You trained for years to become a physician so you could heal people. Yet every day, you find yourself fighting the very system that is supposed to support you. A patient presents with classic symptoms warranting a specific imaging study, medication, or procedure. You know what they need. The evidence is clear. But instead of moving forward with care, you are forced into a gauntlet of prior authorizations, peer-to-peer reviews, and endless documentation. Too often, the final decision comes from an insurance reviewer who has never met the patient, never reviewed the full chart, and follows an algorithm designed more for cost containment than clinical appropriateness. This is not an occasional frustration. It is the daily reality of American medicine.
The crushing weight of administrative burden
According to the American Medical Association’s (AMA) 2024 National Physician Survey, 94 percent of physicians reported that prior authorization delays necessary care, 80 percent said it leads patients to abandon treatment, and 90 percent believe it increases overall health care costs through additional office visits, emergency department care, and disease progression. A 2023 systematic review analyzing 25 studies found that prior authorization requirements are directly associated with increased hospitalization rates, disease flares, and worse survival in cancer patients. These are not theoretical harms, but they are measurable patient injuries caused by administrative barriers.
Prior authorization is only one part of the problem. Physicians now spend nearly half their workday on electronic health record (EHR) documentation and administrative tasks, according to multiple time-motion studies. The burden has become so severe that the American College of Physicians (ACP) has labeled excessive administrative requirements a major driver of physician burnout.
In 2025, Medscape’s Physician Burnout and Depression Report revealed that 62 percent of physicians reported burnout, with “too much bureaucratic work” and “electronic health records” consistently ranking as the top two contributors. Nearly one in four physicians said they are planning to leave clinical medicine within the next few years because of it.
We have also seen the rise of “denials for dollars” strategies. Some insurers and third-party utilization management companies are incentivized to deny claims, with initial denial rates in certain Medicare Advantage plans exceeding 20 to 30 percent. Many of these denials are later overturned on appeal, but only after significant delays and additional unpaid physician work.
Sky-high costs and defensive medicine
The United States spends $5.3 trillion annually on health care, which equals to $15,474 per person and nearly 18 percent of gross domestic product (GDP). That is roughly double the per-capita spending of other wealthy nations, yet we rank poorly on key outcomes, including life expectancy, preventable mortality, and access to timely care.
A significant portion of this spending is pure waste. A landmark analysis in the Journal of the American Medical Association (JAMA) estimated that administrative complexity alone wastes approximately $528 billion per year. Defensive medicine adds another $46 billion to $50 billion annually, with one large hospital study showing that 28 percent of orders and 13 percent of costs were at least partially driven by liability fears.
Physicians practice defensively, not because they lack evidence, but because the medicolegal environment and payer scrutiny punish clinical judgment. The result is a vicious cycle: more tests, more documentation, higher costs, more rules, and even greater distance between doctor and patient.
The human cost of administrative barriers
When advocacy becomes this difficult, patients suffer delayed diagnoses, prolonged pain, and disease progression. Physicians experience moral injury, the deep distress that comes from being unable to provide the care we know our patients need. We did not enter medicine to become professional form-fillers and insurance negotiators. We entered to practice medicine. The current system has inverted priorities: The patient and the physician, who should be the king and queen on the chessboard, have been reduced to pawns while regulators, administrators, and payers hold the power.
A call for systemic health care reform
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True patient advocacy requires more than individual persistence. It demands systemic reform:
- streamlining or eliminating prior authorization for evidence-based, high-consensus treatments
- rewarding outcomes instead of process measures
- meaningful tort reform that reduces defensive medicine without eliminating accountability
- reducing EHR documentation burden through sensible regulation
- greater transparency in how insurers make coverage decisions
Until these changes occur, patient advocacy will continue to feel like swimming upstream against a powerful current of bureaucracy, profit motives, and regulatory overreach. The data is clear. The studies are consistent. The burnout statistics are alarming. The patients we lose to delays and abandonment are real.
As principal speaker and chairman of the board for the National Campaign to Protect People in Pain (NCP3), I strongly believe that physicians and patients must keep pushing back and be together on this. Because if we do not fight for the primacy of the doctor-patient relationship, no one else will. The system was built for patients. It is time we demand it starts acting like it.
This essay is cited in the KevinMD record on physician burnout.
Kayvan Haddadan is a physiatrist and pain management physician, and president and medical director of Advanced Pain Diagnostic & Solutions, a multidisciplinary pain management practice in California that he founded in 2012. A physician and surgeon licensed by the Medical Board of California, he is double board-certified in pain medicine and physical medicine and rehabilitation. He is also certified in controlled substance registration through the DEA and serves as a qualified medical examiner through California’s Department of Industrial Relations Division of Workers’ Compensation.
Dr. Haddadan earned his Bachelor of Science degree from the College of Alborz in Tehran, Iran, and his medical degree from Shahid Beheshti University of Medical Sciences. He later received his Educational Commission for Foreign Medical Graduates certification in Philadelphia, completed an internship in medical surgery at Loyola University Medical Center’s Stritch School of Medicine in Illinois, and finished his residency in physical medicine and rehabilitation at the same institution. He completed his fellowship in pain medicine at California Pacific Medical Center’s Pacific Pain Treatment Center and also trained in medical acupuncture for physicians at the University of California, Los Angeles David Geffen School of Medicine.
Dr. Haddadan has contributed to 29 research publications across multiple specialties, including pain management, cardiology, pulmonology, endocrinology, gastroenterology, and infectious disease. His work has examined topics such as hyperlipidemia in high cardiovascular risk patients, hyperuricemia and gout management, type 2 diabetes and hypertension, chronic obstructive pulmonary disease and asthma therapies, influenza treatment, irritable bowel syndrome, and opioid related complications in chronic pain care. His research has also included clinical outcome studies in spinal cord stimulation and award-winning presentations on neuropathic pain management and neuromuscular disorders.
