I never thought I’d be here—working for an insurance company, overseeing prior authorizations, and spending more time reviewing paperwork than helping patients.

When I first left clinical medicine a few years ago, it felt like the right decision. I was burned out from the long hours, the constant pressure, and the never-ending demands of patient care. The insurance world offered stability, better hours, and, frankly, a more comfortable lifestyle. I told myself I’d still be helping people, just in a different way.

But as the years have passed, I’m starting to question that.

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At first, I thought my role would allow me to fix things from the inside.

I’d seen how frustrating insurance hurdles were for doctors and patients alike, and I figured I could be part of the solution—make the process smoother, more rational, less of an obstacle to care.

But it hasn’t worked out that way. Instead, I find myself spending my days reviewing prior authorizations, deciding which treatments or tests get approved and which don’t.

On paper, it’s supposed to be about ensuring “medical necessity” and “cost-effectiveness.” But the reality is much more complicated—and a lot uglier.

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The longer I do this, the more I feel the weight of the decisions I’m making. I know what it’s like on the other side of this process—the doctor fighting for their patient to get the MRI or the life-changing medication. I remember the frustration, the helplessness when an insurance company denied something I knew my patient needed. And now, I’m the one making those calls, deciding if a treatment fits the company’s criteria or if it’s too expensive to justify.

I used to think I was still helping people by ensuring that the system worked efficiently. But the truth is, every day I feel more disconnected from the reason I became a doctor in the first place: to care for patients.

Instead, I’m stuck in a system that seems more focused on the bottom line than on what’s best for the individual.

The justifications I’ve heard given over the years, including “preventing unnecessary care”, are starting to ring hollow. Sure, there’s waste in the system, and some tests or treatments are overused.

But when you’re sitting at a desk reviewing files and you know that your decision is going to cause someone pain, delay their diagnosis, or complicate their treatment plan, it’s hard to reconcile that with the values that brought me to medicine in the first place.

I’ve risen through the ranks here. I have more responsibility, more influence, and yet, I feel more powerless than ever.

I tell myself that I’m doing the best I can, that someone has to make these tough decisions, but it’s getting harder to believe that. I used to be the person advocating for patients, fighting the system on their behalf.

Now I’m part of the machine, and it’s wearing on me in ways I didn’t expect.

I feel guilty, if I’m being honest. Guilty for all the patients I’ll never meet whose care I’ve impacted by denying a prior authorization.

Guilty for the doctors who have to spend their time arguing with me over the phone instead of being with their patients.

Guilty because, at the end of the day, I’m comfortable while they’re suffering through the very system I’m helping to uphold.

I don’t know what the solution is. I can’t just walk away—it’s my job, and I’ve built a career here.

But I’m struggling with the question I’ve been avoiding for years: Am I still a doctor, or have I become something else entirely? And if I’m not helping patients anymore, what am I even doing here?

I’m not sure how much longer I can keep ignoring that question.