Physician Productivity Gains Offset Cost of Medical Scribes

The addition of two new patient visits per day or three returning patient visits was profitable for all specialists.

Physicians who use medical scribes can book up to 20% more patient visits in a workday, with the increased productivity paying for the cost of the scribe, a study released Tuesday finds.

Corresponding author Neda Laiteerapong MD, associate professor of Medicine at the University Chicago Medicine, said that adding a scribe to the medical staff gives physicians more time to treat patients, add new patients, and schedule more return visits.

"The idea that you have to see more patients can be really scary," Laiteerapong said. "But the idea is that you're actually spending that time more focused on the patient. A scribe allows doctors to focus on thinking and talking and listening, and not on the typing and clicking and ordering. I don't know anyone who became a doctor to do those things."

The study, which was published Tuesday in Annals of Internal Medicine, did an economic evaluation of 30 specialties, physician assistants, and nurse practitioners and found that the cost of employing a medical scribe can be offset within a year, after which increased profits follow.

"Scribes can help a practice add up to 20% more visits, which increases patient satisfaction," Laiteerapong said. "That is valuable to patients, who have increased access, and to providers who are able to do what they were trained to do, which is take care of patients, not paperwork." 

The increased number of new patients varied with specialties, from 0.89% per day in cardiology to 2.78 new visits per day with orthopedic surgery. The addition of two new patient visits per day or three returning patient visits was profitable for all specialists.

"We found that an average of 1.3 new patient visits per day (295 per year) was required to recover the cost of a scribe at the one-year point," Laiteerapong added. "And for returning patient visits, it's two or three patients per day."

Researchers assumed that every patient visit would be reimbursed by Medicare and estimated the number of additional visits needed to have 90% certainty of breaking even one year after hiring a scribe. That break-even point could be even faster in practices with higher mixes of privately insured patients

The number of new patients or return visits needed to recoup costs is lower for specialists who order a lot of lab testing and radiology, and higher for others.

The study was done before the coronavirus pandemic and Laiteerapong conceded that that could prove problematic.

"Obviously, having an extra person in the room is not something that many physicians can do these days," she said. "But with modern technology, there can be a device in the room listening to the conversation and transmitting it electronically. So, a scribe working in another space can still have the notes 90% done when the physician leaves the room."