The hidden workload of “free” communication: a longitudinal case study of physician e- mail traffic at a Swiss tertiary care centre

In the modern hospital, a doctor's day is often measured in tangible actions: the number of patients seen, the surgeries performed, or the beds managed. These are the visible metrics of healthcare, the activities that fill appointment books and generate billing records. Yet, a significant portion of a physician's professional life now happens in the quiet, invisible space of the computer screen. Electronic mail has become a standard tool for clinical work, valued for its speed and ability to connect people across different departments without the need for paper. But while a single message might seem like a quick exchange, the cumulative effort required to read, write, sort, and act on thousands of these messages creates a hidden layer of labor. This digital work is real, it consumes time, and it often goes unrecorded in the systems that track how doctors spend their days. Understanding this hidden workload is crucial because it represents a substantial investment of professional energy that does not always show up in the traditional counts of patient care.

To understand the true scale of this invisible labor, researchers at a major hospital in Switzerland conducted a detailed, year-long examination of a single senior doctor's institutional email account. They did not rely on surveys or guesses; instead, they tracked every single message that arrived, was sent, or was actively deleted by the physician throughout the entire calendar year of 2025, excluding messages filtered as spam or quarantined. The team exported the data weekly, converting the messages into a format that allowed them to analyze the metadata—the information about the messages rather than the private content itself. They used an artificial intelligence tool, supervised by human review, to sort the emails into three distinct categories: messages about specific patients, messages related to scientific research and publications, and administrative messages covering everything from hospital operations to committee work. By applying standard rates for reading and typing speed to the word counts of these messages, they calculated how much time the doctor likely spent processing this digital traffic.

The results revealed a volume of work that would surprise many observers. Over the course of the year, the physician processed nearly ten thousand emails. When the researchers estimated the time required to read and respond to these messages, the total came to approximately 913 hours. This is equivalent to a mean of 2.5 hours of focused work per calendar day across the entire year. However, the data showed a clear pattern: the workload was heavily concentrated on weekdays, with the doctor handling dozens of messages a day during the work week, while weekends saw a sharp drop in volume. The median daily processing time was 151.1 minutes on working days versus just 18.1 minutes on weekends. The busiest months of the year were September and October, when the daily processing time peaked, while the summer months saw a noticeable dip, likely corresponding to holiday periods.

Perhaps the most revealing finding concerned the nature of the work itself. The researchers found that only about one-quarter of the emails were directly related to the care of specific, identifiable patients. The remaining three-quarters consisted of administrative tasks and scientific correspondence. This means that for every hour the doctor spent communicating about a patient's health, they spent roughly three hours on other professional duties, such as coordinating with hospital staff, managing departmental logistics, or reviewing research papers. While the patient-related emails could theoretically be linked to a billing system that recognizes the time spent, the vast majority of this digital labor—those thousands of administrative and scientific messages—remains invisible to financial metrics. The study estimated that if the patient-related emails were billed according to Swiss outpatient rates, they would represent a value of roughly 67,000 Swiss francs for the clinic. However, this figure highlights a gap: the much larger portion of work that keeps the hospital running and the medical field advancing has no direct monetary value in the current system.

The researchers also looked at how this workload has changed over time. By comparing the 2025 data with records from previous years, they observed a steady increase in the total number of emails. The volume grew from just over 7,000 messages in 2023 to nearly 10,000 in 2025, with projections for 2026 suggesting an even higher number. This trend indicates that the digital demands on physicians are not static; they are expanding. The study noted that this specific mailbox was protected by a strict spam filter that removed a significant amount of unsolicited mail before it ever reached the doctor's inbox; the analysis focused only on the legitimate traffic that passed this filter. Even with this filter in place, the doctor still had to manage a massive flow of legitimate communication. The researchers acknowledged that this single case study cannot represent every doctor in every hospital, but it provides a concrete, measurable example of how a communication channel often perceived as effortless can actually consume a massive amount of professional time.

Ultimately, this work illustrates that the "free" communication of email comes with a hidden cost. It is not merely a tool for passing information; it is a recurring workflow demand that competes for a physician's attention and time. The study suggests that the current ways of measuring a doctor's work, which focus on patient visits and procedures, fail to capture the reality of modern medical practice. A large portion of the professional day is spent on digital tasks that are essential for the system to function but are largely invisible in traditional workload accounts. As hospitals continue to rely on digital tools, understanding the true magnitude of this hidden labor is a necessary step toward planning for a sustainable workforce and designing communication systems that support, rather than overwhelm, the people who care for patients.