Who Should Handle Patient Portal Messages? What MGMA’s October 2026 Poll Means for Your Practice

Who should handle patient portal messages in a medical practice?

As of November 2026, the answer to who should handle patient portal messages is a designated person or team that sorts, answers and escalates them so physicians do not handle every one themselves. An October 27 MGMA Stat poll found 71% of medical groups have someone designated, usually medical assistants or nurses, but most receive no added time or pay for the work.

What MGMA found: Seven in 10 groups designate someone for other providers’ inbox messages, yet most say it is simply added to an existing job.

Why it matters: Patient-authored portal messages per active patient rose 153% over five years, according to Epic Cosmos data published in JAMA.

The fix: A dedicated virtual inbox team, with assistants handling administrative requests and registered nurses triaging clinical ones, gives every message an owner.

What MGMA’s October 27 Poll Found

On October 28, 2026, the Medical Group Management Association published “Who owns the inbox? How medical groups can redesign portal-message work.” It reported results from an October 27 MGMA Stat poll that asked practice leaders whether anyone is designated to handle portal and inbox messages for other providers. Of 238 applicable responses, 71% said yes, 24% said no, 1% were unsure and 4% reported having no portal.

The follow-up comments show who is doing the work. Nearly two-thirds of the “yes” respondents who named a role cited medical assistants, nurses or both. Some practices pair an MA with each physician, while others have triage nurses screen messages first or split administrative messages to the front desk and clinical messages to nurses and MAs. About one in 10 named advanced practice providers, and roughly one in eight described physicians and APPs covering each other’s inboxes during absences.

The most telling finding was about time and pay. About 71% of “yes” respondents who addressed the question said the work came with no separate schedule time or added pay. One respondent described it as a new expectation with no protected time. Only a few practices had created a position for the work, including one piloting an “inboxologist” whose main job is the inbox.

Among groups with no designated person, about six in 10 said the treating provider handles their own messages. Almost as many had considered or were pursuing a role, and MGMA listed outsourcing among the options those leaders named. Others cited cost or messages that need provider input as reasons for leaving things as they are.

In short, most practices already know someone besides the physician should own the inbox. What they have not done is staff it as a real job.

Which practices need a dedicated inbox team?

Any practice where physicians answer portal messages between visits or after hours, or where MAs and nurses absorb inbox work on top of full schedules, needs a dedicated inbox owner. Primary care, specialty groups with chronic-condition patients and practices with high telehealth use typically feel the strain first.

The burden is not spread evenly, which is why some practices feel it far more than others. A 2026 Health Affairs study cited by MGMA found that at UCSF Health, the top 5% of patients generated more than half of patient-initiated medical advice messages. Nationally, primary care physicians in the highest-volume quartile received 53.3 messages a week, compared with a median of 9.6.

That spread means two practices of the same size can have very different inbox loads. A practice with an older or sicker patient panel, a large Medicare population or a strong telehealth program will see more messages than one built around acute visits. The same is true inside a group: one physician may be overwhelmed while a partner barely notices.

Watch for a few warning signs. Physicians logging into the EHR at night or on weekends to clear messages is the most common. Others include patients calling because portal messages went unanswered, refill requests aging past a day, MAs falling behind on rooming because they are answering messages, and nobody being able to say how many messages are waiting at any given moment.

When we place remote staff with a practice, the first conversation is usually about exactly these symptoms. Practices rarely ask for “inbox help” by name. They ask why their providers are working every evening, and the inbox is almost always part of the answer.

Why Portal Messages Keep Climbing

Patients have embraced the portal as the easiest way to reach their care team. Epic Cosmos data published in JAMA showed patient-authored portal messages per active patient rose 153% over five years. An earlier MGMA Stat poll found 70% of groups reported higher portal message volume over the prior year, so the October 2026 findings describe a trend that has been building for years.

Every message carries a task. Lab questions, refill requests, scheduling changes, symptom updates and paperwork requests all arrive in the same queue. MGMA describes the typical pattern: an inbox that looks manageable at 8 a.m. is full of questions for every clinician by noon.

Payment has not kept pace with the work. Most portal replies are not billable. Patient-initiated messages from established patients can qualify as e-visits under CPT codes 99421 through 99423 when they involve clinical evaluation and at least five minutes of cumulative physician or qualified health professional time over seven days, but MA and nursing time does not count toward that threshold, and consent, documentation and payer rules apply.

Technology is helping with sorting but not with ownership. A 2026 JAMA Network Open study cited by MGMA found an intelligent messaging tool at Southern California Permanente Medical Group classified more than 3 million portal messages by topic and urgency, cutting the median time until a clinician first read a high-acuity message from about 22 hours to five. MGMA’s point is that a person or team still has to act on what the tool sorts. Software can flag the message; it cannot call the patient back.

How much physician time does the patient portal inbox cost?

For a high-volume primary care physician, the inbox can consume several hours a week, much of it after clinic. Every hour spent on messages that staff could resolve is an hour not spent seeing patients, which means lost visit capacity and a steady driver of burnout.

