Patient E-Message Character Limit Impact on Primary Care Clinician Burnout

Article Figures & Data

Table 1. Sociodemographic Characteristics of Survey Respondents Pre-/Post-Implementation of Character Count Limit in June 2023.

Variables	Pre n = 81 (%)	Post n = 72 (%)	P-value^*
Sex			0.47
Female	42 (52)	36 (50)
Male	32 (40)	33 (46)
Other	0 (0)	0 (0)
Prefer not to answer	7 (9)	3 (4)
Race/ethnicity			0.72
Asian	7 (9)	3 (4)
Black non-Hispanic	1 (1)	2 (3)
Hispanic or Latino/a	1 (1)	2 (3)
White non-Hispanic	62 (77)	57 (79)
Prefer not to answer	10 (12)	8 (11)
Age			0.76
Less than 20	0 (0)	0 (0)
20-29	7 (9)	2 (3)
30-39	25 (31)	26 (36)
40-49	20 (25)	17 (24)
50-59	12 (15)	10 (14)
60-69	7 (9)	8 (11)
70+	4 (5)	2 (3)
Prefer not to answer	6 (7)	7 (10)
Department			0.8
Family Medicine	71 (88)	65 (90)
Pediatrics	10 (12)	7 (10)
Other	0 (0)	0 (0)
Prefer not to answer	0 (0)	0 (0)
Years in practice			0.15
Less than 5 years	22 (27)	11 (15)
5-10 years	12 (15)	18 (25)
11-20 years	24 (30)	21 (29)
More than 20 years	23 (28)	20 (28)
Prefer not to answer	0 (0)	2 (3)
Provider role			0.92
Advanced practice clinician (nurse practitioner or physician assistant)	17 (21)	14 (19)
Attending physician	63 (78)	58 (81)
Other	0 (0)	0 (0)
Prefer not to answer	1 (1)	0 (0)

^* P-value for chi-squared or Fisher’s exact test (Fisher’s exact used when cell size <5 for 20% or more of cells)

Table 2. Comparison of Survey Responses Pre-/Post-Implementation of Character Count Limit in June 2023.

Survey Items^*	Pre Mean (SE)	Post Mean (SE)	Difference (SE)	P-value^†
Mini Z Items^‡
Job satisfaction	3.88 (0.08)	3.72 (0.11)	-0.15 (0.14)	0.28
Job Stress	3.64 (0.11)	3.58 (0.1)	-0.06 (0.15)	0.69
Burnout	2.56 (0.09)	2.58 (0.11)	0.02 (0.14)	0.91
Control over my workload	2.66 (0.1)	2.71 (0.12)	0.05 (0.16)	0.76
Documentation Time Sufficiency	2.34 (0.12)	2.38 (0.12)	0.04 (0.17)	0.81
Work area chaos	3.2 (0.11)	3.26 (0.08)	0.06 (0.14)	0.65
Alignment of Professional values with department leaders	3.83 (0.09)	3.67 (0.12)	-0.16 (0.15)	0.30
Care team efficiency	3.41 (0.1)	3.51 (0.11)	0.09 (0.15)	0.53
Time spent in EMR at home	2.28 (0.14)	2.2 (0.13)	-0.07 (0.19)	0.70
Mini Z score	27.79 (0.28)	27.61 (0.38)	-0.18 (0.47)	0.71
E-Message Burden Items^§
Less work to communicate with patients via patient e-messages^∥	3 (0.08)	3 (0.09)	0 (0.12)	1.00
Patient e-messages are too long^∥	3.28 (0.08)	3.14 (0.08)	-0.14 (0.11)	0.20
Patients send e-messages too frequently^∥	3.38 (0.07)	3.33 (0.07)	-0.04 (0.1)	0.66
Patient e-messages are too complex^∥	3.45 (0.07)	3.3 (0.07)	-0.15 (0.09)	0.11
Patient e-messages are a source of stress ^#	4.14 (0.08)	3.91 (0.1)	-0.23 (0.13)	0.08
Patient e-messages enhance my relationship with patients^#	3.34 (0.09)	3.36 (0.12)	0.02 (0.15)	0.87
My work schedule leaves me enough time for my personal and/or family life^#	2.79 (0.12)	2.7 (0.12)	-0.1 (0.17)	0.56