Scribes

[Groove]

How many of you work without scribes? I’ve gotten really spoiled over the past few years in that the cost of the scribe was paid by my CMG but recently it has been decided by the powers that be that the cost will come out of the physician’s pocket. It’s roughly $15/hr. There are a couple of docs that decided to forego using them entirely and seem to have done fine. For a long time in my career, I didn’t use one and did just fine. Lately though, I’ve definitely grown to appreciate the merits of having someone there to not only document, but do all my scutwork (remind nurses/techs to draw labs, fetch EKGs, call radiology and check on the status of a CT, hell...I even have them page the hospitalist for me if the unit secretary is on a smoke break.)

We’ve had about 2 months of trialing this new system out and I’m basically losing $2K/mo and almost $25K/yr. My numbers have always stayed steady over the years and fluctuate anywhere from 2.1pph to 2.3pph. I definitely feel less stress during and after a busy shift when I have a scribe and that part has been really nice. However, I don’t know if I can stomach the loss in salary. I mean, no scribe is worth that to me, no matter how good they are.... Plus, I kind of like knowing that my chart will completely reflect my own history, physical and exam. That being said, our scribes are very good and can “fluff” my chart with all types of stuff that I might not have time to add on my own if I were doing them 100%. They are also super fast and I can see 5 patients quickly, 2 of which I want to dispo immediately and they have the completed chart to me definitely faster than I could do it on my own.

What do you guys think? Get rid of them entirely and go back to 100% charting on my own? It’s worth mentioning that we have dragon dictate installed recently, so I can dictate on my phone or on the computer mic. I’m decent with dragon but not an expert as I don’t know a lot of the fancy shortcuts. I basically just click where I want the text to go and dictate. Most of the time, I haven’t used dragon because I’m a fast typer and the scribes are doing the majority of the text input in my chart so it would be somewhat of a workflow change for me.

Ugh, I hate change but damn.....$2k/mo? Ugh.

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[BoardingDoc]

How many of you work without scribes? I’ve gotten really spoiled over the past few years in that the cost of the scribe was paid by my CMG but recently it has been decided by the powers that be that the cost will come out of the physician’s pocket. It’s roughly $15/hr. There are a couple of docs that decided to forego using them entirely and seem to have done fine. For a long time in my career, I didn’t use one and did just fine. Lately though, I’ve definitely grown to appreciate the merits of having someone there to not only document, but do all my scutwork (remind nurses/techs to draw labs, fetch EKGs, call radiology and check on the status of a CT, hell...I even have them page the hospitalist for me if the unit secretary is on a smoke break.)

We’ve had about 2 months of trialing this new system out and I’m basically losing $2K/mo and almost $25K/yr. My numbers have always stayed steady over the years and fluctuate anywhere from 2.1pph to 2.3pph. I definitely feel less stress during and after a busy shift when I have a scribe and that part has been really nice. However, I don’t know if I can stomach the loss in salary. I mean, no scribe is worth that to me, no matter how good they are.... Plus, I kind of like knowing that my chart will completely reflect my own history, physical and exam. That being said, our scribes are very good and can “fluff” my chart with all types of stuff that I might not have time to add on my own if I were doing them 100%. They are also super fast and I can see 5 patients quickly, 2 of which I want to dispo immediately and they have the completed chart to me definitely faster than I could do it on my own.

What do you guys think? Get rid of them entirely and go back to 100% charting on my own? It’s worth mentioning that we have dragon dictate installed recently, so I can dictate on my phone or on the computer mic. I’m decent with dragon but not an expert as I don’t know a lot of the fancy shortcuts. I basically just click where I want the text to go and dictate. Most of the time, I haven’t used dragon because I’m a fast typer and the scribes are doing the majority of the text input in my chart so it would be somewhat of a workflow change for me.

Ugh, I hate change but damn.....$2k/mo? Ugh.

Can't answer what is right for you but I have never used a scribe and as a result I've become very efficient at charting and I have the benefit of knowing exactly what all my charts say. If you offered me the services of a scribe right now for free, I'd say no.

