Who’s calling the shots? Doctors worry about insurers overriding their treatment decisions

Doctor pausing with a frown on his face
Doctors' frustration is growing over insurers' hand in treatment decisions. (Getty/Wavebreakmedia)

A new survey of doctors found that healthcare plans are increasingly overriding the treatment decisions they make for their patients.

The survey (PDF) of 600 doctors found that 89% said they no longer have adequate influence in the healthcare decisions for their patients. And 87% reported that health insurers interfere with their ability to prescribe individualized treatments.

The survey, conducted for the nonpartisan Alliance for the Adoption of Innovations in Medicine (Aimed Alliance), an organization that works to improve access to quality healthcare, found that as a result of their frustration, many doctors (52%) said they are thinking of leaving the profession and 67% would not recommend a career in medicine to others.

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As a result of the changes in medicine, 47% of respondents said they are worried patients are losing confidence in the care physicians provide and 79% said insurance companies have a negative effect on patient care.

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“Medical professionals feel angry and frustrated knowing that unqualified insurance company personnel have the power to override their professional judgment and that the long-term health of their patients is being compromised so health plans can achieve short-term cost savings,” said Shannon Ginnan, M.D., director of medical affairs for Aimed Alliance, in an announcement about the survey.

Over 9 in 10 physicians (92%) said staff employed by insurance companies are not competent enough to make medical decisions about treatment regimens, the survey found.

Insurance practices are affecting doctors and compromising the health of patients through such restrictive practices as step therapy, nonmedical switching and prior authorization, the Aimed Alliance said.

“These findings put a spotlight on health insurer practices that interfere with shared decision-making and harm patients,” said Nellie Wild, Aimed Alliance policy adviser, in a statement. “Today, decisions about a course of treatment that were once made by the doctor and patient are being questioned, and often overturned, by health plans to control their costs.”

The online survey was conducted in February and March and included doctors practicing family medicine, internal medicine, pediatrics or obstetrics/gynecology in the U.S.

Among the insurance hurdles physicians said are most burdensome, physicians are especially exasperated with prior authorization requirements, with almost two-thirds of respondents (63%) reporting the need to obtain 10 or more prior authorizations per week from insurers.

The findings confirm research from the American Medical Association that found medical practices spend an average of 14.6 hours each week to complete the prior authorization requirements insurers impose—the equivalent of nearly two business days.