Impact of Medical Scribes on Physician and Patient Satisfaction in Primary Care

Pozdnyakova, Anastasia; Laiteerapong, Neda; Volerman, Anna; Feld, Lauren D.; Wan, Wen; Burnet, Deborah L.; Lee, Wei Wei

doi:10.1007/s11606-018-4434-6

Cited by 70 publications

(145 citation statements)

References 27 publications

(31 reference statements)

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“…Expanded care teams have demonstrated value in reducing physician EHR time in primary care. 20 Assisting physicians with certain clinical tasks may also increase physician well-being. 6 This organization has taken recent steps to improve well-being, including creating an office of physician wellness, piloting multidisciplinary in-basket support, providing enhanced leadership development support and training, and implementing a primary care transformation program including in-basket support from APCs.…”

Section: Discussionmentioning

confidence: 99%

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Frontline Perspectives on Physician Burnout and Strategies to Improve Well-Being: Interviews with Physicians and Health System Leaders

et al. 2019

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BACKGROUND: Nationally over 50% of physicians report symptoms of burnout. OBJECTIVE: To understand the perspectives of health system leaders and frontline physicians on contributors to physician burnout and strategies to improve wellbeing. DESIGN: We conducted in-depth interviews with health system leaders and frontline physicians at a large, predominantly fee-for-service, multispecialty group practice with approximately 1300 physicians. PARTICIPANTS: The 17 participants included 15 physicians, (12 Internal Medicine and Family Medicine physicians and 3 from other specialties), 11 individuals in leadership roles, and 11 women. APPROACH: Interviews included a review of factors associated with burnout at the organization, asking participants which factors they believed contributed to burnout, questions about experiences of burnout, and what specific changes would improve well-being. KEY RESULTS: All 17 participants agreed that organizational factors were key contributors to burnout, while only 9 mentioned the salience of individual factors: "It does not matter how resilient or positive you are, the work environment, especially in primary care will eventually be a problem." An increasing workload associated with the electronic health record (EHR) and a culture focused on productivity were cited as contributing to burnout, especially among physicians in Internal Medicine and Family Medicine (primary care) departments. Physicians in primary care, women, and leaders described multiple barriers to well-being. Participants described responding to increased workloads by reducing clinical work hours. Participants suggested reducing and compensating EHR work, expanding care teams/support staff, reducing use of metrics, providing more support to leaders, changing the business model, and increasing positivity and collegiality, as essential to improving well-being. CONCLUSION: Interviews reveal a variety of interacting factors contributing to physician burnout. Reducing clinical work hours has become a coping strategy. Changes recommended to improve physician well-being include increasing support staff, reducing EHR workload, changing revenue generation and compensation approaches, and shifting organizational culture to place more value on physician wellness.

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Section: Discussionmentioning

confidence: 99%

“…17,18 Health systems are increasingly taking steps to enhance physician well-being. 19,20 For instance, the Mayo Clinic has used a bottom-up approach to tackling burnout using focus groups with physicians. 21 Other approaches target individual factors such as promoting resilience and mindfulness.…”

Section: Introductionmentioning

confidence: 99%

Frontline Perspectives on Physician Burnout and Strategies to Improve Well-Being: Interviews with Physicians and Health System Leaders

et al. 2019

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“…Several individual studies have described increased provider satisfaction, including one report from a family medicine clinic that showed that all measures of provider satisfaction significantly improved with utilization of scribes . Similarly, a study of six internal medicine physicians reported 100% satisfaction with clinic workflow in the primary care setting after implementation of a scribe program, compared to only 33% before the scribe program . Two studies in urology clinics also found that physicians were more satisfied with their workload and clinic hours when working with a scribe .…”

Section: Discussionmentioning

confidence: 99%

“…Although patients have reported positive attitudes toward scribes and perceived improvement of provider-patient interactions, [10][11][12] no studies have found a quantitative difference in patient's satisfaction with providers. 11,[13][14][15][16][17] Conclusions are further limited by heterogeneity in the methodology for assessing patient satisfaction in all of these studies, including many studies that created their own surveys and metrics.…”

Section: Discussionmentioning

confidence: 99%

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Clinical scribes and their association with patient experience in the otolaryngology clinic

et al. 2019

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Objectives/Hypothesis Electronic health records have brought many advantages but also placed a documentation burden on the provider during and after the clinic visit. Some otolaryngologists have countered this challenge by employing clinical scribes. This project aimed to better understand the influence of scribes on patient experience in the otolaryngology clinic. Study Design Retrospective cohort survey study. Methods Patients presenting to the otolaryngology clinic for new and follow‐up appointments were recruited to complete surveys about their experience. Results A total of 153 patients completed the survey, and 96 of those patients (62.7%) interacted with a scribe. Patient satisfaction was not significantly associated with participation of the scribe (P = .668). Similarly, patient rating of their physician on a scale of 1 to 10 was not associated with scribe involvement (P = .851). The patients who did interact with a scribe responded that the scribe positively impacted the visit 77.1% of the time. Participation of a resident, primary language other than English, and use of interpreter were associated with lower satisfaction (P = .004, P < .001, and P < .001, respectively). Conclusions There are no published data on the effect of scribes on patient experience in the otolaryngology clinic. In other specialties, scribes have been demonstrated as having a positive effect on provider satisfaction, clinical productivity, and patient perception. These data demonstrate that patient satisfaction was neither impaired nor improved by the presence of the scribe in this clinic. In light of benefits demonstrated by prior studies, these findings support the conclusion that scribes are a useful adjunct in providing high‐level otolaryngology care. Level of Evidence 4 Laryngoscope, 130:E134–E139, 2020

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Prevalence of Burnout Among Physicians

Rotenstein

Torre

Ramos

et al. 2018

JAMA

1,415

1,215

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IMPORTANCE Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown. OBJECTIVE To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout. DATA SOURCES AND STUDY SELECTION Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018. DATA EXTRACTION AND SYNTHESIS Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively. MAIN OUTCOMES AND MEASURES Point or period prevalence of burnout assessed by questionnaire. RESULTS Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined. CONCLUSIONS AND RELEVANCE In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardiz...

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Impact of Medical Scribes on Physician and Patient Satisfaction in Primary Care

Abstract: In an academic GIM setting, employment of a scribe was associated with improved physician satisfaction without compromising patient satisfaction.

Cited by 70 publications

References 27 publications

Frontline Perspectives on Physician Burnout and Strategies to Improve Well-Being: Interviews with Physicians and Health System Leaders

Frontline Perspectives on Physician Burnout and Strategies to Improve Well-Being: Interviews with Physicians and Health System Leaders

Clinical scribes and their association with patient experience in the otolaryngology clinic

Prevalence of Burnout Among Physicians

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