RESEARCH LETTER
Christopher R. Davis, MD, MPH; Benjamin N. Fogel, MD, MPH; Terrah M. Keck-Kester, MD; Makayla B. Lagerman, MD; Timothy D. Riley, MD; Kathryn A. Risher, PhD, MHS; Katherine E. Shedlock, MD; Matthew L. Silvis, MD
Corresponding Author: Christopher R. Davis, MD, MPH; Department of Community and Family Medicine, The Pennsylvania State University.
Email: cdavis4@pennstatehealth.psu.edu
DOI: 10.3122/jabfm.2025.250229R1
Keywords: Electronic Medical Records, Health Workforce, Occupational Burnout, Patient Care, Primary Health Care, Surveys and Questionnaires
Dates: Submitted: 06-17-2025; Revised: 08-25-2025; Accepted: 09-08-2025
Status: Volume 39, Issue 1 (Publishes March 2026)
INTRODUCTION: Burnout is prevalent among primary care (PC) clinicians. One driver of this is asynchronous work, an important component of which is electronic messages (e-messages) between patients and clinicians in the electronic medical record (EMR). Studies have shown mixed results regarding the EMR’s impact on clinician burnout and patient care, though none have been identified that investigate the impact of limiting the size of e-messages on PC clinicians.
METHODS: Our institution limited patient-initiated e-message length to 1000 characters across one health system. Impact on e-message burden and clinician burnout was assessed using anonymous, electronic, Likert scale-based questionnaires which were distributed to family medicine and general pediatrics PC clinicians before and after the character count limit implementation.
RESULTS: Approximately 150 clinicians were invited to participate, and about 54% and 48% completed the pre-/post-intervention surveys, respectively. There were no significant sociodemographic differences between respondents in the pre-/post-intervention surveys and there were no significant differences in Mini Z burnout scores or measures of e-message burden before and after the intervention.
DISCUSSION: These findings highlight that primary care provider burnout is a complex issue, and limiting e-message character counts alone may not be enough to make an impact.