The advent of patient portals and inbox messaging was promised to help improve patient care and foster convenience for both the doctor and the patient. With just a few quick taps on their mobile apps or through a patient portal online, a patient can quickly get in touch with their physician’s office and leave a message or send a query. However, this concept has evolved over the years into a much larger administrative crisis, where patients feel dissatisfied with the responses they often get and doctors have to spend hours of time after work to keep up with and respond to messages.
This phenomenon has largely been deemed by the industry as the “portal paradox,” referring to the idea that while portals were built to ease workflows and reduce administrative burdens, many have noted that they have actually inflated workloads as an addition to existing schedules and clinic hours. The concept has overwhelmingly blurred the lines between professional and personal hours for physicians, overburdening an already tenuous workforce. A study published in JAMA found that online portal messages have more than doubled between 2020 and 2025, emerging as a new medium for uncompensated work and time for many physicians. For patients, the portal represents a quick way to inquire about new medical symptoms, request medication refills or share new information that may be relevant for treatment plans; however, the cognitive load of switching between patient histories and responding in an appropriate manner is significant for physicians, and requires time and effort which is often unaccounted for in addition to their regular clinical workloads.
Studies are increasingly showing a strong correlation between time spent with messages and EHRs and physician burnout rates. A recent analysis found that “Mean time actively working in the EHR per week increased for all specialty groups following the onset of the COVID-19 pandemic. PCP EHR time increased 6.5%, from a mean of 10.6 to 11.3 hours per week, medical subspecialists’ time increased 9.9%, and surgeons’ time increased 5.2%. Physicians with greater than 40 visits per week saw similar trends, with PCPs having the highest EHR time before and after the start of the pandemic (7.8% increase from 14.1 to 15.2 hours per week).”
Nevertheless, the portal does represent an opportunity and bridge for thousands of patients that cannot otherwise access healthcare services easily. An AMN Report found that “the average wait time for a physician appointment across six medical specialties in the 15 large metro areas surveyed is 31 days.” For many patients, the portal is a lifeline and method to stay in touch with their care team as they are not able to get faster appointments, and often, may not be able to discuss everything in one appointment.
However, systems, policymakers and technologists need to fix the mismatch between these two phenomena. Given modern advances, many organizations are turning towards auto-triaging by AI services and other digital tools to help ease the burden for physicians. However, the reality is that inbox messages cannot be cleared easily and often require the intricate efforts of a physician to truly address the issue; otherwise, patients are left feeling unattended to, defeating the entire purpose of the inbox itself. There is significant opportunity for improvement in this arena, and the system simply cannot effort to further disenfranchise physicians who already have too much administrative burden. This has led to significant attrition and burn out rates, which the nation simply cannot afford any longer.
