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Untethering The Physician From the ‘Inbox’: A Win, Win, Win!
Inefficiency Insights #69
Daniel Nimoy
February 27, 2025 • Estimated Reading Time: 12 minutes
INEFFICIENCY INSIGHTS
Untethering The Physician From the ‘Inbox’: A Win, Win, Win!
What’s the Problem?
Physicians spend 1-2 hours per day, sometimes more, tethered to the EHR ‘inbox’, managing digital work, patient inquiries, notifications, and alerts— work that does not require their clinical expertise.
On the surface, this system looks like a win, win: it improves access to care and engages patients. It is also a significant source of ‘new’ work and an operational burden, leading to physician burnout, wasted resources, and system-wide inefficiencies.
The Problem
For the last 5-6 years, I (Daniel) have studied this issue deeply, collaborating with multidisciplinary teams, physicians, and healthcare leaders to try to fix what is broken. Spending countless hours turning over the data, studying workflows, analyzing inefficiencies, connecting with peers, and developing solutions that make sense for physicians, patients, and organizations.
Most primary care physicians see between 16-20 patients daily—balancing acute issues, chronic disease management, reviewing labs, filling, and renewing prescriptions, developing care plans, taking emergency calls, and care coordination. The work is nonstop.
In addition to demanding clinic schedules, physicians are expected to manage a high volume of ‘inbox’ work—much of which could (and should) be delegated to other team members. This challenge has intensified post-COVID.
To be clear, the ‘inbox’ and patient inquiries itself is not the root issue. The real challenge stems from factors such as high-deductible insurance plans shifting more and more financial responsibility onto patients, limited access to primary care, and prolonged wait times—leading patients to seek care through digital channels that are usually low to no cost. These issues highlight inefficiencies within the current system. How inbox work and patient inquiries are managed today is fundamentally broken, and addressing it requires smarter, more strategic solutions rather than simply increasing workload.
This is not sustainable for patients, physicians, or organizations.
Another inefficiency in outpatient care that feels ripe for a redesign.
So, how do we build systems and leverage technology to proactively meet patients’ healthcare needs, where and when they need it, while also balancing the impact and workload on doctors and care teams? By untethering physicians from the ‘inbox’.
Insights
Root Cause Analysis: 5 Whys
The 5 Whys process in root cause analysis involves repeatedly asking "Why?" five times to drill down into the root cause of a problem by exploring the cause-and-effect relationships underlying the issue.
The problem: Doctors are spending 1-2 hours per day managing ‘inbox’ work and patient inquiries that do not require their level of expertise.
Why are physicians spending so much time in the ‘inbox’?
Because they must respond to many tasks and patient inquiries, many of which are non-clinical and do not require their level of expertise.
Why are physicians handling this ‘inbox’ work?
Because most EHR systems automatically route everything—prescription refills, lab results, patient messages (including scheduling), insurance questions—directly to physicians instead of to the right team member.
Why does the EHR route everything to physicians?
Because many workflows were not originally designed with efficiency in mind, and some organizations have yet to implement team-based care approaches due to various constraints, including financial and operational factors.
Why haven’t all organizations adopted team-based care approaches?
Because the rapid increase in digital work, particularly post-COVID, has outpaced the development of supportive workflows. Additionally, limited reimbursement and misaligned incentives within the current system present challenges to widespread adoption.
Why is this challenge still unresolved in many healthcare organizations?
Because many healthcare organizations balance competing priorities, traditional productivity models often take precedence. As a result, addressing fundamental system inefficiencies and misaligned incentives can be challenging, despite their impact on physician well-being and patient care.
Root Cause: The current systems and workflows for managing ‘inbox’ work are often inefficient and lack a structured team-based approach. As a result, physicians spend a significant amount of time addressing ‘inbox’ work and patient inquiries that could (and should) be optimized for greater efficiency and value.
Impact Analysis
Impact analysis is the assessment of the potential consequences and effects that changes in one part of a system may have on other parts of the system or the whole.
Patient Lens:
Improved access to care but unclear messaging expectations.
Possible delays in response due to ‘inbox’ overload.
Risk of miscommunication or fragmented care—some issues just require a visit.
Physician Lens:
Increased ‘inbox’ load leading to documentation burden, clerical work overload, and cognitive burden driving burnout.
Poor work life balance and job satisfaction; direct correlation with the ‘inbox’.
Less time for direct patient care and no aligned incentives or compensation.
Healthcare System Lens:
Higher risk of physician turnover and reduced clinical hours due to burnout, driving workforce shortages.
Inefficient use of physician time completing work that others could complete.
Potential financial strain from uncompensated digital care.
Solutions
Here are three solutions to mitigate provider burnout while maintaining exceptional patient engagement:
Swim upstream to find the waste—analyze ‘inbox’ work & categorize avoidable messages (in lean terms, these are defects, and avoidable).
Solution:
Conduct a thorough data analysis to identify common avoidable work and patient inquiries.
Categorize the work into themes (e.g., medication clarifications, scheduling, new symptoms, etc.).
Proactively address common themes before a message is required—some things can be addressed with process while others may require technology.
Impact:
Engage and empower patients through clear communication and self-service options to efficiently address common inquiries.
Less ‘inbox’ work for physicians driving improved job satisfaction.
Reduced ‘inbox’ work has the potential to improve access to care.
Redesign EHR workflows with team-based models and ‘virtualist’ support—technology can help enable this but is not the solution.
Solution:
Utilize team-based care models, including ‘virtualists’, to support ‘inbox’ work and patient inquiries while maintaining the local connection between the patient and physician.
Train and empower support staff to manage common inquiries and escalate only when necessary.
Utilize AI-powered triage tools to route messages correctly, reducing physician workload and required triaging resources.
Impact:
Reduces physician workload by appropriately distributing ‘inbox’ work and patient inquiries.
Enable physicians to focus on higher-value, complex care.
Significantly decreases physician ‘inbox’ volume and increases joy in work, untethering them from the ‘inbox.’
3. Advocate for Reimbursement for Asynchronous Care:
Solution:
Advocate for optimized reimbursement for asynchronous digital interactions (e.g., CPT 99421—currently underpaid at ~$15.50 for 5-10 min).
Collaborate with payers to design reimbursement models align incentives for virtual and asynchronous care models.
Impact:
Improves physician morale by recognizing and valuing digital work.
Reimbursing asynchronous care aligns financial incentives with efficient, structured, patient-centered care.
Helps fund additional staff to support team-based care models.
Next Steps
Perform a thorough ‘inbox’ analysis—Identify opportunities to reduce overall ‘inbox’ volume and patient inquiries. Think—what percent of ‘inbox’ work or patient inquiries can be avoided altogether? What percentage can be handled by non-physician staff?
Implement team-based care models and adopt triage systems to get the right work, to the right people, at the right time. There are many tech solutions out there that can help with this when woven with strong process.
Engage key stakeholders— IT, leadership, physicians, and clinical teams must collaborate on workflow design (and hopefully payers soon, too).
Monitor physician wellness metrics pre- and post-intervention.
Here’s an example of an AI-powered tool that categorizes patient inquiries and routes them to the appropriate team member, reducing the need for manual triaging.
Has your physician group or hospital implemented ways to save you from the inbox?
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