Michael L. Barnett is an Assistant Professor of Health Policy and Management at the Harvard T.H. Chan School of Public Health and a primary care physician at Brigham and Women’s Hospital. His research focuses on understanding and improving the health care delivery system with a specific interest in prescribing of high-risk medications, nursing homes and studying innovative models for health care payment and care delivery.

A new thread of research has found female physicians spend substantially more time than men working in the electronic health record (EHR), a well-known source of frustration for physicians. This disparity could contribute to why female physicians are 20% to 60% more likely to have symptoms of burnout than male docs. A recent study published in the Journal of General Internal Medicine built on these observations to dig into why there are gender-based differences in EHR workload.

Authors Eve Rittenberg, Jeffrey Liebman and Kathryn Rexrode analyzed 6 months of EHR use in 2019 for 125 primary care physicians (PCPs) at Brigham and Women’s Hospital to compare differences in time spent for men and women. They were able to take into account differences in hours worked as well as the number and gender of patients seen by different doctors, which otherwise could bias conclusions.

The researchers found:

• Female PCPs spent 20% more time on internal clinical emails and 22% more time on clinical notes compared to male PCPs.
• Among those internal emails, female PCPs received 26% more emails from hospital staff and 24% more messages directly from patients than male PCPs.
• Despite this, there was no significant difference in message turnaround time between female and male PCPs (though average turnaround was 4 days!)
• The differences in message volume were not explained by female doctors having more female patients (who previous research has shown ask more questions of doctors).

This study has several limitations: There were relatively few doctors in the sample, and they all work at the same academic medical center. The authors also did not include information about patient complexity or other characteristics that could play a role in how often patients send messages.

The authors concluded these findings show “gendered expectations of physician accessibility, leading to a lower threshold to contact a female physician than male physician,” which could fuel higher burnout in women. This suggests that higher EHR burden for women comes from others’ behavior and expectations rather than from physicians themselves, which is what I find most fascinating about this study.

To that end, the authors suggest solutions to reducing EHR use and burnout need to be targeted at the clinical team, not the physician herself. Hospital leaders can use EHR time as a flag for burnout and as a way to inform additional support systems for overworked physicians, such as medical scribes or protected time for documentation and patient correspondence.