Medical Scribing

[FromMic2Meds]

Wanted to talk a little about this form of experience as a Pre-PA. 

I am an Urgent Care Medical Scribe in NYC for City MD - this position offers such an incredible stepping stone and learning environment which was enough to have me go back to school in hopes of becoming a PA. The title itself is unique but City MD really took it a step further with the clinical exposure of scribes. When I first joined 5 years ago and before wanting to be a PA, the position had only been given to FMGs awaiting residency. As the company grew, it’s now become a coveted position in NYC for health profession hopefuls. Whether you’re looking to get your feet wet after undergrad, gathering experience before or whilst completing PA/MD/DO/RN program applications, awaiting residency, or simply need a job, this company has made this position fully hands on and immersive.

I have read a few PA programs who do Not accept medical scribing for patient contact hours. This was quite disheartening as this position lead me to my desired and potential future career in the most organic of ways. Leaving my career in Entertainment and Mass media to pursue this dream as a non-trad applicant. However, I did reach out to schools to ask about this alongside a clear delineation of my duties for them to see that there is direct patient contact and care. Most schools have agreed that this does qualify as patient contact.

As a scribe for this urgent care, upon registration I take them into their exam rooms, perform and record vitals, acquires a detailed medical history, as well as the HPI [History of Present Illness], perform a variety of tests accordingly (rapid strep/flu/mono, urinalysis [UA], urine pregnancy, glucose measuring finger sticks, and EKGs), present the case in a resident-like manner to the physicians and confer treatment plan (before and after examination), enter rooms with physician to observe and record physical examination [PE], electronically write and transmit orders (prescriptions, specialist referrals, diagnostic imaging requests), and formulate discharge/treatment plans for patient education. Not to mention the intense training process once hired, the need to stay updated with both company wide, as well as state/federal health protocols such as response to epidemic outbreaks such as our recent Measles outbreak or as simple as learning the current EMR. Every medical scribe is to be able to handle minimally 2 patients/hour. 

Though this is paid experience and should be complimented with other volunteer and shadowing experience, should the Medical Scribing position be widely accepted for PCH? Or is the scribing position still deemed a clerical position?

Edited June 11, 2019 by FromMic2Meds

[PA115]

Scribe positions are widely still considered clerical because scribes are not allowed to touch patients at all, but in your (and my) case, it would be PCE. My scribe hours at CityMD were my only PCE and I interviewed at a few places and was accepted to PA school. Also, HPI = history of present illness. 

[karebear12892]

I've contributed to many posts pertaining to this topic; please feel free to browse through them.

Scribing (ER) was also my only paid medical experience prior to PA school. I was accepted to multiple programs, graduated at the top of my class, received multiple EM job offers, and accepted an EM fellowship at an academic Level 1 trauma center (my top choice). I am also moonlighting in a rural ER before/during my fellowship. 

I barely had the grades to get into PA school, but I came out of the program with a 4.0 GPA largely due to everything I learned as a scribe. I was incredibly lucky to have worked with ER doctors who took teaching seriously and were invested in developing my education. OSCE's, which seems to cause PA students a great deal of stress (lol) were easy for me -- after witnessing thousands of patient encounters, I knew exactly what to ask, what to look for, what to order, and how to communicate this to the patient. These skills made the transition to clinical year incredibly easy for me. I always tell people that PA school taught me how to pass the PANCE, but the doctors I worked with as an ER scribe taught me how to practice emergency medicine. 

It's not just me. My PA program has specifically gone back and looked for patterns regarding pre-PA experience and academic/clinical year performance. Scribes have consistently outperformed every other health profession who has come through our program, both in grades and preceptor evaluations. As a result, our program has actually restructured its admissions process to weigh scribe experience more heavily. I would love to find out if other PA programs have identified a similar trend. 

Unfortunately, there are still many PA programs that don't consider scribing to be adequate pre-PA experience. Their loss. If I had to do it all over, I'd be a scribe again in a heartbeat. Countless peers have told me that they wish they had been a scribe instead of [fill in the blank]. Everybody's job is important and everyone brings something valuable to the table, but there are very few (if any) other pre-PA jobs that provide continuous patient/provider exposure throughout the duration of the encounter - from initial stabilization to disposition and, most importantly, every single step of the provider's medical decision making process. 

