You did not hire a full-time prior authorization coordinator. Check your payroll and you will not find one. Yet somewhere between your exam rooms and your phone, roughly a third of a full-time salary is being spent every year on faxes, portal logins, hold music, and peer-to-peer calls with a nurse reviewer who has never met your patient. That invisible position is the prior authorization full-time staff salary almost no solo specialist ever writes down, and the first step to fixing it is admitting how large it has quietly grown.
This piece is a self-audit for solo specialists. Not a survey of national averages you can nod at and forget, but a way to put your own hours and your own dollars on the table. The national numbers are the starting reference. The point is to hold them up against what happens in your office next Tuesday.
The AMA and MGMA Numbers That Frame Your Hidden PA Salary
Start with the two figures that anchor every honest conversation about prior auth workload. The American Medical Association's annual prior authorization survey has, year after year, put the average physician's burden at 39 to 45 prior authorizations per week and roughly 13 hours of practice time consumed processing them. Thirteen hours. That is not a rounding error tucked into a busy afternoon. It is nearly two full working days, every week, spent not treating patients.
Run that forward. Thirteen hours a week across a 52-week year, minus a couple of weeks off, lands near 676 hours annually. A full-time equivalent, at 40 hours across roughly 48 worked weeks, is about 1,920 hours. So your practice is already spending better than a third of a full-time position on prior authorization alone, without a job posting, an offer letter, or a line on the org chart.
For a solo specialist the distribution is what makes it invisible. You do not have a dedicated PA team where the cost is obvious. Instead the 13 hours gets sliced across your medical assistant who steps away from rooming patients, your front-desk person who abandons the phone to sit on hold, and you, in the exam room doorway at 6:40 p.m., waiting to argue with a reviewer about an imaging study you have ordered a hundred times. Because no single person owns it, no single person feels the full weight, and the true total never gets summed.
Running Your Own One-Week Prior Auth Time Audit
National averages are a frame, not a verdict. Your specialty, your payer mix, and your ordering patterns can push you well above or below the 39-to-45 range. A rheumatologist starting biologics, a cardiologist ordering CT angiography, an interventional pain specialist scheduling injections, and a dermatologist prescribing a specialty topical will each see wildly different volumes. The only number that governs your practice is the one you measure.
Here is the audit. For one ordinary week, log four things on every prior auth: the date, the payer, the total minutes spent across every touch, and who did the work. Count everything. The initial portal submission. The re-submission when the portal times out. The 22 minutes on hold. The fax that has to be re-sent because page three did not transmit. The peer-to-peer call scheduled for a window that collides with your afternoon clinic. When you tally minutes, include the dead time, because the payer's hold queue is still your staffer's paid hour.
flowchart TD
A[Order requires<br/>prior auth] --> B[Staff logs payer<br/>and start time]
B --> C[Submit via portal<br/>or fax]
C --> D{Approved on<br/>first pass}
D -->|No| E[Hold time<br/>and resubmission]
E --> F[Peer to peer<br/>call scheduled]
F --> G[Log total minutes<br/>and who did work]
D -->|Yes| G
G --> H[Multiply minutes<br/>by loaded wage]
H --> I[Annualize the<br/>hidden salary]At the end of the week, sum the minutes and convert to hours. Then attach a dollar figure using the loaded hourly cost of whoever did the work, meaning wage plus benefits and taxes, usually 1.25 to 1.4 times base pay. A medical assistant at 22 dollars an hour costs you closer to 29 loaded. When you spend that person on hold, you are paying clinical-support wages for administrative waiting.
Converting Minutes Into the Salary You Never Budgeted
Now the arithmetic that turns a vague annoyance into a number you can act on. Say your audit confirms the average: 40 prior auths in the week. Say each one, fully loaded with resubmissions and hold time, averages 20 minutes of human effort. That is 800 minutes, or about 13.3 hours, landing you almost exactly on the AMA figure.
