Rural Pharmacies in Trouble

An important story from The Rural Blog.

Medicare drug program is Wal-Marting rural pharmacies, CBS says

“What Wal-Mart once did to rural downtowns, Medicare is doing to the rural drug store.” That was how CBS correspondent Wyatt Andrews summed up his report last night on how the new Medicare Part D program for prescription drugs is hurting the small, independent pharmacies prevalent in rural areas — a story to which The Rural Blog has been calling attention for months.

“My life’s earnings have gone right out the window,” said Columbus, Miss., pharmacist Don Walden, the focus of Andrews’ report. “Walden says the problem is that seniors get Medicare coverage through private insurance companies, which in turn, have lowered the fees and reimbursements they pay him.” (Photo of Walden in his Medical Arts Pharmacy from

Walden is resisting chain pharmacies’ offers to buy his store, but Andrews lists several that have gone out of business: “Gone this year is the old Taylor Drug Store in tiny Granville, Ohio. There is no more Centennial Merit Drugs in Monte Vista, Colo. When Randy Spainhour closed down Penslow’s pharmacy in Holly Ridge, N.C., he mailed his license back blaming, the ‘low reimbursement of Medicare’.”

The Rural Blog reported Aug. 24 that a survey of more than 500 community pharmacists revealed that nearly nine out of 10 (89 percent) are getting less money and a third are considering shutting down since Part D started last Jan. 1. “The survey found that more than half (55 percent) of respondents said they have had to obtain outside loans or financing to supplement their pharmacy’s cash flow because of slow reimbursement by health care plans,” according to the National Community Pharmacists Association.

A May 8 item in The Rural Blog referenced a study that shows rural residents are paying more for drugs than urbanites under Medicare Part D prescription drug plan. The study by the Center for Rural Health Policy Analysis of the Rural Policy Research Institute reported that average monthly premiums for Medicare Advantage prescription drug plans vary from $6 in urban New Hampshire to $53 in rural Hawaii. Click here for the archived item and click here for the study.

Ed. Note:
I draw a lot of source material from The Rural Blog which is supported by the The Institute for Rural Journalism and Community Issues at the University of Kentucky. I recommend the site to anyone who likes the material on this site.

California Rural Hospitals

Nearly all of the rural hospitals in California are facing the risk of being closed by the state if they cannot meet new seismic building codes. The new codes are intended to make sure hospitals are still standing and operational after a major earthquake. The state has not provided funding or a funding mechanism to help small and nonprofit hospitals implement the changes.

The cost of upgrading all California hospitals to meet the new seismic codes likely exceeds $50 billion.

Rural Health Professional Shortage

Nearly the entire state of North Dakota is a “health professional shortage area.”


In prior years Canadian and other foreign doctors in the country on J1 visas have helped to fill the void in rural areas. J1 visa applicants are required to work in underserved areas, but the number of applicants for J1 visas is falling.

A hospital administrator in rural North Dakota says towns like his are getting left out in the cold as a result.

“We used to have 150 applicants,” Urvand said.

The hospital has had a physician vacancy for nearly a half year, with only a handful of applications. […]

Since 1994, the J1 visa program has cut the number of physician vacancies by half, while at any given time, there are still 20 vacancies statewide.

The same is true in Tioga. It made a couple of offers to physicians, but in both cases, the offer was turned down because the physician’s spouse didn’t want to make the move. […]

Since 1994, the J1 visa program has cut the number of physician vacancies by half, while at any given time, there are still 20 vacancies statewide.

The problem with spouse comfort is common, but so is cultural comfort.

Tioga Medical Center administrator Randall Peterson said he’s found that’s part of the reason some foreign physicians don’t want to come to small rural communities. […]

Yet another factor is a separate visa program, called H1B, which does not require rural service.

In effect, one visa program undercuts the other.

It’ll get worse. By 2020, the physician shortage will reach 200,000, with small towns feeling the hardest pinch. […]

Prior to September 11, 2001, the USDA administered a program to recruit physicians to practice in rural areas on J1 visas, and they were successful in bringing at least 3,000 doctors to underserved rural areas during the 1990s. The USDA terminated its program in early 2002.

