If you run (or work in) a private psychiatry practice in the United States, you’ve probably learned a new clinical skill during the nationwide stimulant shortage:
advanced pharmacy logistics. It’s not in the DSM. There’s no billing code for it. Yet it has quietly become one of the most time-consuming “treatments” we provide.
Stimulant medicationsmost commonly prescribed for ADHDare a cornerstone of care for many patients. When supply is unreliable, the impact isn’t just a mildly inconvenient
scavenger hunt. It changes workflows, clinical decision-making, patient trust, and the financial health of a practice. It can also turn a calm refill cycle into a weekly
crisis that lands on your front desk, your nurses, and your clinical inbox like a surprise group project.
This article breaks down what the stimulant shortage looks like inside a private psychiatry practice: the operational drag, the clinical ripple effects, and the practical,
ethical, and regulatory realities that shape how psychiatrists respondwithout turning your day into an endless game of “Guess Which Pharmacy Has It.”
Quick primer: what “stimulant shortage” really means (in real life)
“Shortage” rarely means “zero supply everywhere.” In practice, it often means:
- Some strengths are unavailable while others are fine.
- Immediate-release might be scarce while extended-release is intermittently available (or vice versa).
- Brand-name supply may differ from generics, and availability changes week to week.
- One wholesaler has it, another doesn’t. One ZIP code has it, the next ZIP code is a desert.
This matters because psychiatry relies on continuity. A patient who is stable on a specific stimulant formulation often isn’t thrilled to “just switch” because the pharmacy
shelves are moody. Even when switching is clinically reasonable, it can require added monitoring, new prior authorizations, new side-effect counseling, and more frequent
follow-ups.
Why private practices feel the shortage differently than big systems
Large health systems may have centralized pharmacy teams, embedded prior authorization staff, population health workflows, and institutional leverage with payers and
pharmacy networks. Private practicesespecially solo or small-group clinicsare built for personalized care, not supply-chain chaos.
In a private setting, shortage pressure typically concentrates in three places:
- The inbox: refill requests, “out of stock” messages, and urgent patient calls.
- The schedule: unplanned visits to reassess treatment, document changes, and manage symptoms.
- The front office: pharmacy callbacks, insurer paperwork, and frustrated (sometimes panicked) patients.
The result is a mismatch: private practices are optimized for clinical care, while the shortage forces them into high-volume coordination work that is often uncompensated.
The operational impacts: the hidden tax on time
1) Refill volume balloonsand it’s not “just a refill” anymore
During stable periods, stimulant refills can be structured: a predictable cadence, clear monitoring expectations, and routine documentation. During a shortage, refill
workflows become nonlinear. A typical chain looks like this:
- Patient reports the medication is unavailable.
- Staff calls pharmacies (or the patient does, then reports backsometimes with conflicting information).
- Prescription is resentpossibly multiple timesuntil stock is found.
- Insurance rejects an “early fill” or flags a new formulation.
- Practice scrambles to document medical necessity and manage timing rules.
Multiply that by dozens (or hundreds) of patients, and your clinical day starts to look like a customer support queueexcept the stakes include academics, employment,
safety, and mental health stability.
2) Pharmacy communication becomes a full-time sport
Pharmacies are dealing with their own constraints: allocation limits, supplier backorders, staffing shortages, and strict controlled-substance policies. Many will not
disclose inventory over the phone, and some won’t confirm stock until the prescription is receivedcreating a frustrating loop for everyone.
Private practices often respond by building “pharmacy maps”: notes on which locations tend to stock which formulations, how each pharmacy wants prescriptions sent, and
what documentation frequently triggers delays. It’s practical, but it also shifts time from patient care to system navigation.
3) Prior authorizations spike (even when your plan was “no surprises”)
Shortages force substitutions. Substitutions trigger payer scrutiny. Even a clinically straightforward adjustment can cause administrative delays. This creates an unfair
dynamic: the practice is making changes because supply is unstable, yet the burden of proof lands on the clinician and staff.
4) Scheduling gets messyand “urgent” becomes the default
When medication access breaks down, patients often need earlier follow-ups to reassess symptoms, side effects, functioning, and comorbid anxiety or mood changes.
Practices may experience:
- More short-notice visits
- More crisis calls (“I have finals next week” / “I’m about to lose my job”)
- More requests for documentation for school/work accommodations
It’s clinically appropriate careyet it strains appointment availability and increases clinician burnout.
The clinical impacts: when supply shapes treatment
1) Symptom rebound is realand it’s not always subtle
For many patients, abrupt gaps in effective ADHD treatment can lead to reduced attention, increased impulsivity, disorganization, emotional dysregulation, and sleep
disruption. That can cascade into:
- Work or academic impairment
- Increased anxiety from falling behind
- More family conflict (especially in households already stressed)
- Higher risk of missed appointments and missed refillsbecause ADHD itself impairs planning
The shortage can therefore amplify the very symptoms that make medication coordination difficult. It’s a self-feeding loop, and it’s exhausting for patients and
clinicians.
