While patient portals were promised to ease workflows, they have added significantly to clinician workloads.
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Patient portals and inbox messaging were introduced with the promise of enhancing patient care and providing convenience for both doctors and patients. These tools allow patients to quickly contact their physician’s office via mobile apps or online portals to send messages or queries. However, over time, this has led to a significant administrative challenge. Patients often feel disappointed with the responses they receive, and physicians find themselves working extra hours to manage and reply to these messages.
This issue has been termed the “portal paradox” within the industry. Although these portals were designed to streamline workflows and decrease administrative demands, they have instead increased workloads by adding tasks to existing schedules and clinic hours. This development has blurred the boundary between doctors’ professional and personal time, placing additional strain on an already stressed workforce. A study in JAMA revealed that messages sent through online portals more than doubled from 2020 to 2025, creating a new avenue for uncompensated labor for physicians. For patients, these portals offer an efficient means to ask about new symptoms, request medication refills, or share information relevant to treatment plans. However, the cognitive demands of switching between patient histories and crafting appropriate responses require significant time and effort from physicians, often beyond their regular duties.
Studies have increasingly highlighted a strong link between time spent on messages and electronic health records (EHRs) and the rates of physician burnout. According to a recent analysis, the mean time spent actively working in EHRs per week rose for all specialty groups after the onset of the COVID-19 pandemic. Primary care providers (PCPs) experienced a 6.5% increase from an average of 10.6 to 11.3 hours per week. Medical subspecialists saw a 9.9% rise, and surgeons had a 5.2% increase. Physicians with more than 40 visits per week showed similar trends, with PCPs having the highest EHR time both before and after the pandemic began, rising by 7.8% from 14.1 to 15.2 hours weekly.
Despite these challenges, patient portals offer critical access to healthcare for many who cannot easily reach services otherwise. An AMN Report states that the average wait time for a physician appointment across six medical specialties in 15 large metropolitan areas is 31 days. For many, the portal is a vital tool to remain connected to their healthcare team, especially when quick appointments are not feasible or when additional discussion is necessary beyond a single visit.
To address this mismatch, systems, policymakers, and technologists must seek solutions. With modern advancements, some organizations are considering AI-driven auto-triaging and other digital tools to alleviate the burden on physicians. However, many messages require the detailed attention of a physician to truly resolve patient concerns; otherwise, patients may feel neglected, undermining the purpose of the portal. There is considerable room for improvement in this area, and it is crucial to avoid further burdening physicians who are already overwhelmed by administrative tasks. This situation has contributed to high attrition and burnout rates, which the healthcare system can ill afford.
