A Look Back: Unveiling the Realities of Pharmacy with Kachi Eke, RPh
The first Last Zebra guest was a childhood friend with a PharmD who told me, on tape, that a staff pharmacist clears less disposable income than a Chick-fil-A worker. Two and a half years later, the profession he described is the one every American pharmacy walkout is now describing back.
The first person across the microphone from me on The Last Zebra was not a pulmonologist or a surgeon. It was Kachi Eke, a pharmacist I have known since Nigeria, then Jamaica, then Thibodaux, Louisiana — the kind of friend who does not perform for a recording. We taped on October 30, 2023. I did not know it then, but pharmacists at CVS and Walgreens were walking out that same week for the reasons Kachi was calmly describing to me in real time.
I keep coming back to why I started with a pharmacist and not a physician. If you want to understand how American medicine actually reaches a patient, you don't start with the physician who wrote the prescription. You start with the pharmacist who explains, six times a shift, why the insurance denied it — and who, Kachi told me, is often "the most accessible" clinician in the whole system.
Three things Kachi kept saying
The money doesn't add up. I did not push him toward this. He walked himself there. On a staff pharmacist salary, he did the arithmetic out loud: rent, utilities, phone, student-loan servicing. Then the line I still remember:
I tried to complicate it. I pointed out the Chick-fil-A worker has to pay their own bills too. Kachi conceded the point and then landed the harder one: "In disposable income, in headroom, if you got a second job as a Chick-fil-A worker, you've been making more than a pharmacist. Which is incredible." The median PharmD in his cohort graduated owing $158,000 (AACP, 2023). His math wasn't hyperbole. His math was the survey.
The corporate part doesn't add up either. He said something I did not expect to be quotable and it turned out to be the whole thesis:
The drastic action started three days later. Pharmacists walked out at Walgreens and CVS over understaffing, unsafe conditions, and a business model that treated a doctorate-level clinician like a fulfillment worker. Kachi did not predict it. He described the pressure the walkouts were about to release.
The invisibility doesn't add up either. He said, of the pandemic:
I finished the sentence for him — "excluded from" — and he agreed. The people running your inpatient dosing during the worst year of American medicine were not on any Thank a Hero poster. In my experience, that omission was not accidental. It reflects a professional hierarchy that hospital pharmacists have been quietly propping up, from behind a wall, for decades.
What has changed since we recorded
Pharmacy school enrollment has fallen sharply, and some programs have closed entirely (UW CHWS, 2024). BLS still projects roughly flat pharmacist employment through the early 2030s. Kachi, in October 2023, was already calling for "counter-programming" — his word for people in the profession telling honest 22-year-olds not to mortgage their lives against a salary the corporate side is no longer willing to pay. The market has quietly done the counter-programming for us. Applicants stopped applying. That is not the correction anyone wanted.
What a patient should take from this
Two things.
One: when your pharmacist looks tired, they are tired. They are also probably the most accessible healthcare professional in your zip code. Ask them the medication question you were saving for your six-month follow-up. That is what they trained for.
Two: if the pharmacy line is long, the problem is not the person handing you the bag. The problem is a business model that decided a doctorate-level clinician was a fulfillment worker. Treat them accordingly.
Why this episode still matters
I could not have known, in October 2023, that the first conversation on this podcast would end up being small pre-history to a national labor story. Listening back, though, Kachi was already telling us the story. He was doing it the way a pharmacist tells you anything important — quietly, in the middle of doing three other things.
That is the sound this show has been chasing ever since.
If you have a moment, hit reply and tell me: who is the healthcare worker in your life whose job you have never fully understood? I read every reply.
Dum spiro, spero.
— Ugo
Doc Populi is a weekly essay by Dr. Ugo Ezema on medicine, culture, and the space between them. If this landed, forward it to a friend, or subscribe below to get the next one Wednesday.