question: The number of applicants to US pharmacy schools has been declining since 2013, leading to a national enrollment crisis. Enrollment challenges threaten the viability of many pharmacy programs. Some schools are better equipped than others to confront the risk of having to downsize or close, creating survival-of-the-fittest conditions. Four potential risk factors have been identified based on how applicants might perceive the comparable value of respective programs. Schools with lower risk are public, established before 2000, located within an academic health center, and traditional (ie, four-year) programs. The Academy cannot sustain more than 140 schools much longer. Market forces are establishing a new equilibrium between the number of graduates and the availability of pharmacist jobs. As more jobs become available, more applicants will apply. Until then, the fittest Doctor of Pharmacy programs will thrive, while others might have to downsize to survive, and the weakest will be at risk of extinction.