Patient messaging promises access and convenience. For many family physicians and general practitioners, it is also becoming a second clinic without a schedule, a physical examination, or a reliable payment model.
Healthcare professionals: 489 responses
Complete responses: 344
Countries: 6
Survey ID: 8873071
Quick Read — Key Findings
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Patient portals were designed to make routine communication easier. A medication question, test result, photograph, or follow-up request could be handled without another visit. The channel expanded access, but it also removed the natural limits created by appointment slots, clinic hours, and face-to-face assessment. The perspectives in this report come from family physicians and general practitioners in the United States, United Kingdom, Canada, Italy, France, and Germany.
National EHR research published in JAMA and JAMA Internal Medicine describes patient messaging as a central mode of care delivery and links rising message volume with more after-hours EHR work and concerns about sustainable workload.1,2
The clinical problem begins when a message that looks transactional contains a new symptom, hidden urgency, or a request that cannot be safely resolved through text. The operational problem begins when that work is routed directly to the physician, added to the existing day, and paid inconsistently or not at all.
76.7% of respondents receive at least 15 asynchronous messages each day, including 34.1% who receive 31 or more. Yet only 9.0% report an advanced nurse-led triage protocol that can resolve low-acuity requests before physician escalation.
The result is a workload that often reaches the clinician without enough filtering, time, reimbursement, or clinical context. That mismatch appears across the report: diagnostic risk is widely recognized, AI is viewed cautiously, and the financial model is described as unsustainable by more than four in five respondents.
A routine message enters the portal. It may contain a hidden red flag. The physician must decide whether to stop the interaction, split the request, or manage it asynchronously. The decision happens without the full diagnostic cues of an encounter and often without immediate triage support.
Then comes the second layer: documentation, liability, after-hours monitoring, and payment. AI can draft a response, but the physician still carries responsibility for its accuracy. The system therefore accelerates text generation without transferring clinical accountability.
Finally, repeated exposure becomes a workforce issue. Physicians report sustained burnout, panel downsizing, practice-model changes, and consideration of early exit. The tool intended to expand access may reduce capacity if it makes primary care less sustainable.
For primary care physicians, the safest inbox is one with clear limits. Routine refills and stable, protocol-based questions may be managed asynchronously, but new, worsening, or potentially urgent symptoms should move quickly to nurse triage, telehealth, or an in-person assessment.
Practices also need defined response windows, team-based screening, clear ownership, and protected time for clinical review. Treating inbox work as real clinical care, rather than invisible administrative work, is essential to reduce missed red flags, after-hours burden, and uncompensated decision-making.
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