Oncology Rounds

Can medical scribes alleviate EHR-related oncologist burnout? It's complicated.

by Deirdre Saulet and Mallory Kirby

Across 2018, we partnered with the Association of Community Cancer Centers (ACCC) to conduct our second annual Trending Now in Cancer Care survey. One new topic we covered? The employment of medical scribes.

Medical scribes relatively rare in cancer programs 

The use of EHRs is unavoidable for today's clinician's—as are the resulting complaints from providers. In fact, 59% of respondents in our Trending Now in Cancer Care survey report that EHRs have worsened their provider and staff wellbeing, while 69% note that EHRs have lengthened provider and staff workdays. What's more, dealing with the EHR and other administrative tasks is the second-most commonly reported reason for physicians leaving a practice.

Cancer programs have introduced many strategies to combat provider burnout, but most fail to directly alleviate the burden caused by EHRs. Enter: Medical scribes. Medical scribes specialize in charting physician-patient encounters in real time and can help complete patient documentation—but they're not employed by a majority of cancer programs. Scribes are an additional, and under-researched, staffing expense for cancer programs, which may be why so few of our respondents employ them.

Independent physician practices are the most likely to employ scribes, with 30% indicating they employ this position. That's compared to 29% of teaching hospitals, 25% of academic medical centers, 16% of non-teaching hospitals, and 0% of freestanding cancer centers.

Scribes not mitigating the impact of EHRs

Given that the majority of cancer programs do not employ scribes, it stands to ask: Are they missing out? Our team hypothesized that delegating EHR documentation to scribes would lessen the negative impact of EHRs on providers.

But, to our surprise, when we asked how EHRs have affected providers and staff, organizations employing scribes were more likely to report that the EHR had a negative impact on length of workday, provider and/or staff wellbeing, and provider-patient interactions during appointments.

Respondents who employ scribes were more likely to report that the EHR improved provider-patient interactions during appointments (40%) compared to respondents without scribes (25%). However, respondents who employed scribes were also more likely to report that the EHR worsened provider-patient interactions during appointments (46%) compared to respondents without scribes (39%).

At first blush, these results are surprising, given that they seem to indicate that scribes have little or even a worsening effect on EHRs' impact. However, the Trending Now survey is just one snapshot in time—we don't know when or why scribes were introduced. Additionally, it's important to recognize that only 30 respondents who answered this question employed scribes, giving us a pretty small sample size compared to respondents who do not employ scribes. And of those 30 respondents, private practices were overrepresented compared to the overall respondent pool.

Mixed impact of scribes on physician turnover

We also asked respondents about their level of physician turnover and the reasons for that turnover. The majority of respondents (67%) reported some level of turnover. Based on the results, scribes do not appear to lessen the likelihood of turnover: 78% of programs employing scribes reported turnover, compared to 64% of programs without scribes.

However, the reasons for that turnover differ. Programs with scribes are less likely to report that physicians left because of too many bureaucratic tasks (25%) compared to programs without scribes (29%).

Physicians burdened by heavy workflows, with and without scribes

Several factors contribute to provider and staff burnout, and we thought the assistance of scribes could potentially alleviate issues like heavy workloads or decreased focus on patient care.

We asked survey respondents about nine potential issues that their providers might express concern about on a typical day. Cancer programs with scribes reported their physicians expressing concern about a majority of issues at a higher rate than programs without scribes.

Nearly all cancer programs employing scribes (96%) reported that their physicians expressed concern about heavy workloads, compared to 81% of programs that do not employ scribes. 

These results don't tell us if scribes are somehow adding to physician workload or if they were brought on recently to try and address heavy workloads. While we don't have a definitive answer on the value of scribes, these results drive home the need for more research on their role in cancer centers.

Cancer programs should think carefully before making the decision to invest in scribes and consider the unique circumstances of their providers. If it does seem like the right call for your cancer program, take the time to measure things like provider burnout and turnover before and after introducing scribes to make sure you're getting an accurate sense of the ROI.

In addition, consider the three keys to scribe deployment identified by Advisory Board's Medical Group Strategy Council:

  1. Understand the clear cases for scribes;

  2. Consider outsourcing, which is likely the cheaper option; and

  3. Make sure physicians are willing to modify their workflows.

Want more? Continue reading with "Medical scribes: When they're worth it."

 

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