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Scribe as HCE


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So I'm finishing up my last semester of my Bachelor's while simultaneously taking an EMT-B course, and after noticing the difficulty in getting ER tech or EMT jobs, I've been looking at the possibility of working as a Scribe while also volunteering in the ED or as an EMT.  My question is how much does being a medical scribe count towards HCE?  I've seen some job descriptions from some hospitals that make it sound like there's absolutely no patient interaction, you're just sitting at a computer transcribing material or organizing patient files, etc.  Would this even count as HCE?  Obviously I want as much patient interaction as possible, but are there specific things I should be looking for or avoiding when looking for scribe positions?  And for those who have worked as a scribe for HCE - how long did you work, how much pt interaction was there, do you feel its really the best HCE or should I put more time into finding something more ED related?

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I can't tell you about how it is for PA school, because I haven't applied yet, but I found working as a scribe to be incredibly valuable as medical experience for me. It wasn't just "transcribing material or organizing patient files" where I worked. I would follow the doc around from pt to pt and write down the history and physical as we saw the patient. The doc would often just dictate his physical exam to me as he was doing it (describe the heart murmur as he hears it and then I write it). I would check that the orders were in the computer and that they were getting done in a timely manner. This meant that if the patient had abd pain and there was no order for abd x-ray or CT in the computer, I might ask "did you want an image of the abd on that lady in room 9?" and then if the doc said yes, I'd have him sign the order for it (eventually you learn which patients the doctors will want imaging of and which they won't). You also learn how to work with all the different healthcare professionals because you may have to call RT and ask them to come down, call radiology to ask if they could read a study quick, call the lab if they are running slow, remind a nurse/tech (who can touch patients, while you cannot) to do something clinical the doc wants done. It's difficult because you are really the lowest on the totem pole, but often speaking for the doctor- you really learn how to approach busy professionals with respect and get them to help you (some nurses/techs seemed to dislike scribes in general because scribes would "order them around" by delivering messages from docs- certain messages DO need to come directly from doc). This also gives you an understanding of how essential everyone is in healthcare. I would also keep an eye on the labs as they came back and might tell the doctor if one came back abnormal or if they all came back normal. This helps you learn when to alert them, when you initially start you think everything abnormal is critical to tell them ASAP, eventually you learn that they were expecting some to be abnormal and they are not super urgent (other labs ARE super urgent and you tell the doc right away). Finally, seeing the patients with the doctor usually lead to them helping you understand their thinking about the patient ("his story sounds really good for X or Y, but I think Z is likely because..." or "Did you notice how much sicker that patient looks than the one we saw last time? I can tell you now that I want to admit them...")  I don't know how all schools view it, but I honestly would do it if I were you... my experience was really good (if you couldn't tell from this long response....)  Hope this helps!

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You need to verify with the schools you are applying to. Scribe is often, but not always, accepted as HCE. TeacherPA had the kind of scribe experience you want. Sitting at a computer transcribing may be accepted but you will learn so much less. Scribes with the right experience seem to do very well in PA school.

 

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do a search here on scribe experience. it is viewed differently by different programs and not universally accepted. while it is acceptable at several programs I don't think anyone would go so far as to call it "the best hce" as that would be something more along the lines of nurse, paramedic, resp. therapist.

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i'm a scribe, and it's not direct patient care experience obviously, you aren't supposed to interact with patients, but it was considered health care experience, and the programs i got interviews at really liked it, and somewhat more obviously the programs that accepted me stated that they really liked the scribe thing. not all programs will, direct patient care is definitely better, but scribe is generally still HCE. of course maybe it depends what kind of scribe you are, i'm a medical scribe in the ED, so I follow the doctors/pa's around while they see patient's and write their charts for them while observing everything, ie hpi/exams/mdm/discharge, etc. You're description of a scribe sounds more like a medical transcriptionist which is different from a scribe to my knowledge, as in it sounds like you would sit at a computer and write things up completely separated from the patients and physicians

