ZDoggMD on Prior Authorization: Why Doctors Call It the Most Infuriating Thing in Medicine

Prior authorization. Two words that make physicians' blood pressure spike. ZDoggMD — Dr. Zubin Damania, Stanford internist and founder of the billion-view physician media platform — has been one of the loudest voices calling out what prior auth actually does to doctors and patients.

What Prior Authorization Actually Is

Prior authorization is a process where insurance companies require physicians to get advance approval before prescribing certain medications, ordering certain tests, or performing certain procedures. In theory: cost control. In practice: a system where a doctor who spent 11 years training has their clinical judgment second-guessed by an algorithm or a non-physician reviewer who has never met the patient.

The AMA has documented that physicians spend an average of 14 hours per week on prior authorization. That's 14 hours not seeing patients, not talking to families, not doing the thing they went to medical school to do. It's 14 hours filling out forms and sitting on hold to justify decisions they've already made.

The Patient Harm Is Real

This isn't just a physician frustration issue. Prior authorization delays care. Patients don't get medication they need while the paperwork processes. Some abandon treatment entirely because the friction is too high. Studies have documented prior auth contributing to hospitalizations that didn't need to happen and worsening of conditions that could have been treated earlier.

ZDoggMD frames this as a moral injury: you know what your patient needs. You've diagnosed them. You've chosen the right treatment. And a system built for cost reduction is telling you no, fill out these forms, justify your clinical judgment to someone who isn't in this room and didn't examine this patient. That is a daily violation of why physicians became physicians.

What Physicians Are Doing About It

Some physicians are fighting the system. The AMA's Prior Authorization Reform initiative has pushed for legislation requiring faster turnaround, more transparency, and gold carding (exempting physicians with high approval rates). Some states have passed laws limiting the most egregious prior auth practices.

Others are voting with their feet — moving to direct primary care, concierge medicine, or cash-pay practices where insurance companies have less control over clinical decisions.

Many are simply absorbing the burden. Staff spend hours on prior auth. Physicians spend evenings on it. The time it takes comes out of somewhere — usually documentation, patient care, or the physician's personal life.

What would help: anything that reduces the total administrative load so that prior auth — when it's unavoidable — doesn't break the day. If documentation is handled by ambient AI and notes are done during the encounter, there's more bandwidth for the administrative fights that actually require physician judgment.

ZDoggMD on administrative burden:

You Can't Fix Prior Auth. You Can Fix Documentation.

NoPajamaTime handles your notes so prior auth and the rest of the admin burden don't also steal your evenings. One less thing crushing you.