Background and Objectives: Administrative burden from electronic health record (EHR) in-basket messages is a major contributor to physician burnout. In the current study, we piloted a pragmatic approach to evaluate effective time allocation strategies and reduce after-hours EHR work while maintaining productivity and patient care quality: Inboxologists, advanced practice providers (APP) who managed provider-level in-basket messages.

Methods: We conducted a longitudinal experimental study comparing three approaches at the practice level: 1) APP inboxologists; 2) clinicians with dedicated template time for in-basket work; and 3) a non-intervention control group. Changes in clinician wellness were assessed via the Stanford Professional Fulfillment Index via pre-post survey questionnaires. Secondary outcomes included clinician job satisfaction, EHR after-hours time ("pajama time"), productivity (relative value units, RVU), message turnaround time, patient satisfaction, and intervention cost.

Results: Protected slots in the template arm were not utilized as intended, and this arm quickly dissolved. Inboxologist arm clinicians experienced 2-fold improvements in overall wellness and job satisfaction. Inboxologist effort correlated with reductions in clinicians’ pajama time, which declined modestly (average -3.32 min/day), showing greater reductions among those with more after-hours work at baseline. RVUs in the inboxologist arm improved by 38 points from the prior year and 7 points from pre-intervention. Message turnaround time and patient satisfaction scores improved slightly, indicating the Inboxologist intervention did not compromise patient experience. With APP inboxologists spending half their time seeing patients, the model was fiscally positive.

Conclusions: Dedicating template time to in-basket work was ineffective, but deploying inboxologists offered a scalable, cost-effective strategy to support clinician wellbeing, particularly when integrating inboxologist support into existing APP clinical time. Our pilot intervention reduced pajama time and improved clinician wellness and job satisfaction in the Inboxologist arm without negatively affecting productivity, responsiveness, or patient satisfaction. Implications exist for broader adoption in specialty care settings.