In the first-ever survey to look at the drug shortage problem through the lens of physicians, AMA researchers found that drug shortages affect nearly 90% of primary care physicians, leading to treatment delays or the need for an alternative drug. In rare instances, severe adverse outcomes were reported.
At their highest level in a decade, drug shortages are driven by numerous factors such as supply chain disruptions, few manufacturers, regulatory hurdles, natural disasters and demand surges.
“It’s a pervasive problem. We have seen significant patient challenges with reporting on GLP-1 shortages and stimulant medication shortages for children with ADHD, as well as antibiotic shortages,” said Jennie Jarrett, PharmD, MMedEd, PhD. She is the AMA’s director for science and drug policy.
Much of the news focuses on hospitals and inpatient practice, such as the IV fluid shortage that occurred when Hurricane Helene hit Western North Carolina. Few studies have explored the impact of drug shortages on outpatient physician practices and how it affects treatment, patient outcomes, and administrative burden.
Between July and August 2024, Jarrett and colleagues conducted a cross-sectional, web-based survey among primary care physicians affected by medication shortages, publishing their results in a JAMA Network Open research letter. Of the 1,281 people screened, 902 met eligibility criteria. Participants primarily worked in family medicine practices (42%), outpatient-only settings (75%), urban locations (78%) and private practices (71%).
“This is one of the first pieces of research that really highlights how it's impacting physicians and patients in an outpatient realm in their communities,” said Jarrett, who co-wrote the research letter with AMA research associate Katlyn Dillane, MPH, and policy analyst Geoff Hollett, PhD.
Shortages led to Rx changes, care delays
The survey revealed that drug shortages negatively affect one in five patients. Nearly 88% of physician respondents reported experiencing drug shortages within the previous six months.
“What surprised me most was the severity of the adverse outcomes we observed,” said Jarett. A small but significant minority (2%) reported that a patient death may have happened because the patient couldn’t access their medication.
Among specific drug categories, endocrinology (54%), stimulants (52%), infectious disease (26%), pulmonology (17%), and pain management (14%) suffered the greatest impact of shortages.
Most primary care physicians (87%) reported that drug shortages led to changes in the quality of care. The most common practice change was switching to an alternative, less preferred medication (92%) followed by postponing treatment (63%).
Pediatricians were less likely than family doctors or internists to delay prescribing. “For children, postponing treatment isn’t usually an option. If a young patient can't get an antibiotic because they have an ear infection or strep throat, it puts them at risk for hospitalization from complications of their infection, such as sepsis”, explained Jarrett. “Likewise, children with ADHD need their medications to function well in school.”
More shortages, more stress
Drug shortages also led to more prior authorization requests, overtime work and higher levels of burnout. To manage the increased workload, practices had to extend hours or hire additional staff.
“When you're having to choose a different medication because of a drug shortage, it often requires a prior authorization. There's extra insurance adjudication that has to happen, which takes physicians and their staff time and effort” Jarrett explained.
Medication effectiveness (89%), side effects (81%), patient out-of-pocket costs (78%), prior authorization requirements (73%) and route of administration (58%) were the key factors driving drug-shortage management. Additionally, 44% of physicians worried that no suitable substitute was available.
Thirty percent had to prescribe combinations of alternative medications, and 11% expressed concern about potential medication dispensing errors.
The AMA is fighting to fix prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles. And as the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine®.
Learn more with the AMA about the connection between physician burnout and prior authorization.
Communication of drug shortages is lacking
Physicians most often learned about drug shortages from patients or community pharmacists instead of proactive, formal channels. This contributed to widespread frustration, workplace stress and delays in care.
“Ideally, earlier communication of drug shortages would help physicians know how and when to prioritize certain medications, potentially reducing the impact of drug shortages”, said Jarrett. “Transparency in the drug supply is challenging, which limits the ability to act proactively.”
Onshoring or nearshoring drug manufacturing is another solution that would help stabilize the supply chain. But this strategy also has challenges, said Jarrett. Hurricane Helene demonstrated that systems can still be disrupted, even when production is domestically located.
AMA actions to address drug shortages
The survey results underscore the harmful effects of drug shortages on patient care, primary care operations, and physician well-being, the investigators concluded.
The AMA has been taking action on several fronts to address drug shortages. The AMA has policy opposing laws, regulations or business practices that create artificial scarcity of drugs. The AMA also urges drugmakers to accelerate the adoption of advanced manufacturing technologies such as continuous pharmaceutical manufacturing.
The AMA participates in the Drug Shortages Task Force, convening over 20 organizations to raise awareness of the severe harms of shortages and the causes behind them, provide insights to inform data-driven solutions, and advocate for reforms in a collaborative and productive manner. The AMA offers further information to help physicians address and manage drug shortages, highlighting the AMA Council on Science and Public Health’s annual report that provides an overview of drug shortages and policy recommendations.
