressure, cholesterol, or even mentally unstable and you counsel them and provide medication and tips on the best ways to succeed in reaching their goals. Then you see the recommended medications and vitamins correcting their drug-induced nutrient depletion. The patient comes in with a smile and tells you their A1C went down and they feel great, or their blood pressure is finally under control, or they can actively hold a conversation with you without talking to themselves. This proves to me that they are living a better life because of the recommendations we made, and that makes it all worth it.
"It's important, now more than ever, for pharmacists to integrate into the medical side of healthcare and advocate for the importance of independent community pharmacy access."
Q. What are some industry trends you're keeping an eye on?
A. Unfortunately, right now the biggest trends are loss of funds nationally through PBMs and cuts to Medi-Cal reimbursements in California that are threatening community pharmacies. It's extremely hard to focus on innovation when pharmacies are not sure if they will have enough funds to make it through the year. Across the nation, I see that Walmart laid off 3% of its pharmacy staff, including 40% of its pharmacists. The CVS-Aetna merger earlier this year laid off 138 employees. This year alone, CVS has closed 46 stores and is slowing the opening of new stores. Walgreens is closing 200 stores. I see independent pharmacies being forced to close down, including Anderson's Drug Store, which closed after 75 years, Manchester Pharmacy after over 100 years in operation, and Halethorpe Pharmacy after being open for more than a century. More than 630 rural communities that had a pharmacy, chain or independent, in 2013 no longer have one.
Every community pharmacy's script count is lower. This is why it's important, now more than ever, for pharmacists to integrate into the medical side of healthcare and advocate for the importance of independent community pharmacy access.
Q. What do you think the future holds for the industry?
A. I think the industry is changing drastically, and hopefully for the better. Pharmacies can no longer just fill prescriptions and expect to survive. The effects are even seen in the chain stores with large numbers of pharmacists getting laid off and multiple stores closing. But chains can downsize and still make it through this hard time. Independent pharmacies don't have those types of resources and are affected much more severely when put in situations like these. This is unfortunate because independent pharmacies are the ones that take those complex cases and improve patients’ lives.
Community pharmacies used to only have to worry about audits and making sure prescriptions were correct or risk losing payment. Now, we are responsible for policing patients into refilling their medications on time or risk higher fees from the PBMs. I don't see that as helpful. Education is, of course, crucial to improving patient outcomes. When patients understand why a medication is important, they are more likely to stay adherent. But just forcing someone to pick up their medication every month doesn't make them actually take it nor does it tell you if a patient stopped taking that medication because of how it made them feel. I hope someday soon the community pharmacy's issues are removed so we can focus on improving patient outcomes.
Pharmacists are a missing piece in this broken healthcare system and when we all get together and solve that puzzle, insurances will realize that it is significantly more beneficial to have a pharmacist integrated into the process. Studies have shown improved outcomes when a pharmacist is involved, from clinical ER pharmacists to collaborative practice agreements between community pharmacists and physicians. That said, I hope pharmacists continue to move toward being medical providers because we are the link between primary care physicians, differing specialists, urgent cares, and hospitals in connecting the care of our patients. We see our patients on average 10 times more often than prescribers. We talk to our patients and get to know them. We are the source that keeps doctors informed of drug interactions, drug duplications, insurance coverage, and drug alternatives, as well as updated on patient contact information and even changes in health and behavior so that our patients can be provided the best level of care possible. Together, we improve outcomes.
