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Original Article
Medical Scribes in an Orthopedic Sports Medicine
Clinic Improve Productivity and Physician
Well-Being
Jordan R. Pollock, B.S., M. Lane Moore, B.S., Aaron C. Llanes, B.S.,
Joseph C. Brinkman, M.D., Justin L. Makovicka, M.D., M.B.A.,
Donald L. Dulle, P.A.-C., M.P.A.S., Nathaniel B. Hinckley, D.O., Anthony Barcia, M.D.,
Matthew Anastasi, M.D., and Anikar Chhabra, M.D.
Purpose: The purpose of this study is to examine the effects of scribe use on physicians, nurses, and patients in an or-
thopaedic sports medicine clinic. Methods: Surveys containing validated outcome measures relating to physician well-
being and workplace satisfaction, among other variables, were used to assess the influence of medical scribes on clinic
function. These surveys were collected for 8 months from all patients, nurses, and orthopaedic surgeons working in one
orthopaedic sports medicine clinic. Time during a half-day clinic (i.e., 20 or more patients) was documented by surgeons
after the last patient was seen. Results: The average time spent per half day of clinic was 104 minutes on nonscribe days
and 25 minutes on scribe days. Additionally, the time spent documenting encounters per half day of clinic was 87 minutes
on average without scribes and 26 minutes on average with scribes. The average surgeon single assessment numeric
evaluation (SANE) score was 48.1 without scribes, and 89.3 with scribes. The overall assessment of the clinic by nurses
was 73.4 out of 100 on average without scribes and 87.7 out of 100 on average with scribes. Patients did not report a
significant change in rating of overall experience (4.7/5.0 with scribes and 4.8/5.0 without scribes, (P¼.27) or wait time
between scheduled appointment time and surgeon arrival (15.1 minutes with scribes and 18.1 minutes without scribes;
P¼.12). Conclusions: We found the use of scribes in a high-volume orthopaedic sports medicine clinic to have a
favorable impact on physicians, nurses, and trainees. The use of a scribe also significantly reduced the time required by
surgeons for documentation during clinic and at the end of each clinic day. Patients also reported no significant difference
in patient clinic experience scores. Clinical Relevance: Orthopaedic surgeons spend a substantial amount of time on
paperwork. The results of this study could provide information on whether the use of a scribe helps to reduce admin-
istrative burden on orthopedic surgeons.
Introduction
Orthopaedic surgery is a time-consuming career.
According to a recent survey by the American
Association of Medical Colleges (AAMC), orthopaedic
surgeons work an average of 57.0 hours per week.
1
Another study of 152 “highly successful orthopaedic
surgeons”,defined as surgeons who are departmental
chairs, presidents of major orthopaedic organizations,
or editors of major orthopaedic journals, reported an
average of 70.3 hours worked per week.
2
In addition to
working long hours, a 2020 survey reported that 37%
of orthopaedic surgeons are either burned out,
depressed, or both.
3
The two most highly cited causes of
burnout in these surgeons were “too many bureaucratic
tasks (e.g., charting, paperwork)”, and “increasing
computerization of practice (EHRs),”with 65% and
44% of orthopaedic surgeons reporting these factors,
respectively.
3
The implementation of the Electronic
Mayo Clinic Alix School of Medicine, Scottsdale Arizona, U.S.A. (J.R.P.,
M.L.M.); University of Arizona School of Medicine, Phoenix, Arizona, U.S.A.
(A.C.L.); Department of Orthopedic Surgery, Mayo Clinic (J.C.B., J.L.M.,
D.L.D., N.B.H., A.B., A.C.); and Department of Family Medicine, Sports
Medicine, Mayo Clinic (M.A.).
The authors report the following potential conflicts of interest or sources of
funding: A.C. reports personal fees from Arthrex and Zimmer Biomet, outside
the submitted work. A.C. reports receiving a Mayo Clinic Clinical Practice
Committee Grant. Full ICMJE author disclosure forms are available for this
article online, as supplementary material.
Received October 4, 2021; accepted February 8, 2022.
