Before the pandemic, connecting with your doctor meant booking an in-person appointment. However, the landscape changed dramatically with the rapid expansion of telehealth, allowing patients to communicate with their healthcare providers through text or email.

A researcher in healthcare information technology at the University of California San Francisco, A Jay Holmgren, highlights that during the pandemic, many patients discovered the convenience of virtual visits and messaging for the first time. This direct interaction with their doctors was highly appreciated by patients, leading to an influx of messages inundating doctors' inboxes. Consequently, some hospitals and health systems have begun charging patients for certain responses to their message queries.

Holmgren's research letter published in the JAMA reveals that doctors spent more time managing electronic health records during the pandemic. Even after lockdowns were lifted, the volume of patient messages remained consistently over 50% higher than before. This placed additional stress on doctors who were already grappling with the challenges of the pandemic and now had to respond to emails after regular working hours, effectively working without compensation.

"Physicians who receive a ton of portal messages tend to report being burned out, tend to report being more cynical about their job, tend to report that they are thinking about leaving clinical practice," Holmgren says.

Many hospitals and health systems have now begun to charge patients who receive clinical advice through messages, which is generally covered by Medicare and Medicaid, as well as most private insurance, though patients may bear co-pays, ranging from $5 to $75, depending on plan type.

According to Holmgren, the introduction of charges for these messages aimed to compensate doctors for their time and discourage patients from excessive emailing. However, his research reveals that these new charges failed to address either of these issues effectively. Doctors only bill for a minuscule portion of the messages they received, accounting for approximately 3%. Additionally, implementing fees did not lead to a significant reduction in email volume, with only a slight decline of around 2% in the number of messages.

"Uptake has not been super high amongst our clinician workforce," Holmgren says, in part because billing for messages itself is complex and time consuming, and doctors don't want to alienate patients by charging them for communicating.

The challenge lies in the current compensation model known as fee-for-service, which is widely used in the healthcare industry. Under this system, healthcare companies charge for every individual service provided by doctors and nurses. Eve Rittenberg, a primary care doctor and assistant professor at Harvard Medical School, suggests a different approach, advocating for payment systems that compensate doctors based on the overall care they provide, irrespective of whether it's delivered in-person at their office or through email consultations.

"For me it's an incredible privilege that my patients share their fears and their worries and their questions with me and I can talk with them directly," Rittenberg said, according to

Rittenberg says compensating doctors would give both the doctor and patient flexibility to decide what works best for them. "Finding ways to make clear communications sustainable is really, really important," she says.