World Journal of Urology

, Volume 36, Issue 10, pp 1691–1697 | Cite as

Implementation of medical scribes in an academic urology practice: an analysis of productivity, revenue, and satisfaction

  • Benjamin J. McCormick
  • Allison Deal
  • Kristy M. Borawski
  • Mathew C. Raynor
  • Davis Viprakasit
  • Eric M. Wallen
  • Michael E. Woods
  • Raj S. Pruthi
Original Article



Pressure on physicians to increase productivity is rising in parallel with administrative tasks, regulations, and the use of electronic health records (EHRs). Physician extenders and clinical pathways are already in use to increase productivity and reduce costs and burnout, but other strategies are required. We evaluated whether implementation of medical scribes in an academic urology clinic would affect productivity, revenue, and patient/provider satisfaction.


Six academic urologists were assigned scribes for 1 clinic day per week for 3 months. Likert-type patient and provider surveys were developed to evaluate satisfaction with and without scribes. Matched clinic days in the year prior were used to evaluate changes in productivity and physician/hospital charges and revenue.


After using scribes for 3 months, providers reported increased efficiency (p value = 0.03) and work satisfaction (p value = 0.03), while seeing a mean 2.15 more patients per session (+ 0.96 return visits, + 0.99 new patients, and + 0.22 procedures), contributing to an additional 2.6 wRVUs, $542 in physician charges, and $861 in hospital charges per clinic session. At a gross collection rate of 36%, actual combined revenue was + $506/session, representing a 26% increase in overall revenue. At a cost of $77/session, the net financial impact was + $429 per clinic session, resulting in a return-to-investment ratio greater than 6:1, while having no effect on patient satisfaction scores. Additionally, with scribes, clinic encounters were closed a mean 8.9 days earlier.


Implementing medical scribes in academic urology practices may be useful in increasing productivity, revenue, and provider satisfaction, while maintaining high patient satisfaction.


Medical scribes Efficiency Productivity Satisfaction 


Authors’ Contribution

BJ McCormick: Project development, Data Collection, Data Analysis, Manuscript writing/editing. A Deal: Data analysis. M Borawski: Data collection, project development, Manuscript editing. MC Raynor: Data collection, project development, Manuscript editing. DP Viprakasit: Data collection, project development, Manuscript editing. EM Wallen: Data collection, project development, Manuscript editing. ME Woods: Data collection, project development, Manuscript editing. RS Pruthi: Project development, Data Collection, Manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval/informed consent

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Sinsky C (2016) Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med 165:753–760. CrossRefPubMedGoogle Scholar
  2. 2.
    Dewa CS, Loong D, Bonato S, Thanh NX, Jacobs P (2014) How does burnout affect physician productivity? A systematic literature review. BMC Health Serv Res 14:325. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Shanafelt TD (2018) Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 90(12):1600–1613CrossRefGoogle Scholar
  4. 4.
    North AC, McKenna PH, Sener A, McNeil BK, Franc-Guimond J, Meeks WD, Schlossberg SM, Gonzalez C, Clemens JQ (2017) Burnout in urology—findings from the 2016 AUA annual census. Urol Pract. CrossRefGoogle Scholar
  5. 5.
    North AC (2017) Review article: physician burnout in urology. Urol Pract 4(2):155–161. CrossRefGoogle Scholar
  6. 6.
    Romeyke T, Stummer H (2012) Clinical pathways as instruments for risk and cost management in hospitals—a discussion paper. Glob J Health Sci 4(2):50–59. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bauer JC (2010) Nurse practitioners as an underutilized resource for health reform: evidence-based demonstrations of cost-effectiveness. J Am Acad Nurse Pract 22(4):228–231. CrossRefPubMedGoogle Scholar
  8. 8.
    Bank AJ, Gage RM (2015) Annual impact of scribes on physician productivity and revenue in a cardiology clinic. ClinicoEcon Outcomes Res 7:489–495. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Allen B, Banapoor B, Weeks EC, Payton T (2014) An assessment of emergency department throughput and provider satisfaction after the implementation of a scribe program. Adv Emerg Med 2014:1–7. CrossRefGoogle Scholar
  10. 10.
    Arya R, Salovich DM, Ohman-Strickland P, Merlin MA (2010) Impact of scribes on performance indicators in the emergency department. Acad Emerg Med 17:490–494. CrossRefPubMedGoogle Scholar
  11. 11.
    Bastani A, Shaqiri B, Palomba K, Bananno D, Anderson W (2014) An ED scribe program is able to improve throughput time and patient satisfaction. Am J Emerg Med 32:399–402. CrossRefPubMedGoogle Scholar
  12. 12.
    Koshy S, Feustel PJ, Hong M, Kogan BA (2010) Scribes in an ambulatory urology practice: patient and physician satisfaction. J Urol 184:258–262. CrossRefPubMedGoogle Scholar
  13. 13.
    Bank AJ, Obetz C, Konrardy A, Khan A, Pillai KM, McKinley BJ, Gage RM, Turnbull MA, Kenney WO (2013) Impact of scribes on patient interaction, productivity, and revenue in a cardiology clinic: a prospective study. Clinicoecon Outcomes Res 5:399–406. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Shultz CG, Holmstrom HL (2015) The use of medical scribes in health care settings: a systematic review and future directions. J Am Board Fam Med 28(3):371–381. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Urology, UNC School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Lineberger Comprehensive Cancer Center, Biostatistics and Clinical Data Management CoreUniversity of North Carolina at Chapel HillChapel HillUSA

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