From 18th-century apothecaries to modern drive-thru drug stores, pharmacies have evolved in form, but their central purpose has stayed constant: They serve as community centers to help people navigate medications with confidence, safety, and support.
Every day, pharmacists play a critical role in preventing medication errors and helping people use their prescriptions and receive vaccines safely. While it’s clear that pharmacies are vital to public health and integral to healthcare in general, these invaluable institutions have been shuttering at an alarming rate — and there’s no end in sight.
Nearly one in three retail pharmacies has closed since 2010. At first, new pharmacies were opening quickly enough to offset the losses. But since 2018, closures have outpaced openings. Today, an estimated 45% of U.S. counties are considered pharmacy deserts, forcing rural residents to drive for an average of 85 minutes round-trip to reach the nearest pharmacy. Even in major metro areas, pharmacy deserts mean an average round-trip of 53 minutes. Independently-owned pharmacies — which are more prevalent in small towns and Black and Latino-majority urban neighborhoods — have experienced the highest rates of closure.
With a disproportionate amount of closures occurring in lower-income, rural areas, and urban communities of color, the expansion of pharmacy deserts is particularly concerning, given that they could deepen existing health disparities.
Compared with 2019, researchers estimate there are over 7,000 fewer pharmacies in the U.S. today. For the roughly 60 thousand pharmacies that are still open, longer waits, reduced hours, and understaffing are common.
When people find out I’m a pharmacist, they immediately want to know: What’s going on? It’s not just the closures they’ve clocked — it’s the tension behind the counter, the long waits, the harried staff. The truth? Chaos has always been part of pharmacy life; the volume has just been turned up. With 77% of community pharmacists rating their workload as high or extremely high — and 91% of pharmacists working in large chains — pharmacy work-related stress is at an all-time high. We’re in a crisis, and it’s happening just as community pharmacies are needed more than ever.
With one in three Americans lacking a primary care provider, community pharmacies are increasingly needed to help bridge gaps in healthcare access, says Soojin Jun, PharmD, a geriatric pharmacist, patient safety activist, and founding member of Patients for Patient Safety US. However, she points out that the growing demands on pharmacy workers — without corresponding time, resources, and staffing support — are contributing to widespread burnout.
Despite the growing need, pharmacies are rapidly disappearing. Both CVS and Walgreens are planning for more closures, and Rite Aid just went bankrupt (again). As for independent pharmacies closing at a rate of more than one per day, some say they’re on a path to extinction. With all of the closures and accessibility difficulties, the public is at risk and they know it. Some 59% of Americans worry about losing medication access close to home.
“The loss of a nearby pharmacy means the loss of a lifeline — a trusted accessible healthcare provider within their reach,” says Nadia Ahmad, PharmD, a District Engagement Lead Pharmacist at Walgreens.
“The loss of a nearby pharmacy means the loss of a lifeline — a trusted accessible healthcare provider within their reach.”
But what are the reasons contributing to the pharmacy closures and growing chaos behind the counter — and how are these issues putting medication safety and access at risk?
Pharmacy Deserts: How Did We Get Here?
I entered the pharmacy profession in the late ’90s, a time when new pharmacies seemed to be opening on every corner. It was the heyday of prescription drug sales — the shelves were stocked, the scripts were flowing, and all signs pointed to even more growth ahead. An aging population, a pipeline of soon-to-be blockbusters like Lipitor and Viagra, and the loosening of laws around direct-to-consumer pharmaceutical ads created a perfect storm. Even as shopping moved online and brick-and-mortar retail started to crumble, pharmacies managed to hang on.
“People like being able to go into a pharmacy and ask a question and get help,” says David P. Zgarrick, Ph.D., Professor Emeritus of Northeastern University. Even today, he says online-only pharmacies still only make up a fraction of market share, and points to the fact that pharmacies have always been about more than dispensing medication.
For many years, Dr. Zgarrick explains, pharmacists have been acting as unpaid, unrecognized primary care providers.
With many Americans lacking care access, pharmacists are often the first point of contact for basic health concerns. People frequently turn to their local pharmacist for help choosing over-the-counter medications or deciding whether a trip to urgent care is necessary, explains Shane Jerominski, PharmD, a pharmacist previously employed by several large chains who now practices in independent pharmacy settings.
Pharmacy Benefit Managers: Driving Up Complications and Costs
As more pharmacies shut their doors, the ones that remain are taking on a growing burden. But higher prescription volumes don’t always translate to higher profits, thanks, in large part, to pharmacy benefit managers (PBMs).
