Sole pharmacists: Out on one’s own

Australia’s cities hug the coast, but in rural and remote areas, sole pharmacists are providing communities with an essential service. Some may think it’s isolating, but many wouldn’t change a thing.

Around 1800 registered pharmacists work across outer regional to very remote Australia. It’s about a 10th of the number working in major cities and, in a country the size of Australia, that can mean a long time before seeing a colleague.

The challenges pharmacists face working in remote and rural Australia, especially as a sole pharmacist, are well recognised. ‘There’s no backup if you are sick, you may be the only health professional consistently in that community, and you can miss out on that incidental professional interaction, or even just knowing what is happening in our own profession,’ said Helen Stone, PSA’s State and Territory Manager for South Australia and the Northern Territory.

But the majority of those working in rural Australia, as sole pharmacists or as part of a small practice, love where they work and have found ways to overcome the challenges.

Chief among those ways is technology, which has made it easier both to run the administrative aspects of a sole pharmacist practice, and to keep in touch with one’s peers, as well as stay across best practice via online webinars and resources.

South of Darwin, pharmacist Sam Keitaanpaa MPS said initiatives like PSA’s Rural Pharmacists Special Interest Group page on Facebook were good, but it was often up to pharmacists to connect.

‘The best way is to identify other healthcare professionals working in the area and just start talking about the work; what’s good, what’s bad, what’s something that is needed,’ he said.

Moving forward

Contrary to what many would assume, rural practice offers many chances for career advancement. Mr Keitaanpaa said he originally moved rurally because it gave him the opportunity to improve the way medicines are used and how the community engages with the profession.

‘The career advancement is a major plus, as there aren’t many others working to do what I’m doing in my community,’ he said. ‘I might not get to deal with the sexy, high-cost items or novel agents as much as possible, but I can spend my time talking and upskilling people in medicines use.’

Even the physical isolation isn’t always a barrier to career advancement or participating in research. Hannah Loller MPS has worked in rural and remote Australia for 20 years and is currently based in Karoonda, 150km east of Adelaide. ‘There are interesting projects – Quality Use of Medicines projects – in rural areas, and it doesn’t restrict you from taking on roles that don’t fit the traditional model of what we think pharmacists do,’ Ms Loller said.

Currently, she is PSA’s Project Coordinator on the Integrating Pharmacists within Aboriginal Community Controlled Health Services to improve chronic disease management (IPAC) project, in partnership with James Cook University and the National Aboriginal Community Controlled Health Organisation (NACCHO).

‘The IPAC project involves embedding a pharmacist into 22 ACCHOs across the Northern Territory, Queensland and Victoria to research how it improves health for Aboriginal clients with chronic disease. Their role is not focused on supply, instead, they will consult with clients and clinical staff to improve how medicines are prescribed and used,’ said Mike Stephens, NACCHO’s Director of Medicines Policy and Programs.

Despite the distance, Ms Loller is passionate about the opportunities for such work in rural Australia: she coordinates with pharmacists in Queensland, the Northern Territory and Victoria as part of the project. ‘I don’t feel constricted that my only roles can be either community or hospital,’ she said.

Working in rural and regional Australia also offers more opportunity to be involved with Aboriginal and Torres Strait Islander healthcare and closing the gap. ‘Currently there are around 10 pharmacists at AACHOs who would be considered “practice pharmacists”, Mr Stephens said.

Many more pharmacists from community pharmacies and other external organisations have roles across Australia where they work closely with the ACCHO team,’ Mr Stephens said.

Logistics and access to other services can be particularly difficult in rural Australia. In Stansbury in South Australia, pharmacist George Kokar said even getting stationery can be a mission. In the Northern Territory, Mr Keitaanpaa said identifying suppliers and arranging deliveries is a large part of his work. ‘It’s an ongoing game of locating a supplier, identifying delivery times, working out a reasonable cost for clients, and then how they will transport it home if it is cold-chain or controlled medicine,’ he said.