 

[GonnaBeADoc2222]

I work at two different shops, both with excellent scribes. They make my life easier and less stressful.

Are you RVU based in anyway? If so, need to think about the cost of the scribe vs the value of the RVUs you generate with them.

If you are straight hourly, I would forego the scribe, and drop my productivity by 1 pph. No sense in busting your a** and taking documentation home in order to satisfy crazy metrics that you aren't afforded the resources to meet.

 

[Groove]

I work at two different shops, both with excellent scribes. They make my life easier and less stressful.

Are you RVU based in anyway? If so, need to think about the cost of the scribe vs the value of the RVUs you generate with them.

If you are straight hourly, I would forego the scribe, and drop my productivity by 1 pph. No sense in busting your a** and taking documentation home in order to satisfy crazy metrics that you aren't afforded the resources to meet.

I’m 100% RVU. However, my productivity has remained the same over the years regardless of whether I had a scribe or not. The extra RVU from having a scribe argument is what I used to rationalize keeping them but the reality when I look back historically is that my numbers always stay the same. We have 9 hour shifts and I’m always aiming for at least 21 pts. I have a feeling I would hustle a bit more but productivity would more than likely stay the same. I’d have to sit down and add a lot more custom macros to my EMR.

I use Cerner. I’m also religious about having 100% of my charts completed by the end of every shift and I generally never leave more than 30 mins after a shift. Worst case scenario is that I would have to spend a little more time charting and possibly finish a few at home, though I doubt it. In general, I think foregoing the scribe would only hurt me if I was seeing 2.5+pph consistently each month and I just don’t feel comfortable going that fast because it almost always leads to cutting corners and an increased reckless coefficient for me. Our APCs sop up the lower acuity so I’m generally seeing the sicker pts.

 

[GonnaBeADoc2222]

Are you 1099? If so can deduct as business expense.

 

[Groove]

Are you 1099? If so can deduct as business expense.

I’m 1099 but can’t deduct. We’ve checked on this...that would certainly make it more tolerable. In short, the CMG pays the scribe co directly. We are never actually paid the money for the scribes and then deducted for the expenditure, otherwise we could write that off as an expense. CMG gets to write it off but not us.

 

[Zebra Hunter]

I’m 1099 but can’t deduct. We’ve checked on this...that would certainly make it more tolerable. In short, the CMG pays the scribe co directly. We are never actually paid the money for the scribes and then deducted for the expenditure, otherwise we could write that off as an expense. CMG gets to write it off but not us.

So forego hiring a scribe through CMG and then hire your own scribe.

 

[martvubo]

So forego hiring a scribe through CMG and then hire your own scribe.

This is what one of the docs did when envision did the same at one of the sites I used to scribe. She paid a higher hourly than we were making, but it was less costly to her than envision would have charged her for us. Unsurprisingly, shifts working for her were better for everyone involved by cutting out the CMG.

However, she was older and not very savvy with the EMR and coding, so having us there enabled her to go a lot faster and bill better... it sounds like you get less benefit though

 

[GeneralVeers]

Envision used to include the cost of the scribe in my gross salary for the year. I had to look at my December totals for the annual cost of the scribe, but it certainly is a 1099 expense, as it's not reasonable to pay 37% tax on money that Envision has already deducted. Likewise with malpractice insurance.

 

[deleted497653]

I found scribes to not be as useful but missed them when I didn’t have them. Having someone start the note for me and populate all the non thinking parts certainly helps. However you can work without a scribe but you have to be very efficient about it. Less time to socialize and have to be militant to chart as soon as you see 2 patients instead of saving the charts for the end of the shift. I agree paying 2 k a month is a lot. Apollo used to make the docs pay for the scribes the same way... so seems like the same thing envision does.

 

[thegenius]

This has been said in the past, remember guys you pay for your scribe one way or another. Whether it's deducted from your paycheck, or it's built into your RVU, or your CMG just takes more money from you and pays for them themselves, bottom line is *you the doctor* pay for your own scribe.

