The Inbox Clinician: An Agile Member of the Care Team

According to a 2023 Medscape report, 57% of family physicians say they are burned out, with “bureaucratic tasks” and the “increasing computerization of practice” most frequently cited as the causes.¹ We now use terms like “pajama time” to describe the hours we spend in our EHR after leaving the clinic, charting the day's patient visits and tending to a seemingly bottomless inbox of messages, correspondence, and forms.² When a colleague is out of the office on vacation, leave, or the inpatient service, the task of monitoring their unattended inbox adds to the burden of addressing our own. Previous articles have proposed inbox management solutions, including using clinic staff to triage messages so physicians only have to address those that truly need their attention.^3–6 These strategies have merit, but the volume of messages and high rates of burnout persist.

Our organization addressed this problem by creating a new role: the 50-50 inbox clinician (IC) — a nurse practitioner or physician assistant who spends half their time performing inbox cross coverage and the remainder of their time seeing patients for acute care, which funds their salary.

Our purpose in creating the IC role was to disrupt the status quo by designating a single licensed clinician to take on urgent messages, provide scheduled inbox cross coverage for colleagues who are out of the office, and be the go-to resource for nursing staff (who do the initial triage of messages) so they don't have to track down the other clinicians. Our goal was to reduce burnout among our clinicians and hopefully prevent some emergency department (ED) and urgent care visits for our patients.

For our initial IC pilot, we used funds our practice earned through value-based payment work to hire a nurse practitioner. We decided this clinician would have no patient panel of their own but instead would expand our same-day and next-day access by seeing patients for acute issues. To continue beyond the pilot period, we knew we would need to demonstrate financial sustainability. (See our results below.) At a second site, our residency practice, we jointly onboarded two full-time ICs with mirrored schedules (e.g., when one is seeing patients, the other is providing inbox cross coverage). Because of the different payment models at the two sites, the IC at the first practice had more flexibility in their inbox-time-to-patientcare ratio, whereas those in the second practice were held to a 50-50 model as we monitored their financial viability. (See “Clinic demographics”.)