I graduated from UNC in the spring of 1998 with a degree in Accounting. At that time, my husband, who is a Registered Pharmacist, and I purchased a community pharmacy in the rural community of Atwood, Kansas.
In the last 24 years, our community has had 35 different (healthcare) providers. The most consistent healthcare provider in most rural communities is the Community Pharmacist and a handful of nurses. Demand will continue to grow and supply of primary care doctors will continue to diminish, and it is mainly due to payment. While critical care hospitals typically are paid a higher rate than non-critical care hospitals, it does not cover the cost of having a doctor in house. We just don’t have the same volume, so even the higher payment doesn’t cover the fixed costs that a facility has. It barely covers the cost of PAs (physician assistants) and ARNPs (advanced registered nurse practitioner who has completed a graduate-level program). This is why clinics no longer have a registered nurse on staff. Many are LPNs (licensed practical nurses) or CNAs (certified nursing assistants). All good people, but they are limited by their licenses.
Our rural health system has only recently—in the last two years—been able to afford a doctor, mainly due to the 340B program (the program helps health systems stretch scarce federal resources to reach more eligible patients and provide more comprehensive services). This year, my family’s pharmacy will pay our hospital approximately $550,000 to our local critical care access hospital. This currently pays for the one part-time doctor we have. Medicare likes to pay specialists and the new technology they use. Until we talk about how a newly minted general practitioner will get paid and how they will pay off their massive student debt without having to drive their 15-year old car for another 15 years, then our country and our healthcare system will continue to kick this can down the road.
In my county, the pharmacist, chiropractor, and massage therapist are the only ones that are actually vested with their own money to make a difference in the healthcare lives of the communities that they serve. Somehow, we have to get back to a more vested system. It honestly would bring the cost of healthcare down. Whatever UNC’s Doctor of Osteopathic does to stem this tide, make sure that those doctors understand the importance that a rural Registered Pharmacist plays in these communities and that they know their patients better than (doctors) do. It is about lack of payment and how rural providers vs their administrators are paid.
Also, (doctors should) know that the pharmacy is on the line for the same reason. My husband is 63 and will be retired in two years, whether we sell the pharmacy or not. No one wants the responsibility of ownership and the dedication it takes to serve a consistent population. Are pharmacy services wanted in my community? Yes, they are, (but) payment is a real problem. Good rural health is vital.
I appreciate your article. We need to discuss this topic more vigorously and I hope your article will allow people to become more aware of this issue.
–Dawn Hampton ’98, Accounting Owner/Accountant, Currier Drug Inc. Atwood, KS