Patient-written portal messages rose 153% from 2020 to 2025, from 0.99 to 2.50 per active patient per year, according to a JAMA study published June 22, 2026. Office visits rose 17% in the same years, so messages grew about nine times as fast as visits.
The study, led by Long and colleagues, used Epic Cosmos data covering about 8 billion encounters from more than 2,000 hospitals and 47,000 clinics. This post uses the study and a second analysis of physician workload to show what the volume means for a practice.
Portal messages grew 153% while office visits grew 17%
AJMC reported the JAMA numbers per active patient per year. The table shows the 2020 and 2025 rates. Taken together, a practice received 0.4 patient messages per office visit in 2020 (0.99 against 2.37) and 0.9 in 2025 (2.50 against 2.77), by our calculation from the same figures.
| Encounter type | 2020 per patient per year | 2025 per patient per year | Change |
|---|---|---|---|
| Patient-written portal messages | 0.99 | 2.50 | +153% |
| Office visits | 2.37 | 2.77 | +17% |
| Clinician and staff messages | not reported | 5.70 | +24% |
Source: AJMC, "Patient portal messages outpace office visits," June 2026, reporting Long et al., JAMA, 2020 to 2025.
Clinician and staff messages peaked at 6.86 per patient per year during the COVID-19 pandemic and then fell back to 5.70. Telephone encounters fell 6% among all active patients and 7% among patients who sent messages. AJMC lists total volumes for the study of 1.77 billion office visits, 1.34 billion patient messages, 3.25 billion clinician and staff messages, 1.59 billion telephone encounters and 146 million telehealth encounters. On those totals, patient messages equal 76% of the number of office visits (1.34 billion against 1.77 billion).
A small share of patients sends a large share of messages
In the first quarter of 2025, 30% of active Epic patients sent at least one portal message. AJMC puts that group at 41.8 million people out of about 139.4 million active patients. Among those senders, messages per year rose 146%, from 2.2 to 5.4.
The volume is uneven. TechTarget reported on August 3, 2026, on a Health Affairs study that used 2022 UCSF data. In that data, the top 5% of patients sent 52.8% of all messages.
Use of the portal also differs by patient group. The JAMA study found these shares of patients who sent a message:
- Ages 40 to 64: 35.1%, the highest age group
- Women: 33.0%, against 26.1% for men
- Lowest social vulnerability quartile: 36.7%, against 25.2% for the highest quartile
- Rural patients: 28.5%; micropolitan patients: 28.3%
A separate study in the American Journal of Managed Care by Ali and colleagues, published in 2026 and cited by AJMC, followed more than 250,000 adults with chronic conditions. It found lower portal use among older patients and patients who do not speak English. A practice with those patients will see a lower share of senders than the national 30%.
Physician message load varies by a factor of five
TechTarget's summary of the Health Affairs study gives message counts for primary care physicians. The average physician received 19.9 patient medical advice requests per week. The median physician received 9.6. The top quartile received 53.3, about 5.6 times the median. A practice with five primary care physicians at the median would receive about 48 such requests a week (9.6 times 5).
That gap shows up in after-hours work. Measured against a base of five 8-hour clinic days, the second-lowest quartile of physicians by message volume spent 1.95 additional hours per week in the EHR outside clinic time. The third quartile spent 2.15 hours. The highest-volume group spent 2.6 hours, which TechTarget describes as pajama time. The article headline gives the top figure as up to 2.5 hours.
At 2.6 hours per week, one physician adds about 135 hours of EHR work per year (our calculation: 2.6 hours times 52 weeks). TechTarget did not state a sample size for the Health Affairs study.
What practice managers can measure
A practice can scale the national rate to its own size. At 2.50 patient messages per active patient per year, a practice with 10,000 active patients would expect about 25,000 patient messages a year (our calculation). At the 9.6 weekly median per primary care physician, one physician handles about 499 requests a year. At the top-quartile figure of 53.3 per week, one physician handles about 2,772.
The JAMA data suggests three counts that a practice can pull from its own EHR. The first is patient messages per active patient per year, to compare with the 2.50 national rate. The second is messages per physician per week, to compare with the 9.6 median and 19.9 average. The third is the share of messages that come from the top 5% of patients, to compare with the 52.8% UCSF figure.
Not every message needs a physician. AJMC cites a 2022 study by Escribe and colleagues in the American Journal of Managed Care that found more than 30% of patient-initiated EHR messages were administrative. Those messages can go to front desk or billing staff.
Some message work is payable. AJMC notes that portal interactions can be billed as e-visits with CPT codes 99421 through 99423. AJMC does not list payment rates for the codes, so check each payer's fee schedule.
The volume of staff messages also counts. Clinicians and staff sent 5.70 messages per patient per year in 2025, up 24%, against 2.50 patient-written messages. A practice that tracks only incoming messages misses more than half of the message work.
Sources
- AJMC, Patient portal messages outpace office visits, June 22, 2026
- TechTarget, Patient portal messages yield up to 2.6 hours of after-hours work, August 3, 2026
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