Physicians Angels is the first virtual real-time scribe service for medical professionals. Our innovative service offers live data entry and support to busy medical professionals. Physicians Angels helps you focus on patient care, not paper care.

1. The Many (Many) Benefits of Virtual Medical Scribes - Physicians Angels
Cost/Benefit Analysis:
A true cost-benefit analysis is an area that doctors and hospital executives struggle to understand
when it comes to using scribes. First, it helps to understand what the most expensive recurring
cost in healthcare is for labor: doctors, physician assistants, and nurse practitioners.
According to data we have collected for our own internal studies – which were subsequently
confirmed by Michael E. Porter and Thomas H. Lee in a Harvard Business Review article titled,
“The Strategy That Will Fix Healthcare” – a doctor’s cost per minute runs up to $4 minute. This
drops to $1 per minute for NPs/PAs. So, to speak of cost-benefit ratios, we first have to know
what is the cost for a medical facility’s doctor per minute of work. Hold in mind the thought of
$240 per hour: the cost of 1 hour of a doctor’s time.
Would you pay $240 per hour to have someone type and click information into an electronic
medical record? Of course not. So then why would you take your most expensive group of
employees and make them into data entry staff?
And what happens during the time that the doctors are typing? If they type in front of a patient,
that is akin to texting during a conversation.
Studies report that patients perceive doctors, who are typing while they are talking, as not
listening to them. If the doctor types their notes after the encounter, then the next patient has to
wait longer to be seen (lowering patient satisfaction scores) – or less patients are being
scheduled, which means less revenue (confirmed by multiple studies), unless each patient is
billed more (also confirmed – EMR’s allow upcoding, but no real improvement in patient care or
health outcomes).
So the current status quo with EMRs is thus: Expensive EMR deployments, doctor’s time poorly
utilized, less patients seen, more expensive patient encounters, longer wait times to be seen,
increasing patient dissatisfaction, and higher physician burnout.
Breaking Down the Data and the Day:
The minimum amount of time that it takes a physician to process his or her portion of the patient
encounter in an EMR is 4 minutes, with most charting taking 12 minutes, and complex patient
cases taking up to 20 minutes. So at $4 per minute, a physician can cost $16 to $80 per minute
just to type up a single patient encounter.
The cost of a Physicians Angels’ Virtual Medical Scribes cost $14 per hour. Onsite scribes are
more expensive ($18 to $26 per hour, and have several drawbacks associated with absenteeism,
turnover, and overhead costs). The average doctor using a scribe can easily see one more patient
per hour. This means that seeing just one new patient covers the cost of a scribe and saves the
doctor over 2 hours of typing each clinic day.

2. The average doctor can then either take the time savings or have more time for other activities
(research, publishing, management), or they can see more patients in the same number of hours.
Considering the halo effect of each extra patient encounter, this translates into extra lab tests,
radiologic studies, or surgeries. Not only the small clinic, but the big health systems stand to gain
a tremendous amount of ancillary revenue from using medical scribes.
By fractionating and specializing work, a combination of doctor/scribe can be more productive
than a doctor alone. This is Adam Smith’s division of labor argument that many in healthcare
don’t fully understand or trust yet. Many clinic directors and hospital directors only see another
person being hired as a liability, not realizing that the EMR is no different from a CT scan or
EKG machine. The EMR is a data acquisition device. You don’t see the radiologist or
cardiologist operating the CT or EKG. They have technicians, thus allowing their mental
energies to be devoted to the interpretation of data and management of the patient. A medical
scribe is an EMR technician, in other words.
Some doctors claim they already use a scribe. In fact, they have assigned an existing medical
assistant or nurse to “scribe” for them. This is something my ENT group tried, and it was a costly
mess. Pulling a staff person off of existing responsibilities and patient care, and then asking them
to work as a scribe means that other work piles up. Having a patient care provider, like an MA or
nurse, work as an EMR data entry clerk is not a productive use of their training or time neither.
What healthcare groups nationwide deploying EMRs have experienced, without fail, is a
reduction in the number of patients seen per office day, along with an increase in wait time. The
cause is doctors acting as EMR data entry clerks for large portions of the day, instead of seeing
patients.
Instead of hiring medical scribes, the response in healthcare has been to hire more doctors, NPs,
PAs, and extend office hours. Medical groups have increased their most expensive labor costs to
see the same number of patients they saw pre-EMR. They can achieve the same results with a
low cost medical scribe, instead.
We have to keep in mind that the EMR is the ultimate aggregator of data for doctors to use. But
by asking doctors to be their own data entry clerks expends their energy incorrectly. It also
results in doctors developing poor data entry behaviors, reducing the quality of the patient data –
which threatens the ultimate quality and purpose of the EMR, not to mention the patient’s care.
Physician and Patient Satisfaction:
Recent, independent research and publications are confirming that physicians are happier with
medical scribes. We have on hand emails and letters from doctors who have been able to rejoin
their families for dinners or spend evenings and weekends with their kids, instead of typing or
dictating charts. This was my personal experience as well. I got my family back when I started
using virtual scribes.
KPMG authored a global study in 2012 on physician burnout. One of the leading sources of
burnout was documentation burdens. Countries like the United States, which have created