Nuthin is free

 

[thegenius]

I use Cerner as well. If there was a way to easily import EKGs and all the imaging, the same way you can import lab results, then I would consider not using a scribe. But dealing with pulling in all the radiology and EKGs is such a time suck. Is it worth 25K / year? Perhaps.

 

[Groove]

Thanks for the input all. I'm still mulling it over... I'm going to have to run it by my CPA to make sure I can deduct the expense. Our regional president (who's not a CPA) was of the opinion that it couldn't be written off as an expense because the money is technically never coming out of our paycheck. I think his logic is flawed though... From my perspective, any money that is kept from me, in any capacity, through internal billing or otherwise and shunted towards a scribe company seems a legit expense. Now, whether I will be provided any tax or income documents to substantiate/justify filing it as an expense is another matter...

 

[filhodeinferno]

How many of you work without scribes? I’ve gotten really spoiled over the past few years in that the cost of the scribe was paid by my CMG but recently it has been decided by the powers that be that the cost will come out of the physician’s pocket. It’s roughly $15/hr. There are a couple of docs that decided to forego using them entirely and seem to have done fine. For a long time in my career, I didn’t use one and did just fine. Lately though, I’ve definitely grown to appreciate the merits of having someone there to not only document, but do all my scutwork (remind nurses/techs to draw labs, fetch EKGs, call radiology and check on the status of a CT, hell...I even have them page the hospitalist for me if the unit secretary is on a smoke break.)

We’ve had about 2 months of trialing this new system out and I’m basically losing $2K/mo and almost $25K/yr. My numbers have always stayed steady over the years and fluctuate anywhere from 2.1pph to 2.3pph. I definitely feel less stress during and after a busy shift when I have a scribe and that part has been really nice. However, I don’t know if I can stomach the loss in salary. I mean, no scribe is worth that to me, no matter how good they are.... Plus, I kind of like knowing that my chart will completely reflect my own history, physical and exam. That being said, our scribes are very good and can “fluff” my chart with all types of stuff that I might not have time to add on my own if I were doing them 100%. They are also super fast and I can see 5 patients quickly, 2 of which I want to dispo immediately and they have the completed chart to me definitely faster than I could do it on my own.

What do you guys think? Get rid of them entirely and go back to 100% charting on my own? It’s worth mentioning that we have dragon dictate installed recently, so I can dictate on my phone or on the computer mic. I’m decent with dragon but not an expert as I don’t know a lot of the fancy shortcuts. I basically just click where I want the text to go and dictate. Most of the time, I haven’t used dragon because I’m a fast typer and the scribes are doing the majority of the text input in my chart so it would be somewhat of a workflow change for me.

Ugh, I hate change but damn.....$2k/mo? Ugh.

I have 2 diff jobs. Both Cerner. One with scribes, one with Dragon. The scribes are great, and I love them, but if forced to choose between the two, I'll take a dictaphone.

 

[GeneralVeers]

Thanks for the input all. I'm still mulling it over... I'm going to have to run it by my CPA to make sure I can deduct the expense. Our regional president (who's not a CPA) was of the opinion that it couldn't be written off as an expense because the money is technically never coming out of our paycheck. I think his logic is flawed though... From my perspective, any money that is kept from me, in any capacity, through internal billing or otherwise and shunted towards a scribe company seems a legit expense. Now, whether I will be provided any tax or income documents to substantiate/justify filing it as an expense is another matter...

Make sure you look closely at your paycheck. Every month I would have a "net pay" deposited in my bank account, but the gross income reported to the government was higher because they were reporting the income before deducting malpractice and scribe. If these two figures are reported out separately, look at your December pay stub, and that should be your total for the year. I deducted both from the gross income as a business expense.

 

[RustedFox]

I use Cerner as well. If there was a way to easily import EKGs and all the imaging, the same way you can import lab results, then I would consider not using a scribe. But dealing with pulling in all the radiology and EKGs is such a time suck. Is it worth 25K / year? Perhaps.

Every CERNER build is different, but this works for me:

1. Open the radiology interpretation window.
2. Click on the top-left box to "select all", or highlight only the reads you want included.
3. Click the "copy" box in the toolbar.
4. Close window.
5. Open "Other" under radiology reads.
6. Left click and paste.

