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To Scribe or Not to Scribe

I recently started my foray into a series of premed extracurricular topics. This began with how to get involved in medicine. That article centered around passive things, like shadowing and volunteering, to get your feet wet. A competitive premed application will need to include some more active things though. Like anything, the greater your role, the more impressive and the more you have to show for it. I thought it would be fitting to begin detailing an emerging opportunity given the recent electronic medical record mandate. That’s right, I’m talking about scribing.

There are a variety of paid medical positions. At their core, they differ in the training required and the level of patient care and responsibility you garner. For instance, an EMT requires more training than a scribe, which makes sense since they are first on the scene, which often includes people trying to crump on them. So, this is just something to balance as you consider which fields to pursue. Ultimately, there is no “perfect” application. There is however the perfect application for you. This means you should pursue what peaks your interest. This will allow you to be satisfied with your choice, as well as excel given your interest and enthusiasm, ultimately translating to more feathers in your cap. To give you an idea of what is out there though, I will detail a variety of paid medical positions, going through my personal experience with them (if applicable), as well as any pros and cons.

I thought it would be fitting to start with something near and dear to my heart, scribing. I worked as an orthopedic scribe for two years after college (this followed a brief stint in an analytical chemistry lab, which I absolutely dreaded). There is no limit on the specialty you may scribe in. I have seen opportunities ranging from emergency medicine to specialized outpatient clinics, such as my orthopedic experience. So, there is the opportunity to pursue a lot of different areas, as well as jump around to get increasing exposure. This will obviously be limited by the job opportunities in your area though.

What exactly do scribes do? To put it simply, they document the in the electronic medical record. The precise documentation differs from specialty to specialty, as well as electronic medical record to electronic medical record. To give you an idea though, as an orthopedic scribe, I crafted the history of present illness, physical exam, any diagnostics and procedures, diagnosis, and discussion. The history of present illness articulates why the patient presented to clinic that day. It can be simply summed up with the acronym OPPQRS (onset, provoking factors, palliating factors, quality of pain, such as sharp or dull, radiation of pain to other areas, and severity of pain). In my clinic, diagnostics usually included X-rays and MRIs, while procedures were generally cortisol or hyaluronic acid injections into joints. Finally, the discussion were the recommendations the doctor provided to the patient.

Before venturing down this path, there are some things to be aware of. There is definitely a steep learning curve. The exact structure of this differs from institution to institution. At mine, there was really no structure haha. You shadowed current scribes and occasionally jumped in to write notes before being set loose after a month max. So, you had to be a sponge not only with respect to the electronic medical record, but the complex medical jargon too. The pace differs from setting to setting too, but most places are likely crazy busy. My providers would routinely see 20-30 patients in a half day. My notes were generally chaos after this haha and needed much cleaning up. I am not trying to scare you away. You are up for the challenge! Just know it may be an adjustment, especially initially.

Another important point to address is the differing scope of pay. If you work directly for a company, which is often the case with private clinics, you get paid significantly better. I got paid $16/hour to scribe, which was equivalent to my pay in the analytical chemistry lab, which required a college degree. On the other hand, if there is a middle man, such as a scribing company, they take a ridiculous cut and you are left with near minimum wage. This is generally the case in emergency rooms. It all depends on your financial situation. It is unfortunately you may have to bust your ass for minimum wage in pursuit of your medical school aspirations, but lots of people bust their ass for minimum wage every day. If this is the path you choose, there are ways to mitigate this, such as living with roommates and cutting back on splurges. Again though, there are lots of medical positions, including several with better pay, so do what works into your own situation.

A cool perk of scribing is the potential for special relationships with the providers you work for. You are basically their shadow every day in clinic, which translates to getting to know them really well (unless they are a dick, which can happen). I scribed consistently for four providers and got along well with all of them, but this is not always the case. In fact, I would frequently watch them operate either before or after clinic, which was an awesome experience. Even cooler than this though, one of the physicians took me to Honduras with him for a 10 day mission trip. I spent every day alongside him in clinic and scrubbed in next to him in the operating room. It was certainly the experience of a lifetime, especially given the pathology that presents in a medically underserved area. Last, the year I matriculated, several of the physicians I worked for wrote me strong letters of recommendations. What I am getting at is scribing, if done well, has the opportunity to lead to so much more, not to mention endless fodder for your application and interviews!

So when do you begin this fantastic opportunity? Well, this is variable as well. Some positions can be part time and bode well with school, while others require a full-time commitment, which can only happen after graduation obviously. So, it really depends on your time-line, but in retrospect, I wish I could have scribed part-time in college as opposed to working as a certified nursing assistant. So, hit up google and see what opportunities are near you!

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