Dr. Arthur Jey shepherded a middle-aged female patient, hunched over in pain, from the Sutter General emergency waiting area to a nearby exam room – wrapping an arm around her back as he placed her gently in a chair. He knelt on the hospital floor as he examined her aching abdomen and asked about her health history. In a corner of the room, Veronica Cordero, a medical scribe, clacked at the keyboard on her mobile workstation.
With doctors such as Jey burdened by what they say are the growing demands of digital record keeping, Cordero was providing much-needed relief. Medical scribes electronically document patient visits so doctors don’t have to, and they’re in high demand across the country. Physicians say scribes are boosting efficiency at a crucial time, just as health care providers take on millions of new patients under the Affordable Care Act.
Entering details about a patient during a typical emergency room visit means doctors have to constantly move back and forth between the patient and their computer, making it difficult for physicians to maintain eye contact, hold conversations and make personal connections with patients, said Dr. Bob Wachter, a professor in the University of California, San Francisco, department of medicine and the author of a recent book on digital health care.
“The (electronic health record) is a great source of doctor dissatisfaction,” he said. “Scribes are just one creative solution to the problem that when a physician sees a patient now, he or she has to spend a considerable amount of time and effort feeding the electronic record and keeping it happy.”
Up until a few years ago, many physicians were using paper charts or dictating into recorders and typing charts out afterward. Now, federal mandates from the Centers for Medicare & Medicaid Services penalize hospitals and clinics that do not keep records electronically.
The change has been stressful for many physicians, said Dr. Justin Wagner, medical director of the Sutter Emergency Department, which employs about 40 scribes. A Mayo Clinic study, published last month, found that more than half of physicians nationwide experience “professional burnout,” which describes emotional exhaustion and dissatisfaction with one’s work burdens.
About 70 percent of emergency medicine physicians experienced burnout – higher than any other specialty and up about 10 percentage points since 2011, according to the study.
“As time goes on, the landscape of health care becomes more complicated,” Wagner said. “Scribes can help reduce that burden for physicians. ... They’re worth their weight in gold, for sure.”
Dignity Health has incorporated scribes in emergency departments at all six of its local facilities over the past three years. The UC Davis Medical Center employs a few scribes in its emergency department and is considering using them on other floors. Kaiser Permanente does not employ medical scribes.
At Sutter’s Sacramento and Davis emergency facilities, scribes work eight-hour shifts shadowing doctors. When not in the exam room typing out physician observations about patients, they enter patient data into digital charts, which the physician later approves and submits.
“A good scribe gets it down so the chart tells the story of the patient in a medically accurate way,” said Dr. Caroline Nguyen, a Sutter emergency medicine physician who uses scribes. “You cannot physically do both; something is going to give.”
By noon on a recent workday, Sutter medical scribe Hannah Chan had seen 12 patients since her 6 a.m. shift began. A 23-year-old Elk Grove native, Chan returned to the Sacramento area after completing her undergraduate degree at UC Berkeley. She has applications in for medical school, but in the meantime she’s gaining valuable experience in the emergency room, she said.
“In the past, I hadn’t felt like I got to engage with many doctors in medical settings,” said Chang, who has been a scribe for about a year and a half. “Here, I get to get into the brain of the doctor and really understand what they’re doing. We don’t get paid a lot, but we get really valuable experience.”
Scribes in California make an average of $45,000 a year – about $9,000 more than the average salaries for scribes nationwide, according to the Bureau of Labor Statistics.
The industry is hungry for scribes, and the job is easy to break into with the right attitude, said Michael Murphy, CEO of ScribeAmerica, the nation’s biggest medical scribe recruiting and training agency. The company has grown from having scribes in 300 hospitals to deploying them to 1,200 hospitals this year, with about 10,000 current active scribes.
Scribes can earn optional certifications from the American College of Medical Scribe Specialists, but for the most part, they learn on the job.
They are not allowed to order tests or prescribe medication, and most do not speak directly to patients. Physicians said the most important thing is they have an accurate understanding of what the physician is doing, so they can document it appropriately.
“They put the carriage in front of the horse in that they learn the what vs. the why, but once they learn the why later on, it makes even more sense,” Murphy said. “That can do our overall health system good.”
Some concerns have been raised about scribes and privacy – one study found that about 10 percent of patients were uncomfortable having a scribe present during an exam.
But it’s not a problem for Jey, who said he simply introduces his scribe to the patient before proceeding. He affectionately calls the emergency department scribes “ninjas” because of their unobtrusive nature and quick-thinking abilities.
“They’re not performing medical care, but they’re like an accessory brain,” he said. “It’s the efficiency – they just make the flow better.”