Why your portal message takes six days

A study published in JAMA Internal Medicine examined monthly, physician-level electronic health record data from more than 280,700 outpatient physicians between June 2019 and March 2022. It found that patient-initiated medical advice messages rose sharply at the start of the COVID-19 pandemic, when other routes into care closed — and, unlike telephone calls, did not settle back to where they had been.

At the end of 2019, primary care physicians were receiving roughly 10 medical advice messages and 18 patient calls a week. By March 2020 that was 16 messages and 24 calls. The calls stabilised afterwards. The messages, in the study's language, "meaningfully increased" and stayed there — a sustained, ongoing source of physician work.

This is the part that explains your six days. A clinic day is built out of appointment slots. Messages are not slots. They get handled in the gaps — between patients, at lunch, and after the last visit of the day.

The same study tracked where that time went. Off-hours EHR time for primary care physicians rose 6.5%, from 10.6 to 11.3 hours a week. Medical subspecialists saw a 9.9% increase. For primary care physicians carrying more than 40 visits a week, off-hours EHR time reached 15.2 hours — the better part of two extra working days, every week, invisible on any schedule.

Dr. Christine Sinsky, the AMA's vice president of professional satisfaction and a co-author of the study, put the structural problem plainly: systems should block time for this work, and should pay physicians for it.

Work published in the Journal of the American Medical Informatics Association found that physicians in the top quartile for messages received had more than six times the odds of burnout compared with those in the lowest quartile. It is not a subtle effect.

That matters to patients for an unglamorous reason. Burned-out physicians reduce hours, leave practices, and retire early. Every one of those decisions makes the queue you are sitting in longer.

The AMA's own recommendations start upstream: cut the volume of low-value notifications, empower nurses to handle most messages, help patients pick the right channel in the first place, and cover the inbox when a physician is away.

All sound. But a nurse triaging "is this normal?" still has to write back and ask how much, how long, how bad, and what else — then wait for you to be free to answer. Each round trip costs a day. Three rounds is your six days, and no one in the chain did anything wrong.

The fix is to collect the answers before the message is sent, not after.

Nobody should promise a reply in six minutes for every message, and any service that does is describing a call center rather than your physician.

What a practice can reasonably do is publish its response target, show it to you on screen before you send, say plainly which hours are covered, and route anything urgent somewhere monitored. That is a commitment to effort with the terms written down — which is a great deal more than most portals offer.