Report says docs are buried in messages, most from EHRs

New published research shows a link between physicians’ well-being and the volume of messages that come in their inbox.

In-box messages generated by electronic health records systems accounted for nearly half of weekly messages received per physician, far exceeding the number of messages received from colleagues and patients, which further contributes to burnout.

The EHR potentially creates a 24/7 work environment for physicians, according to Ming Tai-Seale, a professor at University of California San Diego, along with colleagues who have published an article in Health Affairs on the onslaught of information that bedevils clinicians.

“Its impact on physicians’ wellness has become a challenge for most healthcare delivery organizations,” she notes. Understanding the relationships between physicians’ well-being and ‘desktop medicine’ work in the EHR and work environment is critical if burnout is to be addressed more effectively.’”

Also See: Why it’s essential to solve all causes of physician burnout

In a survey, 36 percent of responding physicians reported burnout symptoms, and 29 percent intended to reduce their clinical work time during the next year. Physicians working in a more positive environment were associated with lower odds of burnout, and the intention to reduce clinical work and have greater satisfaction of life.

Female physicians had a higher risk of burnout and lower satisfaction of life, compared with males. “While these findings have been reported previously, actions are still needed to support female physicians,” researchers say. “It is necessary to recognize the different manifestations of burnout symptoms across physician genders.”



Studies have documented that female physicians are more likely to suffer from emotional exhaustion, whereas male physicians first experience depersonalization. Females are more successible to burnout because of work-home conflict. Consequently, more flexible work schedules could enable female physicians to better harmonize work-life responsibilities.

For all physicians, “meaningful redesign of EHR in-basket workflow and a wellness-enhancing work environment are necessary to effectively improve physicians’ well-being,” researchers caution.

Only 12 percent of respondent doctors deemed the statement “physicians are highly valued,” to be completely true regarding conditions in their primary care settings.

Yet, 83 percent reported having good or optimal control over their work schedule, and 60 percent reported having a calm to busy but reasonable primary work area.

The average number of weekly in-box messages was 243, with nearly half of the messages generated by EHRs. These included pending orders automatically sent to doctors based on algorithm-driven health maintenance reminders, requests for prior authorization, patient reminders and many more orders. Only about 30 messages weekly came directly from patients.

In the University of California San Diego report, researchers have multiple ideas on how to reduce burnout and improve life satisfaction.

Providers, for example, need to reconsider approaches to improving the quality of care and population health. As such, physicians might not be the most appropriate recipients of system-generated messages. Electronic health record design engineers should reconsider whether system-generated automatic messages are the best way to ensure quality of care. And, it may be time to determine if every reminder to order chronic disease management lab tests must be signed and placed by a physician.

Limiting desktop medicine work during evenings, weekends and holidays, unless the physician is on call, could reduce burnout. Organizations could allow messages to reach physicians’ in-baskets only during work hours, conveying the message that physicians are so highly valued that the organization wants to protect their private time, researchers suggest.