Outdated and complicated drug reimbursement rules allow PBMs to act as middlemen, charging pharmacies extra fees — often applied retroactively after a prescription is filled — that can be difficult to anticipate or fully understand.
Although PBMs were initially created to help lower drug costs for consumers and insurers — and some say still do — their practices have come under scrutiny. Sometimes, PBM-issued fees are referred to as “pay-to-play” because pharmacies must pay them to be part of an insurer’s preferred pharmacy network. When these fees are collected after a prescription is dispensed, they’re called “clawback fees.” These complicated PBM practices can cause a pharmacy to lose money after dispensing a prescription, explains Dr. Jerominski.
In 2024, the Federal Trade Commission (FTC) released a critical report detailing how PBMs are threatening the survival of community pharmacies and driving up prescription costs. The report highlights that after decades of consolidation, just three PBMs (CVS Caremark, Express Scripts, and OptumRx) set pricing for nearly 80% of all prescriptions dispensed in the U.S.
These “powerful middlemen” cannot possibly act as independent third-parties, the report argues, when they also own or are affiliated with insurance companies and pharmacies. What’s more, the FTC found evidence showing that PBMs profit more when retail drug prices are higher, questioning their incentives to control costs.
Following the report, the FTC took legal action against the three largest PBMs, alleging that their rebate and pricing systems artificially inflated drug costs. The PBMs countersued, saying the FTC is acting unconstitutionally and relying on limited and incomplete information. At present, the lawsuit is on hold since the FTC is in disarray following recent cuts by the Trump administration — which included the firings of the only two Democratic FTC commissioners, Alvaro Bedoya and Rebecca Kelly Slaughter.
Meanwhile, pharmacies — especially independent ones — are struggling to stay financially viable. But PBMs aren’t sole problem, says Dr. Zgarrick.
“A lot of pharmacies, particularly pharmacies in grocery and discount stores, were never profitable in the first place,” he notes. Often added as a ‘one-stop shop’ convenience to attract more customers, continues Dr. Zgarrick, these pharmacies were designed to increase revenue overall — not just inside the pharmacy itself.
Ultimately, current shrinking and unpredictable revenues make it difficult for pharmacies to invest in staff and resources, which can compromise patient safety and quality of care. With many pharmacies stuck operating in a vicious cycle of understaffing, burnout, and turnover, it’s not surprising that over a third of pharmacists plan to look for a new job in the next year.
Why Pharmacists Feel So Burned Out
“How hard can filling prescriptions be, especially when you’re well paid to do it?”
I’ve heard sentiments like that from people my entire career. I try to explain it to others like this: Imagine the intensity of a fast-paced retail job layered with the pressure of a high-stakes healthcare role — one where a single mistake could seriously harm someone.
My first position was with Walgreens, where I worked as a “floater,” traveling between various pharmacy locations near the company’s Chicago headquarters. During each shift, I stood, planted like a tree, staying inside a small square literally outlined with duct tape on the floor.
My first position was with Walgreens, where I worked as a “floater,” traveling between various pharmacy locations near the company’s Chicago headquarters. During each shift, I stood, planted like a tree, staying inside a small square literally outlined with duct tape on the floor.
With a phone, computer terminal, and a conveyor belt within reach, the setup was designed so the pharmacist never had to move, allowing them to keep up with checking hundreds of prescriptions each shift. All the while, people watched and waited from both the drop-off and pick-up sides of the counter and from behind at the newly added drive-thru window.
I didn’t stay long, leaving when I was offered a position at a home infusion pharmacy. I was hoping to start a family, and I worried about working through a pregnancy in that environment — especially without another pharmacist nearby to cover for me if I needed a break or suddenly felt unwell. Since then, I’ve worked in other demanding settings, including hospice and oncology, but I still consider community pharmacy the most challenging, and that was before pharmacists were expected to do as much as they are today.
Worries About Medication Errors
It’s not just expanded vaccinations and clinical services that have pharmacists feeling spread thin. Increasingly, they’re also tasked with managing drug shortages, handling recalls, and navigating complex insurance protocols, all of which demand more time and attention, says Dr. Ahmad. New regulatory steps are also currently required to track drugs through the supply chain. Each individual step might seem minor, but as Dr. Jun explains, even a small delay can quickly create a backlog of prescriptions waiting to be checked.
“Pharmacists and technicians are now expected to do more with less, leading to exhaustion, chronic stress, and an alarming rise of burnout,” says Dr. Ahmad. “This environment erodes [employee] morale and ultimately the quality of patient care,” she adds.