Address correspondence to Anikar Chhabra, M.D., Department of Ortho-
pedics, Mayo Clinic, 5777 E Mayo Blvd., Phoenix, AZ, 85054, U.S.A. E-mail:
Chhabra.anikar@mayo.edu
Ó2022 THE AUTHORS. Published by Elsevier Inc. on behalf of the
Arthroscopy Association of North America. This is an open access article under
the CC BY license (http://creativecommons.org/licenses/by/4.0/).
2666-061X/211389
https://doi.org/10.1016/j.asmr.2022.02.003
Arthroscopy, Sports Medicine, and Rehabilitation, Vol 4, No 3 (June), 2022: pp e997-e1005 e997
Health Record (EHR) systems has increased the burden
of time spent on patient charting, with studies reporting
an increase in physician documentation time between
11% and 22%.
4
This is confounded when considering
orthopaedic surgeons spend an average of 13.7 hours
per week on paperwork and administration duties
beyond their clinical responsibilities.
5
As physician burnout becomes an increasingly rele-
vant topic, practice adaptations to reduce burnout and
increase physician satisfaction and health have
become paramount. Several studies have examined
the role of scribes and found improvements in physi-
cian quality of life, physician burnout, and patient
satisfaction.
6e9
Additionally, scribes have been shown
to reduce the number of hours spent charting by sur-
geons.
10
Not only do the physicians themselves benefit
from scribes, but the practices and hospitals can also
benefit. For example, numerous studies performed in
subspecialty clinics, emergency clinics, and primary
care settings have shown that the use of medical
scribes can increase physician productivity, as well as
revenue, while improving physician and patient
satisfaction scores.
11e20
Physicians, and particularly surgeons, thrive when
performing patient care. However, the burden of
charting and documenting within an EHR can inhibit
high-volume surgeons from maximizing their time with
patients. Decreasing the amount of time surgeons
spend charting could allow surgeons to fully use their
expertise, listening, examining, diagnosing, educating,
and treating patients in clinic. With the help of trained
experts in documentation, there is a potential to in-
crease patient and surgeon satisfaction, reduce patient
wait times, and increase clinic productivity. This is
especially important in the digital era, where patient
satisfaction and dissatisfaction are publicly available on
websites such as Healthgrades, Vitals, and Yelp.
21
Innovative approaches to shift the physician’sfocus
back to patient care and away from repetitive docu-
mentation are needed. One such approach is the use of
medical scribes. Medical scribes are trained personnel
who provide physicians with documentation assis-
tance and perform other EHR tasks.
22
There is a
paucity of literature regarding the use of scribes in
orthopaedic clinics, particularly in high-volume prac-
tices, classified in this study as 20 patients or more per
half-clinic day, or 40 patients per full day. The purpose
of this study is to examine the effects of scribe use on
physicians, nurses, and patients in an orthopaedic
sports medicine clinic. We hypothesize the use of
scribes in a high-volume orthopaedic sports clinic will
decrease documentation time for physicians and
nurses, with no associated decrease in patient
satisfaction or clinic experience.
Methods
Our study was deemed exempt by the Institutional
Review Board of our institution. Beginning on January
1, 2020, data collection began for three orthopaedic
sports medicine physicians, their nurses, and patients
via surveys on clinic days with scribes and clinic days
without scribes. These participants were surveyed every
clinic day. These surveys contained a validated outcome
measure to assess physician time utilization and well-
being, as well as nursing and patient surveys to assess
the influence of medical scribes on clinic func-
tion
17,23-25
(Appendix).
