Prior Authorization: A Crisis in Healthcare

A recent survey by the American Medical Association has uncovered the profound and far-reaching impact of prior authorization on patient outcomes, physician burnout, and overall productivity. Conducted in December, the survey gathered responses from 1,000 physicians—400 in primary care and 600 specialists—shedding light on the often-detrimental effects of prior authorization practices.

Impact on Patients

The data is stark and alarming. An overwhelming 94% of physicians reported that prior authorization results in delays in patient care. Such delays are not just inconvenient; they can lead to serious consequences. Twenty-two percent of respondents indicated that these delays often result in patients abandoning their treatment plans altogether.

The statistics on adverse events are particularly concerning:

  • 24% of physicians noted that prior authorization has led to adverse patient outcomes.

  • 19% reported that these processes have caused hospitalizations.

  • 13% cited instances where delays led to life-threatening situations or required interventions to prevent permanent damage.

  • 7% reported that prior authorization delays have resulted in disabilities, birth defects, or even death.

Furthermore, 79% of respondents indicated that prior authorization sometimes forces patients to pay for medications out of pocket, adding a significant financial burden on top of health risks.

Impact on Physicians

The toll on physicians is equally significant. On average, a physician's practice handles 43 prior authorizations per week, with physicians and their staff dedicating approximately 12 hours weekly to this paperwork. This administrative burden has led 35% of practices to employ staff solely for managing prior authorizations.

The survey also revealed that:

  • 27% of physicians experience frequent denials of their prior authorization requests.

  • 95% of physicians believe that the process contributes significantly to burnout.

Despite the negative impacts, only 18% of physicians always appeal denied authorizations, often due to a lack of faith in a successful outcome based on past experiences.

Prior authorizations also drive-up overall healthcare utilization:

  • 87% of physicians reported increased utilization due to ineffective initial treatments (69%), additional office visits (68%), urgent care or emergency department visits (42%), and hospitalizations (29%).

The findings from this survey paint a grim picture of the current state of prior authorization practices. It is imperative for the healthcare industry to address these issues head-on. Medical professionals, policymakers, and insurance companies must collaborate to reform prior authorization processes, ensuring they are evidence-based, efficient, and truly beneficial to patient care.



We urge all stakeholders to prioritize patient outcomes and physician well-being over bureaucratic hurdles. It is time to reimagine a system where healthcare professionals can focus on delivering the best possible care without the debilitating distractions of inefficient administrative processes.

Your voice is crucial in this dialogue. Advocate for change, support initiatives aimed at reforming prior authorization practices, and join us in striving for a healthcare system that prioritizes the well-being of both patients and providers.