During the COVID-19 pandemic, patients became accustomed to the convenience of emailing their doctors through patient portals and receiving answers without the need to book a clinic visit. This contributed to the number of messages already in the electronic health record that required doctor responses.
Even though the pandemic has abated, patients still want the ability to reach their doctors electronically – and this is contributing to burnout in a medical discipline already characterized by high stress.
University of Michigan researchers recently published the results of a study titled, “In-basket message volume in primary care: a cross-sectional analysis by gender and specialty,” in the Journal of General Internal Medicine.
They found that primary care doctors who practice in family medicine, pediatrics, internal medicine, geriatrics, and obstetrics and gynecology, received an average of about 15 electronic messages per clinic hour, with family medicine doctors experiencing the highest burden of portal messages, with an average of 17 messages received per hour of patient-facing clinical care. These messages can include everything from test results, patient calls, portal messages, prescription refill requests, work orders and documents that require a signature.
The study cohort included 295 primary care physicians -- 218 females and 77 males, who received almost 2.2 million in-basket messages during the study period of January-December 2023.
The team found that physicians who worked with adults handled more than twice the volume of messages per hour than those who worked with children. Additionally, doctors who worked fewer hours received more in-basket messages per hour.
"Physicians in primary care often spend nights and weekends replying to patient messages,” said lead author Kathryn J. Gold, MD, MSW, MS, associate professor in the departments of Family Medicine and Obstetrics and Gynecology at the University of Michigan. “The number of messages has exploded since COVID. While patients love the convenience, messages are rarely billed, and clinicians are burning out from all the extra hours."
While there were no significant differences between male and female doctors in terms of message types, female doctors had more variation in the number of messages. “Message burden by sex was significantly higher for female physicians only in two departments with low numbers of male physicians (pediatrics and obstetrics and gynecology) so data may be skewed by the small sample size of men in those cohorts,” the authors write.
However, the authors argue that primary care practices need support to manage high in-basket volumes considering that responding to messages is mostly uncompensated. Furthermore, patients not only appreciate electronic communications with their primary care doctors but consider it a contributor to care continuity. In other words, the trend promises to continue.
“It's already hard to get an appointment with a primary care doctor in the U.S,” Gold added. “We need to figure out how the system can pay for patient care over the portal so that we still have primary care doctors available for routine care."
Article cited: Gold, K. J., Udegbunam, C. J., Shikanov, E. H., Miwa, C., DeRoos, L. J., Cohn, A., & Springer, E. (2025). In-basket message volume in primary care: A cross-sectional analysis by gender and specialty. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-025-09377-x