We collected these surveys from orthopaedic sur-
geons, patients, and nurses during an 8-month time
period. Of these 8 months, 6 months were collected
Table 1. Orthopaedic Sport Surgeon Data on Clinic Days With Scribes and Without Scribes
Item Overall (n¼62) Scribe Present (n¼30) No Scribe (n¼32) PValue
I had adequate time to perform patient education
in clinic today (1-Strongly Disagree to 5-Strongly
Agree), mean (SD)
3.3 (1.4) 4.4 (0.5) 2.2 (1.1) <.001
I had adequate time to teach medical students and
trainees today (1-Strongly Disagree to 5-Strongly
Agree), mean (SD)
3.0 (1.4) 4.1 (0.9) 2.0 (0.8) <.001
Number of patients seen 19.8 (7.3) 22.0 (7.6) 17.8 (6.4) .02
Time
Time (minutes) spent documenting after last
patient per half-day of clinic, mean (SD)
63.6 (77.6) 24.7 (30.9) 104.2 (90.1) <.001
Total estimated time (minutes) spent documenting
encounters throughout each half day of clinic,
mean (SD)
57.2 (46.0) 25.5 (10.25) 86.8 (46.8) <.001
Measures of Well-Being
Physical well-being, mean (SD) 7.8 (2.3) 9.3 (0.9) 6.5 (2.4) <.001
Emotional well-being, mean (SD) 7.8 (2.2) 9.3 (0.9) 6.5 (2.3) <.001
Spiritual well-being, mean (SD) 8.1 (1.9) 9.2 (0.9) 7.0 (2.0) <.001
Intellectual well-being, mean (SD) 8.6 (1.3) 9.4 (0.8) 7.8 (1.2) <.001
Overall well-being, mean (SD) 8.1 (1.7) 9.3 (0.9) 7.1 (1.6) <.001
Sane Score, mean (SD) 68.1 (24.5) 89.3 (7.0) 48.1 (16.9) <.001
e998 J. R. POLLOCK ET AL.
from study participants without scribes, and 2 months
were collected from participants with scribes. The study
group of physicians and nurses was the same
throughout the length of the study. Intentionally, the
only difference in clinic was the use of scribes or no
scribes. Surveys that were incomplete or illegible were
excluded. Each surgeon was given their own personal
scribe during the scribe period. The scribes were
consistent, outsourced scribes trained in orthopaedic
surgery, and were implemented in the outpatient clinic.
Several local companies provide this service. Notes
were completed in real time. The clinic sees a mix of
new patients, consults, and follow-ups. The clinic
typically sees 20-25 patients per half day of clinic.
Physician Survey
All orthopaedic surgeons working at the orthopaedic
sports medicine clinic were asked on the basis of a 5-
point Likert scale with 1 being “strongly disagree”and
5 being “strongly agree”if they felt that they had
“adequate time to perform patient education”and if
they felt they had “adequate time to teach medical
students and trainees.”A Single Assessment Numeric
Evaluation (SANE) score was calculated for each sur-
geon, and surgeons were asked to score their physical
well-being, emotional well-being, spiritual well-being,
intellectual well-being, and overall well-being on a
scale of 1 being worst possible and 10 being best
possible.
Nursing Survey
All nurses working at the sports medicine clinic dur-
ing the time period of this study were asked a binary
answer of “yes”or “no”to “the surgeon was rushed
today”as well as “communication outside of the exam
room was effective today.”In this sports clinic, each
orthopaedic surgeon worked with the same nurse every
day. These nurses help room the patient, meet the pa-
tient, direct physician clinic flow, help fill orders, help
direct the patient out of the clinic, among other tasks.
Each nurse was tasked with assigning an overall score
as to their assessment of clinic functioning for the day
when the surgeon did not have a scribe and when the
surgeon had a scribe. The physicians were blinded to
nurse responses to maintain confidentiality and to
ensure unbiased responses.
Patient Survey
All patients presenting to the orthopaedic sports med-
icine clinic during the time period of this study were
asked to rate their experience in the clinic on a Likert
scale from 1 to 5 with 1 being “worst possible experience”
and 5 being “best possible experience.”The time to clinic
room was recorded for each patient visit, as was the time
between rooming and when the physician first entered
the room to begin their encounter. Physicians were
blinded to patient responses.
Statistical Analysis
The collected data were summarized using descriptive
statistics such as mean, standard deviation, median, and
frequencies as appropriate. A 2-tailed t-test was used to
assess the differences between the scribe present and
scribe absent groups for all continuous variables. Alpha
was set to .05. All statistical analysis was completed
using Microsoft Excel (Microsoft, Redmond, WA).
