Happier Physicians, Happier Patients — New Study Says Scribes are the Answer
You can’t watch TV for more than a few minutes, it seems, without seeing one of those direct-to-consumer commercials that urges you to “ask your doctor” about this, or “ask your doctor” about that. Maybe it’s time for a “tell your doctor” commercial.
But instead of the obligatory list of warnings and frightening potential side effects that always seem to accompany such ads, the commercial we have in mind would come with nothing but a list of benefits — benefits that are sorely needed by legions of physicians.
With the plague of physician burnout said to be approaching epidemic levels, it’s hard to overstate the importance of any asset that has the potential to dramatically improve the professional and personal lives of providers and, by extension, their patients. There’s no miracle drug to relieve burnout, but there is a way to reduce the time physicians spend trying to feed the insatiable data monster. It’s also a way to increase eye contact and quality interaction time with patients, as well as keeping administrators and others at bay by ensuring documentation requirements are taken care of in a timely manner. All, by the way, while increasing revenue.
A new study conducted by researchers at Kaiser Permanente, published in JAMA Internal Medicine, further confirms what increasing numbers of caregivers already know — that certified medical scribes are a strong antidote for overwhelming workloads. Scribes, the study found, improve efficiency and workflow, reduce documentation burdens, improve patient-physician communication, and increase patient satisfaction.
The study was especially intriguing because the doctors who took part were their own controls. To begin, primary care physicians were randomly assigned scribes (or no scribes) for three months. Over the next nine months, they then went through alternating three-month stretches with and without scribes. The findings: “Scribed periods” were associated with fewer after-hours spent entering EHR data, a higher likelihood that physicians would be able to spend more than 75% of visits interacting with patients (and less than 25% of their time on computers), and a greater chance that physicians would finish documenting all related data by the end of the next business day.
As for what patients thought — among those who responded, 61.2% said scribes positively affected their visits, while only 2.4% felt negatively impacted.
- Improved physician satisfaction: “I feel like I have my life back,” says a physician from the Vancouver (Wash.) Clinic, which added scribes to help ease a growing documentation burden. “I feel like I’m a real doctor again,” says another clinician.
- Better patient interactions: Having a scribe present improves physician-patient relationships because the physician can give the patient his or her undivided attention and isn’t distracted by data entry, says the AMA’s “STEPS forward” module on team documentation.
- Mitigated physician burnout. Scribes can return precious rejuvenation time to physicians who feel as if they’re on a treadmill that never stops.
- Better teamwork: “The biggest return on investment was achieving a real sense of teamwork,” says a family physician from Auburn, Ind.
- Scribes are extremely cost-effective: For example, more than three quarters of dermatologists in one study found they could increase volume, thanks to scribe support, resulting in a 7.7% increase in revenue. At a cardiology practice, the improved productivity of 10 physicians who used scribes (versus 15 who didn’t) translated to a revenue boost of nearly $1.4 million at a cost of slightly less than $100,000. Talk about a good investment.
The current overwhelming and potentially debilitating state of so many physicians is now front and center for the American Medical Association, which recently adopted a new policy that’s designed to predict and prevent suicide among physicians in training. The AMA says that roughly 500 physicians and med students take their own lives every year, the highest suicide rate of any profession.
“There are certainly improvements that we know can improve physician well-being,” says Arlene Sujin Chung, MD, the chair of the American College of Emergency Physicians’ Physician Well-Being Committee. Scribes, she says, are among the interventions that can have “a huge impact on the individual providers”.
The authors of the Kaiser Permanente study agree: “Our results suggest that the use of scribes may be one strategy to mitigate the increasing EHR documentation burden among [primary care physicians],” they wrote. “Although scribes do not obviate the need for improving suboptimal EHR designs, they may help alleviate some of the inefficiencies of currently implemented EHRs.”