Keeping the balance

Out in far west South Australia in Ceduna, pharmacist Ken McCarthy MPS said rural work is demanding and had advice for those looking to move rurally: ‘You’ve got to keep fit and keep well. Try and have a break every now and then. It’s an all-consuming commitment, but it’s very rewarding as well, so the benefits far outweigh the disadvantages.’

Ms Stone echoed Mr McCarthy’s sentiments and said the rewards are often connected to working in the bush. ‘It can be challenging to realise you aren’t an anonymous person when you are in a rural community – everyone knows everything about everyone. But this can also be one of the greatest joys – having a sense of belonging and community,’ she said.

George Kokar – Stansbury, SA

The small town of Stansbury sits on the coast of the Yorke Peninsula, just over 200km west of Adelaide. George Kokar and his wife established the town’s pharmacy nine years ago and are now an integral part of the community. ‘I grew up in a neighbouring town and just love it. The beaches, the scrub, the sport, the people – also the lack of people,’ Mr Kokar said.

They pack onsite for about 100 clients in local nursing homes and the community, and while they have two pharmacy assistants, Mr Kokar is the sole pharmacist. ‘Over lunch breaks, I help cover the shop and bank agency as well as the dispensary,’ he said.

It also means Mr Kokar is largely responsible for running the business. ‘My wife does our accreditation procedures and templates, but apart from that it would be me,’ he said.

Mr Kokar has found the sense of belonging in rural Australia makes the work worthwhile.

‘You become a big part of the community, and in the country, people will often let you know how important you are to them, which is quite satisfying,’ he said.

His advice for other pharmacists considering moving to a rural or remote practice: ‘Do it! it might seem hard at first, but it’s extremely rewarding in all aspects.’

Alex Page MPS – Broken Hill, NSW

Broken Hill is about as far west as you can get in New South Wales: 50km from the South Australian border. Pharmacist Alex Page is based at CP Peoples Chemist in the town, but a partnership with the Royal Flying Doctors and the Maari Ma Aboriginal Health Corporation sees him providing services across an area the size of France, spanning SA, NSW and Queensland.

‘I could be working at CP Peoples Chemist providing pharmacy services to families in three different states in the same day, or working with Indigenous clients in Broken Hill, or visiting the small communities of Menindee and Wilcannia,’ Mr Page said.

Mr Page grew up in rural Australia and spent some time working in a city pharmacy before moving to Broken Hill. ‘In the city, I found there was a stronger focus on you and the other pharmacies in the area competing hard for market share,’ he said. ‘I wanted to work more remotely as a challenge, but also because I knew so many opportunities were available that I couldn’t get in a metro setting.’

He also says the lifestyle is tough to beat. ‘No traffic or commute times coupled with a very close network of friends and colleagues makes for a very high quality of life. Living on the doorstep of the Outback, it’s very difficult to get bored living here.’

Support and services available

Working in rural pharmacy in Australia, particularly as a sole pharmacist, has its challenges. But online resources and government grants are helping address those issues and keep pharmacists connected, no matter where they’re located.

The Pharmacists’ Support Service is a great place to start for pharmacists who may be stressed or in need of advice. For rural and remote pharmacists in particular, PSA’s Rural Pharmacists Special Interest Group recently launched a Facebook page to help connect rural pharmacists and provide them with a direct forum. The page already has almost 200 members – pharmacists working right around regional Australia – making it a good aid for connecting, sharing and getting support from others working in similar conditions.

PSA also offers online CPD courses, and a range of online practice support tools and resources that rural pharmacists can access from anywhere. Beyond the online tools, PSA also runs workshops and networking events to help pharmacists connect. ‘Be a part of PSA and local health networks and go to anything and everything that is on offer in your wider region,’ Ms Stone said. ‘Start your own network if none exists – connect with your local PHN [Primary Health Network] who may have small grants available to start a networking group or have events in your area.’

There are also rural workforce programs under the Sixth Community Pharmacy Agreement that provide additional funding to rural pharmacists. There are eight programs, including an emergency locum service as well as $2000 grants for professional development. ‘The ability to attend education and be reimbursed for travel is useful as it removes the personal cost barrier that doesn’t exist if you’re in Sydney or Melbourne,’ said Mr Keitaanpaa.