073 - Compelling Reasons to Hire a Scribe to Decrease the Stress of Medical Documentation For Physicians In Medical Practice

Have you ever felt overwhelmed by the number of patients you see and the mounting pile of notes you need to complete? In this episode of "The Independent Physician's Blueprint," we dive into scribe solutions that can help you decrease stress and increase your income.

• Discover the vital role a scribe can play in reducing your workload.
• Learn the benefits of having a scribe and how it can transform your practice and decrease burnout
• Explore the future of AI in the scribe industry and its potential impact on medical documentation.

Join us as we break down the definition of a scribe and discuss the differences between virtual and in-person scribes. Hear the compelling story of how a successful virtual scribe company was founded and the unique benefits it offers. Understand how scribes can enhance patient care by allowing more personal interaction and accurate documentation.

 Tune in to hear our expert guest share insights on:

• The process of hiring and training scribes.
• How virtual scribing works and the technologies involved.
• The challenges and solutions in implementing scribing in a busy practice.
• The future landscape of medical scribing with the advent of AI and its potential advantages and pitfalls.

Don't miss this episode if you're looking to streamline your practice, improve patient interactions, and stay ahead of the curve with cutting-edge technology in medical documentation. Listen now and take the first step towards a more efficient and less stressful medical practice!

Discover how medical graduates, junior doctors, and young physicians can navigate residency training programs, surgical residency, and locum tenens to increase income, enjoy independent practice, decrease stress, achieve financial freedom, and retire early, while maintaining patient satisfaction and exploring physician side gigs to tackle medical school loans.

Transcript

Coach JPMD (00:00.088)
Have you ever felt like you're seeing too many patients and you just can't keep up with your notes? Welcome back to another episode where I help younger physicians decrease stress and increase income by transitioning from corporate to independent practices, even without any business experience. Well, in this episode, you're going to learn details of how my scribe has helped me decrease my stress, benefits of a scribe and my thoughts on the future of AI in the scribe industry. That's wonderful. So what is a scribe?

For those that may not know and I know that some physicians already have scribes and but what what is it? What is the definition of a scribe? So pretty much the definition of a scribe is someone that would Assist the provider in the documentation of kind of what's going on in the visit I know a lot of providers their documentation is a lot of Templates or they might take their other charts home with them and they're not necessarily getting all the details that are going on in the

So a scribe is a person that will be in the exam room or be listening to the audio in the exam room and pretty much be documenting everything in as much detail as possible for the provider on the EHR so that you'll have accurate notes for billing and have a very good patient history.

And so you mentioned either in the room or virtually, at least your company is a virtual scribe company. explain what's the difference between a virtual scribe and a regular scribe? So yeah, an in -person scribe is someone that actually goes in the room with the provider and will be kind of charting on a computer listening in real time. So there'll be another person in the exam room with you when you're examining the patient. With the virtual scribe, pretty much there's a microphone in the exam room.

connected to the computer and we use some HIPAA compliant software so that the scribes could listen in real time what's going on. Nothing's really being recorded during that time so the scribes have to be kind of actively listening and they'll document in real time on the chart. And so this is something you went to school for and you got an MBA and no actually I went I went to UT Austin I went government route.

Coach JPMD (02:17.838)
I worked in parliament in London. So I was actually totally opposite to this. one day my dad came up to Austin for a meeting. He's a physician in South Texas internal medicine. And I think the scribing concept first got to him then four years ago. So I think it was still pretty big concept than in -person scribing. And I know his documentation style is he takes everything home. He doesn't like to be in front of the computer in front of the patient.

usually would come home and have two to three hours of chart work. I used to be his typist too, because he used to use chicken finger typing, one finger typing, so he would dictate and I would go through some of his charts with him after school. But pretty much that concept came to him and then we kind of thought through it. And another side piece of information, my sister actually went to medical school in India where most of my scribes are located.

