Female residents experience greater EHR burden, inbasket volume than male residents
A comparison of notes and inbaskets of 156 internal medicine residents found that female residents receive 34% more patient advice requests per day worked than their male colleagues and spent significantly more time in their inbaskets per day.
Female internal medicine residents experience significantly more patient-initiated messages and electronic health record (EHR) workload per day than their male counterparts, despite an equivalent number of results, appointments, and patient complexity, a recent study found.
Investigators assessed 12 months of 156 Mayo Clinic internal medicine residents' (83 males and 73 females) inbasket data between July 2020 and June 2021. They then compared total time spent in EHR per day, time in inbasket and notes per day, time in notes per appointment, number of patient advice requests made through the portal, and message turnaround time between male and female residents. Findings were published by the Journal of General Internal Medicine on June 26.
Annually, female residents received significantly more patient advice requests, an average of 86.7 compared to 68 among male residents, resulting in 34% more patient advice requests per day worked (0.71 vs. 0.53, respectively; P<0.001). Female residents also spent significantly more time in their inbasket per day (10.2 min vs. 8.7 min per day worked; P=0.002) and in their notes per day (38 min vs. 31 min; P<0.001) and per appointment (26 min vs. 19 min; P=0.001) compared with their male coworkers. The average panel size across genders was 90 patients and was similar for male and female residents. By the end of the first year of training, there were significantly more female patients on female resident panels (n=55) versus male (n=34) resident panels (P<0.001). Both female resident gender and the number of female patients on panel were associated with more patient medical advice requests. No differences in message turnaround time, total messages, or number of results received were found.
"We are left with the reality that female residents in our study are suffering from a gender disparity that can pose risks to their mental wellbeing. The fact that this difference begins as early as intern year lends urgency to acknowledging its potential downstream effects, including added years of increased workload, earlier burnout, and increased female workforce attrition," the study authors wrote.
Some potential solutions to better support female trainees in the face of this higher workload include coaching in time-management skills and boundary setting, overhauls in inbasket triaging and administrative support, and more intentional standardization of patient panels, the researchers continued.
One limitation to the study is that only months where residents had five or more appointments were included, meaning the data is underestimating the true totals. Inbasket time also does not account for time spent discussing messages with supervising faculty or coordinating care related to the messages. Data collection was carried out throughout the COVID-19 pandemic, and the authors cautioned the volume of patient-initiated inbasket messaging may have been higher overall compared to pre-pandemic times.
"Gender differences in EHR burden and inbasket volume may have implications for burnout and the overall educational experience. Further research is needed into the underlying cause of these differences and future interventions to make workload equitable for all residents," the authors concluded.