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Research Letter
March 2014

Metastasis of E-mail at an Academic Medical Center

Author Affiliations
  • 1Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
  • 2Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
  • 3Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania
JAMA Pediatr. 2014;168(3):290-291. doi:10.1001/jamapediatrics.2013.3934

For my part, I could easily do without the post-office. I think that there are very few important communications made through it. To speak critically, I never received more than one or two letters in my life…that were worth the postage.

Henry David Thoreau, Walden1

Communication modalities have dramatically changed since Thoreau’s time, and one can imagine how he would regard Twitter. Today, instantaneous communication through electronic mail (e-mail) can be sent for free to an infinite number of recipients with a mouse click. This capability has clear benefits (speed, ease of use, and global reach), yet unintended consequences exist for this convenience.2,3

At academic medical centers, e-mail provides a simple way to communicate and serve the multiple missions of these complex organizations. Less obvious is how e-mail contributes to a daunting volume of information, flooding employees with information frequently irrelevant to their responsibilities. To call attention to some unintended effects of “cost-free” communication, we quantified the volume and described the content of mass distribution e-mails sent to a single physician (I.M.P.) over 1 year and estimated the economic impact of a physician reading these messages.

To accomplish these goals, mass distribution e-mails sent from the department level or higher were compiled during the 2009-2010 academic year and categorized by source and content. Administrative data (number of physicians and mean salary) were obtained, and cost estimates were generated using conservative estimates of a 50-hour workweek throughout the year.

Over 12 months, 2035 mass distribution e-mails were received: 1501 (73.8%) from the medical center level, 450 (22.1%) from the department, and 84 (4.1%) from the university. Medical center e-mails most frequently related to information technology (360; 24.0%), academic/professional development issues (332; 22.1%), and social events/opportunities (285; 19.0%), while e-mails related to clinical care, research, or education combined to total 451 (30.0%). Of 450 department e-mails, 169 (37.6%) were related to academic/professional development, 117 (26.0%) concerned education, and 87 (19.3%) were social in nature.

If 30 seconds were spent per e-mail, the annual cost per physician to read these mass distribution e-mails was $1641 (mean 2009-2010 salary = $231 612). If 90 seconds were spent per e-mail, the cost was $4923 per physician. With 629 employed physicians, the annual institutional cost was between $1 029 419 and $3 088 257 for physicians to read mass distribution e-mails.

These data suggest that mass distribution e-mails at academic medical centers are frequent and costly. Though generalizability is limited by several obvious factors, this problem is pervasive in academic medicine and other industries.4 A 1993 report suggested e-mail made physicians’ lives easier and had a humanizing influence,5 but physicians are now flooded with unfiltered, untargeted e-mails that distract from “real work.” Compounding this overload are messages with errors requiring corrections, failure to consolidate information, and failure to highlight crucial information. The cumulative effect is reduced productivity, wasted time, and potentially a diminished quality of life.2

Several remedies are readily available: (1) consolidate nonurgent emails from one source; (2) use internal web-based messages or calendars; (3) create listserves for targeted audiences (with opt-out options); (4) enable spam filters to internal e-mails; (5) incentivize individuals to consider appropriateness and accuracy when sending messages to “all recipients”; and (6) limit reminder messages.

The risk that important information might not reach every intended recipient must be balanced against not only the cost of our current metastatic e-mail culture, but also “e-mail fatigue” that can undermine effective communication. E-mail undoubtedly serves vital purposes in professionals’ lives, but much e-mail falls into the same category of “so-called comforts of life” that Thoreau described as not only dispensable, but “positive hindrances to the elevation of mankind.”1

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Article Information

Corresponding Author: Ian M. Paul, MD, MSc, Department of Pediatrics, Mail Code HS83, Penn State College of Medicine, 500 University Dr, Hershey, PA 17033 (ipaul@psu.edu).

Published Online: January 20, 2014. doi:10.1001/jamapediatrics.2013.3934.

Author Contributions: Dr Paul had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition of data: Paul.

Analysis and interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: All authors.

Administrative, technical, and material support: All authors.

Study supervision: Paul.

Conflict of Interest Disclosures: None reported.

References
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Renaud  K, Ramsay  J, Hair  M.  “You've got e-mail!” ... shall I deal with it now? electronic mail from the recipient's perspective. Int J Hum Comput Interact. 2006;21(3):313-332. doi:10.1207/s15327590ijhc2103_3.Article
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Sands  DZ, Safran  C, Slack  WV, Bleich  HL.  Use of electronic mail in a teaching hospital. Proc Annu Symp Comput Appl Med Care. 1993:306-310.
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