Assessing the Impact of Prior Authorizations on Dermatology Residents

June 2024 | Volume 23 | Issue 6 | 485 | Copyright © June 2024


Published online May 27, 2024

doi:10.36849/JDD.7617

Dillon Nussbaum MD, Jessica Kalen MD FAAD, Erika McCormick MD, Sapana Desai MD, Adam Friedman MD FAAD

Department of Dermatology, The George Washington School of Medicine and Health Sciences, Washington, DC

Abstract
Introduction: Prior authorizations (PAs) are administrative tasks commonly required by insurers to approve medications or therapies for patients. Dermatology practices frequently employ coordinators to focus on completing PAs, among other solutions. The degree to which this support is offered in academic centers and, importantly, how much time dermatology residents spend on PAs over educational pursuits is largely unknown. The authors sought to identify the impact of PAs on dermatology residents.
Methods: An IRB-approved (#NCR213814) 13-question survey was distributed nationwide to dermatology residents regarding the impact of PAs on aspects of clinical and scholarly activities. 
Results: 150 of 1462 dermatology residents, 10.3%, responded to the survey. 70% of responding residents contribute to obtaining PAs. 58.7% indicated that their program employed a PA coordinator; though, of these, 63.6% still relied on residents for PAs. 84% indicated that for the following month they feared the burden of PAs would lead to a lapse in treatment for patients. 72.7% avoided prescribing certain medications due to PAs. 64% indicated the PA burden impedes their ability to perform scholarly activities. 80.7% indicated the PA burden contributed to burnout or decreased morale.
Conclusion: Our data highlight that dermatology residents are negatively impacted by the burden of PAs, resulting in reduced time to study, research, and best care for their patients. Dermatology residents and patients would benefit from reducing the burden of PAs, especially on residents by reforms or regulations that reduce dermatologic PAs, or by academic institutions removing these responsibilities from residents as best as possible.

Drugs Dermatol. 2024;23(6):485-488.    doi:10.36849/JDD.7617

INTRODUCTION

Prior authorizations (PAs) are administrative duties required by insurers for an increasing number of medications as cost-saving measures that confirm whether patients have previously failed cheaper, and usually older medications, or the reason as to why more expensive medications are necessary in certain clinical scenarios.1 Though the intent of implemented PAs was to save healthcare dollars, clinicians commonly view PAs as barriers to care that can harm patients; a recent American Medical Association (AMA) survey found 91% of physicians reporting that patients requiring necessary care experienced delays due to PAs and that 75% of patients abandoned treatments due to PA-related obstacles. 91% of physicians believe that PAs negatively impact patient outcomes.2 

Several studies have investigated and elucidated the detrimental effect of PAs on dermatology patients, but the impact that PAs have on dermatology residents and their education has yet to be explored.3-5 

MATERIALS AND METHODS

The authors surveyed dermatology residents to determine their involvement in obtaining PAs for patients in varying practice locations and sizes, as well as the impacts that PAs have on resident education and morale. An Institutional Review Board (IRB)-approved (#NCR213814) SurveyMonkey link with 13 questions was emailed with reminders to all US dermatology residents. Thirty respondents were randomly selected to receive prepaid gift cards in return for completing the survey.

RESULTS

Of the 1,462 dermatology residents who were sent the SurveyMonkey link, 150 completed the survey for an overall response rate of 10.3%. Demographics, department size, and survey responses are summarized in Table 1. Notably, 70.5% of dermatology residents contribute to obtaining PAs. 57.3% of respondents indicated that their department uses a biologic or PA coordinator, which is consistent regionally, with the exception of 83.3% of residents in New England and 75% in the Southwest. 6.7% of departments use specialty pharmacies and 1.3% rely on
Close Menu