So she was during that time, she was studying for her steps and it usually takes about a year for someone from a foreign medical graduate to study for the step. she was kind of in this transitionary period. So we thought that this would be kind of a good opportunity for people like that that want to learn about how medicine is practiced here in the U .S. and want to actually put some of their knowledge to use. And we kind of got that idea and then I was on a plane to India two months later.

halfway through my semester went all online and started it from there. So you went to medical school in India? Well, no, I didn't go to medical school. My sister went to medical school. I'm surprised she was able to complete it. She's back now practicing. She actually got a nephrology fellowship recently. She did internal medicine as well. But I went to India and I thought I was the first person with this idea. we can get.

doctors, nurses, or people to do virtual scribing work. And I put out an ad and little did I know there was already companies doing this. That's a great story. So your father, so did he also, was he in part of starting this company or was he? Definitely. was a guinea pig, to say the least. I didn't have very good

Coach JPMD (04:33.558)
Software in the very beginning actually like right now I'm using zoom to connect all the scribes with their providers They have a great HIPAA compliance license. So everything is very secure and encrypted but back then I didn't know about that So we were testing different softwares and it was very cumbersome every time he would go to the exam room He would have to log into something. So it definitely took a lot of iterations. But finally, I think we've kind of perfected that workflow and

It's been a great use to him. So he's actually had his scribe. She was like actually maybe like our fourth or fifth employee. And it's one person he can't let go of. He can't practice without her. And we've had other scribes try. He just gets upset. He loves her. what did you where do you see the industry going? Because obviously, you said that people were doing this in 2018.

I know that there are obviously US based companies as well doing this I've looked into them. I know that you guys had a lot of ad time on Facebook I think that's where I may have seen an ad or social media so Where where do this? Where do you see this is going? So yeah, I think the industry has been usually filled with empty medical transcriptionists right on I think previously people would dictate their notes

someone would come back and give them the paper text of it and then they would put it in the paper chart. So that's kind of evolved now. People have been displaced from those types of jobs. And now I think scribing other virtual medical assistants, other kinds of periphery, ancillary medical service jobs, they're going, they have to evolve to get to this. So we have people in India, all of these companies actually were probably medical transcription companies established 20 years ago doing this type of work. And now they're quickly evolving.

going into virtual scribing like live scribing with an actual person. There's even some companies, know Microsoft and Nuance, I think they produce Dragon. They have a big team over there that are trying to perfect their AI. So AI scribing, so pretty much they're trying to correct the software. So they have people listening in, the software spitting out what the charting would look out. then right now some scribes are actually correcting those things to have the software learn.

Coach JPMD (06:52.986)
and eventually hopefully become fully automated so that they don't have to have a person in the room. So that's kind of where the industry is going. I'm a little more pessimistic towards that. think you still need that human touch and sometimes speaking to your scribe, describe going over the previous chart with you, there's other added value other than just the pure documentation. Yeah, so from my standpoint, I know that when one of

You know, we can talk about the pros and cons, but I think one of the things I've noticed as soon as I lost my scribe was that patients were able to speak to me more freely when they didn't see another person in the room. So I'm not sure what other physicians are seeing or getting from their patients, but by the two, three minute mark.

I find that my patients don't even realize that someone is listening and they're able to actually speak to me more freely. Is that something that you see also in the industry? Definitely. think that also kind of amplified, I guess, during COVID, know, when you didn't want to also have an extra person in the room with you. So I think kind of that virtual person there would help. And definitely most of my providers that use the service, actually

They don't usually speak to the scribe in the room. you, I'm pretty sure you do as well. You speak to your patient whenever you're done speaking to your patient, you could let the patient go and then you could speak to your scribe freely after the visit or something. That's how most of my providers do. So usually, yeah, the patient, they sign that consent form. They are aware that someone is listening in, but it's very, the microphone is not too big. It's not too, I guess, cumbersome or it's not too noticeable.

