MEDICAL STUDENT MENTORING

Mentoring is an art form developed in the United States in the 1970s within large private companies and corporations and is used to support junior staff. Since the 1990s, mentoring programs have emerged in various medical professions, most frequently in the field of nursing though, rather than physician practice. Formal mentoring programs for medical students and doctors did not develop until the late 1990s (Buddeberg-Fisher and Herta 2006).

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SOME PERSPECTIVES ON MEDICAL MENTORSHIPS

Despite the availability of other satisfying or more lucrative career opportunities for the bright and altruistic, admissions to medical schools remain desirable and competitive, thanks largely to an influx of talented and qualified female and minority applicants.  Premedical and medical education has always been stressfully competitive and a financial burden. "Stress in medical school" even merits its own individual entry on Wikipedia.

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MY EXPERIENCES MENTORING

For as long as I can remember, I’ve always wanted to become a doctor. However, I did not realize all the challenges I would have to face in order to make my dreams come true, and I also did not know who I was going to meet along the way to help me become a successful medical student.  When I was reapplying to medical school, I was told gaining more clinical experience could strengthen my application. I reached out to as many physicians as I could in order to shadow them.

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After appropriate extrapolation of this information, the translation of this particular practice is each medical scribe earned roughly $20 per hour, each physician earned roughly $180 per hour, and the scribe enhanced the productivity of a physician by about 20%. The real return on investment (ROI) occurs when this enhancement is represented in reduction of physician coverage. That is, for every physician hour cut, the practice can maintain budget-neutral (20% enhanced productivity x $180 = $36 with a scribe only costing $20) and acquires roughly nine medical scribe hours. With the budget-neutral trade-off, the improved coding and RVU generation results in tremendous financial gains. At this particular hospital’s ED, every 1% gain in RVU resulted in $16,000 annual revenues, and each 1% improvement in productivity gained $32,000 annual income.


In a prospective, controlled study, Bank and associates (2013) compared standard visits (20-minute follow-up and 40-minute new patient) to a scribe assisted system (15-minute follow-up and 30-minute new patient) in a cardiology clinic. Accounting for both direct and indirect revenue savings, the group demonstrated a $2500 savings per patient. And for hospitalists, a recent study noticed an increase of Case Mix Index (CMI) from 0.26 to 0.28 after the implementation of scribes. Translating this change to dollars, each CMI increase of 0.1 yielded about $4500 per patient. (Kreamer, 2015)

Most of us have personally experienced the impact of electronic health record (EHR) and required clinical documentation, which have resulted in decreased productivity and decreased job satisfaction.  Physicians and nurses have traditionally used clinical documentation to record and convey information as well as treatment plans to other members of the care team. However, clinical documentation has evolved to justify reimbursement and serves many purposes which may not contribute directly to patient care.  Adding to this complexity is the requirement to implement an electronic health record (EHR). It was intended to record history-rich notes to reflect gathered information for diagnosis and treatment plans.  The EHR was supposed to improve productivity, quality, and outcomes. Regardless of whether these changes in clinical documentation improve or distract from patient care, the question is whether physicians can identify solutions, such as medical scribes, to facilitate the navigation of this very complex process. What are the financial and lifestyle improvement cost benefit analyses?


Estimates are that physicians click an EHR roughly 750-4000 times during a full day in the clinic or hospital! A recent study at a community hospital in Pennsylvania revealed that ED physicians spend 43% of their time documenting and entering data, roughly twice as much time as that spent on direct patient care. (Hill & Sears, 2013)


A recent systematic review examining the benefits of medical scribes revealed potential improvements in clinician satisfaction,

BY TUYEN T. TRAN, MD

productivity, time-related efficiencies, revenue, and patient-clinician interactions. (Hill & Sears, 2015) Although, the authors commented that the reliability of the data was limited, it is clear that there is mounting evidence demonstrating added value of a medical scribe. Full realization of a medical scribe’s added value remains to be demonstrated; but, it seems to trend very favorably.


In regards to the financial impact, if the cost of the scribe (usually a flat hourly rate) is less than or equal to the additional daily revenue gained, then the medical scribe is feasible. For example, let’s examine some data from an actual ED scenario. (Hill & Sears, 2013) (Specific gains will obviously depend upon the practice and demographic characteristics.) Saint Peter’s University ED realized the following improvements after the implementation of scribes:


1. 8.52% improvement in the average patients seen per hour,

2. 5.87% improvement in average RVU per patient,

3. 14.82% improvement in average RVU per hour, 87% improvement in downcoded charts,

4. 15.85% improvement in length of stay for adult patients,

5. 26.4% improvement in length of stay for pediatric patients, and

6. roughly 40% improvement in door-to-doctor times for patients.    

TUYEN T. TRAN, MD

Tuyen Tran, MD emigrated from South Vietnam after the war. He completed his undergraduate in biology/chemistry and medical school at the University of Missouri – Kansas City in a six year program. His is currently boarded in internal medicine and addiction medicine.


Physicians often work late after their shifts or days, spending up to 30% of their time documenting and performing other non-medical tasks. It’s a burden that distracts from what attracted us to our profession – patient care. This leads to lower job satisfaction, lower quality of life, and shortened careers due to burnout. But, these long hours reflect physicians’ dedication to medicine! How ironic that we often advise our patients to balance work and life, yet we fail to incorporate the same advice. How often do we advise our patients to work smarter and not harder?


So, how do physicians want to spend the extra 20-30% of time a medical scribe affords us? We can increase income by seeing more patients. We can enjoy the satisfaction of devoting more time to each patient.


Or we can simply leave work on time and invest that time in family and friends. It’s a very common scenario and conflict all physicians confront.


We must find innovative ways to enhance productivity without causing burnout. We were trained to care for patients, not to perform clerical work! Using a scribe will allow us to spend more time with patients. Using a scribe will eliminate almost all after hours charting. Using a scribe will help ensure that charts are completed daily. What we choose to do with the time saved is up to us; but let’s agree that getting charts done by the end of the work day is better than completing them at nights and on the weekends.



References

  1. Bank AJ, Obetz C, Konrardy A, et al. Impact of scribes on patient interaction, productivity, and revenue in a cardiology clinic: a prospective study. ClinicoEconomics and Outcomes Research: CEOR. 2013;5:399-406. doi:10.2147/CEOR.S49010.
  2. Hill, Robert G., Lynn Marie Sears.  4000 Clicks: a productivity analysis of electronic medical records in a community hospital ED.  AM J Emerg Med. Sep 23, 2013. Vol. 31, Issue 11, 1591-1594.
  3. Kreamer, Jeff; Rosen, Barry; Susie-Lattner, Debra; Baker, Richard. 2015 The economic impact of medical scribes in hospitals. The Free Library (May, 1), www.thefreelibrary.com/Theeconomicimpactofmedicalscribesinhospitals-a0414692559 (accessed May 17 2017)
  4. Shultz, Cameron G., Holmstrom, Heather L.  The Use of Medical Scribes in Health Care Settings: A Systematic Review and Future Directions.  JABFM.  May–June 2015 Vol. 28 No. 3