Prior authorization reform vital to combat nationwide clinician burnout crisis, US surgeon general says

Eliminating “bureaucratic” requirements such as prior authorization or other workflow tasks that keep providers from caring for patients will go a long way toward addressing the nationwide crisis of clinician burnout, U.S. Surgeon General Vivek Murthy, M.D., said Thursday.

“To be denied the care, often time-sensitive care, that a patient needs because of a bureaucratic process that often feels like it's set up to inhibit care and prevent expenditures rather than improve quality of care—that hurts patients and doctors,” Murthy said during a one-on-one conversation with American Medical Association (AMA) President Jack Resneck Jr., M.D., as part of an AMA webinar.

“Blow after blow, when you're struck by that day after day, it's tough. It's incredibly difficult not to lose faith in the system," Murthy said.

Just over 3 in 5 physicians reported experiencing symptoms of burnout in 2021, up from 38% during the prior year, according to survey data shared by Resneck.

The surgeon general—who has released reports underscoring the issue of burnout among the clinical and broader workforce—welcomed the AMA and other industry groups’ advocacy against current prior authorization practices.

He said that the administration “is very committed” to streamlining the prior authorization process and cited a recent rule proposed by the Centers for Medicare & Medicaid Services that would reform prior authorization in late 2022—though provider groups have since pressed the administration to move faster and ultimately do more.

Murthy said the government is sympathetic to providers’ demands, but placed some of the onus on industry to look at ways clinicians’ administrative burdens can be cut down.

Specifically, he highlighted an initiative by the University of Hawaii Health System called the "Getting Rid Of Stupid Stuff," or GROSS, program that was able to save “thousands” of nurse and clinician hours by identifying and eliminating “some of these seemingly small but … noxious irritants that actually cloud and color the doctor’s experience.”

Additionally, he hailed government-industry collaborations as well as interagency partnerships as necessary tools for developing new policies on clinician burden and burnout.

“Health systems … we’re finding more and more [are] stepping up to ask ‘What can we do to actually accelerate our work on well-being?’” he said. “This is what we need to do more of, because unless we work together—collaboration with medical societies and the government and with health systems and EHR vendors and educational institutions—we won’t get at all the factors that are driving burnout.

“We also have to collectively speak as one voice to the public and help people know that, again, this is not a niche issue. The issue of physician burnout stands to affect the healthcare of everyone in America. That’s why it has to be a national priority,” he said.

The surgeon general and AMA president’s discussion on burnout extended to cultural contributors and concerns and how seeking help could potentially impact their credentials.

Many people in clinical professions “don’t feel comfortable” asking for help or turning to the resources that are already available to them, Murthy said. Communicating to providers that the issue is commonplace and not a personal failing would go a long way toward cutting down that stigma, whether it be through sharing data or by seeing leaders normalize addressing their own stressors, he said.

Meanwhile, state licensure applications and questionnaires often include questions “that would make you scared, potentially, to be honest about the fact that you had to seek care. … We should not be punishing people for seeking care when they need it," Murthy said.

AMA has “seen some successes” in its petitions to have such questions removed by certain states’ licensure boards, or at the least limiting the questions to current impairment “and not something that maybe happened five years ago,” Resneck said.