Gender differences in secure chat and electronic health records use among hospital-based physicians
Clinical Snapshot
PICO Framework
| P — Population | Hospital-based internal medicine and medicine-paediatrics physicians (108 senior residents, 97 faculty) at a single academic tertiary care hospital in the United States |
| I — Intervention | Female gender (as the exposure of interest in this observational study) |
| C — Comparator | Male gender |
| O — Outcomes | Daily EHR time (minutes), secure chat time (minutes), messages sent and received, and hours worked — all derived from EHR metadata over a 12-month period (July 2023 – June 2024) |
Bottom Line
This retrospective single-centre study of 205 US hospital-based physicians demonstrates that women spend approximately 26 more minutes per day in the EHR and 4 more minutes in secure chat than men, despite working equivalent total hours. These differences were consistent across residents and faculty and persisted after a scheduling model change — suggesting they are not simply artefacts of differential work hours. The annualised excess digital burden for women approximates 100 additional hours per year, which has plausible implications for burnout and cognitive load. However, the study's most significant limitation is the absence of multivariable confounder adjustment: differences in patient complexity, panel size, and service type between male and female physicians are not accounted for and could substantially explain the findings. The single academic centre design and binary gender classification further limit generalisability. Confidence intervals are not reported, preventing precision assessment. Clinicians and health service administrators should treat these findings as hypothesis-generating rather than definitive. Australian health services with EHR metadata capability are encouraged to conduct analogous audits, incorporating appropriate confounder adjustment, to determine whether similar gender-based digital workload disparities exist in local contexts before implementing equity-informed interventions.
Key Findings
P Value: EHR time p<0.001; Secure chat time p<0.001; Messages sent p<0.001; Messages received p<0.001; Hours worked p=0.40 (non-significant)
Effect Size: EHR time: 248 vs. 222 min/day (women vs. men; difference of 26 min/day, ~12% more); Secure chat: 38 vs. 34 min/day (difference of 4 min/day); Messages sent: 62 vs. 53/day; Messages received: 56 vs. 48/day
Primary Outcome: Women physicians spent significantly more time in the EHR and secure chat per day compared to men, despite working similar total hours
Nnt Or Sensitivity: Not applicable (observational association study); no NNT, hazard ratio, or diagnostic accuracy metrics reported. Approximate annualised excess EHR burden for women: ~104 additional hours/year based on 26 min/day differential over ~240 working days
Confidence Interval: Not reported in abstract
Clinical Application
EHR metadata analysis is feasible at any institution with a modern EHR system capable of generating usage logs. Many Australian hospitals using Epic or Cerner have access to equivalent metadata. Implementation of equity-informed workload monitoring would require institutional commitment, IT infrastructure, and governance frameworks to protect physician privacy. Australian relevance is moderate. The RACGP and RACP have both published position statements on gender equity in medicine, and the Medical Board of Australia's workforce data consistently shows gender disparities in specialty distribution and workload. Australian hospital medicine is increasingly EHR-dependent, with jurisdictions such as NSW (eHealth NSW), Victoria (EMR programs), and WA (BESSi/Cerner) rolling out integrated platforms. Secure messaging tools (e.g., Telstra Health's MedicalDirector, Healthlink, and hospital-integrated chat functions) are increasingly embedded in Australian inpatient workflows. The findings are conceptually transferable and should prompt Australian health services to audit their own EHR metadata for gender-based workload disparities. There is no PBS or TGA relevance. RACGP's 2023 Gender Equity in General Practice report provides a parallel framework for contextualising these findings in Australian primary care. Hospital-based internal medicine physicians (hospitalists, general medicine registrars, and equivalent roles) at academic or tertiary care institutions. Most directly applicable to senior residents and attending-level faculty in inpatient settings with EHR-integrated secure messaging systems.
Abstract
BACKGROUND: Digital messaging within electronic health records (EHRs) is central to inpatient communication. While intended to enhance efficiency, these tools may contribute to unequal digital workloads. OBJECTIVE: To evaluate gender-based differences in EHR and secure messaging use among hospital-based physicians. METHODS: Retrospective observational study at a single academic tertiary care hospital using EHR metadata from July 2023 to June 2024. Participants included a total of 205 internal medicine and medicine-pediatrics physicians (108 senior residents, 97 faculty) serving as primary clinicians on hospitalist shifts. Measures included daily number of messages sent/received, time spent in EHR and secure chat, and hours worked, stratified by gender and role. RESULTS: Physicians worked a median of 9.4 h/day, spending 40.7% of their time in the EHR and 6.3% in secure chat. Women and men work similar hours (9.5 vs. 9.3, p = .40) but women spent more time in the EHR (248 vs. 222 min/day; p < .001) and secure chat (38 vs. 34 min, p < .001) and exchanged more daily messages (62 vs. 53 sent; 56 vs. 48 received, both p < .001). Patterns were consistent across residents and faculty. Among faculty, gender differences persisted after a new scheduling model, which reduced overall work hours. CONCLUSIONS: Women physicians engaged more in digital communication than men, despite similar hours worked, and these differences persisted after a workflow change. These findings underscore the need for equity-informed strategies that both mitigate excess burden and recognize the potential value of proactive communication in hospital settings.
References
- 1.Witte, M., McDermott, C., Levy, K. L., Nelsen, K., Shrestha, S., Tian, S., Paje, D., & Sheffield, V. (2026). Gender differences in secure chat and electronic health records use among hospital-based physicians. Journal of Hospital Medicine. Advance online publication. https://doi.org/10.1002/jhm.70236
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