Prior Authorization Fuels Physician Burnout, Decreases Access to Care, AMA Survey Finds
By Alisa Pierce

Burdensome prior authorization (PA) requirements continue to intensify physician burnout, increase health care costs, and limit patients’ access to care, according to recent findings in the American Medical Association’s annual prior authorization physician survey. 

These findings align with the Texas Medical Association’s 10 key issues for the 2025 Texas legislative session, during which TMA continues to fight health insurers’ burdensome delays and denials of patients’ care.  

AMA conducts the 43-question, nationwide survey yearly to assess how the PA process affects patients, physicians, and overall health care spending. The 2024 survey fielded responses from 400 primary care physicians and 600 specialists. 

Of the sample: 

• 94% said that PA has a somewhat or significant negative impact on patient clinical outcomes; 

• 93% reported that PA often denies patients’ access to necessary care; 

• 89% report that PA somewhat or significantly contributes to their burnout; 

• 82% found that patients commonly abandoned their recommended course of treatment due to PA hang ups; 

• 40% have been forced to hire staff to work exclusively on PA; 

• 29% reported that PA has caused serious adverse events for a patient in their care, such as hospitalization or permanent bodily damage; and 

• Clinicians and their staff complete an average of 39 PAs per week, spending approximately 13 hours on the process.  

Gary J. Sheppard, MD, chair of TMA’s Council on Socioeconomics, said these results are “no surprise” to physicians who often worry their patients will be refused critical care due to PA delays or denials.  

On that front, TMA has long advocated against arduous PA requirements placed upon physicians’ shoulders. In 2021, TMA worked with lawmakers to pass a “gold card” law, intended to exempt physicians from an insurer’s PA requirements for a particular service if they receive approvals on at least 90% of their requests for that service during a six-month period, helping to avoid delays in patient care. 

However, findings such as AMA’s prove the severity of the PA challenges that remain, Dr. Sheppard says. 

“These findings support what we’ve been saying at TMA for a long time,” the Houston internist said. “Prior authorization leads to patients not being taken care of the way that we [physicians] know they’re supposed to.” 

To reduce the burden of prior auth on physicians and their patients, TMA supports the following measures at the state level: 

• House Bill 3812, which aims to implement comprehensive PA reform; 

• Senate Bill 1380, which aims to prohibit an insurer from requiring PA for certain services; 

• Senate Bill 547, which builds on the 2021 gold card law framework and promotes its implementation as originally intended with additional transparency and accountability standards for insurers; 

• Senate Bill 177/House Bill 2150 and Senate Bill 815, to require health plans to approve patient care and verify coverage in a timely manner and to prohibit health plans from using fully automated systems to deny care; 

• House Bill 1818 that requires the Texas Department of Insurance to conduct reviews of health plan compliance with requirements related to utilization review at least once annually; 

• Streamlining prior authorization for cancer treatments and chronic conditions similar to what 2023’s House Bill 755 did for some autoimmune diseases and blood disorder drugs; and 

• Initiatives to ensure denials or delays in care do not lead to avoidable medical emergencies. 

Additionally, TMA supports legislation that could prohibit health plans from using artificial intelligence (AI) for PA, such as SB 815 by Sen. Charles Schwertner (R-Georgetown). These efforts may provide solutions to the 61% of physicians who reported in AMA’s survey that they are concerned that AI increases or will increase PA denial rates. 

“There’s probably more prior auth reform bills filed this session than we’ve ever seen,” said Ben Wright, TMA director of public affairs. “It is encouraging to see that there’s an appetite for reforming and streamlining prior auth to make it less harmful to patients and to reduce [physician] burden.” 

TMA continues to meet regularly with Texas’ top health insurers to advocate for streamlined PA processes and fight against oppressive PA requirements. Need insurance-related assistance? Check out TMA’s PPRC.