How The Pandemic Changed Clinic Staffing & How Medical Scribes Can Help

How The Pandemic Changed Clinic Staffing

Author: Sara N. Frye, OD, MPH, FAAO

 

In 2019, healthcare spending grew for the fourth consecutive year. Specifically, it increased by 4.6% to reach $3.8 trillion. This was similar to the 4.7% rate of growth seen in the year prior. The fastest growth was seen in-hospital care and physician and clinic services, as well as retail prescription drug spending. In other words, clinics were busy. And despite declining reimbursement rates, physician salaries were up. Then came something many of us did not anticipate: the Coronavirus-19 (COVID-19) pandemic.

The Pandemic Early Days

The COVID-19 pandemic was not something most health care practitioners had planned for. It forced clinics to think fast and make drastic changes based on limited and constantly changing information. Some clinics that were deemed to provide non-essential services shut their doors completely, while others limited their services to emergencies only. In some cases, these decisions were made in response to state and local government guidelines. In other cases, choices were made with guidance from professional societies, which made recommendations to suspend services. For example, the American Academy of Ophthalmology put out a statement on March 19th, 2020 recommending that all members immediately cease routine in-office visits and surgeries.

Practices were forced to make difficult decisions at this stage. Nobody knew how long the pandemic would last, and therefore business owners didn’t know how long they could keep their staff on payroll. Many employees were furloughed and collected unemployment insurance just to get by. Some business owners continued to pay their employees even though they weren’t working during the pandemic.

In the health care sector, the Bureau of Labor Statistics reports that this held true for 51.86% of establishments. Furthermore, 51.13% of health care establishments paid their employees’ health insurance premiums while they weren’t working. 32.13% of health care settings were able to allow their employees to take advantage of telework; however, this was not possible in every specialty, as some disciplines lend themselves better than others to this mode of practice. 

The government put programs in place to help with employee retention, largely through the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Through the CARES Act, the Small Business Administration put forth the Paycheck Protection Program (PPP). The idea here was to provide small businesses with forgivable loans to keep their workforce on payroll for up to 8 weeks during the COVID-19 pandemic., covering both income and benefits. The funds could also be used for mortgage expenses, rent, and utilities. The PPP kept many health care establishments afloat, but it was a relatively short-term solution to a long-term problem.

After the initial shock of the pandemic, and as personal protective equipment (PPE) supplies improved, businesses attempted to find an equilibrium: a “new normal”. While restrictions eased, however, many challenges remained. Even for those employees that wanted to return to work, the threat of COVID-19 continued to pose difficulties. Health care workers and their families were still at risk of contracting the illness, threatening to put them out of work again. Of those who contracted COVID-19, some were lucky enough only to be out of work for a short time. Others developed much more severe illnesses, leaving them hospitalized, disabled, or even deceased. 

Healthcare Staffing And Shortages 

For those health care establishments that let their staff go during tough times, they were now scrambling to hire new employees. Between February 2020 and November 2021, the US healthcare sector lost nearly half a million workers. Some quit (18%), while others were laid off (12%). The rest of them left the field for a variety of reasons. For some, it was exhaustion by the lack of normalcy despite the availability of vaccines. They had hoped that things would get better, and when they didn’t, they became exasperated. For others, it was frustration with the fact that most COVID-19 patients were now unvaccinated by choice.

For some others, it was the effect of the cumulative psychological trauma of the pandemic. Some were unhappy with how their institution handled the situation. Many were already burned out prior to the pandemic, and this pushed them over the edge. Workers also felt overwhelmed with the volume of non-COVID patients who delayed care, making for a high workload even as COVID-19 numbers eased. Finally, health care professionals felt frustrated by their inability to help patients, a fundamental need that is at the core of what they do. 

Even those that stayed in health care during the pandemic still have plans to leave their positions in the future. Up to 47% of health care workers plan to leave their current roles by 2025.

So, what is a practice to do? How do health care clinics continue to operate and provide patients with the care they deserve under such challenging circumstances? The combination of declining reimbursements and staffing difficulties makes a strong case for increasing the efficiency within a practice. 

Introducing: Medical Scribes 

One way to increase practice efficiency is through the use of scribes. Since the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009, electronic health record (EHR) use has substantially increased in the United States. And although the use of EHR has largely improved quality and safety, it has also placed an increased administrative burden on health care professionals. 

Physicians in outpatient practice spend half their workday on EHR reviewing patient charts, placing orders, and writing notes. And if that’s not enough, they spend an additional 1-2 hours outside of work on EHR as well. 

Scribes are personnel trained in assisting physicians with keeping up with documentation and clinic workflow. They’ve been found to decrease patient encounter time, thereby increasing the number of patients seen in a clinic session. Scribed notes are generally of higher quality. For example, the history of present illness has been found to be more clearly stated. Medication review and reconciliation are more likely, as is making preventative health recommendations to patients. In other words, not only do scribes improve clinic efficiency, but they also improve the quality of patient care. They’ve even been found to restore the joy of practicing!

Medical scribes have been found to decrease provider burnout and increase documentation safety without negatively impacting the patient experience. This benefit has been studied in specialties including dermatology, family medicine/primary care, rheumatology, endocrinology, oncology, pediatric gastroenterology, and emergency medicine. The improved efficiency has been seen for both in-person and telemedicine visits.

The Benefits of Virtual Medical Scribes 

Still, there are some apprehensions surrounding the use of scribes. The Joint Commission has expressed concerns about the use of medical scribes that are not qualified. Some patients and doctors may still have COVID-19 exposure concerns and therefore may not wish to have an additional person in the room. Finally, like other medical personnel, scribes are in short supply, so hiring one poses a challenge. That’s where the option of having a virtual scribe comes in.

Rather than joining the doctor on-site, virtual scribes assist with patient encounters from an offsite location, using video or phone conferencing. Remote scribes are trained professionals. You don’t have to worry about teaching them medical terminology or instructing them on how to take patient notes. With expedited onboarding, your scribe gets right to work, saving you time and money. Without an extra person in the room, there is less concern about contracting COVID-19 or another illness. 

There is also a greater sense of privacy, with just the doctor and patient in the room together. Service is flexible. If you’re in surgery or your office is closed, you won’t be paying your scribe. You also won’t have to worry about your scribe calling out sick; coverage is seamless when you hire from a professional company. Scribes work by the hour, helping you with every patient encounter and reviewing charts, and inputting lab orders in between patients. Paying a virtual scribe will cost you less than it would have someone on site. And that’s not to mention the extra income you’ll earn as a result of your increased productivity.

 

Medical Scribes and Physician Burnout

The pandemic has taken a toll on all of us, and those in health care may have taken the brunt of it. Combating burnout in medicine has always been a challenge, but it’s proven to be even more difficult in this new world we live in. With declining reimbursements and staffing shortages, maximizing efficiency is essential to keeping a practice profitable and manageable. Virtual scribes are a great way to help with this. They are cost-effective, reliable, and flexible, helping to decrease your administrative burden and increase your bottom line. By preventing burnout, remote scribes can ultimately make the difference between continuing to work and calling it quits.

 

Want to learn more about scribes and how they can benefit your practice? 

Check out our Ultimate Guide To Virtual Medical Scribes!


Have questions for us about medical scribes? Let’s chat! 

 

 

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