The odds would seem stacked against someone opening an independent pharmacy today.
But for Emlah Tubuo, the owner and pharmacist in charge at the new Powell Pharmacy, fighting long odds -- and winning -- has been the story of her life.
Since she arrived in the United States in August 2003 from the Republic of Cameroon in central Africa with only $300 in her pocket, she has worked to get an education, find a home, build a family and start a business.
"Everyone looks at me and says, 'Are you OK? In this world of doom and gloom for pharmacies, you're opening?' " she said. "But my philosophy is that a pharmacist should be relational, not transactional, that a pharmacist should take care of patients like they're my mom or my dad or my child.
"As a pharmacist, my primary concern should be the well-being of my patients, not payments."
Tubuo's journey began in Cameroon, where she gained "intense respect" for preventive care and immunizations because she herself had suffered from such preventable diseases as malaria, typhoid fever and dysentery.
Although those illnesses kept her out of school from time to time, Tubuo, now 40, earned a degree in microbiology in Cameroon. She worked at a World Health Organization preventive health clinic, where she met "some pharmacists who came from the United States, and I admired them so much."
Inspired by their example, she traveled to the United States and earned a master's degree in molecular biology at Chicago State University before coming to Columbus to earn her doctorate at Ohio State University's College of Pharmacy.
She worked for eight years as a pharmacist with Kroger, then as an ambulatory care pharmacist for Nationwide Children's Hospital.
Somewhere along the way, she also managed to get married and have three children, ages 9, 7 and 4.
"Yeah, I've been through thick and thin," she said, chuckling. "But I never say, 'Why me?' I had the resilience not to break -- it makes me bulletproof. And I believe that whatever I've been through, I can pass on my resilience to people around me."
Last month, Tubuo bucked the odds again by opening her pharmacy, at 4004 Presidential Parkway in a small shopping strip near the Lazy Chameleon bar and eatery. A grand opening will be held June 6.
While independents still represent 35% of all retail pharmacies, the numbers have been shrinking. In 2017, there were 21,909 independent pharmacies in the U.S., down from 23,106 in 2011. The number is projected to fall below 20,000 before 2025.
Tubuo is definitely going against the trend, said Joe Sabino, former president of the Ohio Pharmacists Association and a second-generation pharmacist who has held a license for 50 years.
"It's very difficult, very difficult," Sabino said. "Years ago it used to be, if you went up High Street from downtown, there was a pharmacy on almost every block until you got to Clintonville. It's all gone.
"We've lost 160 independent pharmacies (statewide) over the last couple years, mostly due to the reimbursement levels that are set by the PBMs" -- pharmacy benefit managers, the middlemen representing insurers who decide when or whether they'll pay for drugs.
"Most all of the prescription business anymore is Medicare Part D or Medicaid," Sabino said. "These plans hire the PBMs to administer the drug programs for them, and the PBMs set the reimbursement level -- and you, the pharmacist, take it or leave it."
Tubuo is aware of the difficulties she faces.
"I have a chance to survive because we are not a high Medicaid space in this area," she said, "and because we're looking beyond the traditional pharmacy. We're finding a niche and doing innovative pharmacy practice."
That includes medication therapy management, or MTM, which helps patients better understand their illnesses and the medications used to treat them.
Tubuo is passionate enough about such services that she has also founded Emlah Consulting, a pharmacy consulting company that provides MTM services to independent pharmacies in central Ohio.
At the pharmacy, Tubuo's personalized care has been an immediate success among patients -- and source of good-natured banter among the OSU pharmacy students who work there as interns.
"She's branching out into nontraditional services." said intern Annie Tam. "We joke she's more of a greeter than a pharmacist."