Cost it out. Thirteen hours a week at a 29-dollar loaded rate is 377 dollars a week, roughly 19,600 dollars a year, if every case is handled by your medical assistant. But some of those 13 hours are yours, the physician, on peer-to-peer calls. Value your own time even conservatively at 200 dollars an hour and just two physician hours a week on peer-to-peers adds 400 dollars weekly, another 20,000 a year in the highest-cost labor in the building. Blend the two and the annual figure clears 25,000 to 35,000 dollars.
That tracks with the per-submission cost research too. Industry cost studies, including the CAQH Index, have long put a manually submitted prior authorization at roughly 11 to 14 dollars in provider labor each, versus a fraction of that when the transaction is electronic and automated. Forty a week at 12 dollars is 480 dollars weekly and just shy of 25,000 dollars a year, arriving at the same place from a different direction. When two independent methods converge on a mid-five-figure number, you are looking at a real, unbudgeted salary.
Here is the part that stings: none of that spend has bought you a single treated patient. It is pure friction cost, incurred before you account for the revenue you lose when a delayed authorization pushes a procedure into next month or a denial makes it evaporate entirely.
Where the Prior Auth Backlog Silently Taxes a Solo Practice
The dollar figure is only the visible tax. The prior auth backlog also taxes your practice in ways that never hit a spreadsheet. Every hour your medical assistant spends on a payer portal is an hour of unanswered phones, and unanswered phones are unbooked appointments and unrenewed prescriptions. In a solo specialty office the same two or three people cover intake, rooming, checkout, and authorizations, so PA work does not add headcount, it steals hours from the work that actually generates revenue.
Then there is the patient-experience cost. A prior auth stuck in a backlog is a patient sitting at home wondering why their MRI has not been scheduled, calling your front desk to ask, and consuming yet more of the same staff time that is already underwater. The backlog is self-reinforcing: the delay generates the inbound calls that prevent the staff from clearing the delay.
If you are drowning in this and looking for medical practice prior authorization backlog help, the structural fix is not another part-time hire you cannot afford. It is removing the low-judgment, repetitive portion of the work from human hands entirely. CallSphere's AI front desk answers 100 percent of your calls around the clock, so the status-check calls the backlog generates never pull your staff off the actual authorization work. Meanwhile the eligibility and benefits checks that should happen before an order is even placed can run automatically, so fewer requests hit the PA queue mispriced or missing information. You can see how those pieces fit together on the /features page.
A Five-Minute Test to Size Your Own Full-Time Equivalent
You do not need a consultant to run this. Grab last week's schedule and answer four questions honestly.
First, how many orders you placed last week actually required a prior authorization? If you do not know, that uncertainty is itself the finding. Second, what did each one cost in minutes, counting hold time and resubmissions, not just the tidy first attempt? Third, who did the work, and what is that person's loaded hourly cost, including your own time on peer-to-peers? Fourth, multiply and annualize.
If your number lands between 20,000 and 40,000 dollars, you are normal for a solo specialist and you have just found a full-time equivalent that was never on your books. The question then is not whether the cost exists, but whether you keep paying it in your own clinical hours and your staff's intake hours, or you shift the repetitive share to automation and reclaim those hours for patient care. A practice spending 30,000 dollars a year in scattered PA labor can redirect a large fraction of that once the phone coverage, eligibility verification, and reminder work stop competing for the same people. That math, and where a plan lands for a practice your size, is laid out on the /pricing page.
What to Do With the Number Once You Have It
The value of this audit is not the outrage, it is the clarity. Once you can say out loud that prior authorization costs your solo practice roughly 13 hours and 30,000 dollars a year, you stop treating it as an unavoidable weather condition and start treating it as a line item you can manage.
Run the one-week tally. Put a real dollar figure on the hours. Separate the judgment-heavy work that genuinely needs a clinician or a trained biller from the repetitive submission, follow-up, and status-check work that does not. Move the repetitive share off your team's plate, and give your staff their intake hours and your evenings back. The full-time coordinator you never hired has been on your payroll all along. Now you can decide what that position is actually worth doing, and what a machine should be doing instead.