The Advantages of Adding Scribes, APPs and Medical Students

Kyle Matthews

With increasing patient volume set as a key goal for most medical practices, one way to do that is to reduce some of the administrative burden on physicians. This can be done by hiring scribes, advanced practice providers (APPs), and medical students, according to Kyle Matthews, CMPE from Phoenix Heart PLLC.

Matthews, who manages a cardiology practice in Mesa, Ariz., spoke at a session at the annual Medical Group Management Association (MGMA) conference, held in San Francisco. He started the session by doing a live audience survey asking attendees if they are currently using, interested in using, have used in the past, or have no interest in using scribes. The majority of the attendees said that they are interested in using scribes.

Matthews explained that scribes can increase both the speed and efficiency of physicians. "If they don't, it's either a bad scribe or bad physician," he said.  But most importantly, he pointed out they can increase patient volume. For a medical practice, patient volume is one of the most important things, he said. "We had a four month backlog for seeing a cardiologist," said Matthews.  "We added a scribe [and] he added four slots [for patients] a day."

Also, scribes can improve patient experience since they allow physicians to have more face-to-face time with the patient. Matthews explained that computers in most exam rooms face away from patients and physicians typically have to type with their back to the patients. With scribes doing the typing, physicians can have a more personal interaction.

Scribes can be hired from a number of qualified companies, directly, or can be developed internally. Matthews gave the example of young personable college graduate he hired to work at the front desk, who later transitioned to becoming a successful scribe. He stressed that you need to make sure the person has the right temperament. A shared scribe within the practice can be a benefit by working with multiple providers and even be moved to other jobs as and when needed.

"They are a niche and not for everyone but for the physicians who wants to see more patients it's an idea," he explained. However, he noted, family practices deal with a lot of people and some do not like to get certain exams done or don't want their children examined with another person present in the room. This is also a problem that comes up with medical students.

APPs are another way to increase patient volume and offer other advantages. They can chart on the physician's desktop, reduce paperwork, take on same day appointments, and bring a sense of team approach to the practice. They can work with multiple providers and also provide additional services that physicians may not want to do since the role of APPs in most states is expanding.

One important realization with APPs is to ensure that patients understands their role, explained Matthews. If a patient comes in expecting to see a doctor, they may not want to see an APP in their place.

As for medical students, a live audience poll showed that the majority believe they slow down physicians. "If they are slowing down the provider they are likely not being used right," said Matthews.

Beyond the first week, medical students actually speed up your provider if they are used in a coordinated way, explained Matthews. They may need a short training period after which they can help increase the physician's speed when it comes to seeing patients.

Moreover, including medical students in the practice can give some physicians a sense of purpose.  For a lot of practitioners who feel overwhelmed by the regulatory burden and feel less motivated, it can be a way of giving back to the profession and they take pride in it. Also, they can increase community connections. For example, Matthews encourages physicians to become guest lecturers at the medical student's school.  

Matthews did warn that it is important for medical students to receive some training, for example in HIPAA and OSHA compliance. "These medical students are acting as agents of the practice," he said.  "If they mess up they will hurt the practice."