Patient portals intended to streamline care have instead added significant uncompensated work for clinicians — a problem called the "portal paradox." A JAMA study found portal messages more than doubled between 2020 and 2025, while EHR active time rose across specialties after the COVID-19 pandemic. Portals improve access (an AMN report found average waits of 31 days in major metro areas), but without workflow redesign, compensation changes and reliable support tools, inbox burden will keep contributing to physician burnout.
Patient Portal Inboxes Are Overwhelming Doctors — The "Portal Paradox" Driving Burnout
While patient portals were promised to ease workflows, they have added significantly to clinician workloads.getty
Patient portals and in-app messaging were introduced to streamline care and reduce administrative work. Instead, many clinicians now report that these channels have become a major source of uncompensated labor, blurring the line between work and personal time and contributing to workforce stress.
The Portal Paradox
Industry observers call this the "portal paradox": systems designed to simplify workflows have in practice added tasks to clinicians' already full schedules. A study published in JAMA found that online portal messages more than doubled between 2020 and 2025, turning inboxes into a persistent after-hours burden for many physicians.
Impact On Clinicians
For doctors, the effort of switching between patient charts, assessing new information, and composing an appropriate response imposes a significant cognitive load. Research increasingly links time spent on messages and electronic health records (EHRs) with higher rates of burnout. One analysis showed mean weekly EHR active time rose across specialties after the COVID-19 pandemic: primary care physicians (PCPs) increased from a mean of 10.6 to 11.3 hours per week (a 6.5% rise); medical subspecialists rose by 9.9%; and surgeons by 5.2%. Among physicians with more than 40 visits per week, PCP EHR time increased from 14.1 to 15.2 hours per week (7.8% increase).
Value For Patients — And The Trade-Off
At the same time, portals offer critical access for many patients. An AMN report found the average wait time for a physician appointment across six specialties in 15 large metro areas was 31 days, leaving portals as a practical lifeline for people who need quicker contact with their care teams or who cannot cover everything in a single visit.
Solutions And Limits
Health systems, policymakers and technology vendors must realign incentives and redesign workflows. Some organizations are piloting AI-driven auto-triage, message routing, delegation to clinical staff, standardized templates, and better reimbursement for inbox work. These tools can reduce simple administrative tasks, but many messages require physician judgment and clinical context; automating them without safeguards risks lower-quality care.
Bottom line: Patient portals expand access but currently shift meaningful workload onto clinicians. Without clearer compensation, staffing support and smarter workflow design, inbox-driven tasks will continue to fuel burnout and workforce attrition.
Recommendations: adopt clear inbox triage policies, reimburse time spent on electronic care, invest in team-based workflows (nurses, pharmacist support, care coordinators), and deploy AI cautiously to assist, not replace, clinical decision-making.
Originally published on Forbes.
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