Office visits to primary care physicians declined by 18 percent between 2012 and 2016, according to a recent study by the Health Care Cost Institute. The HCCI analysts limited their observations to adults younger than age 65 with employer-sponsored health insurance. When other patients were included, "they noted a 2 percent decrease in all PCP office visits from 2012 to 2016" (medscape.com). The question is "Why?"
"Making physicians into secretaries is not a winning proposition," says Dr. Christine Sinsky, a primary care physician in Dubuque, Iowa. The demands of entering data into a computer while talking to and examining a patient has been shown to be a major source of physician dissatisfaction, according to a study published in October by the AMA and the RAND Corporation. In an article co-authored by Dr. Sinsky (Health Affairs, November 13, 2013), she concluded that two-thirds of a primary care physician's time is devoted to clerical work -- a job that can be delegated to someone else. A recommended solution: hire medical scribes.
A scribe accompanies the physician into the exam room, then enters data into a computer as the physician takes the patient's history and does the exam. The doctor is thus able to devote full attention to the patient. Dr. Sinsky has found that doctors who use medical scribes are more satisfied with their work since they no longer have to pull double duty as both doctor and data entry clerk, often staying "after hours" to finish electronic health records.
In the hospital setting, medical scribes usually spend their time in the emergency room. It's only recently, with the transition to electronic health records, that they have moved into doctors' offices as well.
Predictably, several companies have now been established to supply the growing demand for scribes. One is ScribeAmerica, based in Aventura, Florida. Interviewed for a New York Times article (January 12, 2014), ScribeAmerica's CEO Dr. Michael Murphy estimates that "there are nearly 10,000 scribes working in hospitals and medical practices around the country, with demand rising quickly." Companies typically charge $20 to $25 per hour for scribes who are paid $8 to $16 per hour. Training is done by the companies and usually takes 15 to 21 days.
Medical scribes are sometimes college students, including pre-meds and others interested in health-related careers such as physician assistant, nurse, and nurse practitioner. In addition to their salary, they also benefit from the clinical exposure and the opportunity to gain competency with using medical terminology.
As the popularity of medical scribes has grown, so has the idea of their certification based on minimal performance standards. The American College of Medical Scribe Specialists (ACMSS), founded in 2010, is trying to get all scribes certified through the medical Scribe Certification and Aptitude Test (MSCAT). Elements of certification would include documented prior training and a rigorous 2-hour examination.
In the end, clear and well-organized communication between patient, doctor, and scribe should result in not only better patient records by happier doctors and patients as well.