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Patient portal messages yield up to 2.6 hours of after-hours work

Patient portal message volumes are concentrated among a few patients and providers, prompting calls for targeted interventions to reduce workload.

Sara Heath
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Published: 03 Aug 2026

Primary care physicians can see up to two and a half additional hours of EHR work outside the clinic due entirely to a high volume of patient portal messages, according to new data in Health Affairs.

What's more, those high message volumes aren't felt equally, even across the same specialty.

Although available for more than a decade, patient portal messaging experienced a boom during the COVID-19 pandemic, when patients connected with providers remotely to reduce the risk of virus transmission. Following the pandemic, there was a 153% surge in patient portal messaging, according to a 2026 JAMA report.

According to the Health Affairs report, a small group of patients sent the bulk of all patient portal messages during the one-year study period. Likewise, a subset of providers received the bulk of all patient portal messages, signaling a need for more tailored interventions as the nation works to ameliorate growing provider workloads.

The team used internal UCSF data from 2022 to assess how many patients sent a medical advice request. Segmenting out by message type is important, the team said, because providing medical advice can add to cognitive burden much more than booking an appointment or filling a prescription request, the team said.

All said, 5% of patients account for more than half (52.8%) of all messages sent in 2022.

Similarly, a subset of primary care providers received the most messages. Leveraging nationwide data, the researchers found that the typical primary care physician received an average of 19.9 patient-initiated medical advice requests per week.

However, the median primary care provider received 9.6 messages per week. And, notably, the top quartile of primary care physicians received 53.3 messages per week.

More messages, more work

Unsurprisingly, higher volumes of patient-initiated portal messages were linked with more time in the EHR after clinic hours.

Using five days of eight-hour clinic shifts as the baseline, the researchers compared how much extra work patient portal messages yielded by quartile. For example, compared to the lowest quartile, doctors who received the second-least amount of portal messages faced 1.95 additional hours of after-work EHR time each week.

For those in the third quartile, it was 2.15 hours, and for those receiving the most messages, it was 2.6 additional hours of so-called "pajama time."

The data did reveal one unorthodox finding: providers who spent more time in clinic visits received fewer patient portal messages. "Understanding this distribution is crucial to informing interventions to improve portal-based care," the researchers said.

Patient portal inboxes require targeted intervention

Health IT leaders have broadly noted that more must be done to reduce the burden of overflowing patient portal inboxes. There have been some policy solutions, such as introducing billing codes to ensure providers are reimbursed for the time they spend responding to patient portal messages. AI-drafted message responses and team-based approaches to managing portal inboxes have also emerged to defray workloads.

These are all viable options, but require a tailored approach, the researchers noted. After all, those solutions come with costs. Reserving them for providers who receive the bulk of patient portal messages could be more cost-effective.

"At the patient level, identifying patients with high portal use and assigning support such as care coordinators may help proactively manage these patients' issues and reduce message volume," the researchers added.

It should be noted that these approaches require high analytic capabilities within health systems. Before health systems can consider targeted interventions to manage high patient portal message volumes, they need to ensure they have the infrastructure in place to identify high-volume message senders.

Sara Heath is an executive editor at Xtelligent Healthcare Media, where she covers patient engagement, healthcare policy and health IT.

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