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i'm a scribe, and it's not direct patient care experience obviously, you aren't supposed to interact with patients, but it was considered health care experience, and the programs i got interviews at really liked it, and somewhat more obviously the programs that accepted me stated that they really liked the scribe thing. not all programs will, direct patient care is definitely better, but scribe is generally still HCE. of course maybe it depends what kind of scribe you are, i'm a medical scribe in the ED, so I follow the doctors/pa's around while they see patient's and write their charts for them while observing everything, ie hpi/exams/mdm/discharge, etc. You're description of a scribe sounds more like a medical transcriptionist which is different from a scribe to my knowledge, as in it sounds like you would sit at a computer and write things up completely separated from the patients and physicians

and this, in a nutshell is why scribe is not generally accepted as HCE. there is no direct contact with patients. the scribe makes no independent decisions about pt care. there is no sense of risk or growth as a scribe. it is watching other people work...sure, you learn about decision making and developing a differential dx, but so does an er tech, nurse, etc, and they actually contribute to patient care...they learn procedures, they touch patients, they learn physical exam techniques....ever seen a scribe with a stethoscope? didn't think so...I think scribe is a great experience for someone who wants to go to medschool because they have a lot more time to learn how to be a clinician in their residency. PAs are supposed to have "the basics" of health care down BEFORE they start school....they should already understand the language and culture of medicine and know basic pt interaction skills and procedures...

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Haha... I stand corrected :). In that case, better find something PA schools are looking for. If you can fit it in, I still recommend being a scribe because it does give you valuable insight into the minds of PAs and Docs- but then, so does shadowing them extensively or asking them in this forum! Best of luck- finding CNA and EMT jobs near me is very hard, too! Maybe scribing in the meantime would be a good use of time?

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CASPA has one section specifically for "Patient Care Experience" and another for "Other Health Care Experience." Scribing falls into the "Other Health Care Experience" category. Many schools count scribing towards their "hours" requirement, but you definitely need to contact each school and ask. I had 3600 hours as a scribe (Other HCE), 300 hours as an ED Research Assistant (PCE), and 100 hours as an EMT (PCE) when I applied and I was asked to interview at 9 of the 16 schools I applied to. I interviewed at 5 of them and was accepted into all 5. Those 5 schools loved scribing. In my personal opinion, scribing (in the setting that TeacherPA and I were in) is way more beneficial than becoming an EMT (EMT-B). If you have time to become an AEMT (EMT-I) or a Paramedic then I would say the opposite. Granted this also depends on your states EMS system! In Nevada, EMTs can only work events...which means you hand out a whole lot of band-aids and treat a whole lot of drunks. If you can actually get on an ambulance and take 911 calls (which I got to do for my internship), then being an EMT would be the best experience, hands down. That's just my opinion. We'll see if it changes after starting PA school : )

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I second what EMEDPA said. I'm currently a scribe and was an EMT in the past. Scribing is great because you learn how the whole process of initial eval with history and physical, and then diagnostics and interpreting them. You learn how a provider thinks in terms of treating patients. You can see some cool cases too. But it's totally different than being in charge for the health and well being of another individual. Working as an EMT, CNA, respiratory therapist, etc lets you know if you can interact and have a proper relationship with patients. I'd do both if you could. They each give something unique

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Okay so it sounds like scribing is basically like glorified shadowing, but in some cases it can be more involved than others.  Thanks apples1035 for that example; I forgot to consider HCE vs PCE.  Sounds like I need to search hard for EMT positions but a good, involved scribe position may be worth my while in the meantime.