So that they definitely do forget I used to actually use this other microphone in the past that had a big red light on it. And I had to kind of change that because I felt like some providers or it feel comfortable for patients. what other

Coach JPMD (08:55.934)
Negatives that you see in having the virtual scribe. I know that this is you do but but certain things I look at negatives as maybe things that we can improve on it and we can kind of look to see how we can make it better for the patient experience. So Yeah, I think some of the negative things is there are other ancillary things that people in person can do for the practice, right? maybe when you're usually the scribes they don't fulfill an order. usually they pre -fill orders like maybe prescriptions or

referrals to other providers. But having an in person staff, usually will have someone that could kind of do that right away. So there's a little bit more coordination that needs to happen between the scribe and the provider and the clinic so that we can get the patient going in a faster way. But definitely an in person, someone there actually there would actually fulfill the order and kind of have the patient going right away. So I think it kind of cuts a little steps if you have someone in person and but in regards

I guess the documentation, I feel like the scribes themselves, I feel like the people that you're also getting in person, they're also, kind of, have to look at their job perspective and what they're looking to get from their career, right? Most of them are in medical school or trying to get to medical school. So you have a certain knowledge level there. The scribes usually from overseas, this is kind of their career.

So they had to kind of gather a lot of knowledge. They've been maybe in the industry transcriptionist for many years. So they've heard or they've seen how like documentation of charts and how doctors, I guess, lingo is. So I think that kind of changes with in -person ascribing or having a person in person and having a virtual. Yeah. And I, what you're saying about the end of the visit.

I think it happens with us in the practice because we're fairly busy in the office and we kind of move patients one after the other. And what I'm finding is that if my scribe is not able to finish the impression and plan, then they're asking, well, the patient's ready to be checked out. But the patient's like, well, we have lab work that needs to be ordered. So there is.

Coach JPMD (11:06.958)
There's something that we may have to implement a delay in processes, maybe even, I think we gave her instant messaging on our computer, on our EMR system. she may, might be able to communicate with the staff just as though she was there. Yeah. So pretty much like in my dad's clinic, what the work around that we've done on the use ECW. So what the scribe will do, will assign like do an, like assign an action to an MA that's sitting in the nursing station.

and make it urgent. like a notification will pop up on their EMR. So while like he's speaking to the patient, maybe ordering or like maybe sending a prescription or ordering some lab, that message is already communicated to the MMA through the scribe on the back end. And by the time the patient walks out, everything should be fulfilled. So definitely there's a lot of workflows that every practice is unique. There's a lot of workflows

each practice could adapt, it definitely works. It helps with communication and knowing what the capabilities of what the scribe can do, and then just kind of tying all those loose ends together to make sure that the patient's getting the best care.

for sure and you know I think one of the other things is is language I've heard doctors say well suppose a patient speaking another language I speak Spanish I speak Karel some of my patients in so the scribe doesn't speak that other language so I'm having to translate what I'm talking to the patient about and I think

I still think the time spent with the patient kind of trumps that that negative in my opinion, but I don't know how other providers are. So yeah, other Spanish speaking providers, one, he told me the way he likes to do it, that saves some time is pretty much he does the whole visit in Spanish. And then when he's kind of doing the physical exam, he lets the patient know that he's going to kind of do a little dictation to the scribe so that they could do the documentation for him. So maybe he's doing some listening to the lungs and he's kind of just doing a quick summary.

Coach JPMD (13:09.068)
Dictation of what the visit is and then he'll just continue the whole conversation in Spanish with the patient. Yeah Yeah, that's that's that's interesting. I do that a little bit but something to consider I mean, I that also depends on yeah how you feel with how you feel with speaking like that to your patient I know some providers I think it's totally normal that they want the patient to kind of leave the exam room and then speak to the scribe more freely to make the patient feel more comfortable because it is a little awkward then

speaking to the computer when you don't see anyone and then the patient might be thinking what's going on. Yeah. What about compliance issues? you had any issues with compliance in terms of the documentation,

the HIPAA compliance and things of that nature. What have you seen? So yeah, we're pretty compliant. We have all HIPAA compliant software. So we do have a BAA signed with Zoom. We do sign BAAs with all our clients as well. All our scribes, when they initially join our company, we undergo a three month, they undergo a three month training. And in that training, they have to do, we have like a HIPAA awareness course that they have to pass like a module. And we have a little safe, we

on our computers, our company devices, they have safeguards to make sure there's no screenshotting, none of those things could happen while the scribes are working on our devices. Usually, there is some problems when we go to bigger clients hospitals, they'll have to do a lot of security audits. I'm actually going through one right now. So we have multiple meetings with their IT team going through how we connect in all these things, but

Yeah, usually it's just a long process, but luckily everything's simple, compliant and everything. We haven't had any problems so far. Yeah. Knock on wood.

