You notice something that doesn't feel right. Maybe a medication is bothering you, or a symptom that was supposed to fade hasn't. You log in to the patient portal, type out your question, and hit send. Then you wait. A day goes by. Two. When a reply finally arrives, it's polite and careful, but it's from a name you don't recognize, and it ends by suggesting you book the next available appointment.
That experience has become the quiet norm of American medicine, and it's worth understanding why. More and more of your care no longer happens in the exam room. It happens in the space between visits, through messages. The problem isn't the messaging itself. It's who is on the other end, and how long you wait to hear back.
This is the part of concierge medicine that's easy to overlook when people picture it as a luxury. The real value isn't a nicer waiting room. It's that when you reach out, you reach your own doctor.
Care Has Quietly Moved Between the Visits
Here's the shift, measured carefully. A large study published in JAMA in June 2026 looked at roughly eight billion total encounters across more than 2,000 hospitals and 47,000 clinics. Between 2020 and 2025, the number of messages patients sent their care teams through online portals rose 153 percent, climbing from about one message per patient each year to two and a half. Over the same five years, in-person office visits rose only about 17 percent.
Read that again, because the gap is the whole story. In percentage terms, messaging grew far faster than office visits did, and it didn't replace those visits. The researchers found that portal messaging has become a third, additive channel: another way to ask questions and keep receiving care, layered on top of appointments rather than instead of them. Telephone calls, meanwhile, slipped slightly over the period.
What that means in plain terms is this. The doctor-patient relationship used to live almost entirely inside scheduled appointments. Now a growing share of it lives in your inbox, in the quick questions and follow-ups that come up in ordinary life. Medicine has changed where it happens. Most practices haven't changed who answers.
A Message Is Only As Good As Who Reads It
A portal message feels like a direct line to your doctor. Usually it isn't. In a typical practice built around a panel of a couple thousand patients, those messages flow into a shared queue. They're triaged by nursing staff or routed to whichever clinician is covering the inbox that day. Your own physician may never see most of them, and when a question is genuinely simple, that system can work fine.
The trouble is that a lot of questions only look simple. "Is this new symptom something to worry about?" depends entirely on what's normal for you, what you were treated for last spring, and which medications you're already taking. Someone encountering your chart cold has to rebuild that context from scratch, or play it safe and tell you to come in. Neither is the same as a doctor who already knows your history answering in a sentence.
So the surge in messaging has created a strange situation. You can reach a practice more easily than ever, yet reaching the specific person who knows you has, in many places, become harder. Volume went up. Familiarity went down.
What Direct Access Actually Means
In a concierge practice, the between-visit channel is built differently from the ground up. Because the patient panel is kept small by design, the person who reads your message is me, the physician who saw you last and will see you next. There's no pooled inbox to get lost in and no stranger reconstructing your story.
Practically, that changes a few things. A question that would otherwise require an appointment can often be settled in a short exchange, because the context is already there. When something does need to be seen, it gets seen quickly, by the doctor who understands the backdrop. And the small worries that people tend to sit on, the ones that feel too minor to justify booking a visit but nag at you anyway, finally have somewhere to go.
Direct access isn't about texting your doctor at midnight over nothing. It's about removing the friction that currently sits between a patient and a timely, informed answer. The data shows that friction is growing for most people. A practice designed around access is simply choosing not to pass it on to you.
What This Means for You
Picture a working parent here in Lubbock who started a new blood pressure medication a few weeks ago and has been feeling oddly lightheaded in the afternoons. In most practices, that's a portal message into the void, a wait, and then a recommendation to schedule something a week out. The uncertainty stretches across days you'd rather spend not worrying.
With direct access, that same question reaches a physician who already knows your numbers and what was changed and why. You often get a real answer within hours, not a placeholder. Sometimes the answer is reassurance. Sometimes it's "come in today." Either way, you're not managing the uncertainty alone, and you're not navigating a system that treats a message as a ticket in a queue. That's the difference small panels and direct lines are meant to buy.
Talk to a Doctor Who Will Actually Answer
If you've grown used to waiting days for a reply from someone who doesn't know your story, it's worth knowing that isn't the only way care can work. At OmriMed, reaching me between visits is part of the membership, not an extra. If you'd like to understand how direct access fits your health and your life, reach out through our contact page or call us at (806) 778-4395. No pressure, just a conversation about whether it's the right fit.
Sources
- Patient portal message growth (153 percent, 2020 to 2025), per-patient figures, office visit and telephone trends, and the finding that messaging adds to rather than replaces in-person care: Long JJ, McAdams-DeMarco MA, Schwartz MD, et al. "Trends in patient portal messages, office visits, and telephone encounters." JAMA. 2026;336(3):252-254, as reported by The American Journal of Managed Care and Healio.
- Study scale (approximately eight billion encounters across more than 2,000 hospitals and 47,000 clinics, via Epic Cosmos): same source, Long JJ, et al. JAMA. 2026, reported by The American Journal of Managed Care.
This article is for general educational purposes and is not medical advice, diagnosis, or treatment, and it does not create a physician-patient relationship. Individual results vary, and no outcome is guaranteed. Treatment decisions should be made with a qualified physician who knows your full medical history. Omri Med is a private-pay concierge practice; membership is limited and does not replace health insurance.