Physicians Are Pervasively Skeptical that Significant Change will Happen In Close to-term

New survey information from the American Medical Affiliation (AMA) present physicians are pervasively skeptical that significant change will happen—reflecting years of comparable commitments which have failed to supply lasting enhancements.

In June 2025, after profitable engagement from the Trump administration to deal with widespread considerations from sufferers and physicians, roughly 60 well being insurers pledged to streamline, simplify, and cut back prior authorization necessities, with implementation deadlines spanning 2025 by way of 2027. Forward of the primary main deadline, the AMA surveyed 1,000 working towards physicians to evaluate whether or not these commitments are prone to ship significant enhancements for sufferers and physicians.

Findings from the 2025 AMA Prior Authorization Doctor Survey present that just one in three physicians (33%) imagine the most recent insurer pledge will make a significant distinction.

Doctor skepticism is grounded in expertise. As a part of the 2025 pledge, insurers dedicated to making sure that every one medical necessity denials could be reviewed by a licensed and certified clinician. But just one in 4 physicians (24%) report that such evaluations are constantly performed by appropriately certified clinicians. As well as, simply 16% of physicians who take part in peer-to-peer evaluations say the well being plan consultant usually or all the time has the suitable {qualifications}.

“Doctor belief in voluntary insurer pledges is deeply eroded after years of unfulfilled guarantees,” stated AMA President Bobby Mukkamala, M.D. “Physicians are particularly pissed off when so-called peer-to-peer evaluations are performed by people who lack the suitable medical experience to guage a affected person’s care. When solely a 3rd of physicians count on significant impression—and so few report that well being plan reviewers are appropriately certified—it highlights a credibility hole that received’t be closed with imprecise or partial measures. Rebuilding belief would require sustained, clear, and measurable motion to streamline prior authorization and maintain it clinically targeted and patient-centered. Something much less dangers reinforcing the skepticism these pledges have been meant to deal with.”

The AMA survey reveals how a lot work insurers nonetheless should do and highlights ongoing considerations that prior authorization delays care, disrupts remedy, and harms affected person outcomes.

• Affected person Hurt — A couple of in 4 physicians (26%) report that prior authorization has led to a critical antagonistic occasion, together with hospitalization, everlasting impairment, or demise.
• Delayed Care — Greater than 9 in 10 physicians (95%) say prior authorization delays entry to crucial care.
• Disrupted Care — Almost 4 in 5 physicians (79%) report that sufferers abandon remedy as a consequence of authorization challenges.
• Poor Outcomes — Greater than 9 in 10 physicians (92%) say prior authorization negatively impacts medical outcomes.

Prior authorization additionally continues to position vital pressure on doctor practices, driving excessive volumes of requests and denials, consuming medical and administrative time, and contributing to widespread burnout. As administrative calls for intensify, assets are more and more diverted from affected person care to handle an inefficient course of.

• Added Burden — Physicians full a mean of 40 prior authorizations per week, and almost one in three (32%) report that requests are sometimes or all the time denied.
• Doctor Burnout — Greater than 9 in 10 physicians (94%) say prior authorization contributes to burnout.
• Denial Pattern — Three-quarters of physicians (74%) report that denials have elevated over the previous 5 years, and 6 in 10 specific concern that augmented intelligence (AI) could additional enhance denial charges.
• Diverted Time and Sources — Prior authorization consumes a mean of 13 hours of doctor and workers time every week, and two in 5 physicians (40%) make use of workers devoted solely to prior authorization duties.

Past its impression on sufferers and doctor practices, prior authorization additionally drives inefficiencies and pointless prices throughout the well being system.

• Wasted Well being Sources — Greater than 4 in 5 physicians (88%) report that prior authorization will increase general well being care utilization, contributing to waste reasonably than financial savings. Physicians cite ineffective preliminary remedies (75%), extra workplace visits (73%), pressing or emergency care (47%), and hospitalizations (32%) as penalties of prior authorization necessities.

Physicians additionally report constantly excessive administrative burden with prior authorization throughout all main well being insurers. UnitedHealthcare (75%) tops the ranks for “excessive” or “extraordinarily excessive” burden, adopted by Humana (65%), Anthem/Elevance (61%), Aetna (61%), Cigna (59%), and Blue Cross Blue Protect (56%).

The AMA continues to work on each entrance in help of prior authorization reforms that prioritize sufferers’ entry to crucial care and cut back administrative burdens for physicians. The AMA seems ahead to persevering with to work with the Trump administration, Congress and well being insurers on this important problem. To study extra about prior authorization challenges skilled by sufferers, physicians, and employers, go to FixPriorAuth.org.