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Medical Scribes – The Digital Records Workforce

Lauren Silverman
Connie Gaytan, 32, is a scribe for Dr. Ramnath, an orthopedic doctor at Baylor.

There may be a future for an ancient profession.

Scribes, who in times past worked on everything from translating religious texts to historical book keeping, are making a comeback in the doctor’s office. A growing number of physicians in Texas, and across the country, are hiring scribes to gather patient information and lighten their workload.

Another Person In The Exam Room

Dr. Devesh Ramnath used to see his patients alone. Now, he’s always with Connie.

Connie Gaytan is Ramnath’s scribe. And she’s sort of like his shadow. As the doctor examines the patient’s neck, she sits quietly in the corner, typing notes and speaking into a hand held microphone connected to her laptop.

Just a few months ago, Ramnath had to play the role of doctor and transcriber.

“I was really focused on just trying to get the information in and not really focusing on the patient anymore,” Ramnath says. “Also, I was spending an additional 2-3 hours every clinic just trying to get my medical records done.”

Now, Ramnath says, almost all of the paperwork is completed while the patient is in the office.

“That gives me more time to get home, have dinner with my family, work out, etcetera,” he says.

Credit Lauren Silverman / KERA News
A few of "I AM SCRIBE University" students in Fort Worth. From left: Khuyen Tran, Allana Purcell, David Coates.

The Growing Scribe Business

These days, scribes are in high demand at hospitals and clinics nationwide. PhysAssist, the first scribe training and staffing company in the country, is on the second expansion of its Fort Worth headquarters and opened another office in Chicago.

Alex Geesbreght is CEO. He says in 2008, PhysAssist had 35 scribes working in hospitals across the country. Now, there’s nearly fourteen hundred.

“It’s been about a 46 to 50 percent growth rate every year for several years,” Geesbreght says.

The other big medical scribe companies, Medical Scribe SystemsScribe America, for example, have thousands more scribes each. Most scribes are pre-med students – used to hitting the books, but in need of training.

That’s where programs like PhysAssist’s “I AM SCRIBE University” come in. And you thought med school was competitive?

“We have about a 9-to-1 ratio, Geesbreght says. “Which means that every person out of every nine person one matriculates to being a scribe. Our recruiter’s say they don’t recruit they repel.”

A Modern University For Scribes

Once a week, PhysAssist applicants who’ve made it through written exams & Skype interviews are invited to Fort Worth for a 5-day training, part of which is in a mock emergency department.

By the time the students graduate, they need to know how to correctly fill out an electronic medical record, or EMR. There are thousands of different EMR systems, and scribes need to be able to put in the right billing codes and medical terminology at lightning speed.

Brandon Torres started scribing years ago at Harris Methodist in Fort Worth. He says a good scribe can string together a patient’s history even when they’re rambling or upset, and is a master multi-tasker.

“You’re listing to the physician, you’re listening to the nurse, to the patient and any overhead pages that might occur,” he says. “And you’re gathering all that information and presenting it back to the physician for him.”

For all that, scribes are paid just $8 to $16 dollars an hour. Companies charge anywhere from $20 to $30 dollars for the service. Most scribes say it’s an invaluable experience, but what’s in it for the patient?

The Payoff

There are few research studies that explore the benefits and drawbacks of adding scribes to hospitals and doctors’ offices.

Ann O’Malley is a physician and senior fellow at Mathematica Policy Research in Washington D.C. She points to one study of scribes from 2010 in a New Jersey emergency department.

“Scribes were associated with more patients being seen on average per doctor, O’Malley says, “That clearly results in more money coming into the institution.”

But that same study found the amount of time a patient spent in the emergency department didn’t decrease. And while most patients are fine with having an extra person in the exam room, there are concerns about privacy and training standards.

“On the flip side,” O’Malley says. “Scribes could be viewed as physician’s recognizing that they can’t do everything and there has to be some delegation and teamwork in care regardless of the setting.”

More than a third of healthcare providers aren’t’ happy with their electronic health record system but will face Medicare reimbursement penalties if they’re still stuck on pen and paper in 2015.

Which is why the rush to go digital might just revive an ancient profession.

Lauren Silverman was the Health, Science & Technology reporter/blogger at KERA News. She was also the primary backup host for KERA’s Think and the statewide newsmagazine  Texas Standard. In 2016, Lauren was recognized as Texas Health Journalist of the Year by the Texas Medical Association. She was part of the Peabody Award-winning team that covered Ebola for NPR in 2014. She also hosted "Surviving Ebola," a special that won Best Long Documentary honors from the Public Radio News Directors Inc. (PRNDI). And she's won a number of regional awards, including an honorable mention for Edward R. Murrow award (for her project “The Broken Hip”), as well as the Texas Veterans Commission’s Excellence in Media Awards in the radio category.