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.