Results
Surgeon Results
According to 32 physician surveys from 3 surgeons
for the 6 months of nonscribe clinic days, the average
Average Minutes Spent
0
50
100
150
200
Average Minutes Spent on
Computer After Last Patient Per
Half Day of Clinic
Average Minutes Spent
Documenting Encounters
Throughout each Half Day of
Clinic
Average Total Minutes Spent
on Computer and Documenting
Encounters Throughout Each
Half Day of Clinic
Scribe Present No Scribe
Documentation Time of Orthopedic Surgeons Per Half Day of Clinic Scribe Vs. No Scribe
Fig 1. Documentation time of
orthopaedic surgeons with scribes
and without scribes.
ORTHOPEDIC SCRIBES IN SPORTS MEDICINE e999
time spent per half day of clinic documenting after the
last patient was seen was 104 minutes on average. On a
scale of 1 (strongly disagree) to 5 (strongly agree),
surgeons reported a 2.2 out of 5 score for having
“adequate time to perform patient education in clinic
today,”and 2.0 out of 5 score for “I had adequate time
to teach medical students and trainees today.”The time
spent documenting encounters throughout each half-
day of clinic was estimated to be 87 minutes on
average. The average surgeon single assessment
numeric evaluation (SANE) score was 48.1. The
average score relating to physician health was physical
well-being (6.5/10), emotional well-being (6.5/10),
spiritual well-being (7.0/10), intellectual wellbeing
(7.8/10), and overall well-being (7.1/10).
There were 30 physician surveys filled out on scribe
clinic days. The average time spent per half day of
clinic spent documenting after the last patient was 25
minutes, on average, significantly less than the 104
minutes spent on nonscribe clinic days (P<.001). On
a scale of 1 (strongly disagree) to 5 (strongly agree),
surgeons reported a significantly greater score of 4.4
out of 5 (P<.001) for having “adequate time to
perform patient education in clinic today,”and 4.1 out
of 5 (P<.001) for “I had adequate time to teach
medical students and trainees today.”The time spent
documenting encounters throughout each half-day of
clinic was estimated to be significantly less at 26 mi-
nutes on average (P<.001). The average SANE score
was also significantly higher than the no-scribe clinic
days at 89.3 (P<.001). The average scores on mea-
sures of well-being were all significantly higher when
compared to the no-scribe clinic days. These well-
being scores were physical well-being (9.3/10; P<
.001), emotional well-being (9.3/10; P<.001),
spiritual well-being (9.2/10; P<.001), intellectual
wellbeing (9.4/10; P<.001), and overall well-being
(9.3/10, P<.001) (Table 1,Figs 1 and 2).
Nurse Results
There were 42 nonscribe surveys completed by 3
nurses. The average number of patients seen per half-
day of clinic was 24. Nurses answered yes on 30/42
surveys (71.4%) to “the surgeon was rushed today”
and 32/42 (76.2%) answered yes to “the communica-
tion outside of the exam room was effective today.”The
overall assessment of the clinic was 73.4 out of 100 on
average.
There were 30 scribe surveys completed by 3 Nurses.
The average number of patients seen per half-day of
clinic was 27. Nurses answered yes on 8/30 surveys
(26.7%) to “the surgeon was rushed today”and 29/30
(96.7%) answered yes to “the communication outside
of the exam room was effective today.”The overall
assessment of the clinic was significantly greater with a
scribe present with a score of 87.7 out of 100 on
average (P<.001) (Table 2). Additionally, the average
time between the last patient leaving and the comple-
tion of nursing duties was significantly less on scribe
clinic days (53.2 minutes no-scribe vs. 14.2 minutes
scribe; P<.001).
Patient Results
There were 631 nonscribe patients with an average
age of 46.7, consisting of 284 female and 347 male
patients. There was a nonresponse rate of 14%. De-
mographic information can be seen in Table 3.
Patients rated their overall experience as 4.8 out of 5
on average. Patients typically arrived to their exam room
1.1 minutes before their appointment start time.
