Utilization management negatively impacts physician well-being and quality of patient care, study says

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A national survey of 501 physicians was conducted by the Alliance for Patient Access and published in The American Journal of Managed Care®. Responses to the poll demonstrated the personal and professional toll of utilization management, including time consuming practices like prior authorization, step therapy and non-medical switching. Evidently, the issue of physician burnout continues to rise, which contributes to poorer outcomes for patients, poorer levels of productivity, and increased medical errors and costs.

In the survey, two out of three physicians reported experiencing burnout at some point during their careers, with 48% of physicians saying they were currently burned out. Of the physicians reporting burnout, 93% attributed utilization management as a contributor. Additionally, 95% of surveyed physicians said that utilization management complicated their treatment decisions and 81% of them said it undermined their relationship with patients.

“Most physicians agreed that the burden of utilization management can lead to health care provider burnout and that utilization management contributed to or was the main factor for their burnout,” the authors of the study wrote. “Utilization management was believed to disregard physicians’ medical expertise, undermine relationships with patients, take time that could be better spent with patients and make physicians less effective at caring for patients.”

Of the 338 physicians who had ever experienced burnout, many of them reported at least one of the following symptoms:

• Emotional exhaustion (82%)
• Lack of enthusiasm for work (74%)
• Decreased satisfaction/sense of accomplishment (67%)
• Physical exhaustion (60%)
• Cynical and/or irritable behavior (52%)
• Disrupted sleep or diet (48%)
• Apathy (39%)
• Depression and anxiety (36%)

Of physicians who had experienced burnout, 64% have considered leaving their profession prematurely. Additionally, half of them had a harder time trying to sleep, a third isolated themselves from friends and family and 4% reported suicidal thoughts.

“In the free response option [of the survey], individual physicians indicated burnout led to anger and resentment; it also caused them to count the hours until retirement; rush patients through visits, leading to missed diagnoses; leave primary care; and convince students not to go into medicine,” the authors of the study explained.

When asked whether policies should restore treatment decisions entirely to physicians and their patients, 99% of responding physicians agreed or strongly agreed. They also supported streamlining the prior authorization process, requiring that step therapy be based on science rather than financial incentives of health insurers, ensuring that peer-to-peer reviews were conducted by qualified experts, exempting patient medications from step therapy if tried under a previous insurer and creating a straightforward appeals process. Some physicians advocated for the elimination of the prior authorization/utilization management process.

The study cites a 2021 survey of US physicians, according to which, 82.3% of physician have decided against prescribing certain treatments in anticipation of utilization management. The same survey reported utilization management was responsible for prolonged patient visits, additional patient visits and additional lab tests. As a result, 67.7% of responding physicians reported spending extra time working, time which could have been spent on administrative tasks or scheduling new patient visits. With this study now contributing to a growing collection of literature documenting the detriments of utilization management, new strategies intended to restore physician autonomy and alleviate physicians of these added stressors are urgently needed.

“Physician shortages are already a major patient access challenge, with many medical specialties and geographical regions in dire need,” Josie Cooper, executive director, Alliance for Patient Access, said in a news release. “This national poll shows that utilization management tactics stand to worsen those shortages by physically and mentally exhausting providers, who are already in short supply. It is critical that policymakers act with urgency to address these challenges.”