Email fatigue leads to lost physician productivity

A new paper says “metastasis of email at an academic medical center” may cost millions of dollars.

A pediatrician from the Penn State College of Medicine kept track of all of his emails for an academic year and found that 2035 mass distribution emails were received. They originated from the medical center in 1501, the department in 450, and the university in 84.

The emails were about information technology, academic and professional development, social events, and a combination of clinical care, research, or education.

Here’s the fun part.

Assuming it took 30 seconds to read each email and based on the average salary of a doctor at their institution, the cost comes to about $1641 per physician. Since there were 629 employed doctors, that’s more than $1 million worth of time lost. If reading an email takes 90 seconds, multiply that by 3.

The paper points out that the barrage of emails is distracting, and important information may be overlooked. A new term “email fatigue” was coined.

They suggested several possible solutions to the problem, which probably wouldn’t work and won’t be tried anyway.

Like having a child, using email requires no license or training of any kind. Anyone with a computer or phone and an Internet connection can send an email.

Unfortunately, the ubiquitous practice of clueless people clicking “reply all” when responding to every mass email, resulting in even more wasted time, was not addressed.

Sometimes I’m not sure they’re really clueless. I think some people believe they are so important, so widely admired that they feel they must let everyone know that they will attend the next meeting of the task force to decide which brand of ketchup the cafeteria will carry.

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

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  • Dr. Drake Ramoray

    So with your article in mind, what are your thoughts on patient portals and providers giving out e-mail addresses for patient care?

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      There is something you can try regarding this: pick a handful of patients that are most likely to be computer literate (5 or 6), and give them an email address they can use to contact the office if need be. Ask someone other than you (maybe your nurse) to check that account and triage the emails to you as necessary. See how it goes…. My (educated) guess is that you will be surprised.

      Think about it this way: nobody in the government mandated that doctors install telephones in their practice, yet they did. Nobody ever mandated that they buy and use fax machines, yet they did. Email is just another iteration of those things, and for the life of me, I can’t figure out why “regulators” feel that it’s necessary to bribe doctors to use email.

      • Dr. Drake Ramoray

        My fellowship program tried e-mail when I was in training some years ago. It is true that emails get missed at 4:59. None of the providers wish to respond to e-mails at home and the fellows ran a list of the most ridiculous emails received.

        The three candidates were a 1 am email from a diabetic with crushing substernal chest pain, a woman with “insane amounts” of vaginal bleeding (no she was not seen in our office for girl problems), and a request for Percocet for a tooth abscess. It lasted a week before the attendings refused to do it any longer.

        You are correct we weren’t mandated to use telephones. Meaningful use does mandate a patient portal and encourages email communication. Heck they are mandating EMRs in the first place. Most docs just treat e-mail as another medical liability and something else to do that we don’t get paid for while simultaneously increasing our overhead

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          How about phone calls? Didn’t they get ridiculous ones as well? And that’s not a paid activity either.
          The thing is that for many people today, phone calls have been supplanted by texting and email. I don’t think doctors should be coerced to use these things, but I do believe that slowly but surely, the transition will occur.
          BTW, I don’t necessarily think this is a good thing. There is something more personal about talking on the phone that I think is better than email, but email is more convenient, and it seems that convenience today trumps everything else.

          • Dr. Drake Ramoray

            The MA’s answer the phone calls and the crushing substernal chest pain is told to go to the ER and the other two are appropriately told that the specialist office in that case is not responsible for those problems. I don’t hear about them until after the fact and when they have been dealt with. I would wager many a concierge model uses e-mail and home phone numbers too. I will too when my time comes for that model, especially if I go thyroid only practice.

            Unless it’s through a secure patient portal, e-mail and texting also have HIPPA and privacy issues. Lots of bureaucracy, lots of red tape, for more overhead, more liability and no reimbursement. Pay for performance is supposed to change that although not in good ways I’m sure.