3. documentation burdens on doctors, have accelerated the burnout rate. Medical scribes have been
shown to decrease burnout.
As for patient satisfaction, research has shown that scores are higher with medical scribes, and in
particular, with virtual scribes. Most patient exam rooms are small. Patients also fear being
judged. Putting another person in the exam room with the doctor and patient can make it
claustrophobic. The virtual scribes take up no space, and are invisible – “out of sight, out of
mind” to the patient. The virtual scribe allows the doctor and patient to maintain their traditional
dynamic. Because the virtual scribe can only hear what is being said (we do not allow
video/webcams with our virtual scribe service), the doctors are forced to verbalize their thoughts
and communicate better with their patients. The side effect is that patients report that the doctors
explained more to them, making them more satisfied with their visit. In contrast, when doctors
do their own EMR data entry or dictate, they don’t verbalize to patients as much, keeping much
information in their head or silent.
Virtual Scribes – Logistics & Benefits
After trying onsite medical scribes in my clinic, we went with virtual scribes. Virtual scribes
were more cost-effective and allowed specialization. On days I did not need my virtual scribe, I
could share him or her scribe with other ENT practices across the country, lowering our costs
and keeping skill sets high
Physicians Angels specializes our virtual scribes into ENT, Orthopedics, Urgent Care, Internal
Medicine, Plastic Surgery, and other specialties. ENT is our largest specialty, and we have the
largest ENT scribe pool in the world.
Medical practices with multiple locations can move scribes from one site to another based on
work demands during the day without loss of time due to scribe travel. If one scribe is sick or on
leave, we have a large pool of scribes to jump in and take over. Compared to many groups with
in-house or onsite scribes, when an onsite scribe is sick or leaves, the down time before a
replacement is trained can take 3 to 6 months. We have many groups that have transitioned from
in-house scribes to our virtual scribe service, as a result of the benefits of using our virtual scribe
model.
Additionally, we can shift scribes from one facility to another to manage fluctuating work flows.
Large healthcare systems can rapidly shift workforce allocations from outpatient facilities and
even support inpatient care documentation facilitating doctors and nurses to care for patients.
What is required for virtual scribes in terms of technology? A strong broadband connection,
good internal IT infrastructure, and people willing to commit the time to refine their unique
relationship with their virtual scribe team to reach optimal efficiency.
At the end of the day we provide a well-trained virtual scribe who is willing to work hard to
make things work. It will take some time, as it would take any new person joining an
organization. The good get better; the better get exceptional. Our experience has been that

4. practices with good processes and productive doctors seeking better productivity do extremely
well with virtual scribes.
By developing employees dedicated to a career path as scribes, hospitals and practices receive
consistency without the turnover associated with temporary onsite scribes. At Physicians Angels,
we had to build semester-long training programs for each specialty, creating a pool of employees
that can quickly learn a new doctor’s style. We have an ongoing lifelong education and
mentoring program for our scribes that is unique in the industry. When hospitals/practices try to
replicate our process (none have been successful, to our knowledge), they realize how expensive
and time intensive it is to build and maintain a small let alone large pool of scribes. We
encourage doctors to share their lecture sets or internal training programs with us so that we can
customize their scribe service even more tightly to their work flow.
Virtual scribes work out of HIPAA-compliant facilities with biometric scanners and cameras to
ensure no data breaches. The security at our virtual scribe facilities is greater than or equal to
what is present at hospitals. We do not allow our virtual scribes to carry papers, cellphones, or
media storage devices into or out of our facilities. The USB ports are disabled on the virtual
scribes’ computers. All communications and data shared is encrypted at 256-bit AES. Scribes
undergo a background check and regular performance reviews and audits. For this reason, we do
not employ virtual scribes that work out of homes.
Market Growth:
The scribe market overall is growing fast. Within 10 years, we expect that there will be at least
30,000 scribes, across all specialties, needed in the United State. If we consider that EMR
problems are not unique to the U.S. but worldwide, we can expect to see this industry grow
internationally in the coming decade.
For More Details: http://www.physiciansangels.com/many-many-benefits-virtual-medical-
scribes/