Seen yet silent: Does healthcare recognize its scribes' worth?

During a hiatus between finishing my M4 rotations and receiving my MD, I became a medical scribe to stay engaged in clinical work and, importantly, earn a vital income.

Unlike the typical scribes, often college students aiming to gain experience before venturing into postgrad medical programs, my nearly finished medical education was a unique advantage. This led me to accelerated training, supervisory roles, and the task of composing detailed care notes for numerous daily clinic appointments.

ADVERTISEMENT Scribing varies across disciplines and situations. Yet, an early realization for most of us is that scribes should be visible but quiet, diligently recording as per physician's choice and avoiding any direct involvement in patient evaluation or treatment to remain nonintrusive.

It’s logical: the patient remains the encounter's centerpiece. In environments like emergency units or high-throughput clinics where scribes are prevalent, efficiency is key to ensure patient and physician satisfaction with the consultation quality.

Studies evaluating scribes often highlight their clinical or financial merits, generally receiving positive feedback. Scribes have evidently improved patient appointments per hour and elevated the overall patient-provider experience. From a clinical reimbursement perspective, providers with scribes witness hikes in both RVUs per visit and per hour.

Physicians arguably benefit the most from scribes.

With growing EHR systems and rising reliance on encounter notes for billing, doctors now spend roughly double the time on paperwork than direct patient interaction.

Considering nearly half of all physicians face burnout, this administrative load further undermines their capacity for patient-centric care and a balanced personal-professional life. Scribes help doctors delegate almost all these duties, particularly the intricacies of complex EHRs, which those trained pre-EHR era might find challenging.

While more studies are essential, available data indicate that doctors with scribes enjoy longer patient interactions, enhanced clinic satisfaction, improved charting accuracy and efficiency, all while reducing costs — potentially leading to more affordable care for patients.

However, despite these advantages, there's a noted absence of studies capturing scribes' perspectives. The question arises: does shifting this paperwork truly reduce its tedious nature?

Although seen as mere data input agents, scribes are budding medical professionals: tomorrow's doctors, physician assistants, or nurse practitioners. As preliminary clinical exposure grows essential for a competitive academic bid, many premed students get their initial clinical insight in a role designed to absorb the most monotonous tasks. It can feel alienating. Scribes don't assess, guide history-taking, decide on differentials or treatments, and are often silent during encounters. Their core duty? Document so doctors don’t have to.

Now an MD, I sometimes feel overlooked and underappreciated, feeling more like a "high-level secretary."

Though I work with many clinic teams, I'm hired through a scribing agency. While I have built bonds with several physicians, at times, I don't feel wholly integrated. I earn about half of what clinics pay for me, and even full-time, I'm close to the US poverty line for solo earners.

High scribe attrition rates exist due to many advancing to professional schools. But with limited medical school spots and growing applicants, many remain longer in entry-level roles. For scribes, this translates to enduring taxing work for inadequate pay and uncertain professional growth.

Before the rise in telemedicine amid COVID-19, scribes were pivotal in meeting digitalization and documentation demands. Their significance in mainstream academic medicine is expected to grow. Considering their contributions, maybe it’s time healthcare revisits the worth they assign to scribes.