Fig 2. Surgeon self-rated well-
being with scribes and without
scribes.
e1000 J. R. POLLOCK ET AL.
Surgeons arrived to the room 19.2 minutes after room-
ing time and 18.1 minutes after official appointment
time.
There were 147 scribe patients with an average age of
45.5, consisting of 68 female and 79 male patients.
Patients rated their overall experience as 4.7 out of 5 on
average. Patients typically arrived to their exam room
3.5 minutes before their appointment start time. Sur-
geons arrived to the room 18.6 minutes after rooming
time and 15.1 minutes after official appointment time
(Table 4). For the scribe and no-scribe groups, there
was no significant difference between the average pa-
tient experience score (P¼.27), time from patient
appointment until exam room placement (P¼.10),
time from patient exam room placement until surgeon
arrival (P¼.67), or time from scheduled appointment
time until surgeon arrival (P¼.12).
Discussion
The use of scribes in a high-volume orthopaedic
sports medicine clinic decreased the amount of physi-
cian documentation time, positively impacted physician
well-being, improved nurses’assessment of the clinic
overall, with no resulting change in patient satisfaction.
In total, orthopaedic sports surgeons spent a total of 191
minutes per half-day of clinic on average documenting
throughout the day and using the computer with a
scribe. When compared to a half-clinic day with a
scribe, this amount of time decreases significantly from
191 minutes to 50 minutes, a 74% decrease. More
specifically, the use of a scribe decreased the amount of
documentation significantly from an average of 104
minutes to 25 minutes per half day of clinic, a 76%
decrease in documentation time. The use of a scribe also
had a positive impact on surgeon SANE scores and
physician well-being. Surgeons reported having more
time to educate students, residents, and patients when
using a scribe. The use of a scribe improved nursing
assessments of the clinic overall, provider communica-
tion, and sense of physician rushing. Patients also
benefitted from scribes, with reduced rooming time and
reduce waiting time for the surgeon. No significant
difference was noted in patient clinic experience scores.
These findings are similar to a 2018 pilot study per-
formed in an academic practice at the University of
Chicago, where a single outsourced medical scribe was
hired to assist in the clinics of six attending physicians in
primary care on a rotating basis over the course of 3
months.
10
The study found that the use of scribes
decreased post-visit documentation time by half. These
findings corroborate our findings, where documenta-
tion time spent by orthopaedic surgeons per half-day of
clinic after the last patient decreased by 76% after
implementation of scribes. Similarly, a study performed
in primary care clinics showed that physicians with
scribes reported less than 10 hours per week of charting
versus 20-26 hours per week without scribes.
26
The
physicians in this study also reported that the time
saved from using scribes was spent to engage more fully
with patients and staff.
26
Using scribes in high-volume
orthopaedic sports clinics could help decrease post-
visit documentation time, as noted by the substantial
decrease in documentation time.
As there is increased time for surgeons to fully engage
with patient and staff while using a scribe, it is not
surprising that scribe use positively influences physician
satisfaction and well-being. A recent study of emer-
gency medicine physicians with scribes found physician
satisfaction at their institution increased from 62nd
percentile to 92nd percentile.
11
Additionally, a separate
study found that 100% of the 33 oncology physicians in
their cohort strongly agreed that scribes improved their
quality of life.
27
A systematic review and meta-analysis
of studies related to scribe use in the emergency
department found that 14/16 studies reported increased
provider satisfaction with scribes.
28
Furthermore, a
study of clinic days in urology found that 69% of
physicians report statistically significant job satisfaction
when working with a scribe, compared to 19% job
satisfaction without scribes.
15
Not surprisingly, in our
study, we found that the average SANE score increased
from 48 without scribes to 89 with scribes, along with a
substantially increased self-rated physical, emotional,
Table 2. Nurses’Ratings of Clinic with Scribes Versus Without Scribes
Item Overall (n¼72) Scribe Present (n¼30) No Scribe (n¼42) PValue
Overall assessment of clinic, mean (SD) 79.4 (14.0) 87.7 (10.1) 73.4 (13.4) <.001
Was the Surgeon Rushed or Running Late?
