Let me give you the number that should end the conversation about whether prior authorization is a real problem or a paperwork annoyance.
26 percent of physicians say prior authorization has directly led to a serious adverse event for one of their patients - including hospitalization, permanent impairment, or death.
Not delayed care. Not inconvenience. A serious adverse event. For one in four doctors.
That is from the American Medical Association's 2025 Prior Authorization Physician Survey, released in May 2026, which surveyed 1,000 physicians across a range of practice settings. The results are a clear-eyed document of what it costs to run a medical practice in an environment where insurers can say no faster than you can say yes.
The Time Math Is Brutal
Here is the operational reality if you run an independent or small group practice:
Your practice spends an average of 13 hours per week on prior authorization requests.
Those 13 hours cover approximately 40 separate requests. That is not 13 hours of treating patients. It is 13 hours of asking permission to treat patients.
For a practice with 2 or 3 physicians, that is the equivalent of a full day of clinical time - gone before anyone walks in the door.
More telling: 40 percent of practices now have at least one staff member whose entire job is managing prior authorization. Not billing. Not scheduling. Not clinical support. Prior authorization. One dedicated person, often more than one at larger practices, doing nothing but chasing approvals.
If that person earns $50,000 a year, you are spending $50,000 annually on an activity that generates no revenue, treats no patients, and produces value for exactly one party: the insurer who got to delay or deny care.
The Reform Pledges That Did Not Land
In June 2025, over 60 major health insurers signed pledges to reform their prior authorization programs. The pledges included commitments to reduce the volume of requests, speed up decisions, and extend approvals that had already been granted.
The AMA survey asked physicians how they view those pledges.
Only one in three physicians - 33 percent - believes those pledges will lead to meaningful improvements.
That is not cynicism without basis. It reflects years of watching the same cycle: public commitments, minimal changes, continued burden. The AMA found that physicians who have dealt with prior authorization the longest are the least likely to believe reform is coming.
"Prior authorization continues to harm patients while imposing unnecessary financial and administrative burdens on physicians and their staff," the AMA said in releasing the data.
What the System Is Actually Doing to Patients
The survey does not just document physician frustration. It traces the impact to patients directly.
95 percent of physicians say prior authorization delays access to medically necessary care.
79 percent say patients have abandoned prescribed treatment because of prior authorization difficulties.
When a patient gets a diagnosis, has a prescription written, and then gives up before ever filling it - because the calls and appeals and waiting became too much - that is a treatment failure that shows up nowhere in any insurer's claims data. The AMA survey calls this an invisible harm, and the numbers suggest it is happening constantly.
There is also a cost argument that should appeal to anyone looking at healthcare spending: 88 percent of physicians say prior authorization actually increases total healthcare utilization. Delayed treatment leads to more urgent care visits, more hospitalizations, more expensive downstream care. The short-term "savings" from a denied authorization often cost more in follow-on care.
But those follow-on costs are often billed by different providers, at different times, in different ways - making them invisible in the insurer's prior authorization math.
What This Means If You Run a Small Practice
Large health systems have compliance departments, authorization teams, and the leverage to negotiate with insurers. Small practices do not.
The AMA data shows that the prior authorization burden falls hardest on independent and small group physicians - the ones with the least capacity to absorb it and the least power to push back.
Here is what some high-functioning small practices are doing to reduce the friction:
Use AI-assisted prior auth tools. Platforms like Cohere Health, Infinx, and Olive AI use clinical data to pre-populate authorization requests and predict approval likelihood. This does not eliminate the burden, but it reduces the time per request significantly.
Track your denial rates by payer. If you are getting denied at a higher rate by one specific insurance company for one specific procedure or medication, that is a negotiation point - or a reason to examine whether you are documenting medical necessity in the way that payer's reviewers are trained to look for.
Request peer-to-peer reviews immediately on complex denials. The AMA has documented that peer-to-peer reviews - where your clinical team talks directly to the insurer's medical reviewer - result in overturns at a significantly higher rate than written appeals alone. It takes more time upfront, but less total time than the full appeals process.
Document every delay. If a patient suffers a bad outcome after a prior authorization delay, that documentation may matter legally and it certainly matters for the AMA's ongoing advocacy efforts.
The Legislative Picture
The Improving Seniors' Timely Access to Care Act - which would have imposed federal standards on Medicare Advantage prior authorization timelines - has been introduced in multiple sessions of Congress. It has not yet become law.
Several states have passed their own prior authorization reform laws, with varying requirements on response times, gold carding (where prior authorization is waived for physicians with strong approval histories), and mandatory appeals processes.
The AMA maintains a state-by-state tracker of prior authorization legislation at ama-assn.org. If your state has new rules in effect, your front desk staff should know them - because insurers do not always volunteer that information.
The Bottom Line
The 2025 AMA prior authorization survey is not new information for anyone running a small practice. It is a documented account of something you already know. What it adds is the scale: you are not alone in losing 13 hours a week to this. You are not alone in watching patients abandon treatment. You are not alone in believing that the reform pledges from last year will not change much.
What you can do is minimize your exposure through better tools, better documentation, and engagement with the legislative process that is the only thing likely to change the system.
Dr. Renee Carter covers healthcare business and practice management for The Useful Daily. Sources: AMA 2025 Prior Authorization Physician Survey, GlobeNewswire - AMA Survey release, May 13, 2026, Healthcare Dive coverage.