The Productivity Requirements of Implementing a Medical Scribe Program

Ann Intern Med. 2021 Jan;174(1):1-7. doi: 10.7326/M20-0428. Epub 2020 Oct 6.


Background: Economic analyses of medical scribes have been limited to individual, specialty-specific clinics.

Objective: To determine the number of additional patient visits various specialties would need to recover the costs of implementing scribes in their practice at 1 year.

Design: Modeling study based on 2015 data from the Centers for Medicare & Medicaid Services (CMS) and National Ambulatory Medical Care Survey. Scribe costs were based on literature review and a third-party contractor model. Revenue was calculated from direct visit billing, CPT (Current Procedural Terminology) billing, and data from the National Ambulatory Medical Care Survey.

Data sources: 2015 data from CMS and the National Ambulatory Medical Care Survey.

Target population: Health care providers.

Time horizon: 1 year.

Perspective: Office-based clinic.

Outcome measures: The number of additional patient visits a physician must have to recover the costs of a scribe program at 1 year.

Results of base-case analysis: An average of 1.34 additional new patient visits per day (295 per year) were required to recover scribe costs (range, 0.89 [cardiology] to 1.80 [orthopedic surgery] new patient visits per day). For returning patients, an average of 2.15 additional visits per day (472 per year) were required (range, 1.65 [cardiology] to 2.78 [orthopedic surgery] returning visits per day). The addition of 2 new patient (or 3 returning) visits per day was profitable for all specialties.

Results of sensitivity analysis: Results were not sensitive to most inputs, with the exception of hourly scribe cost and inclusion of CPT revenue.

Limitation: Use of Medicare data and failure to account for indirect costs, downstream revenue, or changes in documentation quality.

Conclusion: For all specialties, modest increases in productivity due to scribes may allow physicians to see more patients and offset scribe costs, making scribe programs revenue-neutral.

Primary funding source: University of Chicago Medicine's Center for Healthcare Delivery Science and Innovation and the Bucksbaum Institute.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Costs and Cost Analysis
  • Documentation
  • Efficiency
  • Follow-Up Studies
  • Humans
  • Physicians / economics*
  • Primary Health Care / economics*
  • Program Evaluation*
  • Prospective Studies
  • United States