Opinions are my own and do not represent my employer.
THE SIGNAL
A JAMA study out this week measured something every clinician already felt. Patient portal messages rose about 150 percent between 2020 and 2025, and they now outpace in-person office visits. The paper also found the load and the benefit are not evenly shared.
THE NOISE
The reflex is to call this a burden. Too many messages. Clinicians drowning. The conversation jumps straight to absorbing the flood: more staff, more inbox time carved into the day, a way to finally get paid for the work. Every version of it treats the message itself as the problem to manage.
THE REFRAME
The message is not the problem. It is a demand signal. People are not trying to create work for their doctor. They are trying to ask. The portal is the closest thing most people have to an inside line, and the rising volume is the sound of them reaching for it. I felt it in the inbox I used to carry. The messages never stopped because the worry never stopped, and a worried question does not wait politely for an open appointment.
THE BUILD
The build is not a bigger bucket to catch more messages. It is a trusted place to ask that does not depend on knowing a clinician personally. Most people send a portal message because they have no one to text. Give them somewhere trusted to put the small question and the scary one, with answers they can lean on, and a large share of that inbox was never workload at all. It was people with nowhere else to turn.
THIS WEEK’S NFF SCORE
🟢 A 150 percent rise in five years is people asking to be heard, not making work.
🔴 The portal turned that into a queue clinicians answer after hours, for free.
🟡 The open question is whether asking and answering ever meet somewhere easier than an after-hours inbox.