In 2018, I made the case for more medical scribes. “Medical scribes,” I wrote, “have the potential to remake American medicine.”
Why? I viewed “the possibility of being freed from the burdens of excessive documentation and having more time with my patients” with excitement. Moreover, “on a systemwide level, by helping to reduce after-hours work and refocusing physicians’ time and energy on the direct provision of patient care,” I believed that “scribes [could] help fight physician burnout” at a “relatively low cost.” I concluded by imploring medical leaders to “consider investing in their services.”
At the time, a recently published study in JAMA Internal Medicine illustrated the potential benefits of having more medical scribes in the clinic. Primary care providers working with scribes spent more time interacting with patients and less time on a computer during clinic visits. They also spent less time completing electronic health record documentation after work hours. Most importantly, only 2% of patients reported that scribes had a negative impact on their visits.
In the 16 months since I wrote that article, the case for medical scribes has only gotten stronger. A 2018 study in the Journal of the American Board of Family Medicine examined the impact of medical scribes at an urban safety net health clinic staffed by physicians with backgrounds in family medicine and internal medicine-pediatrics. The study found that physicians working with medical scribes spent more time facing their patients and less time facing their computers. The proportion of each visit spent face-to-face with patients, in fact, increased 39%. The number of patients seen and physician work relative value units surged 9% and 11% per hour, respectively. As with the JAMA Internal Medicine study, most patients were comfortable with a scribe in the exam room.
Medical scribes may have a benefit in the emergency department (ED), too. A 2019 study in BMJ examined the impact of scribes in five EDs in Australia. Physicians who were randomly assigned to a scribe saw 26% more new patients per hour, and patients spent 10% less time in the ED. The quality of care delivered was not impacted. Using this information, the authors concluded that hospitals could save over $26 per hour by hiring a medical scribe.
These and other studies have made clear that medical institutions and physicians have much to potentially gain from hiring more scribes. Assessing the impact of medical scribes in JAMA, Elsa Pearson and Austin Frakt encouragingly concluded that “the current literature, though limited, suggests that scribes may decrease clinician time spent with [electronic health records] and improve clinician productivity and satisfaction.” The benefits, however, run both ways; scribes also benefit from this arrangement. Pearson and Frakt noted that the relationship between medical scribes, who are often “aspiring clinicians,” and clinicians “is mutually beneficial: as the scribe gains [clinical experience], the clinician gains bandwidth to focus on clinical decision making.”
As I have pointed out in the past, American medicine is in the midst of “a devastating crisis within its workforce.” In 2019, over 4 in 10 physicians reported that they felt burned out, and nearly 1 in 7 reported thoughts of suicide. The reasons underlying this unfortunate state of affairs are varied and complex. However, it is clear that having to work long, grueling hours in emotionally challenging environments with little support; being burdened with excessive documentation requirements with little relevance to clinical care; and spending only a small amount of time interacting with patients is having a corrosive effect on the medical profession in America.
Having more medical scribes will not necessarily solve all of these problems. However, studies have shown that scribes can improve life in the clinic for physicians. And the emerging cohort of medical scribes may represent a rich pool from which future clinicians may be selected. Medical institutions should take note.
Dr. Kunal Sindhu is a resident physician in New York City and a 2019-2020 Doximity Fellow. You can follow him on Twitter @sindhu_kunal.