Practices tangled in the tight knot of a primary care physician shortage, administrative burden and physician burnout expect no magic scissors. But a recent study suggests that medical scribes can loosen the ropes.
The use of scribes -- "paraprofessionals who transcribe clinical visit information into the EHRs (electronic health records) in real time under physician supervision," as defined by authors of the study(jamanetwork.com) published online Sept. 17 in JAMA Internal Medicine -- "may be one strategy to mitigate the increasing EHR documentation burden among PCPs (primary care physicians), who are at the highest risk of burnout among physicians," the authors wrote.
Decreasing this burnout is a critical part of solving the worsening problem of a primary care physician shortage, and the study notes that addressing the frustrations of EHRs may be one way to do so. "Although scribes do not obviate the need for improving suboptimal EHR designs, they may help alleviate some of the inefficiencies of currently implemented EHRs," the authors noted.
The study, titled "Association of Medical Scribes in Primary Care With Physician Workflow and Patient Experience," followed 18 PCPs -- six of them family physicians -- at two practices for a year. Scribes were assigned to participants in three-month rotations.
"Use of scribes was associated with significant reductions in EHR documentation time and significant improvements in productivity and job satisfaction," the authors wrote.
- A study published online in JAMA Internal Medicine found that medical scribes "may help alleviate some of the inefficiencies of currently implemented EHRs (electronic health records)."
- Authors also found that scribes were associated with "significant improvements in productivity and job satisfaction."
- Family physician Jennifer Sewing, D.O., has found success using scribes in her practice.
Specifically, use of scribes was associated with less self-reported time spent on after-hours and weekend EHR documentation (less than one hour daily), more time interacting with a patient rather than a computer during visits, and greater likelihood of completing documentation by the day after an encounter occurred.
Some physicians who already employ medical scribes need no further convincing.
"Using a scribe is amazing and does help with job satisfaction," Jennifer Sewing, D.O., of St. Louis, told AAFP News. "It definitely helps with all of the EHR-related issues that we deal with daily. I have more time to talk to patients without worrying about all of the boxes that need to be checked."
Sewing, who has worked with scribes for seven years, told The New York Times(www.nytimes.com) in January 2014 that the experience to that point had been "life-changing." Still, two of the five doctors in her practice weren't yet believers. "I wonder how long that's going to last," she said at the time.
Not long, it turned out.
"Some of my partners were slow to sign on, but there are no holdouts in my office now," Sewing said this month. In fact, the two outliers had signed up their own scribes by the end of 2014.
Sewing and her peers' adoption of scribes into their practice has taken place during a period of increased attention to the issues driving potentially complementary trends: a shortage of primary care physicians and an increase in the number of scribes reported by the American College of Medical Scribe Specialists (ACMSS).(theacmss.org)
A 2017 study(www.annfammed.org) published in Annals of Family Medicine found that, for every hour primary care physicians spent in direct patient care, they devoted two hours to EHR tasks.
One of the authors of that study, Christine Sinsky, M.D., touted the potential of scribes in a May 2018 article(www.jointcommissionjournal.com) in The Joint Commission Journal on Quality and Patient Safety. A medical facility discussed in that article described the addition of scribes as "cost-neutral in primary care, where seeing one additional patient per physician per day covered the costs."
In the JAMA Internal Medicine study, 11 of the 18 participating physicians said they would be willing to accept additional patients if they could hire a full-time scribe. Four of those who would not take on new patients already had panel sizes that exceeded the practice limit. And although the study authors said revenue analysis was beyond the scope of their investigation, they noted that "the willingness of many of the participating PCPs to modestly increase their panel size in return for a scribe suggests the possibility of cost savings."
No standardized system exists for training or certifying scribes. Members of the ACMSS, a nonprofit trade organization, include several large companies that recruit and place scribes such as those Sewing and her colleagues use.
"They do all of the hiring, training, scheduling and management of the scribes," Sewing said of the agency with which she contracts. Turnover is routine, though she added that the scribes' interest in watching physicians in action was a valuable, if intangible, offset.
"They all tend to be applying to medical school, physician assistant (PA) school or planning on something in the medical field," Sewing said. "Over the seven years of our using scribes, eight of the scribes have gone on to medical school and two to PA schools."
Echoing the research so far, Sewing characterized the cost-benefit analysis for the scribes as a break-even-or-better proposition.
"If you see an extra two to three patients a day, the scribe's service will pay for itself," she said. "Instead of charting for hours after you finish patients, you can see a few more and make it pay for itself, instead of spending even more time on notes."
For Sewing, there's no going back. Asked whether anything would lead her to discontinue her use of scribes, she said, "Never. At least not until I retire."
Related AAFP News Coverage
Leader Voices Blog: Real Action on Administrative Burden Is Long Overdue
FPM: Five Lessons for Working With a Scribe