You can import multiple interpretations at once this way. Huge time-save. Having to copy/paste each radiology read is a super pain-in-the-ass.

 

[thegenius]

Thanks for the input all. I'm still mulling it over... I'm going to have to run it by my CPA to make sure I can deduct the expense. Our regional president (who's not a CPA) was of the opinion that it couldn't be written off as an expense because the money is technically never coming out of our paycheck. I think his logic is flawed though... From my perspective, any money that is kept from me, in any capacity, through internal billing or otherwise and shunted towards a scribe company seems a legit expense. Now, whether I will be provided any tax or income documents to substantiate/justify filing it as an expense is another matter...

I too would be extremely surprised if you could write off an expense that you don't pay.

The IRS wants to know if you paid for the scribe directly with your own money out of your bank account. If you consider yourself paying them, then they might be an employee of you....and then have to pay unemployment taxes, etc. Like a nanny. You can't just pay a nanny some money and be done with it. If they make more than a certain amount then they are considered employees...you have to pay payroll taxes on their money, withhold money, give them vacation time etc.

Anyway....I'm not sure it really matters because your tax burden will probably be the same (more or less)...

Say your CMG pays the scribes ($25K/year) and you make $350K/year.
If you want to pay the scribes, the CMG has to give you that money.

So now you make $375K/year....and you get to deduct $25K as an expense so now you are paying taxes on $350K/year. What's the big difference?

 

[thegenius]

Every CERNER build is different, but this works for me:

1. Open the radiology interpretation window.
2. Click on the top-left box to "select all", or highlight only the reads you want included.
3. Click the "copy" box in the toolbar.
4. Close window.
5. Open "Other" under radiology reads.
6. Left click and paste.

You can import multiple interpretations at once this way. Huge time-save. Having to copy/paste each radiology read is a super pain-in-the-ass.

Do you use Firstnet or Cerner / Powerchart?

 

[lucid_leprechaun]

Do you use Firstnet or Cerner / Powerchart?

/rads works for my Cerner build, not sure if that’s universal.

 

[Perrin]

/rads works for my Cerner build, not sure if that’s universal.

We have that in our build and I made a dragon shortcut to import the results. Another option, if you can highlight the text in the report is to Ctrl+C and then Ctrl+V it into your chart. That is what I did in other systems.

 

[GeneralVeers]

So now you make $375K/year....and you get to deduct $25K as an expense so now you are paying taxes on $350K/year. What's the big difference?

Because EmCare reports $375/year of salary to the government. Paying taxes on $350K is much better, and will save you about $5000. Emcare doesn't tell you to deduct the cost of the scribe from your gross. I had to figure it out, and in fact a lot of the docs working at the site had never done it, and as a result overpaid the government for years.

 

[Mister Significant]

I currently am a scribe, and paying 15 dollars per hour for them is way too expensive. You could definitely get away with paying them 10 dollars an hour.

 

[Groove]

Every CERNER build is different, but this works for me:

1. Open the radiology interpretation window.
2. Click on the top-left box to "select all", or highlight only the reads you want included.
3. Click the "copy" box in the toolbar.
4. Close window.
5. Open "Other" under radiology reads.
6. Left click and paste.

You can import multiple interpretations at once this way. Huge time-save. Having to copy/paste each radiology read is a super pain-in-the-ass.

Dude, you need the following smartphrase:

[ * Radiology ] (without spaces)

I have that as part of my ".rad" smart phrase and anytime I want all the rad results dumped into the chart, I just go into the note and type .rad

It will populate anything that has been formally read within Cerner. I think it goes back 24 hours.

 

[TooMuchResearch]

Or just don't blow in the radiology reports.
Say you reviewed the imaging, write the pertinent part of the report (no appy, colitis, obstruction, or other acute pathology).


SDG has a scribe for me at the busier places. They're helpful when busy if you use them right.
Keep them at the desk, dictate the history to them, have them time stamp stuff for you.
Honestly, I'm faster without them.

