What Causes Docs to Burn Out? Prior Authorization a Big Culprit, Says AMA Prez

— Telling physicians to do more self-care is really "blaming the victim," says Jack Resneck Jr., MD

by Joyce Frieden, Washington Editor, �鶹��ý July 19, 2022

WASHINGTON -- What is one of the biggest causes of physician burnout? Prior authorization and other "hassle factors," American Medical Association (AMA) president Jack Resneck Jr., MD, said Monday.

"We have learned a lot in the last decade about what causes burnout," Resneck, a dermatologist at the University of California San Francisco, said in a meeting with a small group of reporters at the association's Washington office. "They always are the things getting in the way of being able to provide the best care. That's why prior authorization is so high on our list."

The list Resneck referred to is the AMA's "Recovery Plan" for doctors, which includes fixing prior authorization -- the requirement by insurers that physicians get pre-approval before performing particular procedures or prescribing certain medications -- among its five pillars. "While resilience is important, and I'm all for yoga and an extra meal with hospital leadership, that is not the answer," he said. "It focuses blame on the victims, but it's not their fault they are burned out."

Prior authorization is one issue that has dogged the physician community for years, and the AMA's attempts to resolve them have resulted in frustration, he said. "We sat down with health plans a few years ago and came up with things we could agree on, and they haven't lived up to any of those agreements," he said. "That's why we're going to Congress and state legislatures now" for solutions. Two bills aimed at fixing prior authorization are currently working their way through Congress, including one bipartisan bill with more than 300 co-sponsors, he added.

Resneck was in town to testify at Tuesday's House Energy & Commerce Oversight and Investigation Subcommittee hearing on the impact of the Supreme Court decision overturning Roe v. Wade, the 1973 high court decision that legalized abortion nationwide. The AMA's House of Delegates "has overwhelmingly made clear that politicians shouldn't be inserting themselves into the exam room, whether it's about reproductive health, gender-affirming care, or pediatricians asking about gun safety," he said, noting that the Supreme Court decision is having a chilling effect, "whether it is what we're seeing chaos in [more] restrictive states in the last few weeks around management of ectopics, miscarriages, and other pregnancy complications, or whether it is just interfering in what we believe are patients' rights to make healthcare decisions."

Traditionally, when states have overreached on abortion and other reproductive rights issues, the AMA and other groups have gone to court, "but on this issue, the Supreme Court has taken away that avenue," he added. "We can't sugarcoat how severe an impact that is having on the ground for doctors and patients, but at the AMA we're going to continue to do everything we can to have doctors' and patients' backs. We're going to look for every way possible to protect the doctor-patient relationship."

He praised the Biden administration for its around the Emergency Medical Treatment and Active Labor Act (EMTALA) that reminded states of hospitals' legal obligation to provide treatment to save a pregnant woman's life in an emergency -- even if that treatment includes an abortion.

Despite such efforts, however, "there's a lot of uncertainty right now" around such emergencies, Resneck said. "What we're hearing from colleagues around the country is extraordinarily concerning," with doctors calling hospitals and asking whether patients with particular issues "are sick enough yet" to be able to have procedures done under the EMTALA guidance. "Even in situations that aren't that severe, they're thinking about that in the back of their mind."

He predicted that these issues are likely to be litigated, such as in the over the EMTALA guidance, "and it's important that courts affirm the responsibility of hospitals."

Resneck also expressed disappointment at the 4.4% payment cut as proposed by the Centers for Medicare & Medicaid Services for the 2023 Physician Fee Schedule. "We're now in 20 years of frozen Medicare physician payments ... and inflation is clearly worse now than it was in the past," he said. With so many costs of practice -- such as hiring staff, paying rent, and investing in "new and improved" electronic health records -- continuing to rise, "it just makes it hard for people to make those investments without some certainty about the future," he said.

Reducing gun violence is another area that the AMA wants action on, Resneck said. "We join with the country in saying 'Enough is enough.' We think of this as a public health crisis, and many of these [gun-related deaths] are preventable deaths."

The new law passed by Congress and signed by President Biden that restricts gun sales to youth and closes the so-called boyfriend loophole "is a good start, but we have a lot more to do," Resneck said.

Joyce Frieden oversees �鶹��ý’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy.