Most patients don’t spend much time thinking about what their surgeon thinks of their insurance plan. But maybe they should.
Behind the scenes of every prior authorization, every billing cycle, and every insurance denial, there’s a surgeon who trained for a decade or more to do one thing: help patients heal. And increasingly, those surgeons are reaching a breaking point with a system that prioritizes paperwork over patients.
Here’s what the data — and the surgeons themselves — actually say.
The Bureaucracy Problem Is Real, and It’s Getting Worse
Physician frustration with insurance isn’t anecdotal. It’s documented at scale.
According to the American Medical Association’s 2024 National Physician Survey, an overwhelming 94% of physicians reported that prior authorization requirements delay necessary care. Eighty percent said those delays cause patients to abandon treatment altogether. And 90% believe the insurance approval process directly increases overall healthcare costs — not lowers them — through additional office visits, emergency department care, and disease progression.
“Prior authorization is only one part of the problem. Physicians now spend nearly half their workday on electronic health record (EHR) documentation and administrative tasks.”
— KevinMDAdministrative Burden Is Driving Severe Physician Burnout, April 2026
Nearly half the workday. For a surgeon, that’s time that could be spent in the operating room, in a pre-op consultation, or in post-operative care with a patient who needs their full attention.
Burnout Is Highest Among Surgical Specialties
The Medscape 2025 Physician Burnout and Depression Report found that 62% of physicians reported burnout — and “too much bureaucratic work” ranked as the top contributor, ahead of electronic health records, long hours, or any other factor.
General surgeons and orthopedic surgeons — the very specialists most likely to be performing the procedures patients need — consistently rank among the hardest hit. According to the AMA’s 2025 Organizational Biopsy, which surveyed nearly 19,000 physicians across 106 health systems, general surgery reported a burnout rate of 43.8% and urological surgery came in at 49.5%.
For context: nearly 1 in 2 urological surgeons reported experiencing burnout symptoms in 2025. That’s not a fringe problem. That’s a systemic one.
— American Medical Association, 2025 Organizational Biopsy
And it’s worth noting what burnout costs patients, not just physicians. Research consistently links physician burnout to lower quality of care, reduced patient satisfaction, and higher rates of medical error. When the system grinds down its best surgeons, patients pay the price.
What Surgeons Actually Want to Be Doing
Ask a surgeon why they went into medicine, and the answer is almost never “to spend four hours a day managing prior authorizations.”
The 2024 Medscape Surgical Compensation Report found that across general surgeons and orthopedic surgeons, the most rewarding aspects of their work were being good at what they do and the gratitude they receive from patients. The most challenging aspect, cited above all others? Reimbursement challenges with insurers and cumbersome rules and regulations.
The same report noted that many physicians pointed to the growing corporatization of medicine as a significant challenge — specifically, frustrations with nonmedical personnel influencing clinical decisions and a system focused more on quantity than quality of care.
That tension is real. A surgeon who spent 12 or more years in training to master a procedure shouldn’t have their clinical judgment second-guessed by an insurance algorithm. But in the current system, that happens routinely.
You Have a High-Deductible Health Plan
If your deductible is $3,000 or higher, you’re likely paying most of the cost of an elective or non-emergency procedure yourself anyway. A transparent cash price can be equal to or lower than your out-of-pocket maximum — and you’ll know the number upfront.
Some Surgeons Are Opting Out of the System Entirely
One of the most significant trends in American medicine right now is the quiet exodus of skilled physicians away from insurance-dependent practice.
A Medical Economics feature on direct-pay practices captured this sentiment plainly. One physician said:
Patients love it, and I feel that I’m fulfilling what I always envisioned in my role as a doctor.
— Physician quoted in Medical Economics, “Getting Started with a Direct Pay Practice
The article also noted that direct-pay models are seen as more streamlined and legally cleaner than hybrid approaches that mix insurance and cash-pay patients — which can create complex compliance challenges.
Notably, an orthopedic surgeon from Colorado Springs was among those featured — a signal that this shift is happening right here in Colorado, not just in coastal markets.
What the Direct-Pay Model Changes for Surgeons
At a direct-pay surgical center like Smith Medical, the insurance middleman is simply removed. The implications for surgeons are significant:
- No prior authorization process. Surgery can be scheduled based on medical need, not insurance approval timelines.
- Faster, more predictable payment. Bundled pricing means no claims processing delays, no appeals, no partial reimbursements.
- Less administrative overhead. Time previously spent on coding, documentation, and insurance-related tasks goes back to patient care.
- Clinical autonomy. Surgeons make decisions based on what’s right for the patient — not what a payer’s utilization review team approves.
This is exactly what Lisa Fagan, CEO of Smith Medical Direct Specialty Care, describes when talking about why the model works:
At Smith Medical, we’ve created a model where surgeons are paid faster, free from the paperwork and insurance bureaucracy that so many physicians are frustrated by today. By removing those barriers, our providers can focus on what truly matters — delivering exceptional care to their patients.
— Lisa Fagan, CEO, Smith Medical Direct Specialty Care
What This Means for Patients
When a surgeon isn’t bogged down in administrative tasks, the benefits flow directly to the patient.
Faster scheduling. More time in the consultation. Clinical decisions made without insurance interference. A surgeon who chose your surgical center because it lets them practice medicine the way they intended — not because of a network contract.
In many cases, the all-inclusive bundled pricing at a direct-pay center like Smith Medical is 40–60% less than traditional hospital billing. That’s not because the quality of care is lower — it’s because the administrative overhead driving up hospital costs has been stripped away.
Less bureaucracy means more medicine. And that’s better for everyone.
The Bottom Line
Board-certified surgeons aren’t frustrated with their patients. They’re frustrated with a system that puts insurance paperwork between them and the people they went to school for a decade to help.
The direct-pay model doesn’t just save patients money. It gives surgeons back something they can’t put a price on: the ability to focus entirely on care.
If you’re exploring surgical options and want to work with a surgeon practicing in a model designed around patient outcomes — not insurance outcomes — Smith Medical is here.
Know your cost upfront. Schedule with confidence. Request a consultation →