The department of Health and Human Services has since reinstituted a much more limited program that is not expected to be able to keep up with demand in underserved areas.

Urban Hegemony

In response to a shortage of dentists in rural Alaska, local leaders decided to send Alaska natives to New Zealand to be trained as dental therapists. The first eight trainees are now helping to perform basic dental work in remote areas of the state.

The American Dental Association (ADA) isn’t happy about it.

A recent court case filed by the ADA seeks to prohibit foreign trained dental therapists from practicing in Alaska. While much of the rest of the developed world has such practitioners (think nurse practitioners for dentistry) the U.S. has no such category. The ADA argues that the practice will “put people at risk.”

As if Alaska’s current lack of dentists and resulting high tooth decay rates don’t “put people at risk.”

Rural areas need to seek creative solutions to deal with the low numbers of healthcare providers in their areas. Dental therapists (good enough for New Zealand, Canada, Australia and Great Britain) should be a part of the solution.

The ADA is also taking their fight to the U.S. Congress where they hope to limit the spread of the program beyond the state of Alaska.

Say What?

From the Brownfield Ag Network.

Vertical integration protecting against bird flu

Because nearly all commercial poultry production in the United States is company-managed — a system known as vertical integration — production processes are safer and more efficient, said Todd Applegate, Purdue Extension poultry specialist. […]

“The poultry industry is the most vertically integrated of all of our livestock industries,” Applegate said. “As we try to reduce the risk of bird flu in this country, having full control over the entire production process is probably a good thing.” […]

While wild fowl carrying the virus could enter the U.S., it is unlikely those birds could come in contact with chickens and other commercially raised poultry, Applegate said. In vertically integrated companies, poultry are carefully monitored to ensure optimum health and production quality, he said. Biosecurity measures are tight throughout the production process, especially on the parent farms and hatcheries, Applegate said. […]

Ops. He forgot to mention that the reason these operations are so “carefully monitored” and require such “tight biosecurity” is that if a bird flu outbreak did occur within the U.S. poultry industry the extreme confinement of animals will contribute significantly to the challenge of reigning the disease in.

In fact the high level of concentration (just four companies control over 50% of US poultry production) is in part to blame for the emergence of this new strain of bird flu.

Emergence of variant strains of both infectious bursal disease and avian bronchitis viruses add to the problems of selecting appropriate vaccines and programs for administration. It is evident that a high concentration of poultry in close proximity allows dissemination of variants. Within three years of the emergence of the Delaware variants of IBDV, virtually the entire industry east of the Mississippi was affected with these strains. There was evidence that the Delaware IBD viruses are now the predominant serotypes in Central America, requiring adjustment of both parent and broiler vaccination programs.

The Washington Post wrote as early as February of this year that the growing concentration in South East Asia poultry production is contributing to the spread of bird flu.

[With] chickens now packed into farmyards alongside other livestock, international health experts warn that conditions are set for a bird flu pandemic that could kill millions worldwide if the virus developed into a form capable of spreading among humans.

Writing in response to the Post, Applied Anthropologist Robert Nigh wrote the following for the Effect Measure blog.

The picture that is emerging, though, is that the rapid development of the confined poultry industry and associated technological changes and export trade has resulted in the appearance and rapid propagation of new, highly virulent strains of poultry diseases, some of which affect humans. These new strains not only represent a major threat to the future of poultry production but have resulted in serious potential threats to human health with very high costs for society.

The solution to this problem is not more of the same, i.e. more high tech solutions, drugs, “biosecurity ” and ” best practices ” applied to confined poultry operations, but rather to reverse the trend, back up from this dead end, abandon large chicken confinements and return to decentralized production in small flocks widely distributed in the countryside. This also implies that long-distance, ” global ” trade in poultry products would be largely abandoned.

Such conclusions may fall outside of Purdue Extension poultry specialist’s preview, but these conclusions are likely more palatable in the long run than any increased biosecurity measures can ever be.