Distribution and Accessibility of Board-Certified Pharmacists: A Cross-Sectional Geospatial Study

Health care access remains a challenge across the United States, particularly in rural areas. Board-certified pharmacists (BCPs) have the knowledge and skills to provide high-quality direct patient care and are a potential resource to improve health access and outcomes. However, their distribution within rural and underserved areas has not been systematically evaluated. This study aimed to characterize the geographic distribution, composition, and accessibility of the BCP workforce within the United States.

A cross-sectional geospatial study of BCPs was conducted using the 2026 Board of Pharmacy Specialties public database. BCP locations were classified using 2020 Rural-Urban Commuting Area (RUCA) codes, assigned to counties using federal crosswalk files with US Census Bureau county code validation, and examined in relation to designated health professional shortage areas (HPSAs). Analysis was performed at the postal code, county, and state levels. Provider density was calculated using 2025 census estimates, and the distribution of certification types was analyzed across geographic categories.

Data for 47 134 BCPs were extracted, representing 52 941 certifications. Of those, 94% were in metropolitan, 3.8% micropolitan, and 2.3% small-town/rural areas. BCPs were absent in 44% of counties. In counties with BCPs, the median county resident-to-BCP ratio was 12 354:1, and BCP density ranged from 0.3 to 123.1 per 100 000 (coefficient of variation [CV] 101% vs. state-level CV of 29%). The proportions of BCPs in geographic HPSAs were 3% and 18.9% based on postal code and aggregated county designations, respectively, with 59% of HPSA counties having none. Across RUCA categories, representation of certifications applicable to broader practice settings increased as area size decreased.

BCPs are concentrated in metropolitan areas, limiting access to specialized medication management services for patients in small-town and rural areas. Development of workforce benchmarks and targeted strategies to increase BCP representation in underserved areas is warranted.