Yes (%) 38 (52.8%) 8 (26.7%) 30 (71.4%)
No (%) 34 (47.2%) 22 (73.3%) 12 (28.6%)
Was Communication Outside of the Exam
Room Effective?
TRUE (%) 61 (84.7%) 29 (96.7%) 32 (76.2%)
FALSE (%) 11 (15.3%) 1 (3.3%) 10 (23.8%)
Time
Time (minutes) between last patient
leaving and completing nursing duties,
mean (SD)
36.6 (46.3) 14.2 (13.6) 53.2 (54.4) <.001
ORTHOPEDIC SCRIBES IN SPORTS MEDICINE e1001
spiritual, intellectual, and overall well-being of the
surgeons using scribes compared to not having scribes.
While we report improvement in physician well-
being and decreased documentation time, the impact
of scribes from a patient perspective also deserves
exploration. Corroborating other studies examining
patient satisfaction and scribe use in cardiology,
otolaryngology, internal medicine, and urology, our
study found that there was no significant impact of
scribes on patients.
10,13,15,29
This is an important
finding, as some would argue that the use of scribes
could decrease patient satisfaction or harm the overall
patient experience. Some studies have even reported
increased patient satisfaction among patients who are
seen by physicians with scribes compared to physicians
without scribes.
11
This could be due to increased time
spent with patients. A study of 129 physicians in an
outpatient oncology practice found that 90% of physi-
cians using scribes strongly agreed that they spent more
time with patients and less time at the computer.
27
In
the 2018 Oxford study of scribes, there was a high de-
gree of patient acceptance associated with the intro-
duction of scribes and overall patient satisfaction
remained high. We also found in our study that patient
satisfaction remained high despite the use of scribes.
With patient satisfaction being reportedly neutral or
positive with the use of scribes, the positive impact of
scribes on patient satisfaction could be due to a variety
of factors. Physicians in a 2018 pilot study for scribe use
at an academic center reported that they felt less
rushed, less distracted by the EHR, and more able to
connect with patients. In exit interviews, one physician
stated, “You had me at the first visit .first time in ten
years I was able to truly focus on the patient without
the distraction of EHR.”Others noted that they had
“less sense of dread during busy clinics,”and it was
“great to have my notes done so I could go home and
have dinner with my family.”We also found in our
study that others could notice the difference in sur-
geons, with nurses reporting that surgeons were much
less rushed when using a scribe (71.4% of nurses re-
ported rushed surgeons without the use of scribes to
26.7% with the use of scribes). Another randomized
crossover study in primary care found that physicians
reported significant improvement in patient interaction
and clinical interactions during scribed-periods versus
unscribed-periods.
30
Our data show that physicians were able to see pa-
tients sooner when scribes were present. Surgeons
arrived to the room 18.1 minutes after the official
appointment time on clinical days without scribes
compared to 15.1 with scribes. These results are further
contextualized by a randomized controlled trial in foot
and ankle orthopaedic surgery virtual scribes. The au-
thors found that surgeons reported more time spent
with the patient when working with a scribe at 14
minutes versus 11.4 minutes on average, and no sig-
nificant difference in patient rating.
31
A study in
emergency medicine found a similar result, with door-
to-doc time decreased from 74 minutes without a scribe
to 62 minutes with scribe use.
