Last week, I drove through my hometown in rural Mississippi and found myself thinking about the pharmacies that no longer exist.
When I was growing up, our town had five or six independently owned pharmacies that I can remember, perhaps even more before I was born. One by one, they disappeared. Some were purchased by regional or national chains. Others simply closed. Today, only one independently owned pharmacy remains.
These pharmacies weren't simply places where prescriptions were filled. The pharmacists often owned the businesses, lived in the community, and cared for multiple generations of the same family. They watched children grow up, leave for college, marry, and eventually bring their own children back to the same pharmacy.
Looking back, what I miss isn't independent pharmacy simply because it was independent. It's the continuity that the model of practice made possible.
As a pharmacist myself, I want to be very clear: Today's pharmacists care every bit as deeply as the pharmacists who came before them. I know because my own journey into pharmacy began during a period when the profession was already starting to change.
I started working as a pharmacy technician the summer after high school while completing my pre-pharmacy coursework at a local community college. One of my first pharmacy jobs was working for Mr. William Hamill, whose family had owned Hamill's Drug Store in my hometown for decades. By the time I worked there, the store had recently been acquired by Fred's, a regional chain. The Fred's signs were up and company policies were in place, but remnants of the old neighborhood pharmacy remained, including store charge accounts that had been grandfathered in after the sale.
And then there was Mr. Hamill.
Everyone wanted to talk to him. It didn't matter whether someone had a serious question about a medication side effect or simply wanted to know what time the store closed. Somehow, only Mr. Hamill's answer would do. I remember being fascinated by how much he knew about the people walking through the door. Before a computer screen could tell him, he seemed to already know the patient's name, medications, medical history, and usually something about their family. It was almost as if he carried the pharmacy's patient database around in his head.
At the time, I thought Mr. Hamill simply had an extraordinary memory. Looking back, I realize I was seeing what decades of continuity in patient care could create.
The following summer, I took a pharmacy internship with Walgreens in Knoxville, Tennessee, and the contrast was striking. Multiple pharmacists rotated through the store. They were knowledgeable and cared about their patients, but patients were less dependent on any one individual because the system itself was no longer built around a single pharmacist who had cared for the same families for decades.
Over the years, pharmacists have been asked to do more than ever before. They administer vaccines, provide clinical services, navigate increasingly complex insurance requirements, supervise technicians, resolve medication shortages, counsel patients, and safely verify hundreds of prescriptions. At the same time, staffing has become leaner and productivity expectations have continued to grow.
The gradual erosion of relationship-centered care is not a reflection of declining compassion among clinicians. Rather, systems that increasingly reward efficiency, productivity, and standardization can leave less room for the human interactions that build trust.
Recently, I read a JAMA Network Open study examining private equity acquisition of substance use disorder treatment facilities. The findings were both encouraging and concerning. After private equity acquisition, facilities experienced an increase in patient volume and prescription volume for buprenorphine. At the same time, 90-day and 180-day treatment retention decreased.
Reading the study, I found myself thinking less about private equity than about relationships. Why is retention considered one of the most important quality measures in addiction treatment?
A buprenorphine prescription can begin treatment, but a prescription alone cannot create a therapeutic relationship. Patients stay engaged because someone notices when they miss an appointment. Someone remembers the conversation they had last month. Someone celebrates a recovery milestone or recognizes when they seem discouraged before they say a word.
Those moments don't appear in pharmacy claims data. They don't fit neatly into quality dashboards. Yet every clinician understands their value.
Healthcare has become remarkably good at measuring transactions. We measure patient volume, productivity, wait times, quality scores, and countless other performance indicators. What we struggle to measure is whether patients feel known.
We don't measure whether clinicians have enough time to ask one more question. Whether they recognize the subtle change that tells them something isn't right. Whether they have the autonomy to exercise professional judgment when an individual patient's needs don't fit neatly within a standardized process.
And we certainly don't have a metric for the kind of trust that develops when someone has cared for you long enough to know your story before opening your chart.
Efficiency has unquestionably improved many aspects of healthcare. But access and quality should not have to exist in opposition. When efficiency and productivity become dominant measures of success, we risk overlooking something equally important: the time and continuity required to build trust.
As I look at today's healthcare landscape, I sometimes wonder whether medicine is beginning to travel the same road pharmacy traveled decades ago.
We cannot undo what happened to community pharmacy. But perhaps medicine can learn from it. If medicine is beginning to travel a similar road, the most important question isn't simply who will own physician practices 20 years from now. The more important question is whether patients will still know their physician. And whether their physician will still have the time to know them.
