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Any of you scribes before PA school and what school did you go to?


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Let me provide some framework for my answer. I have a PhD in physical chemistry and have been involved in the medical profession most of my career, much of it as a laser tech in my own laser rental business. My interest in the PA profession is that my daughter is now applying for admission to PA schools (mostly in Texas) and I spent the past year coaching her, more because its fun for me than because I am indispensible as her coach. She chose to get her health care experience as a scribe and called all of the Texas schools plus LSU to be sure her experience would be accepted. They all agreed that a scribe counted as HCE. I can also tell you that her scribe experience has been an incredible education. After one year, she has learned how to take a patient history and knows what tests to prescribe for any number of patient complaints or presentations. From the tests she can often arrive at the correct diagnosis and treatment plan, though that isn't her job. She sees both main ER and Fast Track patients everyday keeps all the MDs notes in the hospital's electronic records system and often relays information back to patients, nurses and hospitalists. I should add that she volunteers 4 hours per week at an understaffed clinic for the uninsured where her role is medical assistant/lab tech and anything else that needs to be done (not requiring a license of course.) She now has interviews at half the schools she applied to and, I believe, will end up with interviews at most all of them. I know there are many ways to get HCE. Some have more direct hands on contact like EMTs and physical therapists among many others, but if you choose to become a scribe you should not be at any disadvantage. If any school says they won't accept "scribe" as HCE, they probably don't know what scribes actually do. Good luck!

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  • 1 year later...

My only HCE when applying for PA school was working as a medical scribe. I applied to 15 schools (overkill, I know), and was offered interviews to 12. I was careful with my research and reached out to programs I was interested in to see if they accepted scribing hours if it was not already expressly stated on their website. There were also some programs that did not require HCE. You can PM me if you want the list of programs I applied to!

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Not going to weigh in on whether scribing is good HCE for PA school, just want to make one observation. The scribes in the ED I work at (only the docs get one) seem to be trained to upcode rather than document an accurate ROS and exam. Hence I see a lot of charts for an ankle sprain with a 12 point ROS and a full cardio/pulm/abdomen exam checked as "normal." I find this to be unethical and I will never document a something I didn't exam. The medical chart is a legal document and should be an honest representation of the services you have provided the patient. It's a slippery slope... small ethical compromises lead to bigger and bigger cheats so to speak. Also I fear one day I will check "RRR no m/r/g" on an ankle sprain and one day the patient will come back in acute heart failure with raging systolic murmur and I had check "normal" on a previous cardio exam.

 

My point is that at least with the scribes I work with... They are trained to "cheat" before they ever learn the correct way of doing things. It just seems like you could pick up some bad habits from the outset.

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I'm a first year student at Emory and there 5 or 6 of us that did ER Scribe work before. Both Emory and GWU accepted it as pt care hours. Very good prep work for school. I also had some other hands on work but my 3+ years as a scribe was the majority of my hours. Good luck!

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Not going to weigh in on whether scribing is good HCE for PA school, just want to make one observation. The scribes in the ED I work at (only the docs get one) seem to be trained to upcode rather than document an accurate ROS and exam. Hence I see a lot of charts for an ankle sprain with a 12 point ROS and a full cardio/pulm/abdomen exam checked as "normal." I find this to be unethical and I will never document a something I didn't exam. The medical chart is a legal document and should be an honest representation of the services you have provided the patient. It's a slippery slope... small ethical compromises lead to bigger and bigger cheats so to speak. Also I fear one day I will check "RRR no m/r/g" on an ankle sprain and one day the patient will come back in acute heart failure with raging systolic murmur and I had check "normal" on a previous cardio exam.

 

My point is that at least with the scribes I work with... They are trained to "cheat" before they ever learn the correct way of doing things. It just seems like you could pick up some bad habits from the outset.

 

I find this odd. I mean we are trained about what sort of ROS/exam, etc is needed for certain levels of charts - and we are told they are things the provider should be doing but we are also told not to put anything in the chart that the provider didn't do...

 

So I'm not sure why your scribes are... Sounds more like a management/training problem. I would take it up with your higher ups but I wouldn't necessarily blame the scribes who are making near minimum wage to do something they're told. I agree with you that it is unethical and our supervisor before this current one really did pressure us to have at least 10 ROS, 2 exam findings per system, etc or get audited.

 

ALSO UPDATE: I've gotten into 4 different schools with scribe work so thanks everyone for the responses.

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anyone who checks the "all other systems reviewed and neg" box is stretching the truth. do you always ask every dental pain about dysuria and joint pain?  didn't think so.

I liked working with a (free) scribe but I made corrections to every chart. we had very different ideas about no/mild/mod/severe distress was for example. Just saying "this is the worst pain ever" (while texting and eating dorritos) with nl vs and a complaint of hangnail or chapped lips shouldn't qualify for checking the "severe" distress" box. that is "no distress".

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And while you think scribes are picking up bad habits, just to play devils advocate, the number of times I have had to awkwardly ask providers in the hospitalist group about systems they didn't check which pertain to the chief complaint... Just saying.

 

Patients with bilateral LE cellulitis that the provider didn't look under the blankets to assess... Patients in arrhythmia, yet the heart wasn't checked... Hypoxia and no auscultation of the lungs...

 

I've also had providers tell me scribes help make them more thorough. So don't just only bag on scribes.

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And while you think scribes are picking up bad habits, just to play devils advocate, the number of times I have had to awkwardly ask providers in the hospitalist group about systems they didn't check which pertain to the chief complaint... Just saying.