 

[RustedFox]

Dude, you need the following smartphrase:

[ * Radiology ] (without spaces)

I have that as part of my ".rad" smart phrase and anytime I want all the rad results dumped into the chart, I just go into the note and type .rad

It will populate anything that has been formally read within Cerner. I think it goes back 24 hours.

I'll try this - but other "smartphrases" have never worked in the past.

 

[Groove]

I thought of this thread while my scribe fetched EKGs, updated vital signs and harassed nurses for me all day.

100% of my charts completed 10 mins before the end of my shift. Maybe it is worth 25K...

 

[TooMuchResearch]

Hmm, maybe I should get mine to start doing more tasks.

 

[KGflyboy]

Dude, you need the following smartphrase:

[ * Radiology ] (without spaces)

I have that as part of my ".rad" smart phrase and anytime I want all the rad results dumped into the chart, I just go into the note and type .rad

It will populate anything that has been formally read within Cerner. I think it goes back 24 hours.

You would save EM physicians an insane amount of time if you could break this down a little more for us. There was a thread a while back where people talked about how to import radiology reads in Cerner, and no one was ever able to find a good solution.

Can you clarify a few points and help us out? I'm probably not the only one interested.

What is that phrase within brackets? I've never seen any commands within Cerner like this. I've seen dot phrases, but what you wrote is not a dot phrase. Are you saying if you type [ * radiology ] (without spaces) it pulls in your radiology reports? If so, how did you set that up?

And why did you write that with spaces and then add a disclaimer saying (without spaces)? Do we or do we not need spaces to make that phrase work?

Thanks in advance. Radiology imports have been a huge time suck for thousands of EM physicians using cerner, and if you can explain your method it could help a lot people out.

 

[thegenius]

For you Cerner people....do you guys use an app called FirstNet? That is some bastard UI over Cerner / Powerchart. Just curious.

I use FirstNet so I don't know if that makes a difference or not with these commands above.

 

[KGflyboy]

For you Cerner people....do you guys use an app called FirstNet? That is some bastard UI over Cerner / Powerchart. Just curious.

I use FirstNet so I don't know if that makes a difference or not with these commands above.

Yes, I also use Firstnet. That is the ED version of the software here. There is an inpatient version called Power chart.

 

[GeneralVeers]

I used Cerner PowerChart at one location and that dotphrase doesn't work. The other site just switched to "dynamic documentation" which I hate. Dot phrases do work in Dyn Doc, and you can put .rads or .labs24hrs and it will populate in the note completely.

 

[RustedFox]

FirstNet user here too. I'll try out that rads phrase day after tomorrow.

 

[Groove]

You would save EM physicians an insane amount of time if you could break this down a little more for us. There was a thread a while back where people talked about how to import radiology reads in Cerner, and no one was ever able to find a good solution.

Can you clarify a few points and help us out? I'm probably not the only one interested.

What is that phrase within brackets? I've never seen any commands within Cerner like this. I've seen dot phrases, but what you wrote is not a dot phrase. Are you saying if you type [ * radiology ] (without spaces) it pulls in your radiology reports? If so, how did you set that up?

And why did you write that with spaces and then add a disclaimer saying (without spaces)? Do we or do we not need spaces to make that phrase work?

Thanks in advance. Radiology imports have been a huge time suck for thousands of EM physicians using cerner, and if you can explain your method it could help a lot people out.

Ok, I figured it out. It's not as simple as I posted. Also, for reference I'm a FirstNet Cerner user. Ok, here's what I do to replicate my smart phrase.

1) Go into your auto text manager (I call this your smart phrase manager, but that is more of an EPIC term..). The easiest way is to open up a note, click on MDM and go to the notes section and open it up as if you are going to type something. Look at the menu bar. Click on the following icon:

2) Click on the plus sign to start a new "smartphrase".

3)For "Abbreviation" type in .rads including the period. Put in anything for the Description. I put "Radiology Reports". Now, click in the empty text box to place the cursor as if you are going to type something.

3) Click on the following "Insert Template" icon. That will bring up your templates.

4) Within the search field, type "rad" to search for Radiology templates. I have one for Radiology. Select it. Now click "Insert".

