A “prescribetion” for dermatologist burnout
Brian Berman, MD, PhD
Burnout is a psychological syndrome consisting of emotional exhaustion, depersonalization, loss of purpose in work, feelings of ineffectiveness, cynicism, regarding people as objects rather than human beings, and a reduced sense of personal accomplishment.
In 2018, 32% of dermatologists polled reported burnout and 9% reported both burnout and depression. The good news: as a specialty, dermatology was towards the bottom of the list, with the specialties of critical care and OB-GYN being most affected by burnout.
There are negative consequences of burnout for the physician, the patient, and the overall healthcare system. Physician burnout is linked to lower work satisfaction, stressed personal relationships, substance abuse (1 in 10 doctors), clinical depression, and suicide. Of note, physician suicide is 6 times higher than the national average. Burnout is associated with increased physician errors, worse patient outcomes, higher mortality rates in hospitalized patients, increased financial costs due to errors, more malpractice claims, lower job productivity, and higher physician turnover.
Being physicians, we always look for the cause(s) of disease to direct treatment. It remains unclear whether we have identified actual causes of burnout, or just risk factors or associations. In 2018, the most commonly cited burnout factors were too many bureaucratic tasks, such as charting and paperwork, increased electronic health recordkeeping, and too many work hours. In 2021, we might add practice disruptions due to COVID-19 and pervasive restrictions on recreational activities and interpersonal interactions mandated by the realities of the current pandemic.
There is no single magical bullet to “cure” burnout. Burnout requires multiple interventions at the individual, organizational, and national levels. It has been suggested that organizational-directed interventions are twice as effective at reducing burnout than physician-directed ones. So let’s focus on one possible solution—the use of scribes in medical practice. Incorporating scribes in medical practice resulted in a 51% reduction in clinician electronic medical record documentation (EMR) time, a 57% increased patient face time during visits, and a 27% decrease in computer time during these visits. Productivity actually rose, with an 8.8% increase in the number of patients seen per hour, a 10.5% increase in RVUs completed per hour, and a 7.7% increase in revenue.
The incorporation of scribes into a practice improves physicians’ clinical satisfaction by directly addressing the common physician complaint of not having enough face time with patients. While use of a scribe partially solves the problem of time spent on charting, chart quality and accuracy also increase. Provider burnout decreased by 21.8% after offloading electronic or health record documentation by pairing 1 medical assistant functioning as a scribe with 1 physician. After implementing scribing, 6 high-functioning primary care sites reported improved patient staff and physician satisfaction scores, and 82% of pediatric emergency department providers felt their skills were used more effectively when working with a scribe, thereby decreasing the likelihood of burnout. After the implementation of scribes, a survey of dermatologists revealed a 94% increased job satisfaction and a 70% improvement in feelings of burnout.
If one is looking to hire a medical scribe, what are the job requirements? Unfortunately, there are no set standards. Generally, a scribe should possess a high school diploma or GED, computer aptitude, typing speeds of >50 words per minute, excellent verbal and written communication skills, and a familiarity with medical terms and abbreviations, basic anatomy, and drug names. Many scribe agencies provide a 2-week training course as a precursor basis for on-the-job training. Although there is no certification that is universally required to become a medical scribe, there are certification exams for credentialing through The American Health Care Documentation Professionals Group, the American College of Medical Scribe Specialists, and the American Academy of Professional Coders. Less stringent online training courses in scribing typically do provide a “certificate” upon completion. Recently, some community colleges and universities are offering courses in scribing.
Furthermore, there are some legal issues to be considered. Scribes have to be trained for HIPAA and documentation requirements for billing confidentiality, and are not permitted to make independent decisions or translations while entering information into the EMR beyond what is directed by the provider. The scribe’s signature must be clearly distinguishable from that of the physician in the health record. (For example, “Scribed for Dr. Smith by James Jones.”) Many states don’t allow the use of scribes by nurse practitioners or physician assistants if the latter are not independent practitioners.
Finally, is it fiscally viable to have a scribe in your practice? Scribes are generally paid $10-14 per hour. The cost is more than offset by adding 1 extra patient per half-day dermatology session, with an estimated yearly return on investment ranging from $59,600 for a physical scribe to $79,300 for a virtual scribe.
I would like to offer a final caveat. Remain vigilant against becoming so comfortable with scribed assistance that you miss errors. Perform periodic, careful reviews of scribed notes!