 

Patients with bilateral LE cellulitis that the provider didn't look under the blankets to assess... Patients in arrhythmia, yet the heart wasn't checked... Hypoxia and no auscultation of the lungs...

 

I've also had providers tell me scribes help make them more thorough. So don't just only bag on scribes.

agree. folks should do good exams and document what they actually did. As a scribe how often do you say " um, shouldn't you listen to the heart if their complaint is irr heart beat" (outside the pts hearing of course)?

what I think many of the scribes often miss are nuances of patient: provider interaction. If the pt has 15 unrelated complaints and the provider says "ok, what brought you in TODAY" that should be the focus of the note, not the unrelated back pain since 1964 if the are really there for a painful rash on their left arm.

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Not going to weigh in on whether scribing is good HCE for PA school, just want to make one observation. The scribes in the ED I work at (only the docs get one) seem to be trained to upcode rather than document an accurate ROS and exam. Hence I see a lot of charts for an ankle sprain with a 12 point ROS and a full cardio/pulm/abdomen exam checked as "normal." I find this to be unethical and I will never document a something I didn't exam. The medical chart is a legal document and should be an honest representation of the services you have provided the patient. It's a slippery slope... small ethical compromises lead to bigger and bigger cheats so to speak. Also I fear one day I will check "RRR no m/r/g" on an ankle sprain and one day the patient will come back in acute heart failure with raging systolic murmur and I had check "normal" on a previous cardio exam.

 

My point is that at least with the scribes I work with... They are trained to "cheat" before they ever learn the correct way of doing things. It just seems like you could pick up some bad habits from the outset.

 

That is definitely bad practice. I am a scribe and ONLY document the services I see being provided and not one of the providers I work with lie about what they did. They will tell me specifically to leave out the parts of the examination they did not perform.

We don't have a boxes to check for normal examinations, it is all typed up differently for each patient, so maybe that helps. I am not trained to cheat. 

 

To answer the OPs question, I have received interview invites with scribe HCE. I have learned so much as a scribe. The providers I work with take some time to explain why they are doing what they are doing, what certain lab results mean. They will point out findings on imaging. I actually form the entire MDM/Clinical decision making course on my own. It is such an educational experience. I am at the head of the bed during some traumas. I have seen many, many medical complexities. 

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I know this is NOT the point of this thread, but I just want to say a lot of you have hit the nail on the head with the problems with scribes... a lot of them are not trained well enough to know many things:

 

1. What the provider wants in the note/what the pt is really there for (this comes with time/experience) from patient interaction- most scribes eventually (in my experience) learn to distinguish the poor historian's nonsense story from their true complaint (as well as the severity)

2. What parts of the physical exam the provider did and how much ROS they need to check (some physicians will try to get them to upcode the chart, and some scribes are not contentious about paying attention to what was actually done/asked about)

3. Scribes also often miss other parts that are critical like: documenting EKG reading on chart if pt came in with chest pain/irreg heart beat!

4. VOCAB- With dictation, I often saw scribes confuse terms that they did not know and make them into words they did (like patients do with fibroids of the uterus= fireballs of the eucharist)--- I saw "biliary obstruction" as "belly area obstruction" and "ambulatory" meant "pt came in by ambulance"...

 

Most of these things get better with time. I would imagine that a scribe would initially slow you down, but I found that after a period of time, my doctors began to trust me and we could move faster. The doctors would only occasionally mention things like "be sure to put in X" or sometimes "please focus on X instead of the Y because Y would need a totally different workup and they are really here for X" 

 

Scribes can be great, but new scribes (even ones that are working with a new provider) need to work with the provider for a long time before they can really be great and increase your productivity.

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  • 2 weeks later...

To get a job as a scribe, is the best route to get training with one of the large programs (Scribe America, Elite, etc) and get a position through them, or is it possible to get a job independently by applying directly to a hospital (after getting scribe certification from an on-line course)? Thanks for any insight you can give.

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To get a job as a scribe, is the best route to get training with one of the large programs (Scribe America, Elite, etc) and get a position through them, or is it possible to get a job independently by applying directly to a hospital (after getting scribe certification from an on-line course)? Thanks for any insight you can give.

 

I work for an independent company who employs physicians/scribes that the hospitals have a contract with. So it depends on the area. Some of those large programs pay very well. Look through craigslist.

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To get a job as a scribe, is the best route to get training with one of the large programs (Scribe America, Elite, etc) and get a position through them, or is it possible to get a job independently by applying directly to a hospital (after getting scribe certification from an on-line course)? Thanks for any insight you can give.

Though I can't answer your broader questions, I can tell you that my daughter scribed in the ED at Trinity Mother Frances hospital in Tyler, Texas. They have their own program and do their own training. To be a scribe there, you apply to the hospital and become their employee. Not sure how other programs work.

 

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  • 2 months later...

My only HCE when applying for PA school was working as a medical scribe. I applied to 15 schools (overkill, I know), and was offered interviews to 12. I was careful with my research and reached out to programs I was interested in to see if they accepted scribing hours if it was not already expressly stated on their website. There were also some programs that did not require HCE. You can PM me if you want the list of programs I applied to!

I'm not sure how to personal message but I just got a job as a scribe and am in the process of applying to PA school as we speak so I was just wondering if you could send me the list of programs you applied to??

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University of Florida will accept scribe experience. I do not know how many scribes they admit, however. The classes tend to have a variety of HCE backgrounds, so I wouldn't get too wrapped around the axle on that detail. It's a combination of factors that will decide whether or not a person is extended an interview.

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