Coach JPMD (15:01.78)
And are you doing any surveys for patients are within the practices that you're you're you're providing the services for? Because I just thought about this as I'm as I'm talking to you, you know, what are the patients saying? I actually haven't haven't done that. Usually I've just it's been very hard. Usually I try to surveys to providers to none of them answer. So I never really thought to ask the patients how how they feel about that, because definitely some of them might feel

some change, some of them, I know some providers tell me themselves that they get more of a personal visit, they don't have to spend time on the computer. So definitely patients would acknowledge that and notice that difference. So I would be interested probably to see some sort of survey like that to see how patients feel about it. Okay, and I did not get a survey from you, so please. Okay, I'll say, I think yeah, so I actually kind of scrapped that when I kept doing it, it was kind of negative and

my scribe team, they would be like, why is no one giving positive feedback or any feedback to us? Are we doing good? I was like, yeah, let's just hold off on this for a while.

So I have to give a disclaimer because I probably didn't give a disclaimer at the beginning of this. VB scribe is my scribe company after I lost my, my, live scribe. And like I, like I've, I can tell everyone that I, that I coach or that I help, I'm looking to help physicians decrease stress, increase revenue. so if we can have them do something for their practices that allows them to free their time up so that they can care for the patients more powerfully, that's what we're trying to do. And so my idea is to bring

my or our ecosystem of providers of wise counsel people who can help a physician really practice impossible right because that's what we try to do we try to help them understand things that they can do that they certainly weren't taught in medical school because I did I was not taught about scribes in medical school so so where do we find you where

Coach JPMD (17:01.332)
How we find you if we wanted to learn more about your services? Yeah, you could find me on my website. It's VP Scribe. So V as in Victor P as in Paul and scribe .com. VP scribes as well .com. You could search us on Facebook. We have our company page there as well. yeah, once you look on our page, you could pretty much put your information there and you could schedule a meeting with me to see how.

Scribing services could work for your practice and we'll have some we'll have the links to the To your websites as well. I think there there is a at least I I don't know if you're still offering it But I'm gonna throw it out there, but you gave us a two -week two -week free consultation or free scribe service For providers and that was really that was really the key to me converting because it was either I continued the way I was doing things three years ago and Seeing you know 15 20 patients managed care difficult patients

by myself and finishing my notes or hiring another company that can help me do that. So one thing, one question I like to ask my guests.

is it's related to the one thing that Gary Keller, he wrote a book called The One Thing and it's what the what's the one thing you can do such that by doing it, it makes everything else easier or unnecessary. But I'm going to change it around a little bit and ask you, what's the one thing you wish that you're that you could change about your father's practice right now? I think I kind of alluded to this earlier. Right now.

It's very difficult for him to live a day without a scribe. He's so, so very reliant on it. That scribe, I feel a little bad for her. She got married during these three years and not very much vacation time, I could tell. So, I mean, I think he works usually four and a half days a week. So I think he needs to lighten his schedule a little bit more. My brother actually just joined his practice and

Coach JPMD (19:06.03)
he was telling me he's complaining. He's just six months in that he's already having a full schedule. He's like needs an NP already. So he's like, I see my, my colleagues, my classmates just starting in other and other clinics and they just see maybe five, 10 patients a day and he's already at 25 to 30. So he's, he's stressing out too. So definitely love to help them out with describing service, but yeah, I mean, they're, too busy. They're too busy people.

