Document Type


Publication Date


Focus Area

Medical Practice Transformation, Primary Care


Background: The utilization of MyChart messaging has improved the accessibility of primary care with the convenience and flexibility of communication. However, providers receive little reimbursement despite an increased workload from patient advice request messages. Female primary care providers receive more medical questions and experience a higher in-basket workload. Increased time spent on the EHR is correlated with increased provider burnout rates. Thus, the larger EHR burden on female providers exacerbates burnout rates and the gender-based wage gap in primary care.

Methods: Signal data from Epic was obtained from primary care providers who received patient medical advice requests. This data were analyzed using excel.

Key Results: Female providers received more patient medical advice request messages than non-female providers (mean-Female(F) = 68.28 messages, mean-Non-Female (NF) = 49.22 messages, p=0.005) and spent more active time in their in-baskets (mean-F=1.85 mins/day, mean-NF=1.35 mins/day, p=0.006). Female and non-female providers had equivalent turnaround times for these messages (mean-F= 2.61 days, mean-NF = 2.25 days, p=0.68). Staff handling of messages did not differ between female and nonfemale providers.

Discussion: Female-identifying providers receive significantly more patient medical advice question messages and a have a subsequent larger message workload than their male colleagues. Future analysis should include providers’ patient demographics to identify correlations between higher message load and patient panels. Workflow support and patient messaging guidelines should be considered to alleviate the unpaid workload associated with higher message volume.


1. Huang M, Fan J, Prigge J, Shah ND, Costello BA, Yao L. Characterizing Patient-Clinician Communication in Secure Medical Messages: Retrospective Study. J Med Internet Res. 2022;24(1):e17273. doi:10.2196/17273

2. Hoonakker PLT, Carayon P, Cartmill RS. The impact of secure messaging on workflow in primary care: Results of a multiple-case, multiple-method study. Int J Med Inform. 2017;100:63-76. doi:10.1016/j.ijmedinf.2017.01.004

3. Rittenberg E, Liebman JB, Rexrode KM. Primary Care Physician Gender and Electronic Health Record Workload. J GEN INTERN MED. 2022;37(13):3295-3301. doi:10.1007/s11606-021-07298-z

4. Rotenstein L, Gitomer R, Landon B. Pursuing Gender Equity by Paying for What Matters in Primary Care. New England Journal of Medicine. 2023;389(3):198-200. doi:10.1056/NEJMp2301282


AHEC Scholars Summer Project. Poster presented at ACP Vermont Chapter Annual Scientific Meeting on Friday, September 29, 2023.

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.