While the health care debate rages across the nation, rural Oklahomans are facing a challenge beyond high costs. There simply aren’t enough health care professionals to go around.

“There are fewer patients, less financial resources, and more costly choices,” stated Paul Moore, President of the National Rural Healthcare Association. Moore, who owns Roy’s Discount Pharmacy in Wilburton, frequently addresses committees on rural healthcare problems.
Despite decreased options, one healthcare professional provides rural patients convenience, accessibility, and a top-ten ranking on USA Today’s most trusted professions list: pharmacists.

RURAL CHOICES

The shortage of healthcare providers in Oklahoma is nothing new. We rank in the bottom five states for physician to patient ratio with less than 200 physicians per 100,000 citizens according to Dr. David Reece of Practice Support. Nationwide, rural areas have a shortage of approximately 16,000 physicians according to surveys from the US Department of Health and Human Resources. 

The Oklahoma Hospital Association predicted hospital shortages of 3,100 nursing position by 2012, not including nurses for home healthcare, nursing homes and doctors’ offices. They also predict shortages in other health-related professions including lab technicians and physical therapists.

The Center for Rural Affairs lists these major problems facing the rural healthcare consumer: physical limitations, transportation, access to insurance and poverty. Rural pharmacists are often the only healthcare providers left in small towns, and they are offering services most retail chains never considered.

“In many ways pharmacists are the ‘front-line’ of healthcare in rural communities,” Paul Moore says.
Steve and Sally Drinnon are two of the pharmacists fighting to keep their jobs alive. After working in an urban area for years, they now work in several pharmacies in Thomas, Canton and Watonga where they say customer loyalty makes all the difference.

“We have increasing problems with dwindling resources like everybody, but we must relate in a way to keep the patients coming back. They mean our survival,” Steve says.

The Drinnons have good reason to worry about their job security. The Office of Rural Health Policy, Health Resources and Services Administration says Oklahoma lost 10 rural pharmacies from 2006 to 2008. The Drinnons respond to competition from larger stores in other towns and mail order services by offering more than just prescriptions. 

“Our patients expect a different kind of service, more assistance, more questions answered and friendly visiting,” Sally says. “We have the opportunity to view a larger picture of what affects our patients, and it increases our ability to provide better healthcare.”

Jacqueline Stephens, a Kiwash and Northfork Electric member who works for Cheyenne Drug in Roger Mills County, agrees.

“Patients tell me they don’t feel like they get lost in the shuffle here,” Stephens, says. “I change batteries on a glucose monitor or take blood pressures. Nobody expects it, but I feel it benefits my patient’s health.”

Most pharmacists feel an obligation to improve services for the health and benefit of their patients, but their efforts are more visible in rural communities where they are the lone healthcare provider.

“Many folks seek out pharmacist’s advice, hoping not to go to the doctor,” Moore says. “Pharmacists serve as a source of medication information, health promotion and disease prevention. The rural pharmacist is not just a source of medication and merchandise. The true benefit for the patient is their relationship with the pharmacist.”

Pharmacists must also be skilled at navigating today’s healthcare bureaucracies to ensure their patients receive the maximum benefit from their insurance and government programs. Some pharmacists estimated their staff spends 10 to 20 percent of their time dealing with insurance-related problems.

“Since Waynoka’s population is growing older, it’s important I keep up on Medicare Part D and other healthcare plans” says Jerry Dennis, a Cimarron Electric member who owns Jerry’s Pharmacy. “They are confusing and difficult.”

Besides being the main healthcare provider in town, many pharmacies are also one of the only retail shops for miles, which has lead many of them to diversify their offerings.

“When you’re located 45 miles from a town of any size, and the populations of Texas and Cimarron counties numbers 2,000, you know your patients well,” says Jim Weaver, owner of Boise City Family Pharmacy. “We have to go a few extra steps for our patients.” Jim’s store offers a full-line of pharmacy items as well as gifts, cards, a bridal registry and more.  “We’re probably the last of the independents,” he says. 

Thomas Drug in Thomas provides a laundry pickup and key making, Herod Drug in Canton carries Pendleton Blankets and lead crystal, and Boise City Family Pharmacy affords the most complete selection of gifts and cards west of Guymon.

Cynthia Sawatzky, a schoolteacher from Custer City, summarized what establishes customer loyalty in her opinion: “Shopping locally is convenient, but the most important thing is that they know me when I walk up to the counter. I feel more like an individual, not a pill in the bottle.”

RURAL HARDTIMES

Rural pharmacists may be the last of the independents as Bill Weaver described them. Paul Moore stated his concerns that rural pharmacies act as “canaries in the mine.”

“Any policy that may adversely affect the economic sustainability of a pharmacy will show up first in the small towns because of their lower volumes and greater dependence on prescription sales,” Moore says. “When a rural pharmacy closes its doors, the greatest loss is not to the livelihood of the pharmacist—they can probably find work elsewhere—but to the community. There is a cascading effect of economic impact, not just the loss of a local business, but the ability to attract other business. The community now becomes hard pressed to attract economic development without good healthcare.”

Health care policy—as set by insurance agencies and the government—can really affect a pharmacy’s ability to make a profit. Large health insurers negotiate prices with pharmacies, which saves their customers money. While in the short term this may be a positive development for consumers, it can mean that pharmacists make little to no money filling prescriptions once labor and time is figured in. If these changes force the town’s only pharmacy out of business, consumers suffer also.

But not all pharmacists feel the end of the line looms for rural pharmacies. Weaver, and Stephens agreed their rural locations provide a geographic insulation and protect their businesses. The big chains have not invaded their shopping areas yet. But they also agreed rural pharmacists must vigilantly follow changes the industry and roll with the punches. The choices are not always easy.

Pharmacists practicing in  rural areas do so by choice, providing an underserved portion of the public access to highly trained healthcare professionals. Patient’s pride in their communities and loyalty to their rural pharmacist keep the doors open, giving small town Oklahomans a shot at staying as healthy as their urban cousins.