Background: Evidence suggests female physicians experience higher rates of burnout compared to male counterparts1,2. The Electronic Health Record (EHR) is a recognized source of physician burnout (4,5,6). Therefore, efforts to understand gender disparities in EHR use may offer insights into burnout disparities at large. Studies in outpatient settings have found female physicians spend more time in the EHR and receive a higher volume of inbox messages from both staff and patients (7,8,9). Whether similar gender disparities exist within inpatient settings remains largely unexplored. In the hospital, Epic Secure Chat has emerged as a communication tool that could create similar workload challenges to those in the clinic. Recent studies suggest physicians bear the highest daily burden of Secure Chat messages, though gender-based differences have yet to be examined (9). This study aimed to explore potential gender differences in Secure Chat messaging patterns for resident physicians on inpatient Internal Medicine services.
Methods: We conducted a retrospective analysis of Secure Chat data among trainees (PGY1, PGY2, PGY3) in the Mayo Clinic Internal Medicine Residency from October 2023 to October 2024. Data on messages sent and received were extracted from Epic’s Signal Report and matched to resident schedules during 4-week long, non-intensive care inpatient primary service rotations. This data was then matched to administrative records including physician gender (male and female only). We used simple comparisons of mean message counts per day for statistical analysis.
Results: Secure Chat messaging patterns were analyzed across rotations including: PGY2-only rotations (Gastroenterology, Pulmonology), a PGY1-only rotation (Neurology), a PGY3-only rotation (Hospital Medicine), and mixed rotations where PGY3s lead PGY1s (Cardiology, Medicine). For mixed-level rotations, messaging patterns were analyzed separately by resident role (PGY1 vs. PGY3), resulting in eight distinct rotation categories for analysis. Female residents received more Secure Chat messages than males in all but one rotation, with significant differences on the PGY3-only Hospital Medicine (77.1 vs. 61.5) and PGY1 Cardiology rotations (69.5 vs. 61.8), p< 0.05. Women also sent more messages on average than male residents other than during the PGY3-led Cardiology and PGY3-led Medicine rotations. Significant differences in messages sent by women were observed on PGY1 Cardiology (31.8 vs. 23.4), PGY2 Pulmonology (30.4 vs. 23.7), and PGY3-only Hospital Medicine rotations (34.2 vs. 23.2), p< 0.05.
Conclusions: Female residents generally received and sent more Secure Chat messages than male colleagues, with significant disparities on specific rotations. These findings parallel trends in outpatient settings and suggest gender-based differences in communication demands in the inpatient environment. Future research should examine the impact of messaging volume on resident well-being and efficiency.