Here is an illustrative example using round numbers, not reported data. Picture a three-physician primary care practice where each physician receives about 50 portal messages a week, close to the top-quartile figure from Health Affairs. If each message takes an average of three minutes to read, decide on and answer, that is 150 minutes per physician, or 7.5 physician hours a week across the group. At 20-minute visits, that time equals roughly 22 appointment slots every week.

Now assume a virtual inbox team resolves two-thirds of those messages, such as scheduling, refills within protocol, records requests and routine follow-ups, and routes the rest to the right clinician with the chart already reviewed. The physicians get back about five hours a week, or around 15 visit slots, without hiring anyone in the building.

Inbox Model	What MGMA Found	Main Trade-Off
Treating provider handles own messages	About six in 10 groups with no designated person	Physician time and after-hours work
Added to an existing MA or nurse job	Most common model; usually no added time or pay	Rooming, calls and other work slip
Dedicated in-house inbox role	Only a few practices have created one	Local hiring cost and turnover risk
Dedicated virtual inbox team	Outsourcing named among options being considered	Requires clear protocols and EHR access

In our experience placing remote medical staff, the practices that get the most out of a virtual inbox team are the ones that write down, before day one, exactly which message types the team can close on its own and which go to a clinician.

How to Set Up an Inbox Team

MGMA and the American Medical Association both recommend understanding the inbox before redesigning it. Use these steps whether you staff the role in-house or virtually.

1. Audit several weeks of messages. Use EHR audit logs, as AMA STEPS Forward recommends, to sort messages by type, sender, handling time and resolution.

2. Sort messages into pools. Separate administrative, refill, clinical and other messages so each pool goes to the team member best equipped to handle it.

3. Match each pool to the right role. Send scheduling, records and paperwork to assistants, and send clinical questions to registered nurses or APPs.

4. Write resolution protocols. Define what staff can answer alone, what needs physician or APP review and what requires urgent attention.

5. Set message-to-visit rules. Decide when a message becomes a telehealth or in-person visit, and when provider time may qualify as an e-visit under 99421 to 99423.

6. Protect time for the work. Build inbox time into schedules rather than adding it to full days.

7. Measure response times weekly. Track open messages, time to first response and how many messages reach a physician.

A JAMA Network Open study cited by MGMA found that reserving one 20- to 30-minute slot per half-day for messages and other EHR work reduced physicians’ after-hours EHR use with only a small dip in productivity. Combining protected provider time with a staffed first-pass team gets the best of both.

Common Inbox Delegation Mistakes

The most common mistake is adding the inbox to someone’s job without taking anything off it. MGMA’s poll shows this is the norm, and it is why inbox work so often slows rooming, phones and other tasks. If the work matters enough to assign, it matters enough to staff.

The second mistake is sending clinical questions to unlicensed staff. MGMA notes that routing all clinical messages to MAs raises scope-of-practice and escalation concerns when a question needs licensed judgment. Symptom updates and medication questions belong with a registered nurse or a provider.

The third mistake is creating a bottleneck. If one designated person is out sick, or if physicians re-review every message the team already handled, the inbox slows down instead of speeding up. Build backup coverage, and trust protocols once they are proven. Review a sample of handled messages each month instead of re-checking every one.

The fourth mistake is overlooking HIPAA. Anyone handling portal messages, in the office or remotely, is working with protected health information. Remote staff need a business associate agreement, secure access and HIPAA training. Our guide to choosing a HIPAA compliant virtual assistant covers what to require.

The last mistake is treating the inbox as separate from burnout. Unanswered messages follow providers home, and that pressure is part of why so many clinicians are exhausted, as we covered in our post on PA burnout and virtual medical assistants.

In-House Hire vs. Virtual Inbox Team

Hiring a local inbox coordinator is an option, but MGMA’s broader data shows medical assistants and front-desk roles remain among the hardest to recruit and retain. A new hire still needs training on your EHR, your protocols and your providers’ preferences, and if that person leaves, the inbox goes back to the physicians. That cycle of hiring, training and backfilling is exactly the instability the inbox cannot afford.

DoctorsVA places dedicated virtual staff who work as part of your team. Candidates must have at least two years of verified medical experience, hold or earn HIPAA certification, complete remote-work training and pass a personality assessment so they fit your practice. We place registered nurses for clinical triage, virtual medical receptionists for scheduling and administrative messages, and patient care coordinators for follow-up and referrals.

Our placed assistants have a 97% retention rate, so the person who learns your inbox stays with it. There is no minimum number of assistants, staff work full time so there are no scheduling gaps, and we provide HMO medical coverage and paid time off at no added cost to your practice. Our central office also serves as a backup work location to keep service running, so the inbox does not stall when a home connection fails.

For clinical message triage, see our virtual registered nurse services. To compare costs with a local hire, review our breakdown of medical virtual assistant cost.

Frequently Asked Questions

Next Steps

See how virtual nurses handle clinical triage on our virtual registered nurse services page.

Learn how administrative overload compounds the inbox problem in our post on prior authorization burden and virtual medical assistants.

Review how DoctorsVA vets and places remote staff before your first call.