AMWA Addresses the Burden of Utilization Management on Physicians

At the Interim Meeting in September, AMWA held a focus group to learn about our members’ experiences with utilization management (UM), which includes prior authorization, step therapy, and fail-first protocols. While these processes are intended to control costs, they often delay patient care, disrupt treatment, add extra administrative burden on practitioners, and strain the practitioner–patient relationship. Research shows over 90% of providers report they have had to alter care plans due to UM restrictions. Aside from negatively impacting patient outcomes, these policies also contribute to provider burnout and, in some cases, drive clinicians from the profession.

While patient impacts of UM are well documented, the practitioner perspective is less visible and must be elevated, especially at a time when clinician burnout and healthcare practitioner shortages are impacting patient care. Processes should help protect valuable clinical time with patients, not add more administrative overhead.

AMWA is participating in the UM Provider Project with four national groups who are interested in quantifying the challenges for their members and patients:

• AMWA (American Medical Women’s Association)
• AANP (American Association of Nurse Practitioners)
• NABN (National Association of Black Nurses)
• NAHN (National Association of Hispanic Nurses)

Each group will survey members (13 questions) and, for prescriber groups, gather case studies illustrating real-world UM challenges through a dedicated listening session. Findings will support advocacy, policy reform, and potentially publication.

We believe that the physician voice is critical and encourage all of our members to participate. Please complete the survey by October 31. Your input will ensure that practitioner voices are amplified in state and federal policy discussions. We especially want physician perspectives to help shape reform efforts and advance patient care.