“Pharmacists and technicians are now expected to do more with less, leading to exhaustion, chronic stress, and an alarming rise of burnout,” says Dr. Ahmad. “This environment erodes [employee] morale and ultimately the quality of patient care,” she adds.
The term “moral injury” has been proposed as a more accurate way to describe the burnout many healthcare professionals face. It’s often less about physical exhaustion, and more about the emotional toll of not being able to care for patients in the way most pharmacists strive to.
Despite pharmacies doing more, most operate with only one pharmacist on duty at a time. It’s hard to think of another high-stakes healthcare position with an expectation of working as the sole clinician in a public-facing position and no buffer of a front desk or separate waiting area. That’s not just a recipe for burnout: Research suggests solo-pharmacist staffing in busy stores can significantly increase the risk of medication errors. And pharmacists who experience burnout report double the worry that they may have made a medication error within the last three months. That kind of worry stays with you, pharmacists say. You go to sleep with it and wake up with it.
Worrying that you made a mistake doesn’t mean you actually did, but it’s hard to know exactly how often dispensing errors happen in community pharmacies — studies are wildly inconsistent — because there’s no formal system to track or report them. What’s more, factors like understaffing, which raise the risk of errors occurring can also decrease the likelihood a known error will be reported.
Caregivers Bearing the Brunt of Pharmacy Burnout
The solo-pharmacist model is additionally challenging for pharmacists who are caregivers, says Dr. Jun, who graduated from pharmacy school just before the birth of her third child. As any parent knows, needing to call in is more likely to happen when you have young children. Doing so as a pharmacist might mean the pharmacy is unable to open, adding extra guilt, worry, and stress.
Pharmacist social media networks are filled with women talking about the difficulty of juggling pharmacy work and family when there’s no backup or wiggle room, says Dr. Jun. Indeed, the National Pharmacist Workforce Study published in 2025 found burnout was higher among women, particularly those who worked in large chain pharmacies. Women make up two-thirds of the pharmacy workforce.
Pharmacy Techs, Undertrained and Underpaid
To manage their growing responsibilities, pharmacists rely heavily on support from pharmacy technicians. But techs are often undertrained and underpaid. The requirements for becoming a pharmacy technician vary by state. Some states have minimal or no formal training requirements for technicians working in community settings. Other states (16 at present) require pharmacy technicians to become nationally certified by passing an exam after completing training (on the job or through an education program).
Laws regulating the activities technicians can perform are also set at the state level. Most states allow technicians to administer vaccines under a pharmacist’s supervision. The biggest difference you might notice between their roles is that only pharmacists counsel patients and offer advice.
Over the past 25 years, growth in the number of pharmacy technicians has nearly doubled the increase in pharmacists, says Dr. Zgarrick, and technicians are taking on more responsibilities than ever before, he adds. However, their wages haven’t kept pace. Dr. Jerominski points out that many technician positions remain vacant for this reason. Frequent turnover is another problem. He and other pharmacists I spoke with say that pharmacies repeatedly lose highly-trained, experienced technicians because their salaries don’t reflect the value and demands of their work. On average, pharmacists earn about three times more per hour than technicians ($66.10 compared to $20.90).
“Pharmacists want to provide clinical services,” says Dr. Jerominski, but without well-trained pharmacy technicians, he explains, pharmacists are often pulled into tasks typically handled by techs (i.e. handling payments, processing inventory, order entry), leaving little time to focus on patient care.
Unionization: How the Pandemic Pushed Overworked Pharmacists Toward a Solution
In 2021, one gutsy Oklahoman pharmacist named Bled Tanoe, PharmD, wrote an open letter to retail pharmacy employers pointing out that token rewards of free pizza did not make up for unsafe working conditions and pressures from impossible metrics during the heart of the pandemic.
“Yes I love pizza. But it is no longer cutting it. You can’t expect people to survive this amount of work with no help. We are drowning. Pharmacy staff is mentally, emotionally, and physically exhausted. You are asking ONE person to do the work of FIVE,” Dr. Tanoe wrote.
Dr. Tanoe’s hashtag #PizzaIsNotWorking steadily grew into a nationwide movement of thousands of “phriends,” spotlighting the burnout behind the counter in many large chain drug stores. I got goosebumps the first time I heard Dr. Tanoe advocate on the topic. Wow, I thought, she’s actually saying out loud what many others are thinking but too fearful to publicly say.
Pharmacy culture is inherently risk-averse, and pharmacists tend to be cautious about stepping into the spotlight. But we can’t change what we don’t acknowledge. Crucially, Dr. Tanoe’s thoughtful advocacy helped reframe the conversation, showing that the wellbeing of pharmacy staff is inseparable from patient and public safety.
In 2023, Drs. Tanoe and Jerominski, along with two fellow pharmacists, co-founded The Pharmacy Guild, a grassroots effort aimed at supporting union formation and giving pharmacists and technicians a stronger voice in corporate decision-making. As Dr. Jerominski explains it, plans for walkouts, dubbed “pharmageddon,” began when a large chain in the Kansas City Metro Area expected pharmacists to run whole pharmacies alone with no technician help. While the American Pharmacists Association (APhA) expressed support for the walkouts and affirmed the right to organize, it stopped short of endorsing unionization outright.
CVS and Walgreens, the two largest pharmacy chains in the U.S., have publicly stated a preference for engaging directly with employees rather than through union representatives. Several pharmacists at both chains, speaking anonymously due to concerns about retaliation, described a workplace culture that subtly discourages contact with union organizers, even if direct prohibitions are not issued.
Despite the pushback from those two large chains, Dr. Jerominski believes unionization could help stabilize the profession, improve patient care, and lead to fairer technician wages. “If we don’t fix the technician problem,” he says, “we will never fix the pharmacy problem.” He cites the example of pharmacists at Kaiser Permanente, where union representation has led to more favorable working conditions and stronger workplace protections for pharmacy technicians.
Regardless of their views on unionization, every single one of the pharmacists I spoke with agreed that reforming PBMs is crucial. PBM practices are exploitative, says Dr. Ahmad, and a root cause of the pharmacy crisis, she insists.
The community pharmacists I spoke with are eager to serve as advocates and educators as we strive to shift from a sick-care health system to one focused on whole health. They are trained in both medication and non-drug approaches to wellness and chronic disease management, and they want to continue making real impacts in people’s lives. “Anyone willing to face that stress wants to be there,” says Dr. Jerominski. Fixing the pharmacy, he says, ensures they can continue supporting the health of people in their communities.
Getting to Know Your Pharmacist: How They Can Help You
In 2000, pharmacy schools phased out the 5-year entry-level bachelor’s degree in favor of the 6-year Doctor of Pharmacy (PharmD) program. In practice, Dr. Zgarrick notes, many students entering pharmacy school already hold an undergraduate degree — meaning most pharmacists have eight or more years of college education. After graduating from an accredited program, they must pass both federal and state licensing exams to become licensed pharmacists. Some go on to complete residencies to further specialize in specific areas of practice.
One of the most critical roles a pharmacist has is safeguarding the public from medication-related harm. Medication errors cause between 7,000 and 9,000 deaths each year in the U.S., making that final safety check at the pharmacy counter a crucial line of defense. Dr. Jun understands that each number is a person. She decided to become a pharmacist after losing her father to gaps in care that led to a medication adverse event. “Patient safety is my North Star,” she says.
Some other key areas where pharmacists protect the public from medication-related harm include:
They Double Check The Dose
Pharmacists contact physicians if a prescribed dosage might not be safe for a particular patient based on age, underlying health issues, concurrent medications, or other factors. Most adverse drug reactions are dose-related, so getting the dose right is essential.
They Provide Dosing Guidance
Pharmacists can tell you what to do if you miss a dose or whether you should consult your doctor for tailored dosing instructions when starting or stopping a medication. Gradual dose adjustments (also known as tapering) are needed with many medications to avoid bothersome, and sometimes dangerous, side effects.
They’ve Got Tips on Administering Meds
Your prescription label will provide basic directions, but pharmacists can offer tips on taking or timing your medication to reduce side effects. They’re a good source to help answer tricky questions like what to do if you left a cold-storage medication out of the fridge or have trouble swallowing pills.
They Can Screen For Drug Interactions and Allergies
Your pharmacist can make sure a new medication is safe to take with your other medications and supplements, and explain if you need to take any precautions, such as spacing out doses. They can also tell you if your medication interacts with certain foods or other substances, like alcohol.
While your prescriber should screen for allergy risks, a pharmacist adds another layer of safety to help prevent medication-related harm.
They Can Counsel On Side Effects
Knowing what to watch for and when to contact your prescriber, stop a medication, or seek emergency care can help keep you safe in the event of an adverse drug reaction.
They Can Suggest Safer Alternatives
If you want to avoid a certain medication because of side effects, your pharmacist may be able to recommend safer alternatives to discuss with your doctor. Most pharmacists work independently from your prescriber or drug companies, and you should be able to trust that their advice is focused on your safety. Dr. Jun notes that pharmacists may also suggest non-pharmacologic lifestyle approaches that may complement or reduce the need for medication.