2) Switching medications isn’t a simple swap
Even within the same general category, different stimulant formulations can have different onset timing, duration, side-effect profiles, and patient “fit.” Switching can
mean returning to a trial-and-monitor cycle that the patient had already completed successfully years ago.
Clinically, psychiatrists may need to consider:
- Comorbid conditions (anxiety, tics, mood disorders, substance use risk)
- Cardiovascular history and side-effect tolerance
- Functional demands (school schedule, shift work, driving)
- Patient history of response to prior agents
In other words: the shortage can push the practice toward “treatment driven by availability,” which is the opposite of personalized medicine.
3) Non-stimulant supports become more important (and sometimes overdue)
The shortage has nudged many practices to strengthen multimodal ADHD carebecause relying exclusively on one medication supply chain is a risky business plan for a brain.
Common practice-level shifts include:
- More emphasis on behavioral strategies, coaching, and skills-based therapy
- Revisiting sleep, exercise, and routine supports (unsexy, but powerful)
- Considering clinically appropriate non-stimulant medications when indicated
- Using school/work accommodations thoughtfully (without turning paperwork into a second career)
Done well, this can improve long-term resilience. Done under pressure, it can feel like “we’re improvising because the system failed.”
Regulatory and compliance realities: why “just send it” is not an option
Stimulants are controlled substances. That comes with strict prescribing rules and documentation expectations, plus state-by-state variation. During shortages,
private practices may face additional compliance friction:
- More frequent prescription changes: Each change needs appropriate clinical rationale and documentation.
- More coordination across pharmacies: Practices must avoid duplicate prescriptions and ensure accurate reconciliation.
- More payer scrutiny: “Early fill” flags can occur even when the driver is supply disruption.
- More reputational risk: A practice can be perceived as “problematic” if pharmacies see frequent stimulant resends without context.
Telehealth policy has also played a role in access and prescribing workflows. Pandemic-era telemedicine flexibilities for controlled substances were extended through
December 31, 2025, with ongoing federal rulemaking discussions continuing beyond that timeline. For private practices, this creates planning uncertainty: workflows built
around telehealth access may need adjustment depending on future requirements.
Patient trust, frustration, and the “relationship strain” nobody warns you about
Psychiatry is relationship-driven care. The stimulant shortage tests that relationship in unique ways because patients may experience the problem as:
“My doctor isn’t helping me.”
Meanwhile, the clinician experiences it as:
“I am helping you, but I don’t control manufacturing, quotas, distributors, or pharmacy allocation.”
In private practice, where patient loyalty and word-of-mouth matter, the trust impact can be significant. Practices often report:
- More tense phone calls and portal messages
- Higher risk of missed payments or canceled appointments when patients feel unsupported
- More requests for exceptions, urgent scheduling, or “somethinganythingtoday”
- More emotional labor for staff who didn’t sign up to be lightning rods
A shortage can create a subtle but real moral injury: clinicians know what works, but they cannot reliably deliver it. That’s hard on the doctorand often even harder on
the patient who is trying to function in school, at work, or as a parent.
Financial effects on a private psychiatry practice
The stimulant shortage affects practice revenue in contradictory ways:
- More work: More messages, more administrative tasks, more follow-ups.
- Not always more billable care: Many of the most time-consuming tasks are not reimbursed or are only partially reimbursed.
- More no-shows and cancellations: Symptom rebound can worsen organization and punctuality.
- Staffing pressure: Retaining experienced staff becomes harder when days are dominated by conflict and repetitive logistics.
Some practices absorb the workload with longer hours. Others add staffing or restructure workflows. Either way, the shortage introduces a real operational cost.
Practice-level strategies that help (without making unsafe promises)
No practice can “solve” a national supply issue. But many private clinics have found ways to reduce chaos and protect clinical time.
The following are operational strategiesnot medical directivesand should always align with federal and state rules.
1) Build a clear shortage policy and communicate it early
A short, friendly written policy can reduce conflict and set realistic expectations. It often covers:
- How refill requests should be submitted
- What information the patient should include (without asking them to do anything unsafe)
- Typical response times
- How the practice handles pharmacy changes and resends
- When an appointment is required for medication changes
Patients don’t love policies. But they love unpredictability even less.
2) Protect clinician time with triage
Many practices create triage categories such as:
- Stable refill, no shortage issue
- Shortage issue, same medication, different pharmacy
- Shortage issue requiring clinical reassessment
- Urgent functional risk (e.g., major impairment, safety concerns, severe decompensation)
This prevents every shortage message from landing as an “emergency appointment” and helps match the right work to the right team member.
3) Standardize documentation templates
When you’re resending prescriptions, changing formulations, or appealing payer decisions, consistent documentation protects patients and clinicians.
