I have no admin back-up. All prior authorizations are done by me. As a psychiatrist, I book my schedule as tightly as possible, so these extra phone calls, being on "perma-hold" for 10-25 minutes, takes a big bite out of my time. Not to mention that they often are on the mainland, and there is a 2-3 hour difference in time zones between Hawaii and California. Not to mention the 5-6 hour difference to the East Coast, so it's hard to do this at the end of the day for me. A colossal waste of my time, a never-ending source of frustration, and frankly, another thing to push me towards retirement, and I know that there is still a shortage of private psychiatrists in my state.