13 Hours a Week

Inside every American medical practice there is a second job that no one bills for. The American Medical Association surveys 1,000 practicing physicians about it every December, and the latest edition — fielded in December 2025 — found that practices complete 40 prior-authorization requests per physician, per week, and that physicians and their staff spend 13 hours each week completing them.¹

That is not a spike. The prior edition, fielded a year earlier, measured 39 requests and the same 13 hours.²The number has become a fixture of the survey series — steady enough that it stops being a statistic and starts being a line item. This piece does the translation the survey doesn't: what 13 hours a week actually costs a small practice, in fractions of an employee and in dollars, with the arithmetic shown.

Thirteen hours against a 40-hour work week is 32.5% of a full-time employee — roughly a third of an FTE for every physician in the practice. A three-physician practice carries about 39 hours of PA work a week: one entire full-time position that produces no visit, no procedure, and no revenue. The survey's own staffing question corroborates the arithmetic from the other direction — 40% of physicians report employing staff whose only job is prior authorization.¹

Pricing those hours is straightforward, because the people who do most of this work sit in occupations the Bureau of Labor Statistics measures every year. Medical records specialists earned a median of $50,250 a year ($24.16 an hour)as of May 2024 — $45,620 in physicians' offices specifically.³ Billing and posting clerks earned a median of $47,170.⁴ Here is the whole calculation for a solo practice, step by step:

Read the floor for what it is. Roughly $15,000 to $16,300 per physician per year is what the time would cost if every one of those hours belonged to a clerk. They don't. The AMA measures the 13 hours as combined physician and staff time, and a physician-hour spent on a portal or a peer-to-peer call is also a patient-hour not delivered — an opportunity cost this piece deliberately leaves unpriced because no survey measures it directly. Whatever the true number is, it sits above the table, not below it.

If 676 hours a year purchased smooth approvals, a practice might book it as overhead and move on. The same survey says otherwise. Nearly one in three physicians (32%) report that their PA requests are often or always denied, and 74% say denials have increased over the past five years.¹ The burden lands on patients and on the people doing the work:

And the time tax explains the survey's bleakest finding about denials: only one in five physicians (21%) always appealan adverse PA decision. Asked why not, 59% say they don't believe the appeal will succeed, 52% cite insufficient practice staff resources or time, and 49% say the patient's care can't wait for the plan.¹ A practice already spending a third of an employee per physician on the front end of the process has little left for the back end — which is how winnable denials become write-offs.