Prior Authorization

Want to help physicians battle burnout? Fix prior authorization

Tanya Albert Henry , Contributing News Writer

AMA News Wire

Want to help physicians battle physician burnout? Fix prior authorization

Nov 22, 2023

Physicians’ time and resources are dedicated to an administrative burden that interrupts care and harms patients – quintessential burnout complaints.

One doesn’t have to look hard to find evidence that prior authorization is a big contributor to physician burnout.

The most recent AMA survey data (PDF) points in that direction.

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The AMA surveyed more than 1,000 practicing physicians about their prior authorization experiences, and a whopping 89% said (PDF) the practice sometimes, often or always leads to missed doses of medications, interruptions in chronic treatment or otherwise interferes with patients’ continuity of care.

And 33% reported that prior authorization led to a serious adverse event including hospitalization, permanent impairment or death.

On top of that, 81% of those surveyed said prior authorization requirements for prescription drugs rose significantly or somewhat over the past five years. And it’s hard for physicians or their staff to determine whether they need prior authorization. More than 60% of physicians felt that was true when it came to prescription medication or medical services.

“We try to get the best treatment for a patient and the patient may just walk away—from the pharmacy, for example—because it’s not authorized,” said AMA Trustee Marilyn J. Heine, MD, an emergency medicine and hematology-oncology physician in Southeast Pennsylvania. “The time and resources physicians have to devote to prior authorization and the emotional toll it all takes knowing that this process they were forced to go through has been harming their patients contribute to burnout.”

Fixing prior authorization and reducing physician burnout are critical components of the AMA Recovery Plan for America’s Physicians.

Find out how the AMA is tackling prior authorization with research, practice resources and reform resources, and learn about the AMA-developed resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.

It is not just surveys that point to evidence of physician burnout from prior authorization.

Dr. Heine, who also is a clinical assistant professor in the medicine department at Drexel University College of Medicine, has conversations or hears colleagues talk about it regularly. And she said you can find physicians posting about prior authorization on an almost daily basis on social media platforms—a cry for help.

With just a few keystrokes, Dr. Heine found heart-wrenching stories posted by physician colleagues to social media.

They included:

  • A patient who died in the critical intensive-care unit of a massive pulmonary embolism. She had a history of deep vein thrombosis and was supposed to be on anticoagulant medication but had not received this for months due to prior authorization.
  • A teen patient with an anterior cruciate ligament injury and a lateral meniscus tear. With his knee locked, he could not walk or bear weight. There was no nonsurgical option, the physician noted, yet prior authorization was required to proceed.
  • A physician colleague whose infant daughter was diagnosed with brain cancer weeks prior, then an insurer required prior authorization to access vital treatment.
  • A patient denied appropriate medications by the insurance company because of prior authorization. Not getting optimal treatment would result in a longer hospital stay, more exposure to steroids and the symptoms going on longer than necessary.

“The time and resources that could be directed toward patient care that are diverted to navigate the prior authorization barriers to care are huge and the overall administrative burdens—of which prior authorization is a major part—are significant drivers of physician burnout,” Dr. Heine said.

Visit AMA Advocacy in Action to find out what’s at stake in fixing prior authorization and other advocacy priorities the AMA is actively working on.  

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Dr. Heine said it’s urgent that prior authorization be addressed. In a separate AMA survey, one in five doctors reported they planned to leave their current practice within two years and about one in three physicians said they intended to reduce work hours in the coming 12 months.

“There have been conversations with colleagues in the community where, partially because of the administrative burdens which are largely driven by prior authorization, they are cutting back, changing their practice, or retiring early. I have seen locally that access to primary and specialty care in the community has been less as a result. It is a major concern for us,” she said.

This summer, the powerful House Ways and Means Committee advanced provisions that would help bring badly needed reforms to the prior-authorization process within Medicare Advantage. The provisions align closely with the Improving Seniors’ Timely Access to Care Act. 

It’s deeply disappointing, Dr. Heine said, that insurers have largely failed to follow through on the commitment they made (PDF) in 2018 to reform the process, limit its use, be transparent, give timely responses, and implement “gold carding” which would allow physicians with a proven track record of approvals to not have to go through prior authorization on certain services and prescription drugs. which would allow physicians with a proven track record of approvals to not have to go through prior authorization on certain services and prescription drugs.

“The lack of transparency, the process itself, its overutilization, and often being denied by someone without the expertise of the patient’s physician—those are really important aspects that lead to burnout,” Dr. Heine said. “It feels like Sisyphus every day.”

Patients, physicians and employers can learn more about reform efforts and share personal experiences with prior authorization at