Virtually all healthcare professionals have some degree of altruism and a strong desire to help patients in need. As healthcare continues to evolve, the burdens on clinicians change as well. While most of us have been taught that providing a “medical home” to patients along with shared decision-making is the most ethical way to provide effective healthcare, many are finding that other stakeholders may potentially derail those worthy intentions. While insurers are not often considered to be “regulatory agencies” by most, they indeed have become major players in determining the trajectory of everything from pain assessment to treatment planning and implementation to follow-up and monitoring. Many feel that insurance related paperwork and associated administrative burdens are contributing significantly to clinician burnout and ultimately having a negative impact on patient care. Additionally, navigating these challenges is not part of the standard curriculum of most educational training programs. This session will focus on these topics and the concept of “institutional iatrogenesis” and identify the challenges they present to healthcare providers, as well as strategies to manage them and minimize interference with our primary mission: caring for patients with pain.