11
Trainees benefit from scribe use as well. This data
showed that the use of scribes allowed for time to teach
trainees, with an average rating on a scale of 1 (strongly
disagree) to 5 (Strongly agree), surgeons without
scribes reported a 2.0 out of 5 score for “I had adequate
time to teach medical students and trainees today,”and
4.1 out of 5 score with the use of scribes. A separate
study in dermatology about this subject found that 57%
Table 3. Patient Demographics
Total
Number of
Patients (%)
Number of
Patients With
Scribes Present
(%)
Number of
Patients Without
Scribes Present
(%)
Overall 778 147 631
Gender
Male 426 (54.8) 79 347
Female 352 (45.2) 68 284
Age
<18 58 (7.5) 11 47
18-29 142 (18.2) 28 114
30-49 217 (27.9) 33 184
50-64 252 (32.4) 59 193
65þ109 (14.0) 16 93
Average (SD) 45.0 45.5 44.9
Encounter Type
New patient 275 (39.0) 57 218
Follow up 412 (58.3) 76 336
Other 19 (2.7) 7 12
Table 4. Patient Data Scribe vs. No Scribe
Item Overall (n¼778) Scribe Present (n¼147) No Scribe (n¼631) PValue
Patient experience score, mean (SD) 4.8 (0.5) 4.7 (0.5) 4.8 (0.5) .27
Wait Time
Time (minutes) from patient appointment time
until exam room placement, mean (SD)
1.5 (16.0) 3.5 (14.0) 1.1 (16.4) .10
Time (minutes) from patient exam room Placement
until surgeon arrival, mean (SD)
19.1 (14.7) 18.6 (14.9) 19.2 (14.6) .67
Time (minutes) from scheduled appointment time
until surgeon arrival, mean (SD)
17.6 (20.9) 15.1 (19.4) 18.1 (21.2) .12
e1002 J. R. POLLOCK ET AL.
of attendings and 76% of trainees perceived that scribes
increased the attendings’direct teaching time, with
57% of physicians and 80% of trainees reported an
improved overall education with the use of scribes
compared to not using scribes.
32
Also, scribes are often
students applying for professional health programs,
such as nursing, medical school, physician assistant
school. These scribe experiences often provide valuable
clinical experiences to help these students prepare for
professional medical education programs.
Although our study does not report differences in
productivity, it is important to note that scribes have
also been reported to increase physicians’productivity.
A systematic review of scribe use in family medicine
reported that both studies that measured physician
productivity reported increase in work relative value
units (wRVUs) with scribes.
19
According to a study done
at Hennepin County Medical Center, an academic hos-
pital, scribes increased revenue for the emergency
department and frequently increased revenue for sub-
specialty clinics.
33
A study examining the productivity
requirements of implementing a medical scribe program
found that in orthopaedic surgery an average of 2.78
additional visits per day and 1.80 additional new patients
per day are needed to cover the cost of scribes.
34
In gastroenterology, a proof-of-concept study found
that with the average time saved through use of a
scribe, there was enough time at the end of the day to
perform an additional procedure.
35
Another study of
pediatric emergency medicine found that patients per
hour increased from 1.97 patients per hour to 2.21
patients per hour, and wRVUs increased from 2.55
wRVUs per hour to 4.27 wRVUs per hour.
36
Another
study of emergency medicine found that physician
productivity increased from 2.3 to 3.2 patients per hour
and the community emergency departments’produc-
tivity increased from 241 to 336 wRVUs per hour pre-
versus post-scribe implementation.
16
A study of family
medicine found that scribe implementation of two full-
time scribes would cost $79,500 for both of them
combined. The study found the projected increased
revenue is more than $168,600 per year, more than
enough to cover the use of scribes.
6
In conjunction with
increased revenue from scribe use, scribe use has even
been found to lower staffing costs and an annual cost
reduction compared to having no scribes in an ortho-
paedic trauma outpatient unit.
37
The potential cost
savings of scribe use in orthopaedic sports medicine
clinics warrants further exploration, especially in the
context of the rapidly changing financial and political
landscape of orthopaedic surgery, with practice
consolidation and decreasing reimbursement.
38e41
Limitations
Our study is not without limitations. First, we had to
exclude 268 patients because they did not fill out their
survey completely or their answers were unclear (e.g.,
circling no answers or circling two answers for one
question). Additionally, the number of surveys filled
out with scribes is lower than the number of surveys
without scribes due to the limited number of months
we had access to scribes. Lastly, our surveys may not
represent the broader physician, nurse, or patient
experience.
Conclusion
We found the use of scribes in a high-volume or-
thopaedic sports medicine clinic to have a favorable
impact on physicians, nurses, and trainees. The use of a
scribe also significantly reduced the time required by
surgeons for documentation during clinic and at the
end of each clinic day. Patients also reported no sig-
nificant difference in patient clinic experience scores.
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