Every working day, across clinics and hospital systems throughout the country, physicians sit down to do something that has nothing to do with medicine. They fill out forms, make calls, write letters, and wait. They wait for insurance reviewers, often with no clinical background relevant to the case at hand, to decide whether a treatment the physician has already evaluated, already ordered, and already deemed necessary will actually be approved. Sometimes approval comes. Often it does not. And in the hours or days between the request and the decision, patients go without care.
Prior authorization was designed, in theory, to prevent unnecessary or costly treatment. In practice, it has become something else entirely. For many physicians, it is now one of the defining frustrations of clinical life, a bureaucratic layer that sits between a diagnosis and its treatment and that demands time, energy, and documentation that could otherwise be directed at patients.
Dr. Spencer Test, a doctor of physical therapy, works in a field where the friction is particularly acute. Physical therapy is among the specialties most frequently subjected to prior authorization requirements, and the clinical consequences of delays can be significant. A patient recovering from surgery, or managing a degenerative condition, does not have weeks to spare while paperwork moves through an insurer's review process. Function lost during that window is not always recovered.
The administrative load these requirements impose is not trivial. Research has repeatedly documented that physicians and their staff spend substantial portions of the workweek on prior authorization alone. A 2022 American Medical Association survey found that physicians complete an average of 45 prior authorization requests per week, and that more than a third of physicians reported having a staff member who works exclusively on prior authorization. The time cost is real. So is the psychological one.
What physicians describe is a system that asks them to justify, repeatedly and often redundantly, decisions they are trained and licensed to make. The denial is rarely the end of the process. It is usually the beginning of another one, an appeal, a peer-to-peer review request, a second round of documentation. And while that process unfolds, the patient waits. In some cases, the patient deteriorates. In others, the patient simply gives up and goes without.
The debate over prior authorization reform has gained some traction in recent years, with legislation introduced at both the federal and state levels to impose new timelines and transparency requirements on insurers. Progress has been slow. In the meantime, physicians like Dr. Test continue doing what the system requires of them, not because they believe it is a good use of their time, but because for their patients, there is no other option.