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Medical Scribes as an Input in Health-Care Production: Evidence from a Randomized Experiment

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  • Andrew I. Friedson

    (Department of Economics, University of Colorado Denver Author email: Andrew.Friedson@ucdenver.edu)

Abstract

Medical scribes are charting specialists who prepare patient charts in the physician's stead, creating efficiency gains in production via specialization of labor. The scribe industry has grown rapidly in recent years, but relatively little is known about its impact on health-care production. I use data from a randomized experiment in which scribes were assigned to some, but not all, physician shifts in three emergency rooms over nine months. Generally, I find that scribes significantly decrease physician overtime usage, increase the number of relative value units per shift, and decrease patient wait times. The size of the benefits of scribes varies considerably based on the types of shifts worked and characteristics of the physician matched with the scribe.

Suggested Citation

  • Andrew I. Friedson, 2018. "Medical Scribes as an Input in Health-Care Production: Evidence from a Randomized Experiment," American Journal of Health Economics, University of Chicago Press, vol. 4(4), pages 479-503, Fall.
    • Handle: RePEc:ucp:amjhec:v:4:y:2018:i:4:p:479-503
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    References listed on IDEAS

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    1. David C. Chan, 2016. "Teamwork and Moral Hazard: Evidence from the Emergency Department," Journal of Political Economy, University of Chicago Press, vol. 124(3), pages 734-770.
    2. Rosen, Sherwin, 1983. "Specialization and Human Capital," Journal of Labor Economics, University of Chicago Press, vol. 1(1), pages 43-49, January.
    3. Douglas M. Brown, 1988. "Do Physicians Underutilize Aides?," Journal of Human Resources, University of Wisconsin Press, vol. 23(3), pages 342-355.
    4. A. Colin Cameron & Douglas L. Miller, 2015. "A Practitioner’s Guide to Cluster-Robust Inference," Journal of Human Resources, University of Wisconsin Press, vol. 50(2), pages 317-372.
    5. Javitt, Jonathan C. & Rebitzer, James B. & Reisman, Lonny, 2008. "Information technology and medical missteps: Evidence from a randomized trial," Journal of Health Economics, Elsevier, vol. 27(3), pages 585-602, May.
    6. Agha, Leila, 2014. "The effects of health information technology on the costs and quality of medical care," Journal of Health Economics, Elsevier, vol. 34(C), pages 19-30.
    7. Roderick J. Little & Qi Long & Xihong Lin, 2009. "A Comparison of Methods for Estimating the Causal Effect of a Treatment in Randomized Clinical Trials Subject to Noncompliance," Biometrics, The International Biometric Society, vol. 65(2), pages 640-649, June.
    8. Borzekowski, Ron, 2009. "Measuring the cost impact of hospital information systems: 1987-1994," Journal of Health Economics, Elsevier, vol. 28(5), pages 938-949, September.
    9. White, Halbert, 1980. "A Heteroskedasticity-Consistent Covariance Matrix Estimator and a Direct Test for Heteroskedasticity," Econometrica, Econometric Society, vol. 48(4), pages 817-838, May.
    10. Jeffrey S. McCullough & Stephen T. Parente & Robert Town, 2013. "Health Information Technology and Patient Outcomes: The Role of Organizational and Informational Complementarities," NBER Working Papers 18684, National Bureau of Economic Research, Inc.
    11. Koenker, Roger & Bassett, Gilbert, Jr, 1982. "Robust Tests for Heteroscedasticity Based on Regression Quantiles," Econometrica, Econometric Society, vol. 50(1), pages 43-61, January.
    12. Yoram Ben-Porath, 1967. "The Production of Human Capital and the Life Cycle of Earnings," Journal of Political Economy, University of Chicago Press, vol. 75, pages 352-352.
    13. Gary S. Becker, 1994. "Human Capital: A Theoretical and Empirical Analysis with Special Reference to Education, Third Edition," NBER Books, National Bureau of Economic Research, Inc, number beck94-1, March.
    14. Reinhardt, U, 1972. "A Product Function for Physician Services," The Review of Economics and Statistics, MIT Press, vol. 54(1), pages 55-66, February.
    15. Imbens,Guido W. & Rubin,Donald B., 2015. "Causal Inference for Statistics, Social, and Biomedical Sciences," Cambridge Books, Cambridge University Press, number 9780521885881.
    16. Jacob Mincer & Haim Ofek, 1982. "Interrupted Work Careers: Depreciation and Restoration of Human Capital," Journal of Human Resources, University of Wisconsin Press, vol. 17(1), pages 3-24.
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    Cited by:

    1. Dillender, Marcus & Friedson, Andrew & Gian, Cong & Simon, Kosali, 2019. "Does the healthcare educational market respond to short-run local demand?," Economics of Education Review, Elsevier, vol. 73(C).
    2. Kim, Jounghyeon & McCullough, Jeffrey S. & Lee, Jinhyung, 2022. "Do liquidity constraints affect the investment decisions of California hospitals?," Economic Modelling, Elsevier, vol. 113(C).

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    More about this item

    Keywords

    medical scribes; emergency rooms; health-care production; specialization of labor;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • J24 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Human Capital; Skills; Occupational Choice; Labor Productivity
    • L23 - Industrial Organization - - Firm Objectives, Organization, and Behavior - - - Organization of Production

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