Their scribes are now kind of integrated in their lives. So now whenever my dad's taking vacation, he'll let his scribe know, for July 4th, I'm going here. Plan your vacation accordingly. So pretty much it's hard. I've been trying to pair other people have backup scribes for him, but him and his scribe have a good chemistry and she knows kind of what he means by when he's talking to the patient and what he's looking for. So they have that kind of

the same wavelength, so it's hard to kind of change that. Well, it's all about establishing a relationship, right? So he's got a great relationship with his scribe and that's kind of that that goes a long way in practicing medicine. So maybe hopefully his office staff with MAs could do a little bit more to his scribe.

So there you have it. That's a conversation from 2022. And I'm still using VP Scribes at this time. I'm not an affiliate, so there is no affiliate arrangement. I just wanted to share that, share something that I've been doing in my practice has helped me tremendously. And there's two schools of thought on Scribes.

actually maybe now there's three schools of thought. There's an in -person scribe where the person sits in the room with you and documents everything that you say and creates a note, which I think is really expensive these days and difficult to find. And then the second school thought is virtual scribes. And you can have virtual scribes that

Coach JPMD (21:10.752)
in country or they're offshore. And VP Scribe does use offshore resources. And as you heard, many of the resources that they use are well -educated resources that are able to understand the lingo and are able to understand documentation. And it's worked well for me. But what about AI? What about artificial intelligence? So I've done some research on that and I did some digging and there are tons of companies popping up.

And I use chat GPT for some things, in the podcast world, as well as, you know, my brother told me that he actually used, chat GPT to, to write a review for an employee, which I thought was pretty interesting. he entered, some prompts and was able to have his employee review or reference generated in chat GPT. And I think that that's fascinating

it's a big time saver for things that may be a little bit mundane and time -consuming for business owners or people in the business world. But in healthcare, how would that work? So the companies that I research charge a monthly fee.

And they require that the physician actually uses their phone or recording device during the visit. That recording device then is hooked up, I guess, to their servers and their AI software that AI software is connected to the web and it spits out a document that is templated.

on a webpage and depending on your EHR system and depending on the AI software company, that template will then get transferred or integrated with the EHR. At least that's what I understand. I don't use the software, so I'm not sure if, how the integration works. But the thing that came to mind when I was looking at these softwares is number one, cost. Yes, there's a fixed cost to it, but

Coach JPMD (23:19.594)
Are they going to upcharge you for additional patients that you see? I'm not sure how that works. Is there a cost to integrate with the EHR? Pricing was definitely not transparent on many of the sites. Some of them saying that they, if you have more than certain number of patients or a certain number of hours, you have to contact them for pricing. So that wasn't as transparent as I would have hoped that it would have been.

But one of the biggest downsides, I think, of AI is the fact that you still have to review the note. So the notes are generated by the computer and you have to hope that that is generated to your liking. there's a lot of review that I think would have to happen. And it almost seems as though it's like a glorified transcription service to the computer. And if you

anything about medical legal issues, you know that if that computer does not generate the right node or doesn't doesn't document or order tests, or, or transcribe things correctly, that becomes part of the medical document. And it's a legal document. So can you sue the AI company? Can you sue the AI software? I'm not sure how that would work.

So that is one of the biggest downfalls, I think, as far as having an in -person scribe. I have trained that scribe and have been working with the scribe pretty much every day to have them document the notes the way I want them documented. And yes, there is a review process at the end, but it's a live review. I feel that if you're using an AI software,

and you see that there is a mistake, and you're going to have to go back and type or correct those mistakes, as opposed to dictating those corrections to your scribe. So that's my take on AI scribing. Now I might be crazy, you might think I'm crazy for thinking that AI is not going to take over the medical transcription business. And that may be true. But I think that most physicians, at least the physicians that I've spoken to, they want

Coach JPMD (25:43.246)
that touch, personal touch when documenting and dealing with patient information. And I certainly would not want my information recorded on a phone and transmitted on the web

you know, there, there was going to be some security risks associated with that. So that's my take on AI scribes. And I hope that you will take some of this information and do your own research and understand how a scribe can help you decrease your stress and improve your documentation. Thanks for listening. And if you want to get alerts when new episodes are released, don't forget to subscribe or follow this podcast on your favorite podcast app.