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My issue with much of the above and with countless other "scribe as HCE" threads on this forum is the apparent presumption that becoming a PA is a second or more advanced career that necessitates being an EMT, RT, CNA, etc. first. Those who have taken this path often seem to feel that scribing is inadequate HCE in preparation for PA school. Somehow, however, MA seems to get a pass. MAs do a combination of clerical, admin and clinical duties and I recognize their importance in the system but, let's face it, in most settings, their clinical responsibilities are de minimus. They speak with patients to update records, take histories and vitals. In a few settings their clinical responsibilities may be somewhat broader, but not by much. Being a scribe in a setting such as that described by TeacherPA is a far better learning experience because it offers considerably broader exposure and insight into clinical medicine.

Increasingly, PA, is becoming a first career and the purpose of prior HCE is changing. Broad exposure to the clinical setting, including working productively with a medical team can be just as good or, in some cases better preparation than more narrow exposure where you actually "touch" patients. Additionally, HCE that requires separate education and certification, such as EMT, is impractical for many PA aspirants. I submit that a solid background as a scribe, in the proper setting, can be excellent HCE and that fact is borne out by the increasing acceptance of scribe as HCE by the schools and by the proven success rate of these scribes in PA programs. I write this, not in an attempt to win the unwinable argument with EMEDPA and others of like mind, but rather to assure those who need HCE and don't have the realistic option of a first career as an EMT, that being a scribe can serve you well as your only HCE as long as your chosen schools have a positive view of scribes, and that is increasingly the case. The more threads you read on this forum, the more that will become apparent to you.

 

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Medical transcriptionists have been around for a long time. But medical scribing in the room, in real time with the clinician and the patient is a new thing - it only just started about 10 years ago with the advent of electronic health records. Lots of people who work in healthcare have no idea what a scribe does. Heck, some people in healthcare don't even know what a PA does and it's been 50 years since the first PAs were trained. It takes a long time for people to accept new ideas. 

 

I can tell you that, as a scribe, I generally have a better understanding of what's going on with a patient's current medical conditions than the LVN who works alongside myself and the pediatrician. The LVN will take the patient's vital signs and then come in to give the vaccinations, or give a nebulizer treatment, etc. But all the patient's history, how their asthma is doing, how the medications are working for their acne, what a specialist said what about the heart murmur or the upcoming surgery for undescended testes - all that I get to hear and learn about. I can read the previous note and understand that the patient is here for their follow up visit for ADHD evaluation, and I know that the parents should be bringing in Vanderbilt forms for the doctor to review. Sometimes I can type in the note which medications the patient will be prescribed before the doctor even says it. What I mean by all this is that many people do not yet realize how intimately involved scribes are. You cannot just type whatever rambles out of a patient's mouth. You have to organize all the information into problems and diagnoses which means you have to have an  understanding of what's being talked about during the visit. 

 

It is true that actually touching patients is a whole different set of skills. Because of my EMT training (though I never worked on an ambulance), at my current job they let me room patients and take vital signs. I was very nervous when I started doing this with little babies and newborns. But now it's fine. They won't let me give vaccines, but I could easily learn to do that with proper training. The hands on medical stuff is actually EASIER than scribing.

 

Sorry for the rant. If you can get hands-on patient care as an EMT or MA, or better yet a nurse or paramedic, then by all means get it. That's what most PA programs consider the best HCE. But if you get the chance to scribe you will really get a feel for what's going on in the clinician's mind. Some PA programs seem to be aware that scribing is valuable, and they are counting it as HCE.

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For scribes who really want some PCE, you may be able to find a (non paid) job at a free or low cost clinic where you can act as an MA. My daughter did that while scribing. She says she didn't learn a lot but was able to contribute a lot to people who needed it. BTW, she learned all the skills needed to do the MA work from scribing. Basically, she took histories and vitals, entered info into charts and helped out in the lab.

 

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I second what EMEDPA said. I'm currently a scribe and was an EMT in the past. Scribing is great because you learn how the whole process of initial eval with history and physical, and then diagnostics and interpreting them. You learn how a provider thinks in terms of treating patients. You can see some cool cases too. But it's totally different than being in charge for the health and well being of another individual. Working as an EMT, CNA, respiratory therapist, etc lets you know if you can interact and have a proper relationship with patients. I'd do both if you could. They each give something unique

this.....