It will insert some text in your auto text field that looks like [ * Radiology ]. Don't touch it. Just click save and voila...you're done.

Now, go back into your Notes section of the MDM and type .rads and hit enter. It will auto populate all the radiology reads into your note.

Let me know if it works.

Just for clarification on my earlier post, typing the text [ * Radiology ] and saving it will NOT work. You have to follow the method that I described.

 

[thegenius]

Ok, I figured it out. It's not as simple as I posted. Also, for reference I'm a FirstNet Cerner user. Ok, here's what I do to replicate my smart phrase.

1) Go into your auto text manager (I call this your smart phrase manager, but that is more of an EPIC term..). The easiest way is to open up a note, click on MDM and go to the notes section and open it up as if you are going to type something. Look at the menu bar. Click on the following icon:

2) Click on the plus sign to start a new "smartphrase".

3)For "Abbreviation" type in .rads including the period. Put in anything for the Description. I put "Radiology Reports". Now, click in the empty text box to place the cursor as if you are going to type something.

3) Click on the following "Insert Template" icon. That will bring up your templates.

4) Within the search field, type "rad" to search for Radiology templates. I have one for Radiology. Select it. Now click "Insert".

It will insert some text in your auto text field that looks like [ * Radiology ]. Don't touch it. Just click save and voila...you're done.

Now, go back into your Notes section of the MDM and type .rads and hit enter. It will auto populate all the radiology reads into your note.

Let me know if it works.

Just for clarification on my earlier post, typing the text [ * Radiology ] and saving it will NOT work. You have to follow the method that I described.

Oh man I got all excited and tried this....and it doesn't work. I do not have the Smart Template "* Radiology".

I also tried a different Smart Template for labs and that didn't work, just said no labs done for this admission date.

I need to talk to our IT people at my hospital and see if we can get this incorporated into our build.

Also want to a way to automatically import EKGs.



Basically...the entire note should be autopopulated with everything except
HPI
ROS
Exam
MDM / Re-eval
Disposition

 

[EctopicFetus]

I currently am a scribe, and paying 15 dollars per hour for them is way too expensive. You could definitely get away with paying them 10 dollars an hour.

NO offense but you clearly never ran a business or understand payroll taxes, recruiting, training.

 

[TooMuchResearch]

Oh man I got all excited and tried this....and it doesn't work. I do not have the Smart Template "* Radiology".

I also tried a different Smart Template for labs and that didn't work, just said no labs done for this admission date.

I need to talk to our IT people at my hospital and see if we can get this incorporated into our build.

Also want to a way to automatically import EKGs.



Basically...the entire note should be autopopulated with everything except
HPI
ROS
Exam
MDM / Re-eval
Disposition

Epic can even blow in the dispo for you, though I don't know a way to do it without a bunch of other crap coming with it.

 

[Groove]

Oh man I got all excited and tried this....and it doesn't work. I do not have the Smart Template "* Radiology".

I also tried a different Smart Template for labs and that didn't work, just said no labs done for this admission date.

I need to talk to our IT people at my hospital and see if we can get this incorporated into our build.

Also want to a way to automatically import EKGs.



Basically...the entire note should be autopopulated with everything except
HPI
ROS
Exam
MDM / Re-eval
Disposition

Damn, that sucks. See if your Firstnet installer can add them. I can’t imagine they are uncommon Smart Templates. We may have a newer build...

It might also be a permissions issue.

 

[cyanide12345678]

I thought of this thread while my scribe fetched EKGs, updated vital signs and harassed nurses for me all day.

100% of my charts completed 10 mins before the end of my shift. Maybe it is worth 25K...

I personally would pay the 25k. Charting sucks. I hate it. Job satisfaction goes down. I'm a better doctor, spend more time with my patients when I don't have to spend hours charting. Being an ER doctor is hard. I'm also willing to spend 12k a year to have someone drive me back and forth to my post residency job which is an hour away, have to talk to an accountant to make sure I can call it a business expense for a "personal assistant".

 

[ski89]

NO offense but you clearly never ran a business or understand payroll taxes, recruiting, training.

