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Physician burnout is a concern in the medical community, but new research from the University of Chicago Medicine sheds light on potential ways to lighten the load.
Electronic health records (EHRs), which are digital versions of a patient’s chart, are used by more than 80 percent of office-based physicians. Studies show EHR use is associated with fewer medication errors and higher guideline adherence without a decrease in patient satisfaction. But EHRs can become a point of stress for physicians when they have to work outside of regular clinic hours to complete patient charts. There is also concern that physician-patient communication suffers when physicians actively update EHRs during appointments.
To learn more about the role EHRs may have on physician burnout, a UChicago Medicine research team looked at how a medical scribe impacts patient and physician satisfaction, the amount of time physicians spend on EHR documentation and if the scribe’s presence in a doctor’s office could lead to less long-term stress.
Led by Wei Wei Lee, MD, MPH, the team hired a scribe to assist physicians with documentation and other EHR tasks. The scribe spent three months working with six internal medicine physicians for up to three clinic sessions per week. The scribe drafted clinic notes in the EHR and sent them to the physician at the end of each session to review, edit, sign and close.
Currently, scribes are mostly used in emergency rooms and specialty clinics. The researchers studied the use of scribes in general medicine.
“We know burnout rates for internal medicine and primary care doctors tends to be higher than other specialties,” said Lee. “So it’s a way to potentially retain faculty and improve the quality of the work environment, which hopefully decreases burnout.”
The doctors were given pre- and post-study surveys to measure satisfaction. These surveys consisted of a burnout assessment and questions adapted from the Consumer Assessment of Healthcare Physicians and Systems Clinician and Group Survey (CG-CAHPS). Meanwhile, 325 patients who were seen by a physician-scribe team were also surveyed with open-ended questions to learn more about their attitudes toward scribes.
Physician results were encouraging. After the pilot project ended, all six physicians reported they no longer felt rushed during clinic. The group unanimously reported being satisfied with clinic workflow when a scribe was present.
This was a dramatic shift. Only two physicians reported being satisfied with clinic workflow pre-pilot. And five of the six physicians were dissatisfied with the amount of time they spent documenting patient health records outside of clinic time — about two hours each day. With the scribe assisting, the time fell to about 40 to 45 minutes per physician.
“This allows the doctors to go home and have dinner with their families,” said Lee. “That’s a significant improvement for their quality of life and work-life balance.”
Overall, physician attitudes about working with a scribe were positive, Lee said, noting the scribe helped create a less hectic clinic, improved focus and enhanced work satisfaction.
Among patients, the sentiment toward the scribe was neutral or positive throughout the study.
“This allows the doctors to go home and have dinner with their families. That’s a significant improvement for their quality of life and work-life balance.”
Whether or not a scribe was present, more than 80 percent of patients believed their physicians explained things thoroughly and spent sufficient time with them. Almost half of patients said their physician should have a scribe and one third commented their physician was more attentive when a scribe was present —this was especially true for patients 18 to 64 years.
“Older patients may have a different perception out of what they want from their primary care doctor,” Lee said. “They’ve also had many more years to cultivate that relationship.”
Male patients were more likely to dislike having a scribe present during their visit. Lee suspects this may be due to the scribe’s gender.
“The scribe we hired was a young woman,” she said. “This gender discordance seemed to be a factor in male patients being uncomfortable sharing health concerns with a scribe present.” Lee suggested that if more physicians used scribes, perhaps the gender of the scribe could match the gender of the patient.
Although the results reveal a general receptiveness to scribes among patients and physicians – particularly in an academic medical setting – the biggest issue toward widespread adoption may be the cost of hiring additional employees. Medical scribes earn an average of $12/hour according to PayScale.
“When a medical practice considers hiring a scribe, the benefits to provider efficiency will be taken into account,” said Lee. “Are physicians okay with taking on one or two more patients to offset the cost? Will they have more time for patients?” It is also important to note that not every provider wants a scribe.
Despite the financial challenges, Lee said she hopes the study shows that scribes should be more widely adopted.
The study, Impact of Medical Scribes on Physician and Patient Satisfaction in Primary Care, was published this spring in the Journal of General Internal Medicine. Additional authors include Anastasia Pozdnyakova, BS, Neda Laiteerapong, MD, MS, Anna Volerman, MD, Lauren D. Feld, MD, Wen Wan PhD, Deborah L. Burnet, MD, MA.
Wei Wei Lee, MD, MPH, specializes in adult internal medicine and in primary care for underserved populations. A dedicated physician-mentor-educator, Dr. Lee trains medical students and residents in outpatient medicine and preventive care. Her academic research focuses on developing innovative patient-centered models of care and improving patient-physician communication.Learn more about Dr. Lee