Why a physician's list keeps getting longer

For most physicians, deciding on the right care is the easy part. Say a neurologist decides a patient should start an infusion therapy. Before the first dose, the patient needs labs, infection screening, consent, insurance approval, a pharmacy, an infusion order, and a chair on the schedule. No single person owns that chain, so it lives on the physician's list. This piece is about why that list keeps getting longer.

Why does each patient come with more to follow up on than before?

Because patients are sicker, see more doctors, and get care from more kinds of providers. Each of those adds work to the list.

In 2023, 51.4% of U.S. adults had two or more chronic conditions, up from 47.3% in 2013. Among adults 65 and older it was 78.8% (CDC, Preventing Chronic Disease, 2025). Each condition can bring its own specialist, its own labs, and its own plan to keep in sync.

Patients also see more physicians. In 2019, 30.1% of Medicare patients saw five or more physicians in a year, up from 17.5% in 2000. Over the same years, a primary care doctor's patients went from being shared with a median of 52 other physicians to 95 (Barnett et al., Annals of Internal Medicine, 2021). Any of those physicians can owe that doctor a note, a result, or a recommendation.

Newer kinds of care add to the count too, and most of it is good medicine. Precision medicine brings genetics teams into the plan. Chronic care is moving into the time between visits, and Medicare paid more than $500 million for remote patient monitoring in 2024 (HHS Office of Inspector General, 2025). Each new model brings one more party with its own system and its own inbox.

Why does more of it stall before the care happens?

Because more of the work is a request to someone the practice doesn't control. The people on the other side keep changing, and the practice has fewer hands to chase it.

Some of the new work is permission rather than care. Practices handle an average of 39 prior authorizations per physician each week. Physicians and staff spend about 13 hours a week on them (AMA survey, fielded late 2024, published 2025). In the AMA's 2026 survey, 95% of physicians said prior authorization delays access to care (AHA News, May 2026). Every one of those requests waits on an insurer, and no practice can place an order for an insurer's answer.

The other side also keeps changing hands. As of January 2026, 82.0% of U.S. physicians worked for hospitals or corporate owners. Those buyers picked up about 85,000 practices between 2018 and 2026 (Physicians Advocacy Institute and Avalere Health, 2026). A sale can mean a new phone tree, a new fax line, or a new owner who stops answering. When that happens, nobody on the referring side did anything wrong. The request simply left their reach.

And the people who used to chase this work are harder to find. In June 2026, 84% of medical groups told MGMA their costs were higher than a year before. Labor was the biggest driver (MGMA, June 2026). In May 2026, 56% said hiring medical assistants had gotten harder over the past year (MGMA, May 2026). A large health system can staff the problem with a prior-auth team, infusion coordinators, and referral coordinators. A community specialty practice has a medical assistant and a busy front desk, so the physician becomes the connective tissue.

Put these together and the effects compound: more follow-up per patient, more of it outside the practice, and fewer people to notice when it stalls.

Why doesn't the EHR, or the inbox, catch what's stuck?

Because neither one tracks completion. The inbox tracks what someone opened, and Epic tracks its own orders.

Epic does its own job well. An order placed in Epic gets a signed, timestamped completion, and any CMIO will tell you that. But Epic tracks what Epic ordered. It does not track what you asked a person to do, or what you're waiting on from outside. An insurer's decision, a contracted group's note, and a newly acquired practice's callback all sit past that line.

The inbox has a quieter gap. Our cofounder, a practicing neurologist, walked us through a patient message in his clinic. It was created, attached to the chart, and forwarded to the team, and then it went nowhere. Clicking a message marks it read whether or not anything was done, so a message that was opened and never handled looks finished. The patient called back, and that second call was the only alarm.

So physicians hold the list themselves. We asked more than 30 clinicians how they track what they're waiting on, and not one physician named the EHR. An internal medicine attending on a teaching service told us, "I do it by paper and pen." Physicians use paper and memory because they are the only tools that go wherever the work goes.

This is the belief we've built the company on. The instinct is to get everyone onto one shared tool. We don't think that works. An insurer won't join it, a contracted group won't, and a practice that just changed owners can't. So verification has to work by observation, not participation. We watch for the signal wherever one already exists: a result lands, a note appears, a call comes back, a decision posts. We require nothing new from the other side, because you won't get it.

What would it take to make sure the care you order happens, and what does the gap cost?

It takes four facts per patient, gathered by watching. It also takes a clear view of what the gap costs.

The cost shows up in three places. It shows up in time to treatment. Do you know your practice's average days from a treatment decision to the first dose? It shows up in the day. The internal medicine attending spends about three hours a day confirming that consultant recommendations got done. And it shows up in risk. Candello's database covers about a third of U.S. malpractice claims. Its November 2025 report found communication failures in 40% of cases from 2014 to 2024, and 45% of those were between providers (Candello, 2025).

Our cofounder described the fix in one line: "It would be nice to know for each patient what we are waiting for." Taken as a spec, that has four parts.

What is pending, stated by the physician in their own words when they ask, rather than pulled from a note later.

Who has it, meaning a person or a named outside party rather than a department, and whether they've accepted it. That prevents the case where two teams each assume the other one has it.

How old it is, which paper can't show. A consult request six hours old and one three days old look the same on a sheet.

Whether it moved, meaning a result landed, a note appeared, or a call came back. If nothing did, the silence is now old enough to mean something.

All four can be filled by watching what already happens. None of them asks the insurer, the contracted group, or the new owner to do anything new.

The goal is a practice where, when something stalls, the physician knows what, who, and how long, without rebuilding it chart by chart.

That's what we're building at Semblance Health. We want to make sure the care you order actually happens, for every patient, with the staff a practice already has. That includes the people and places the EMR doesn't reach. We're selecting a small number of specialty practices to work with before anything goes live.

If you run a specialty practice where treatment decisions wait on labs, authorizations, and scheduling, give us twenty minutes. We'll walk through the last patient who waited to start treatment, from the moment you decided to the first dose. You keep the write-up either way.