Physicians who have scribes are more satisfied and spend more time with patients

Physicians who work with a scribe are much more satisfied with their clinic hours, the length of face-to-face time they spend with patients, and the time they spend charting, according to the first randomized clinical trial of scribes, recently published in the journal Annals of Family Medicine. In addition, having a scribe doesn’t diminish patient satisfaction. But there is one problem with getting a scribe: cost. 

“Spending less time on documentation frees up the physician to pursue direct clinical care and care coordination, thus enhancing joy of practice and preventing burnout,” wrote professor and family medicine researcher Steven Lin, MD, and colleagues at Stanford University School of Medicine, in Stanford, CA. “These findings suggest that scribes may have a protective effect on physicians’ well-being.”

Dr. Lin is the Medical Director of Stanford Family Medicine, the Associate Chief for Medical Education in the Division of Primary Care and Population Health, and Executive Director of the Stanford Medical Scribe Fellowship.

Although physicians have used scribes for decades, only recently has the popularity of scribes taken off. One estimate predicts that 100,000 scribes will be working in the United States by 2020—that’s 1 scribe for every 9 physicians. But despite the increasing presence of scribes in clinical practice, there’s a lack of high-quality, methodologic evidence regarding their impact.

To that end, Dr. Lin and colleagues conducted a controlled clinical trial in an academic family medicine clinic in which board-certified family medicine physicians were randomly assigned, during the course of a year, to one week practicing with a scribe and then one week without a scribe.

For the week in which the physician was assigned a scribe, the scribe was present for all appointments and drafted all relevant documentation—including the history and physical findings, objective examination findings, laboratory and radiology results, assessment and plan, and patient instructions. The physician reviewed and signed the chart before it was closed. For the week when the physician wasn’t assigned a scribe, the physician performed all charting duties.

Results showed that scribes improved all aspects of physician satisfaction, including overall satisfaction with clinic (odds ratio [OR] = 10.75), having enough face time with patients (OR = 3.71), time spent charting (OR = 86.09), chart quality (OR = 7.25), and chart accuracy (OR = 4.61). In addition, charts done by scribes were more likely to be closed within 48 hours compared with charts completed by physicians (OR = 1.18).

“We found that not only were physicians satisfied with the quality and accuracy of charting done by scribes, they were more satisfied with scribed charts than with their own,” explained Dr. Lin and colleagues.

Also, the study found no difference in patient satisfaction between visits with a scribe or without one.

"The challenge of modifying physicians’ practices to accommodate EHRs without sacrificing quality of care or quality of physician-patient interactions is not trivial,” the authors wrote, pointing out that for every one hour in which the average physician provides direct clinical care for patients, that physician spends two hours on electronic health records and desk work.

“By reducing the time that physicians spend on clerical tasks, scribes serve an important function in a multidisciplinary health care team,” Dr. Lin and colleagues concluded.

So why aren’t more physicians using scribes?

“The biggest barrier is cost. Physicians, especially in primary care, have not been successful in negotiating for scribes with their employers,” Dr. Lin explained in an e-mail interview. “Many employers will ask physician groups to pay for the scribes themselves, or mandate an increase in patient volume in return for scribe services, which is very difficult for specialties that don't generate a lot of profit, such as family medicine.”

But scribes are worth the investment, Dr. Lin added. “Research is growing that scribes are cost-effective,” he said. “Their benefits go beyond simply reducing charting burden and increasing clinical efficiency. They also have the potential to increase the quality of physician-patient interactions, and reduce physician burnout by increasing joy of practice. Other researchers have shown that use of scribes can increase physician revenue.”