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For scribes who really want some PCE, you may be able to find a (non paid) job at a free or low cost clinic where you can act as an MA. My daughter did that while scribing. She says she didn't learn a lot but was able to contribute a lot to people who needed it. BTW, she learned all the skills needed to do the MA work from scribing. Basically, she took histories and vitals, entered info into charts and helped out in the lab.

 

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I have never seen a scribe take vitals, touch a pt, or in fact even talk to a patient...often they are not even in the room with the pt and are checking old ekgs or records while the provider is in the room. when the provider comes out, they dictate the note to the scribe. I understand some places have scribes in the room, but I have NEVER seen any with anything resembling clinical duties different that one would get by shadowing. Both the scribe and the shadower talk to the clinician about the pt and the workup, the differential dx, etc. The difference is that the scribe is paid to type it up...

ps: many MAs have a much broader scope of practice than you have seen. The MAs in my dept do everything the nurses do except start IVs and they also take xrays under a ltd xray license. they do nebs, ekgs, splinting, blood draws, injections, assist with procedures, etc. Basically ER techs who also do xray.

another thing to consider when looking at potential HCE is the reception it will get from employers after PA school. In EM and urgent care at least, the folks who get the jobs are the ones who did well in school AND had significant health care experience before school. As one of the senior PAs in our em group and someone who does a lot of the interviewing and hiring of new folks I can tell you the folks who don't get screened out before interview are prior medics/nurses/RTs/ER techs across the board. I think the only way I would interview a former scribe was if they were coming out of an EM PA residency program. PA school is not enough to get one ready for seeing really sick folks with a high degree of autonomy. it prepares you to be a safe beginner in primary care or surgery. Prio HCE is what gets you that "sick or not sick" from the doorway. Lots of folks don't have this. also being cool under pressure comes from being in tense situations in which one has responsibility for the outcomes. watching other folks work does not give you this experience.

The top 20 EM PAs I know across the nation ( and I know a lot of EM PAs from my involvement with SEMPA) were without exception former military or civilian medics, nurses, or RTs. For anyone who really wants to go the scribe route, please do a residency afterwards to get up to speed. As I mentioned above, I think scribe is great for folks who want to go to medschool because they have a residency in which to learn how to work with patients. PAs don't have that luxury. that is a skill they need before they start school and one you don't get from being a scribe.

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I was a scribe before PA school. It was a great experience and I had no problems getting interviews! Also after a year of working as a scribe I knew everyone at the ER and asked if they needed an ER tech, they did, and I got a job with no problems at all. So, you can get both experiences under your belt that way. I was also a volunteer EMT before I was even a scribe, and continued that through my employment as a scribe and a tech. It was a great experience, I highly recommend it. You would be surprised at how many doors start opening up. 

 

I will tell you this - my ER tech job started AFTER I applied and interviewed at the school I went to. So, while being an EMT in ER for 6 months was a good experience, scribing + being a volunteer EMT is what helped me get into school.  

 

 

I do agree with what others said. I LOVED the ER as a tech/ER scribe. BUT, as a PA student in ER? It is more high pressure than other specialties. I hated it. I couldn't get out of that place fast enough. It is definitely NOT for new grads (no matter how many of my classmates ended up with ER job after graduation). Being in charge of a patient even for practice is totally different that following orders, and very eye-opening.  It is hard to get the kind of experience when you are in charge of a patient before PA school, but you have to work with what you have and just learn as much as you can in those less involved roles.

