"I almost didn't believe it when I heard that I got to follow a doctor and go into every room," said Fera, a 21-year-old Gloucester County native who works as a scribe in the emergency departments in Virtua hospitals in Voorhees and Marlton.
"You get exposed to things that you otherwise would never be exposed to."
Scribes started working in fast-paced emergency departments in the mid-1990s, but hiring has picked up as more hospitals have switched to electronic records, say officials at several companies that hire and train scribes. Having scribes do most of the data entry allows the highest-paid people in the room to focus on patients and see more of them and ensure that information used in billing is complete, the companies say. It also allows doctors to make more eye contact with patients, and that makes patients happier.
"It's created a cottage industry," said James Bonner, medical director of the department of emergency medicine at Underwood-Memorial Hospital in Woodbury.
The 15 doctors in his practice started hiring scribes in 2007. They now have five. "It's an emerging phenomenon," Bonner said.
At Virtua Marlton, emergency physician Ken Sprankle said the doctors worked with about 10 scribes. He said that he could probably see as many patients without them, but that their help "makes our days more enjoyable. . . . It does make the charts more complete."
Virtua and Underwood refused to let a reporter watch scribes at work, citing patient privacy.
The largest scribe company, California-based ScribeAmerica, has 800 employees in 21 states, up from 350 to 400 in 10 states in 2009. Emergency Medicine Scribe Systems (EMSS), another California company, has 600 scribes - 500 more than it had two years ago. PhysAssist Scribes Inc. in Fort Worth, Texas, went from providing 7,500 hours a month of scribe coverage in 2005 to 38,000 last month. All credit electronic records for their growth.
"We can't keep up with the growth," said David Strumpf, chief executive officer of EMSS, which operates in 12 states. "I turn down more projects than I take."
No one questions that electronic records are an improvement, leading to more detailed and legible records that are easier to share and use for population research. Hospitals and doctors are under considerable pressure to make the switch.
In May, the federal government will begin offering $27 billion in incentives over the next nine years to hospitals and physicians who buy electronic health records systems. After 2015, the Medicare program will penalize providers without electronic records.
Everyone recognizes that it takes time to learn the new systems, said Nancy O'Connor, regional administrator for the Centers for Medicare and Medicaid Services. But, she said, having lots of data that different providers can share and analyze has the potential to transform care. "This is the way we need to go as a country."
Fera, who works for ScribeAmerica, schedules her college class work around her 10-hour shifts in the ER. She shadows doctors as they work, typing information into a laptop as they examine patients.
"Our responsibility is to chart that in real time," she said.
Without scribes, emergency doctors usually see patients, then leave the room to summarize what they saw and said. Doctors check the scribes' work.
The trend of using scribes is stronger in other regions, but the companies said they were negotiating with local doctors.
Doctors who work in community hospitals are more likely to want scribes than those who work in academic medical centers, where medical students and residents are readily available.
EMSS is considering offering virtual scribes to remote hospitals that may not have premed students nearby. The idea is to equip a physician with a high-resolution camera and microphone.
Typically it is not hospitals but emergency physicians who pay for the scribes. The doctors make an average of close to $250,000 a year. TeamHealth - a physician-staffing company in Knoxville, Tenn., that employs or contracts with 3,100 emergency doctors, including those at Virtua and Kennedy Health Systems in South Jersey - has about 30 scribe programs and plans to add a dozen more this year.
Michael Murphy, a doctor who is CEO of ScribeAmerica, said, however, that about half of the company's new contracts in the last two years had been directly with hospitals. The institutions are judged on emergency department waiting times and patient satisfaction and are increasingly interested in efficiency, he said.
Scribes are in particular demand in ERs, "the most hectic, busy, fishbowl environment that you could possibly imagine," said Alex Geesbreght, who runs PhysAssist.
Some believe that as doctors grow more comfortable with electronic data entry, the demand for scribes will lessen.
The American College of Emergency Physicians' president-elect, David Seaberg, said that electronic records had slowed down ER doctors at his hospital in Tennessee at first, but that things had improved after about three months.
"It is faster once you learn the system, in my opinion," he said. "It makes your documentation much more complete."
Others believe scribes are here to stay because they speed things up and make doctors' days less stressful.
"I look at my scribe at the end of a nine-hour shift, and they are beat," Strumpf said. "I used to have to do that in addition to being a doctor."
Underwood's Bonner said about a quarter of the physicians in his group preferred inputting their own data. The others really like the scribes. "It's a huge physician satisfier," he said. "I could see it expanding to the nursing side as well."
Responsibilities: Add information into the electronic medical record for doctors while they see patients. Scribes also keep track of lab reports and other tests and communicate with nurses. Most work in hospital emergency departments.
Education: Some college or a bachelor's degree. This is meant to be a temporary position for people who plan to become medical professionals; scribes gain experience with medical problems, vocabulary, and treatments.
Preferred background: Scribe companies want college students studying to become doctors, nurses, and physician assistants. They also accept graduates who plan to work a year before applying to professional school. Companies do extensive training.
Salary: $8 to $12 an hour. With experience, up to $20 an hour.
Contact staff writer Stacey Burling at 215-854-4944 or firstname.lastname@example.org.