Not sure what you’re getting at. Granted it was about 5 years ago but I worked as a scribe before Med school for about 10-11$/hour. Pre-Med students are desperate for clinical experience. Some would even do it for free. If your hospital is within driving distance of a university with premed students, recruitment will not be a problem and you can definitely pay minimum wage

 

[NYEMMED]

Not sure what you’re getting at. Granted it was about 5 years ago but I worked as a scribe before Med school for about 10-11$/hour. Pre-Med students are desperate for clinical experience. Some would even do it for free. If your hospital is within driving distance of a university with premed students, recruitment will not be a problem and you can definitely pay minimum wage

Sure but what he is getting at is that you don’t know payroll taxes, recruiting, or training, which all cost money.

 

[ski89]

Sure but what he is getting at is that you don’t know payroll taxes, recruiting, or training, which all cost money.

I would love to hear how payroll taxes, recruiting, and training costs would offset a 33% wage reduction. Obviously some states have higher mimimum wage requirements and some EDs may be forced to offer higher wages based on lack of supply of eager pre meds. But most hospitals in major cities don't have this problem.

 

[CajunMedic]

For you Cerner people....do you guys use an app called FirstNet? That is some bastard UI over Cerner / Powerchart. Just curious.

I use FirstNet so I don't know if that makes a difference or not with these commands above.

We use FirstNet in the ED and Powerchart on the floor. Our Powerchart is set up for underscore commands. If I type "_xr" it shows the complete phrase "_xrdiagnostic reports", I can click and pull all the X-Rays in from the past 24hrs, same goes for "_ct", "_mri", and "_us"

It will be awhile before I'm back in the ED to test it out, give those a shot in FirstNet and see if they work for you

 

[Birdstrike]

How many of you work without scribes? I’ve gotten really spoiled over the past few years in that the cost of the scribe was paid by my CMG but recently it has been decided by the powers that be that the cost will come out of the physician’s pocket. It’s roughly $15/hr. ....

The truth is, the scribes salary always came out of your pocket. CMGs and any other physician group, make their money primarily from physician collections and out of that money is what you're paid from. In other words, your salary comes from your collections. So does your malpractice, health insurance, CME money and everything else. There is no other pot of money from which to take it from. Scribe salaries come from physician collections from your services. For them to imply they were taking the $15 from some magical pot of gold under a rainbow somewhere and not taking if from the pot of revenue from which they'd otherwise pay you, is BS.

What's more likely true: Previously they were giving you a scribe and paying you $15 per hour less than they otherwise could or would, yet not wording it like that, and not letting you know (what you should already know) that all physician salary and benefits comes from physician collections. Now, as a means of cutting your pay $15 more, they're trying to convince you it was a gift before. In other words, they were taking $15 per hour out of the pot physician collections, which is the pot of money available from which they could have other wise paid you $15 more (with no scribe) and are now wanting to charge you essentially $30 per hour for the scribe (the $15 they were always charging you + the $15 they're now admitting must come out of your salary).

This really isn't that hard. It's simple accounting. But the bottom line is, yes, they are cutting your pay and they're playing mind games in an effort to pacify you to that effect, just as they were in trying to gaslight you into not realizing they were cutting it before, to pay for the scribe you had.

 

[RustedFox]

I also do not have this .Radiology smart template.
Damn.

Oh well, my batch copy/paste technique still works.

 

[KeikoTanaka]

So, I skimmed through these responses, so I didn't get a huge grasp of the conversation. But, I will say this:

I'm a first year who was a scribe for 2 years prior to school. In order to make scribes "worth it" in my opinion, is you need to have a great Scribing "staff". My first 3 weeks of scribing was in a classroom at a computer learning ED Vocabulary, diseases, medications, anatomy, you name it. We were forced to take daily quizzes. 3 weeks! I came out as a Rockstar on the computer software (Epic) and although I had no idea what 80% of the medications were, I knew how to spell them!