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            Agree with the red tape and bureaucracy issues 100%. Funny how trying to force people to do something which is basically a simple thing, makes it just so much harder than leaving well enough alone…
            I think you’ll like the email addition (when the time comes :-), and BTW, MAs triage emails as well… just like phone calls.

          • southerndoc1

            Just from an organizational point of view, the more places the staff has to remember to check on a regular basis for messages increases the chances of an error being made.

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            That’s very true. People should choose to use email if it’s easier for them to do so, not because of some dictum. I find the entire conundrum to be a tempest in a tea pot. As long as communications occur, who cares about the mode…. other than the fact that email is easier to parse and extract data from, which I suspect is at the heart of this idiocy.

          • southerndoc1

            Agree!

          • http://www.ronsmithmd.com/ Ron Smith

            Hi, Drake.

            Re: “Unless it’s through a secure patient portal, e-mail and texting also have HIPPA and privacy issues.”

            I think this is far overblown also. If a patient contacts me via email, then they have accepted the level of risks that has. They know them better than most doctors too.

            Its like seeing a parent in a grocery store who starts talking in the middle of the aisle about their child’s medical issues. Does anyone think those conversations rise to the level of HIPAA protection?

            The point is that email is not *required* to communicate with me, and I don’t contact the patients without their permission, even with text message reminders about appointments.

            Realizing there are possible risks, we still have to stop scaring and being scared of malpractice and HIPAA the way we do when we talk about email communications with patients.

            Warmest regards,

            Ron Smith, MD
            www (adot) ronsmithmd (adot) com

          • Dr. Drake Ramoray

            While I agree it’s overblown to a degree and plan to implement e-mail once/if I move to a concierge model as it currently stands with CMS and third party payers, but most importantly under the advice of our malpractice insurance carrier we do not do e-mail without a patient portal.

    • Skeptical Scalpel

      I guess if doctors want to do that, they can. I wouldn’t because one missed email that leads to a bad outcome would result in a lawsuit. We get sued enough through regular channels. I see no need to open up a new one.

      • southerndoc1

        Exactly. E-mail and patient portals don’t replace any current channels of communication, they’re just additional ways for the staff to miss an important message at 4:59 PM on Friday.

        • NPPCP

          Ooops…Dr., you forgot this is part of the medical home model. That would be 8:59 PM on Friday. :)

      • Dr. Drake Ramoray

        We are in 100% agreement although I believe you are in the minority as someone who posts articles on this blog frequently.

      • http://www.ronsmithmd.com/ Ron Smith

        Hello, Skeptical Scalpel and Drake.

        I have had a different experience. In Pediatrics, the patients parents themselves are younger. I’m a thirty year Pediatric codger.

        These parents come in amazed by the technology.

        But they find the meat of what they want in accessibility and realize they can connect with me personally. Email is then secondary to the relationship. Some still do call the after hours phone line, which I hope someday to give up entirely.

        The reason that most parents call or email often boils down to whether there child needs to go to an urgent care or ER. They know the limitations of email. And I always use language that itself alludes to that inherent uncertainty.

        I can give my full attention to a thirty second, well crafted reply which would take me about ten minutes of phone time, and do a better job. Parents can re-read the emails and respond if they have further questions.

        Contrary to first blush logic, this has no effect on reducing patient bookings. We tell parents that we like them very much (and all of us at our office really do!) but we don’t want them to be in the office anytime they really don’t need to be. The trust that results from this results in a long-lasting bond. The work environment is great and the professionally satisfying even after all these years of practice.

        That’s our experience and of course your mileage may vary. I do think that the malpractice risk is way overblown.

        Warmest regards,

        Ron Smith, MD
        www (adot) ronsmithmd (adot) com

        • Skeptical Scalpel

          Ron, if it works for you, that’s great. Just seems like extra work. You assume some risk. I doubt you are reimbursed. If you think the bonding and trust are worth it, then so be it.

  • southerndoc1

    “the cost comes to about $1641 per physician”
    No problem: just double the facility fees.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      …. and declare a national emergency due to a shortage of doctors.