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EMEDPA, Your POV seems to be very ED centric. Most MAs don't work in EDS and have very limited responsibilities. That was one of my points. Nevertheless, MA seems to get counted as HCE and PCE no matter what the setting. So another of my points was that while my daughter saw more educational and preparatory value in scribing, during that time period she volunteered elsewhere as an MA. Just to clarify, I did not say she assumed MA duties in the ED where she was a scribe. WRT doing a residency, she fully intends to do that because she wants to work in an ED but not because she feels deficient compared to the EMTs in her class. Even after her residency you would probably not hire her because she started out as a lowly scribe and has no EMT experience. That's OK. I doubt she would want to work for someone with your biases and there are many people who don't share them.

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These near minimum wage / subliving wage positions are both what you make of them AND what your supervisors make of them.  The trick is, whether you pushed the limits of the position or not, is to make the adcom think that you did.  Programs have EMTs who did little more than collect specimens and EMTs who did nearly everything that wasn't on lockdown by the RN license.  The same goes for every HCE out there.  Your title matters far less than your resume and resumes are half illusion.

 

From what I see of healthcare, it is better to take a road of least resistance and attempt to maximize your responsibilities than it is to chase a saturated market with certification scams and endless applications.

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These near minimum wage / subliving wage positions are both what you make of them AND what your supervisors make of them.  The trick is, whether you pushed the limits of the position or not, is to make the adcom think that you did.  Programs have EMTs who did little more than collect specimens and EMTs who did nearly everything that wasn't on lockdown by the RN license.  The same goes for every HCE out there.  Your title matters far less than your resume and resumes are half illusion.

 

From what I see of healthcare, it is better to take a road of least resistance and attempt to maximize your responsibilities than it is to chase a saturated market with certification scams and endless applications.

 

Sorry, I don't think I'm understanding this post.  How are you suggesting we take the road of least resistance and maximize our responsibilities without chasing a saturated market?

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I was a scribe before PA school. It was a great experience and I had no problems getting interviews! Also after a year of working as a scribe I knew everyone at the ER and asked if they needed an ER tech, they did, and I got a job with no problems at all. So, you can get both experiences under your belt that way. I was also a volunteer EMT before I was even a scribe, and continued that through my employment as a scribe and a tech. It was a great experience, I highly recommend it. You would be surprised at how many doors start opening up. 

 

I will tell you this - my ER tech job started AFTER I applied and interviewed at the school I went to. So, while being an EMT in ER for 6 months was a good experience, scribing + being a volunteer EMT is what helped me get into school.  

 

 

I do agree with what others said. I LOVED the ER as a tech/ER scribe. BUT, as a PA student in ER? It is more high pressure than other specialties. I hated it. I couldn't get out of that place fast enough. It is definitely NOT for new grads (no matter how many of my classmates ended up with ER job after graduation). Being in charge of a patient even for practice is totally different that following orders, and very eye-opening.  It is hard to get the kind of experience when you are in charge of a patient before PA school, but you have to work with what you have and just learn as much as you can in those less involved roles.

not really. medics, nurses, and RTs all get it...

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EMEDPA, Your POV seems to be very ED centric. Most MAs don't work in EDS and have very limited responsibilities. That was one of my points. Nevertheless, MA seems to get counted as HCE and PCE no matter what the setting. So another of my points was that while my daughter saw more educational and preparatory value in scribing, during that time period she volunteered elsewhere as an MA. Just to clarify, I did not say she assumed MA duties in the ED where she was a scribe. WRT doing a residency, she fully intends to do that because she wants to work in an ED but not because she feels deficient compared to the EMTs in her class. Even after her residency you would probably not hire her because she started out as a lowly scribe and has no EMT experience. That's OK. I doubt she would want to work for someone with your biases and there are many people who don't share them.

I would look seriously at anyone with an EM residency. You will probably find a lot of senior EM PAs with my opinions. We all come from a time when real experience was required to get into PA school.( In the late 80s I was told my years as an ER tech was not sufficient background for PA school so went to medic school and worked as a medic for 5 years).   Much of the hiring in EDs is done by folks like me and will for the next 20 years.

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