So scribing is super awesome, but you need to have a good staff and presence of training to make it effective. I couldn't imagine hiring your own, you'd have to train each and every one of them from the ground up. As opposed to ScribeAmerica which had their own rotating classroom-style lectures which let anyone who just got hired catch onto the next "lesson" to begin working.

This obviously costs a ton of money contracting out the company to do all that, the hospital obviously had to supply all the laptops and resources and training locale as well.

I went on to work as a Medical Scribe for an outpatient private Orthopedic across the state. He loved me because I was a millennial who could obviously pick up easily on their software, but I just had amazing scribe experience with ScribeAmerica, so he didn't need to go into the vocabulary or anything like that, but he said after I got accepted to medical school: "I couldn't hire anyone else because Idk how to train them, I didn't need to train you, so I guess while this was a cool experiment, it's not feasible to continue having scribes here" and that was that. I feel like It's super dependent on provider and you need to be in a position that really enables the optimum learning for scribes to make it worth while.

 

[EctopicFetus]

I would love to hear how payroll taxes, recruiting, and training costs would offset a 33% wage reduction. Obviously some states have higher mimimum wage requirements and some EDs may be forced to offer higher wages based on lack of supply of eager pre meds. But most hospitals in major cities don't have this problem.

HOw many hours will a scribe work before they leave. I am talking an average FT and PT. Costs to train? The scribe manager, payroll company, advertising, Medicare and social security, biz insurance, state and federal unemployment. I can go on.

Also, while you are right in that you can often get scribes for free the issue becomes their loyalty. What will keep them there? I have worked with scribes for the last 8 years. We debated not paying them. It never made sense. For my groups it has been a small enough cost relative to benefit it made no sense. In certain markets it might work.

The fact that all that other stuff adds a lot to the cost of hiring and hourly average rate is important.

I would guess the average (all scribes hired) hours worked prior to leaving is under 2,000. I know some well over 6-8k hours. If every scribe makes it thru training then the training isnt tough.

 

[KeikoTanaka]

HOw many hours will a scribe work before they leave. I am talking an average FT and PT. Costs to train? The scribe manager, payroll company, advertising, Medicare and social security, biz insurance, state and federal unemployment. I can go on.

Also, while you are right in that you can often get scribes for free the issue becomes their loyalty. What will keep them there? I have worked with scribes for the last 8 years. We debated not paying them. It never made sense. For my groups it has been a small enough cost relative to benefit it made no sense. In certain markets it might work.

The fact that all that other stuff adds a lot to the cost of hiring and hourly average rate is important.

I would guess the average (all scribes hired) hours worked prior to leaving is under 2,000. I know some well over 6-8k hours. If every scribe makes it thru training then the training isnt tough.

Yeah. The scribes who stayed scribes where I was from only stayed Scribes because they weren't competitive enough for medical school, so they got rejected and were doing that while figuring out how to change their life direction.

 

[thegenius]

The truth is, the scribes salary always came out of your pocket. CMGs and any other physician group, make their money primarily from physician collections and out of that money is what you're paid from. In other words, your salary comes from your collections. So does your malpractice, health insurance, CME money and everything else.

You said it bro! Say it loud. I've been saying this for, umm, a few months.

 

[deleted836128]

I have worked most of my short career in emergency medicine without a scribe. As a result I am fast and efficient with documenting, and my charts don’t say crazy ish like a one year old is oriented times four. I had a scribe for a few months and found it not really helpful. The way they wrote the HPIs without a cohesive flow. The way they used weird abbreviations. Or the typos - man! Drove me nuts. Eventually I just had them do all the clicking and I would just do the HPI myself. But then I found that me reading through the chart to make sure they clicked the right stuff took just as much time if not more time as me doing the clicks in the first place. Basically, I find them useful for doing things like importing labs, running to ask the clerk to page someone for me, finding an EKG that has been missing, staying on hold with the transfer center. Other than that I don’t find them too essential and thus I prefer not to have one even if they are free! I was admittedly a little relieved when they took them away. I work better alone and in my zone.

 

[thegenius]

One other question, part of this thread was helping those Cerner folks with importing Radiology studies. Is there also a way, with smart templates, to automatically incorporate EKG's into the chart as well?