They Can Promote the Safe Use of Over-The-Counter Products
A growing number of medications have shifted from prescription-only status to over-the-counter (OTC) availability. Supplement intake is also at an all-time high. Like prescription drugs, these readily available products can still pose risks, and community pharmacists are uniquely positioned to help ensure they’re used safely.
Pharmacists can also offer a comprehensive review of your medications and suggest changes if you’re taking medications that might be unnecessary or unsafe. Medicare Part D often covers this service on an annual basis. Although the pharmacist can’t make changes to your medications, they can offer suggestions, such as discontinuing a medication that is unlikely to provide a benefit. Dr. Jun notes “deprescribing” is an important consideration among older adults who may be more vulnerable to side effects, especially if they’re taking multiple medications.
Pharmacists’ Expanding Role in Patient Care and Safety
Dr. Jun credits a Change.org petition launched by Dr. Sandra Leal in 2011 for growing grassroots support to formally recognize pharmacists as healthcare providers under the Social Security Act, a change business leaders say is essential for making community pharmacies viable in the long term. This change in designation is important because it would allow pharmacists to bill insurance providers for services and not only products.
However, the American Medical Association (AMA) has long fought any form of “scope creep.” In response to the AMA’s 2024 statement in opposition, the APhA and American Association of Colleges of Pharmacy (AACP) issued a joint statement reaffirming their support in expanding pharmacists’ roles. They criticized the AMA’s “bullying tactics,” urging the organization to focus on “addressing health care disparities and improving access.”
Anecdotally, clinicians I know — regardless of their credentialing — are committed to finding all-hands-on-deck approaches to better serve patients and communities whenever possible because the needs are just so great. Not only are there fewer physicians, but physicians are working fewer hours. Significant gaps in healthcare persist even as nurse practitioners and physician assistants make up a larger share of providers. Additionally, healthcare is becoming more nuanced, complex, and rapidly evolving. Collaborative work is essential.
Amid the urgent need for more providers, state legislatures are swiftly moving ahead to expand pharmacists’ roles, with new rules and regulations enabling them to provide services beyond traditional dispensing. The American public appears generally receptive to receiving care in pharmacies. A 2022 poll of 1,006 U.S. adults found nearly three-quarters were open to a pharmacist prescribing them medications, and rates were even higher among younger adults.
At least 19 states have given pharmacists some level of provider status. In more than two dozen states, pharmacists now have the authority to prescribe a limited number of medications, including oral contraceptives, treatment for common infections and substance use disorders, and pre- and post-exposure prophylaxis for HIV. This expanded role often integrates with “test and treat” services, which involve point-of-care testing for infections like strep, flu, COVID-19, UTIs, HIV, and more.
How Far a ‘Thank You’ Can Go, And Other Things Your Pharmacist Wants You to Know
Navigating the healthcare system requires you to be both your own protector and your own advocate — and the pharmacy is no exception. Make sure your pharmacy has updated lists of all of your medications, OTC products, allergies, and medical conditions, says Dr. Jun. To ensure accuracy, request to review your profile with a pharmacy team member or look it over through your online portal. You can ask your pharmacist to update, add, or remove any information as needed.
Maintaining these accurate records is essential for proper screening of your prescriptions, notes Dr. Jun. Inspecting your prescription when you pick it up (or at least before you take it), she says, is also important.
“If a patient has a question, concern, or needs clarification about their medication, we not only encourage them to ask but view it as an essential part of ensuring their safety and success in treatment,” says Dr. Ahmad.
“If a patient has a question, concern, or needs clarification about their medication, we not only encourage them to ask but view it as an essential part of ensuring their safety and success in treatment,” says Dr. Ahmad.
And while it may be tempting to take out your frustrations on the person explaining why a certain medication isn’t available or ready, Dr. Jerominski emphasizes the importance of patience when interacting with pharmacy staff, noting that pharmacists often have little control over staffing levels or budget constraints.
“Pharmacists prioritize accuracy over speed,” adds Dr. Ahmad, who explains that prescriptions can’t be filled until they’re confirmed to be both safe and appropriate. “Rushing a prescription isn’t just unhelpful — it can compromise safety,” she says. Pharmacists need time to check your prescription for drug interactions, contraindications, and risk of side effects.It’s also worth remembering that pharmacists have no influence over insurance-related issues like copays, deductibles, or coverage denials.
And if you’re wondering how to support your local pharmacy workers, Dr. Ahmad says this: “A simple ‘thank you’ can mean the world to the person behind the counter.”
