Institute for Community Health, Malden, MA (Dr. Zallman, Ms. Touw, and Ms. Chu); Cambridge Health Alliance, MA (Drs. Zallman, Elvin, and Sayah and Mr. Dolat); Harvard Medical School, Boston (Drs. Zallman, Elvin, and Sayah); Tufts University School of Medicine, Boston (Dr. Altman); Massachusetts General Hospital, Boston (Ms. Hatch); University of New England, Biddeford, ME (Ms. Rajagopal) *Deceased. wayne.altman@tufts.edu
The authors reported no potential conflict of interest relevant to this article. This study was funded by institutional funds of the Cambridge Health Alliance and the Department of Family Medicine at Tufts University School of Medicine.
Limitations of this study. Our study should be interpreted in the context of several limitations:
The study was conducted at 1 institution. Our findings might not be generalizable beyond this setting.
The study measures the impact of scribes when providers work with scribes part time. Because providers who utilize a scribe for all, or nearly all, their visits are likely to use a scribe more efficiently, our study might underestimate the full impact of a scribe.
In some settings, team members such as medical assistants are trained to assist with documentation and other responsibilities (such as closing care gaps) in addition to other patient care responsibilities.29-32 The extent to which our findings transfer to other models is unclear; studies comparing the impact of other models (which might provide even stronger outcomes) to the impact of medical scribes would be an interesting area for further research.
In addition to the variability of models, there is likely variability in the quality and interactions of medical scribes, which might impact outcomes. We did not examine the qualities of scribes that led to outcomes in this study.
We examined the impact of scribes on quality measure–ordering behaviors of providers, not on whether quality measures actually improved. Because scribes are associated with more face-to-face time with patients,27 they might allow for increased attention being paid by physicians to barriers to pay-for-performance measures (eg, patient education). This could increase the likelihood that patients complete a multitude of screenings, and thus improve adherence and follow-up. However, the impact of scribes on quality measures is a topic for future study.
Value beyond volume. Any limitations notwithstanding, our study suggests that scribes are associated with financial benefit in addition to the benefit of increased volume. Primary care practices should therefore consider the financial benefit of scribes independent of their ability to add patient volume. By recognizing this additive value, primary care practices might more fully capture the benefit of scribes, which might then allow practices to employ scribes with less demand to increase volume. This added support without increased volume would, in turn, likely reduce provider burnout (and the costly associated turnover) and increase patient satisfaction, leading to a synergistic financial benefit.
CORRESPONDENCE Wayne Altman, MD, FAAFP, Tufts University School of Medicine, 200 Harrison Avenue, Boston, MA 02111; wayne. altman@tufts.edu