Edited June 6, 2019 by karebear12892

[Allegro]

11 minutes ago, karebear12892 said:

My PA program has specifically gone back and looked for patterns regarding pre-PA experience and academic/clinical year performance. Scribes have consistently outperformed every other health profession who has come through our program, both in grades and preceptor evaluations. As a result, our program has actually restructured its admissions process to weigh scribe experience more heavily. I would love to find out if other PA programs have identified a similar trend.

That's really interesting.  Do you know if they looked at the environments where the scribing was done or was it just scribing in general?  It would be intriguing to see if other programs saw similar outcome data.

[FromMic2Meds]

On 6/5/2019 at 4:47 PM, PA115 said:

Scribe positions are widely still considered clerical because scribes are not allowed to touch patients at all, but in your (and my) case, it would be PCE. My scribe hours at CityMD were my only PCE and I interviewed at a few places and was accepted to PA school.

That's awesome! Congrats. Which location were you from?

[FromMic2Meds]

On 6/6/2019 at 2:59 PM, karebear12892 said:

I've contributed to many posts pertaining to this topic; please feel free to browse through them.

Scribing (ER) was also my only paid medical experience prior to PA school. I was accepted to multiple programs, graduated at the top of my class, received multiple EM job offers, and accepted an EM fellowship at an academic Level 1 trauma center (my top choice). I am also moonlighting in a rural ER before/during my fellowship. 

I barely had the grades to get into PA school, but I came out of the program with a 4.0 GPA largely due to everything I learned as a scribe. I was incredibly lucky to have worked with ER doctors who took teaching seriously and were invested in developing my education. OSCE's, which seems to cause PA students a great deal of stress (lol) were easy for me -- after witnessing thousands of patient encounters, I knew exactly what to ask, what to look for, what to order, and how to communicate this to the patient. These skills made the transition to clinical year incredibly easy for me. I always tell people that PA school taught me how to pass the PANCE, but the doctors I worked with as an ER scribe taught me how to practice emergency medicine. 

It's not just me. My PA program has specifically gone back and looked for patterns regarding pre-PA experience and academic/clinical year performance. Scribes have consistently outperformed every other health profession who has come through our program, both in grades and preceptor evaluations. As a result, our program has actually restructured its admissions process to weigh scribe experience more heavily. I would love to find out if other PA programs have identified a similar trend. 

Unfortunately, there are still many PA programs that don't consider scribing to be adequate pre-PA experience. Their loss. If I had to do it all over, I'd be a scribe again in a heartbeat. Countless peers have told me that they wish they had been a scribe instead of [fill in the blank]. Everybody's job is important and everyone brings something valuable to the table, but there are very few (if any) other pre-PA jobs that provide continuous patient/provider exposure throughout the duration of the encounter - from initial stabilization to disposition and, most importantly, every single step of the provider's medical decision making process. 

This is really great, positive reinforcement to this journey of mine! I do think it will be at a loss of schools not accepting students with this kind of experience - I know the scope of the Scribe is very limited depending on the company and setting but when you really outline your duties as a scribe at some places, there is a lot of direct patient contact going on. At my job, sometimes we spend more time with the patients than the physicians themselves!

[karebear12892]

On 6/6/2019 at 3:12 PM, Allegro said:

That's really interesting.  Do you know if they looked at the environments where the scribing was done or was it just scribing in general?  It would be intriguing to see if other programs saw similar outcome data.

I believe it was just scribing in general. In our class, the only scribes we had were from EM, UC, and FM backgrounds. I think the upcoming class has scribes who worked in more specialized areas. I'd be curious to know how they compare as well. 

[FromMic2Meds]

1 hour ago, karebear12892 said:

I believe it was just scribing in general. In our class, the only scribes we had were from EM, UC, and FM backgrounds. I think the upcoming class has scribes who worked in more specialized areas. I'd be curious to know how they compare as well. 

Either way, regardless of setting, it’s nice to know they experience will not go in vain! Many of my scribe peers that went on to their respective programs [PA/MD/DO/RN/NP] come back and talk about how they had the upper hand because of the scribing experience.

[qasder]

I think the scribing experience can be helpful. Yes, you are limited in your actions with the patient. But while interacting with him, you'll learn a lot of practical information. Lack of practice is always frustrating, but maybe this is just the first step. You can't spend your whole life recommending gastritis sufferers to go through intolerancelab.co.uk. In every professional area, there must be development. If you survive the position of a scribe, then medicine is definitely your calling.

Edited June 14, 2022 by qasder