The Prior Authorization Burden on Academic Physicians
The Paperwork That Delays Patient Care
I was on a call last month with a faculty physician who had just spent forty-five minutes on the phone getting a prior authorization approved for a medication she has prescribed hundreds of times. Forty-five minutes she could have spent seeing a patient, mentoring a resident, or reviewing a manuscript. Instead, she was on hold, repeating clinical justifications to someone reading from a script.
Prior authorization has become one of the most frustrating administrative burdens academic physicians face. And it is getting worse.
The Numbers Tell the Story
A 2024 AMA survey found that physicians and their staff spend an average of nearly two full business days per week completing prior authorizations. That number is staggering on its own. But in academic medicine, where faculty are already splitting time between clinical care, teaching, research, and institutional service, those lost hours hit differently.
For academic physicians, the consequences compound:
- Clinical productivity drops, which directly affects compensation in RVU-based models
- Teaching and mentoring get squeezed because patient care cannot wait but prior auth can sit in a queue
- Research time evaporates since the hours lost to administrative tasks have to come from somewhere
- Burnout accelerates as faculty feel the gap between why they chose academic medicine and how they actually spend their days
It is like being a coach who spends the entire first half filling out permission slips instead of running the offense. Eventually, the score reflects the distraction.
Why Prior Authorization Hits Academic Physicians Harder
Community physicians deal with prior authorization too. But academic medical centers often treat more complex patients, prescribe more specialized therapies, and order more advanced imaging. Each of those carries a higher likelihood of triggering a prior authorization requirement.
Add in the teaching mission, and you have attending physicians trying to explain to trainees why a clinically appropriate treatment plan just got denied by an insurance reviewer who has never examined the patient. That is a demoralizing lesson in the reality of modern medicine, and it is one our residents are absorbing early.
What Faculty Can Do
I will not sugarcoat this. Individual faculty members cannot fix the prior authorization system. That requires legislative and regulatory change, and thankfully some momentum is building at the federal level.
But I work with faculty who have found ways to reduce the damage:
- Delegate strategically. Know which parts of the prior auth process can be handled by trained staff and which require your direct involvement.
- Track the time. Document how many hours you lose to prior authorization each month. Department leaders need real data to advocate for support resources.
- Protect your boundaries. Do not let prior auth paperwork bleed into your evenings and weekends without recognizing the cost.
The system will not change overnight. But you do not have to absorb its inefficiency in silence.
Learn about coaching for departments.
