Linda Bosserman, MD
Linda Bosserman, MD, went on vacation recently with what she considered to be 50 hours of transcribing and other administrative work related to her oncology practice. She routinely puts in hours of work on documentation each night.
Bosserman thinks that having a medical scribe working alongside her each day, helping with the note-taking and computer entry portions of her job, would be ideal, except for the fact that she doesn’t believe medical scribes have enough training or capability to relieve oncologists of the type of complex documentation tasks they have to do.
Bosserman, a medical oncologist at City of Hope in Rancho Cucamonga in Southern California, believes that she’s not alone in her opinion. Based on her interactions with other doctors, she believes that scribes are rarely if ever used in the oncology profession. “The challenge in oncology is we’re trying to personalize cancer care with multiple cancers, multiple different stages, tumor types, and now this explosion of molecular diagnostics. That’s a huge amount of data you’ve got to pull together for every patient to figure out what the right treatment is and what their side effect management is. It’s hard to train people to know that much,” Bosserman says.
Bosserman, an efficiency expert who has served on numerous medical boards and committees and is a founding member of the Community Oncology Alliance, says scribes are becoming more commonplace in other areas of medicine. Scribes are becoming integral in emergency departments, and primary care doctors are reaping huge efficiency benefits by employing them, she says.
But oncologists can only stand by wistfully as their documentation needs grow and current electronic health record technology remains inadequate to the task of easing the workload, Bosserman says.
This worries her, as it indicates that oncologists have no source of relief, and that the profession is up against a serious problem: workplace overload.
“Burnout is associated with doing nonproductive work, administrative burden, authorizations, pre-authorizations, and notes,” she says. “The challenge in oncology is that you’re one-on-one with very sick patients, making decisions, and then you’ve got to go and capture all of this.”
Michael Murphy, MD
Michael Murphy, MD, CEO of ScribeAmerica, takes exception to Bosserman’s view that scribes have not penetrated the oncology profession and are not capable of working with the complex data that have to be recorded. Founded in 2004, ScribeAmerica has seen huge organic growth as well as growth through acquisition. The group now employs 7300 scribes across the United States in 950 hospitals and other health centers, according to Murphy. While ScribeAmerica would not indicate how many of those scribes are employed by oncology practices, Murphy contends the use of scribes in oncology has been roughly similar to that in other medical branches.
“I can’t really tell you the ratio of [oncology] growth compared with other specialties,” Murphy says. “All of the specialties seem to be growing pretty dramatically over the last few years, but we’re with some of the largest oncology groups in the country—Texas Oncology, 21st Century Oncology. These are some of the behemoths around the country, and then we’re with a lot of other, small hematology/oncology practices that are private or within big medical groups. So, it’s probably been the same pace as the other specialties of growth,” he says.
The biggest growth in scribe employment has been in the urology, cardiology, and orthopedics lines, Murphy says, while endocrinology has been slow to develop due to the high complexity of the field. “Most of the time their [patient] visits are a half hour or longer, and sometimes they just can’t really see more patients because they’re spending so much time trying to figure out the different pathways.” The same documentation needs that have plagued the oncology profession are contributing to the rising use of scribes across the board, Murphy says, echoing Bosserman’s sense that burnout is one chief reason physicians would turn to scribes if they could. “The physicians, when they come to us, they’ve just about had it and they’re ready to hang it up. They’re frustrated, they’re really just angry and just burned out,” Murphy says.