The pharmacist workforce is shrinking. According to the 2024 National Pharmacist Workforce Study, the number of practicing pharmacists younger than 40 has declined from previous years, while more pharmacists report heavier workloads and longer hours than at any point in the past decade. The report warns that those pressures could make it harder for hospitals and health systems to fill critical roles — a challenge compounded in rural communities, where recruiting has long been difficult.
It is in places such as Tuba City, Ariz. — 320 miles from the nearest major city — that those shortages feel most acute.
At Tuba City Regional Health Care Corp., a tribally operated hospital in the Navajo Nation, that challenge is more than theoretical. When Carlette Norwood-Williams, PharmD, arrived as chief of pharmacy services in December, about 80% of pharmacist staff were contracted through outside agencies. Since her arrival, recruitment efforts have achieved a 60% reduction in expenses related to contracted staff. Her approach was not about perks or pay, it was about reimagining what a pharmacy career in “the middle of nowhere” could mean.
“You need to stop thinking of this location as a glass half empty,” she told her colleagues. “This is a glass half full, and here’s why.”
Tuba City is one of the few tribal health systems operating under a federal 638 contract, which allows it to function as a private, nonprofit organization rather than as part of the Indian Health Service. That independence has enabled Dr. Norwood-Williams to build what she calls academic alignment agreements with pharmacy schools in Arizona and neighboring states. Students rotate through Tuba City during training, and the best candidates are recruited before graduation.
“You meet them while they’re still forming ideas about where they want to be,” she said. “The goal is to build a relationship before they ever graduate.”
The approach has already produced results. Dr. Norwood-Williams’ growth and development programs have led to multiple staff promotions. Of those promoted, three originated from within Pharmacy Services at TCRHCC, while the remaining seven to 10 were professionals from other health systems who had previously been part of her pharmacy teams.
Recruiting people to rural Arizona is one challenge; keeping them is another. Dr. Norwood-Williams introduced leader rounding, a deliberate practice of checking in with every employee — not just about workflow or equipment, but about their lives. “What’s making you smile when you’re not at work?” she asks. The answers, she said, shape how she leads.
From there, she moves to what is going well, what could be better, and what support employees need from her. “If you don’t round, you’ll never find that out until it’s the worst of the worst,” she said. “People don’t quit their job; they quit their boss.”
The scheduling model she has implemented is equally intentional: Pharmacists can work seven days on, seven off, or four 10-hour shifts each week. The flexibility, she said, offsets the isolation. “I’m in the middle of nowhere,” she said, laughing. “So I give you an escape two weeks a month without using vacation time.”
For many pharmacists used to standard five-day weeks or rotating weekends, the schedule is a rare advantage. It offers extended breaks for those who want to travel home or spend time with family — something especially valuable in a remote area.
“A younger person, my kids, my grandkids, they want somewhere to be,” she said. “I’m OK with sitting down. But a younger person doesn’t want to stare at the sky. So you tell them that we have a great schedule for you.”
That schedule, she added, is part of why people come — and why they stay.
Retention, however, depends on more than work-life balance. Dr. Norwood-Williams said the key is growth. “Grow them to stay,” she said. “There are only so many promotional opportunities, but growth can also mean initiative, assignments and participation.”
For her, that means identifying strengths early and encouraging staff to pursue them, even if it eventually takes them beyond the pharmacy. She has urged technicians interested in informatics or data systems to move into new roles, sometimes even creating those positions through conversations with other departments. “It hurt me to lose them,” she said, “but I have pride in the careers that I’ve developed because of that.”
She has watched technicians become data leaders, corporate IT professionals, even specialists in nuclear medicine. Before leaving, she asks each to help recruit and train their replacement. “Stop thinking about yourself,” she said. “Give them what they need. Focus on others.”
Those departures, she added, strengthen the team rather than weaken it. They show others that advancement is possible and that the department values ambition. “They’ll never forget you for that,” she said.
