Over the past decade, physicians have had to spend increasing amounts of time on electronic inboxes and health records, an issue that only intensified after the start of the pandemic.
It’s work that’s typically unpaid and done before and after clinic, even on nights and weekends during what Lisa S. Rotenstein, MD, and many others refer to as “pajama time.”
But though that EHR inbox work can be exhausting, it also appears to be valuable to patients, according to a new study co-written by Dr. Rotenstein. She is medical director of ambulatory quality and safety at the University of California, San Francisco, Health, and also directs the Brigham and Women’s Hospital and Physicians Foundation Center for Physician Experience.
Published in the Journal of General Internal Medicine, a study of 133 primary care physicians shows that the more time that they spent corresponding with patients in electronic inboxes, the more likely those patients reported being to recommend their doctor.
For the study, conducted among primary care doctors at the Brigham and Women’s Hospital, Dr. Rotenstein and her colleagues found that women physicians received 42% more patient medical advice request inbox messages per patient each year when compared with their male counterparts.
For women doctors, greater yearly message volume and time spent in the electronic inbox per patient were associated with more than double the odds of a higher likelihood-to-recommend score. Taking longer to respond to messages from patients, by contrast, was linked with lower odds that patients would recommend their primary care doctor.
Studies have previously found that women physicians spend more time, and an increasingly large amount of time, on EHR work. It’s also been shown that women physicians get more electronic messages.
“We know that time spent on the electronic health record and on the electronic inbox is actually associated with better quality of care, in some circumstances,” she said.
A piece of the burnout puzzle
Dr. Rotenstein said the recent study’s findings are important in considering the problem of physician burnout.
“We know that physicians are spending time on the electronic health record and on patient care after hours, on weekends, in times that cut into their ability to recharge and have time with their families, and that all leads to burnout,” she said. “Where this study fits in is that it tells us that the solution is not just to cut back on that time spent on the electronic inbox, because particularly for female PCPs, our patients appreciate this electronic communication and maybe they even expect it.”
There are ways to cut the burden of electronic inbox communications, though, according to Dr. Rotenstein. She said some e-inbox communications can be handled by other members of the patient’s care team and don’t require a physician’s time.
Dr. Rotenstein added that health care organizations should help set expectations regarding e-inbox communications, and those discussions shouldn’t be handled by individual physicians—particularly women, who might be seen in a negative light by their patients for setting boundaries.
Patients need to understand that “there are things that are really well-suited for” electronic communication, she said, “and then there are some topics that are just really complex and so they may not be the right thing for a patient message.”
Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians. Far too many American physicians experience burnout.
That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
Time to pay for inbox care?
Another key, according to Dr. Rotenstein, is that the time spent on electronic inbox communication needs to be considered patient-care time and paid for appropriately. That means, she argued, reworking the current payment model that emphasizes visits.
“The work of primary care is really increasing, and our patients value relationship-based, longitudinal, easy-to-access care,” she said. “The real opportunity lies in thinking about how we pay for the primary care of 2023.”
The study was funded as part of the AMA Electronic Health Record Use Research Grant Program, which was launched in 2019 to identify patterns in EHR use that may detract from patient care. The AMA has awarded more than $2 million in grants to 26 organizations over the years to study a variety of EHR-use topics.
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