Prior Authorization Is Burning Out Your Doctors. Here's the Real Cost.

Physicians spend nearly a full working day every week on prior authorizations. Most of those authorizations get approved anyway. This is what that costs.

Prior authorization is one of those healthcare system mechanics that sounds reasonable in theory and is catastrophically destructive in practice. Insurers review planned treatments before approving them — in principle, to prevent unnecessary care. In practice, it has become a bureaucratic wall that physicians spend billions of hours climbing while patients wait for treatment they've already been prescribed.

The numbers physicians are actually living with

According to the AMA's 2023 Prior Authorization Physician Survey:

  • Physicians complete an average of 45 prior authorizations per week
  • That takes an average of 4.6 hours per week — nearly one full working day
  • 94% of physicians report that prior auth delays patient care
  • 33% of physicians report a prior authorization has led to a serious adverse event for a patient
  • 88% of physicians say the prior auth burden is high or extremely high

    • And the number that makes it hardest to swallow: in 2022, United Healthcare — the largest US insurer — approved 90% of prior authorization requests ultimately submitted . The review process consumed physician time for treatments that were approved anyway at a 9-in-10 rate.

    What prior auth actually does to a physician's day

    Prior authorization doesn't just consume time — it consumes the wrong kind of time. Completing a prior auth requires pulling together clinical documentation, writing justification letters, making phone calls to insurance companies, and waiting on hold. It demands cognitive resources and interrupts clinical workflows.

    For most physicians, prior auth work happens in fragments: between patients, during lunch, after clinic. It's rarely a single focused block of time. The fragmentation increases cognitive load and makes everything else — including the documentation that also needs to happen — harder.

    Physicians describe prior authorization work with consistent language: dehumanizing, futile, adversarial. It is the clearest example of a physician's time being used to serve an insurance company's administrative process rather than a patient's care.

    The moral injury dimension

    Moral injury — the damage caused when a professional is forced to act against their values — is a significant driver of physician burnout. Prior authorization is a primary source.

    A physician who knows what treatment a patient needs, prescribes it, and then spends hours justifying that decision to an insurance company reviewer who may have no clinical training — and who may deny it anyway — is experiencing moral injury. The treatment decision was clinically correct. The process around it was adversarial, time-consuming, and patient-delaying.

    The cumulative effect of this experience — 45 times per week, 48 weeks per year — is significant. It's one reason physicians who transition away from insurance-heavy clinical practice, to concierge medicine or direct primary care, report dramatically higher job satisfaction even when seeing fewer patients.

    What's changing

    The prior authorization problem is partly regulatory and partly technological. CMS finalized rules in 2024 requiring insurers to respond to prior auth requests faster and to provide clearer denial reasons. Some states have passed laws limiting prior auth for certain drug classes.

    On the technology side, AI-assisted prior authorization — tools that automatically pull the clinical documentation and draft the justification letter — is reducing the per-auth physician time from 15–20 minutes to under 5 minutes.

    Combined with AI scribing that eliminates clinical documentation burden, some physicians are beginning to recover something close to a functional workday. The administrative overhead still exists. The time it consumes is shrinking.

    The part you can fix today

    Prior authorization reform is slow. The documentation burden — 1–2 hours of after-hours charting per day — is solvable right now with AI scribing. Eliminating pajama time doesn't solve prior auth, but it removes the other major time drain from the equation.

    The NoPajamaTime free 24-hour proof lets you create and review one note. If you're going to spend 4.6 hours a week on prior auths, at least explore a different documentation workflow.

    Eliminate the charting burden. Today.

    Free 24-hour proof to create and review one note.