Writing a prescription takes me about 30 seconds. Everything that happens after that can take 30 minutes, or it can derail my entire afternoon.
We talk a lot about physician burnout. We talk about how documentation burden and administrative bloat contribute to burnout. But e-prescribing, one of the most routine acts in medicine, rarely makes that list. It should.
After more than 15 years practicing medicine across diverse healthcare environments as a pediatrician and neonatologist, I came to view the shortcomings of legacy e-prescribing as one of the most persistent and overlooked sources of waste in healthcare. Since working outside the traditional health systems and building care delivery from the ground up, like for my pediatric virtual care platform, that conviction has only grown stronger.
We are spending too much clinician time, operational effort, and healthcare spending on workarounds for a prescribing system that was never designed to meet the needs of modern patients, clinicians, or care models. The promise of electronic prescribing was simple: replace paper scripts with a digital workflow, reduce errors, and close the loop between clinician and pharmacy. In narrow technical terms, it delivered. The script gets transmitted. The medication exists in the system.
What it failed to account for was everything between transmission and the patient actually getting their medication.
From the clinician side, the friction is relentless. Which pharmacy is in network? Does that location have it in stock? Is the formulary version I'm prescribing covered, or am I about to trigger a prior authorization? Most e-prescribing systems give you no visibility into any of this. You make your best guess, send the script, and move on. Until the callbacks start. Physicians currently complete an average of 39 prior authorization (PA) requests per week, burning roughly 13 hours of staff time in the process. Nearly all of them (93%) say PA delays patient care. Those aren't abstract numbers. That's an afternoon of clinical time, every week, on hold.
From the patient side, the consequences are more serious than they appear. One in four new prescriptions is abandoned at the pharmacy. In 2023 alone, 98 million new therapy prescriptions were never picked up — 44 million of them for medications that cost patients less than $10. The problem isn't always financial. Sometimes it's a stock issue. Sometimes it's the surprise copay at the counter that no one warned them about. Sometimes it's just enough friction to make a patient not try again. And when patients don't try again, they don't get better: medication nonadherence drives an estimated 125,000 preventable deaths each year and accounts for nearly a quarter of all hospital readmissions.
The prescription I carefully wrote and electronically transmitted does nothing if it never makes it into the patient's hands. Translate this to real life and this means an asthmatic with an exacerbation doesn’t have his inhaler and will end up in the ER and possibly an ICU rather than safely at home after two puffs of his medication. There is a huge cost implication here as well. A per-hospitalization cost can be 84 times higher than the cost of asthma prescription controller meds.
Legacy e-prescribing platforms were built to digitize the act of writing and sending a prescription. They were not built to solve the patient experience, the pricing transparency problem, or the pharmacy logistics problem. And because they were embedded into enterprise EHR systems designed for large institutions, their incentive was to serve the institution, not the clinician in the field, and certainly not the patient at the pharmacy counter.
The result is a workflow that technically functions but practically fails. The prescription leaves your hands with no real handoff. There’s no confirmation of whether the patient can access it, no pricing information, and no inventory check. Prescribing should work the way handing someone a paper script used to, except better. You write it, the patient gets it, they choose where to fill it, they see what it costs before they commit, and it goes somewhere that actually has it in stock.
That's the design principle behind Doximity Prescribe, built in partnership with Photon: a way to prescribe that has both the doctor and patient as the priority. A physician writes the prescription inside Doximity platform. The patient receives a text with a secure link to select their preferred pharmacy and view estimated pricing upfront, before the script is routed anywhere. No surprises at the counter. No callbacks because they drove to the wrong location. It's free for verified U.S. physicians, NPs, and PAs. And critically, it was built from feedback from working clinicians, not handed down from above.
Medication access is a health equity issue. Patients who abandon prescriptions because of cost surprises, complicated re-routes, or missed callbacks are disproportionately those with the least margin for error. Getting the prescription right at the point of care means fewer patients falling through the gap — fewer asthmatics left short of breath heading to the hospital for lifesaving treatment that is 100% avoidable.
The administrative burden of medicine isn't separate from care quality — physician time is a clinical resource. Every minute physicians spend on a misdirected-prescription callback is a minute we are not spending on the patient in front of us. I want that time back.
Dr. Lyndsey Garbi, MD is a board-certified pediatrician and neonatologist, CMO and co-founder of Blueberry Pediatrics, and a mom of three.
Image credit: george tsartsianidis / Getty Images
