Beating Burnout: How Doctors Can Regain Control

Leigh Page

Disclosures

October 12, 2016

In This Article

Spin Off Some of the Burden of EHRs

Electronic health records (EHRs) continue to play an ever-larger role in burnout—and not in a good way. "Increasing computerization of practice" rose from ninth place in 2013 to fourth place in 2015 in Medscape's survey[3] of factors leading to physician burnout.

Most EHR data-entry work can be transferred from the physician to a nonphysician. This person sits in the exam room with the physician and the patient and enters information in real time. The work can be assigned to PAs, RNs, or MAs, especially if they're already assisting the physician in the exam room. Or it can be done by nonclinical scribes, called clerical documentation assistants (CDAs) in the parlance of STEPS Forward.

CDAs save physicians a great deal of time and can pay for themselves. A 2014 study[4] showed that using pre-med students and others as scribes saved internists 75 minutes, and geriatricians 122 minutes, in a 4-hour session. The team documentation module says that CDAs could save a physician more than 3 hours of work a day and could produce net savings of $91,520 a year. Based on salary and benefits for a CDA of $40,480 a year, the gross savings were $132,000.

A good CDA will be able to elicit the preliminary history; have good keyboarding and EHR-navigating skills; and understand billing requirements. You can decide how much autonomy you want to give the CDA. In any case, the physician reviews and signs off on the medical record before the patient's visit is closed, the module states.

Scribes are already present in some practices, which means that many patients are already used to seeing them in the exam room.

Nevertheless, concerns have arisen that their presence interferes with the visit and makes the patient less willing to divulge sensitive health information. In a Medscape article on the use of scribes, physician opinion was divided. The scribe as an intrusive presence in the exam room was mentioned by several commenters. "As a health professional and a patient, I know patients are reticent to share personal but important information with their PCP because of the presence of a scribe," one provider observed. "Undoubtedly this harms the doctor-patient relationship and could hinder a diagnosis."

However, Dr Sinsky says that the survey found that the opposite may be true. "We find that the extra person actually improves the physician-patient relationship because the physician is able to provide his or her full attention to the patient and is not distracted by data entry," a source surveyed by the study stated.

RNs have sometimes balked at being assigned scribe work, Dr Sinsky noted.

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