A good template reduces errors, speeds up charting, and supports continuity if a covering clinician steps in.
4) Strengthen multimodal ADHD care so medication gaps are less catastrophic
Practices that embed skills-based supportssleep routines, time management tools, therapy/coaching referrals, and structured follow-upsoften find that patients cope
better during gaps. It doesn’t replace medication for everyone, but it reduces the “cliff effect” when supply is unstable.
5) Support staff like you actually want them to stay
The shortage increases emotional load on front-desk teams and nurses. Small changes help:
- Scripts for difficult calls
- Clear escalation pathways
- Rotation for inbox coverage
- Leadership backing when staff enforce policy
If your staff feels thrown under the bus, your practice will eventually be run by… you. Alone. On a Tuesday. With 48 unread portal messages.
What the shortage teaches us (even if we didn’t ask for the lesson)
The stimulant shortage has exposed structural vulnerabilities in how the U.S. medication supply chain, controlled-substance quotas, manufacturing capacity, and
distribution systems interact with real clinical care.
It has also reminded private psychiatry practices of something important:
When a treatment depends on fragile systems, care must be resilient by design.
That means building workflows that protect clinical attention, communicating clearly with patients, and offering broader support that doesn’t collapse when one medication
becomes hard to find.
Conclusion
The nationwide stimulant shortage doesn’t just affect pharmacy shelvesit reshapes private psychiatry practice from the inside out. It increases administrative work,
destabilizes patient routines, complicates clinical decisions, and strains trust. It can also push practices to improve: better policies, better triage, better multimodal
care, and better support for staff.
The most realistic goal isn’t perfection. It’s reducing chaosso patients still feel cared for, clinicians can still think clearly, and practices can still function like
healthcare clinics instead of frantic dispatch centers.
Experiences from the front lines (composite vignettes from private practice life)
The following stories are compositesblended from common patterns clinicians, pharmacists, and patients have described publiclyso no single person is identifiable.
Think of them as “this happens a lot” snapshots rather than a diary of one clinic.
Monday: The inbox tsunami
The week starts with fifteen portal messages that all say the same thing in different fonts of panic: “My pharmacy is out.”
The practice manager prints a running list (because paper feels emotionally supportive), and the front desk starts calling pharmacies.
Two pharmacies won’t confirm stock. One says, “We might get a shipment Wednesday,” which is the pharmacy equivalent of “maybe it’ll stop raining eventually.”
A patient asks if the doctor can “just send it everywhere at once.” The staff member politely explains that controlled substances don’t work like email.
Tuesday: The pharmacy ping-pong match
A prescription is resent to a different location. That pharmacy calls back: “We have a different strength, can you change it?”
The practice can’t make changes based on a casual phone request; the clinician needs to review the chart and ensure it’s clinically appropriate.
Meanwhile, the patient is texting from work, refreshing the pharmacy app like it’s a concert ticket drop.
The psychiatrist squeezes chart review into lunch and documents the rationale carefullybecause “the pharmacy was out” is true but not enough to tell the full clinical story.
Wednesday: The prior authorization plot twist
The clinic finally finds a formulation that’s in stock. Victory! Then the insurer denies it. Not because it’s unsafe, but because it’s “non-preferred.”
The staff submits documentation. The insurer requests more documentation.
The staff submits more documentation.
The insurer requests the same documentation again, proving that time is a flat circle and prior authorization is its most dedicated philosopher.
The patient is doing their best, but their ADHD symptoms are flaringand now they’re expected to be a project manager for their own medication access.
Thursday: The clinical consequences show up
A patient comes in for an “ADHD follow-up” that turns into a broader visit: sleep is off, anxiety is higher, work performance is slipping, and they’re worried their
supervisor is noticing. They’re not asking for miraclesjust stability.
The psychiatrist discusses options, emphasizes safety, and reinforces that nobody should change medication plans without medical guidance.
They also spend time on coping strategies for the immediate week: structure, reminders, environmental supports, and stress management.
It’s good care, but it’s not the care either person scheduled. It’s care shaped by a supply problem.
Friday: The staff debrief
The clinic team meets for ten minutes at the end of the day. They talk about what worked: a clearer refill policy posted in the patient portal, a triage workflow for
shortage-related messages, and a standard note template that reduced duplicate charting.
They also talk about what hurt: the angry calls, the sense of helplessness, the emotional weight of being blamed for a national problem.
Someone jokes, “We should get honorary degrees in supply chain management,” and everyone laughs a little too hardbecause it’s funny and also not funny at all.
These experiences illustrate the real story of the stimulant shortage in private psychiatry: not a single catastrophic event, but an ongoing series of small disruptions
that add upstealing time, increasing stress, and forcing clinical care to compete with logistics. Practices that survive it best don’t rely on heroics.
They build systems: clear communication, triage, documentation, multimodal care, and staff support. Because the shortage may change form over time, but the need for
resilient care is not going away.