How Does Electronic Health Record In-Basket Workload Vary by Physician Gender and Specialty?
Ashley, Sharma Alison, Yong Marie, Sandoval Michelle, Cangiano
Ashley, Sharma
Alison, Yong
Marie, Sandoval
Michelle, Cangiano
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Abstract
Background:
Female physicians often reported to have greater electronic health record (EHR) in-basket burden in ambulatory settings, yet most studies focus on primary care,1,2 leaving specialty-specific patterns underexplored. This study aims to examine in-basket EHR workload differences by physician gender across multiple specialties to better understand the drivers of these disparities and guide the development of specialty-specific strategies to reduce physician workload and burnout.
Methods:
A one-month retrospective analysis of EPIC Signal data from physicians in General Surgery, Obstetrics and Gynecology (OBGYN), Otolaryngology, Urology in the University of Vermont Health Network was conducted. In-basket metrics analyzed included total in-basket time per day, in-basket time on Patient Medical Advice Requests (PMAR) per day, in-basket time per appointment, PMAR message volume per day, and PMAR turnaround time. Group comparisons used Mann-Whitney U and Kruskal-Wallis tests with effect sizes; significance was set at p < 0.05. Analyses were performed in Microsoft Excel and SPSS version 29.0.
Results:
Among 167 clinicians, 62.3% were physicians; most male clinicians (93.9%) and fewer female clinicians (49.2%) were physicians. Female physicians spent significantly more in-basket time on PMAR per day and more in-basket time per appointment. Significant specialty differences showed that OBGYN and Urology physicians per day had higher total in-basket time, in-basket time on PMAR, and PMAR message volume than General Surgery and Otolaryngology physicians. No significant physician gender differences for in-basket metrics were seen within specialties.
Conclusions:
Per day, female physicians spent more in-basket time per appointment and in-basket time on PMAR, but these physician gender differences did not persist within individual specialties. Instead, specialty-specific variations, particularly in OBGYN and Urology, had a stronger influence on EHR workload than physician gender. These findings highlight the need for specialty-focused interventions, such as optimizing message triage protocols, to reduce physician burnout.
References:
1. Akbar F, Mark G, Warton EM, Reed ME, Prausnitz S, East JA, Moeller MF, Lieu TA. Physicians' electronic inbox work patterns and factors associated with high inbox work duration. J Am Med Inform Assoc. 2021 Apr 23;28(5):923-930. doi: 10.1093/jamia/ocaa229. PMID: 33063087; PMCID: PMC8068414.
2. Liddell SS, Tomasi AG, Halvorsen AJ, Stelling BEV, Leasure EL. Gender Disparities in Electronic Health Record Usage and Inbasket Burden for Internal Medicine Residents. J Gen Intern Med. 2024 Nov;39(15):2904-2909. doi: 10.1007/s11606-024-08861-0. Epub 2024 Jun 26. PMID: 38926324; PMCID: PMC11576718.
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Date
2025-11-04