The accessibility-sustainability paradox: Optimizing the community pharmacist's role in public health

Community pharmacists are among the most accessible health professionals and play an increasingly vital role in advancing public health. The COVID-19 pandemic magnified their contributions and highlighted longstanding structural vulnerabilities in community pharmacy practice. As community pharmacies close and workload intensifies, the infrastructure that once ensured access to care is eroding. This commentary explores the "accessibility-sustainability paradox" facing community pharmacy: pharmacists are essential to public health, yet their service environments are increasingly untenable due to misalignment between expanded clinical expectations and unsustainable practice and payment models. Contributing factors include the growth of pharmacy deserts, workforce burnout, and payment models that fail to support nondispensing services. Despite demonstrated impact, many pharmacy-based public health initiatives lack mechanisms for reimbursement and, thus, long-term viability. Aligning scope of practice expansion with sustainable reimbursement, workforce support, and practice models is essential to preserving community pharmacy as a public health access point. Without change, pharmacists will continue to face untenable expectations to meet public health needs without the necessary resources. Ensuring sustainable support for community pharmacists is therefore not only a workforce issue but a public health imperative.