By Andrew Friedson
Physician extenders such as nurse practitioners and physician assistants have long been studied as a potential source of efficiency gains in health care production. These efficiency gains come from allowing the health care workforce to specialize tasks based on differing levels of human capital, enabling practice “at the top of one’s license.” More recently, a new member of the health care workforce has emerged to further enable this form of specialization: the medical scribe.
Medical scribes follow providers during patient visits, and take on all of the charting tasks. This often takes the form of the scribe following the provider around with a computer on a rolling pedestal, taking notes as the patient visit takes place. The provider will later review the chart and sign off on its accuracy. The scribe allows the provider, usually a physician with a high level of human capital, to specialize away from the professional tasks requiring the least use of their large stock of human capital: writing things down. They have become particularly popular in emergency departments, where patient inflow is not scheduled and physicians can be stretched thin in terms of time to complete charting between patient visits – often resulting in substantial physician overtime costs.
Unfortunately, the existing literature on the effects of medical scribes on productivity, outcomes, and satisfaction is extremely limited, and characterized by medical researchers as of relatively low quality (Heaton et al., 2012). In forthcoming work in the American Journal of Health Economics, I present the first randomized control evidence on medical scribes and production efficiency. In a nine-month pilot study, medical scribes were randomly assigned to roughly half of all physician-shifts for a subset of the physicians in three emergency departments in suburban Denver.
The presence of a medical scribe caused changes in three outcomes relevant to production: patient wait times decreased, as did physician overtime utilization, and the number of treatment activities per visit (as measured via relative value units) increased. The results also provide useful information as to under what circumstances scribes are the most effective. For example, the reductions in wait times and in overtime use were greater during the busiest times of day.
This study will help to nail down what exactly the benefits to scribe use are, and to whom they accrue. The results will serve as a baseline for decision making as to when scribe use will provide a net benefit to productivity, and to the quality of patient care.
Heaton, Heather A., Ana Castaneda-Guarderas, Elliott R. Trotter, Patricia J. Erwin, and M. Fernanda Bellolio. (2016) “Effect of scribes on patient throughput, revenue, and patient and provider satisfaction: a systematic review and meta-analysis.” The American Journal of Emergency Medicine 34(10): 2018-2028.
Andrew Friedson is an Assistant Professor of Economics at the University of Colorado, Denver.