Our Take
Patient messaging is additive, not a substitute for clinical visits, which means healthcare systems need to staff for both channels or face capacity pressure.
Why it matters
Health systems budgeted messaging as a cost-reduction play. If it doesn't deflect visits, the infrastructure investment increases operational load without the expected offset.
Do this week
Health IT leaders: audit staffing models for patient communication channels now before Q2 budgets lock in, so you can account for dual-channel demand instead of betting on visit reduction.
Patient messaging nearly tripled in five years
Patient-written messages to clinicians rose 153% between 2020 and 2025, according to research published in JAMA (peer-reviewed). The spike reflects pandemic-era adoption of patient portals and growing patient comfort with digital communication. But the headline masks a critical operational reality: office visits also rose during the same period.
The data comes from a peer-reviewed study, not vendor benchmarks, and covers a five-year window that includes the full post-COVID normalization cycle. This matters because the trend is not an artifact of lockdown demand shifting to digital; it reflects sustained, parallel growth in both channels.
Health systems may have misbudgeted the messaging channel
When patient portals became standard post-2020, many health systems treated messaging as a visit-deflection tool. The logic was straightforward: enable patients to ask non-urgent questions in writing and reduce no-show rates or unnecessary appointments. A 153% increase in messages supports that use case.
The problem: office visits did not contract. Both channels grew. This means messaging absorbed incremental demand (clarifications, follow-up coordination, prescription refills) that might have otherwise gone unaddressed, rather than substituting for face-to-face visits. For staffing and budget models, this creates a dual-channel burden instead of a substitution play. Clinical staff must staff for message triage, response, and documentation on top of existing visit loads.
The implication is operational, not clinical. Patient outcomes may improve (more touchpoints, faster clarification). But operational efficiency gains assumed in portal ROI models may not materialize if messaging is net-additive labor, not net-subtractive.
Recount your staffing assumptions
If your health system modeled patient messaging as a visit-reduction lever, the JAMA data suggests that assumption did not hold. Review your message-handling workflow: time spent per message, triage rules, escalation rates, and whether message volume correlates with visit no-shows or cancellations at your site.
Compare your deflection rates against the national trend. If your system is seeing net-additive messaging (visits flat or up alongside message growth), messaging is a channel expansion, not a deflection. Adjust staffing headcount and training spend accordingly, and revisit portal ROI projections to reflect dual-channel capacity instead of single-channel substitution.