IDEAS home Printed from https://ideas.repec.org/a/ucp/amjhec/v4y2018i4p479-503.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: https://www.journals.uchicago.edu/doi/pdf/10.1162/ajhe_a_00103
    Download Restriction: Access to the online full text or PDF requires a subscription.
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    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(4), 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.
    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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    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).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Benjamin L. Collier & Andrew F. Haughwout & Howard C. Kunreuther & Erwann O. Michel‐Kerjan, 2020. "Firms’ Management of Infrequent Shocks," Journal of Money, Credit and Banking, Blackwell Publishing, vol. 52(6), pages 1329-1359, September.
    2. MacKinnon, James G. & Nielsen, Morten Ørregaard & Webb, Matthew D., 2023. "Cluster-robust inference: A guide to empirical practice," Journal of Econometrics, Elsevier, vol. 232(2), pages 272-299.
    3. María Arrazola & José de Hevia & Marta Risueño & José Félix Sanz Sanz, 2005. "A proposal to estimate human capital depreciation: some evidence for Spain," Hacienda Pública Española / Review of Public Economics, IEF, vol. 172(1), pages 9-22, June.
    4. Dyah S. Pritadrajati & Anggita C. M. Kusuma & Sweta C. Saxena, 2020. "A Non-Healing Wound: Lasting Consequences Of Unemployment And Informal Self-Employment: An Empirical Evidence From Indonesia," Working Papers WP/09/2020, Bank Indonesia.
    5. Seth Freedman & Haizhen Lin & Jeffrey Prince, 2018. "Information Technology and Patient Health: Analyzing Outcomes, Populations, and Mechanisms," American Journal of Health Economics, University of Chicago Press, vol. 4(1), pages 51-79, Winter.
    6. Jeffrey D. Michler & Anna Josephson, 2022. "Recent developments in inference: practicalities for applied economics," Chapters, in: A Modern Guide to Food Economics, chapter 11, pages 235-268, Edward Elgar Publishing.
    7. Seth Freedman & Haizhen Lin & Jeffrey T. Prince, 2014. "Information Technology and Patient Health: An Expanded Analysis of Outcomes, Populations, and Mechanisms," Working Papers 2014-02, Indiana University, Kelley School of Business, Department of Business Economics and Public Policy.
    8. Steven J. Davis & John Haltiwanger, 2014. "Labor Market Fluidity and Economic Performance," NBER Working Papers 20479, National Bureau of Economic Research, Inc.
    9. Fangzhou Su & Peng Ding, 2021. "Model‐assisted analyses of cluster‐randomized experiments," Journal of the Royal Statistical Society Series B, Royal Statistical Society, vol. 83(5), pages 994-1015, November.
    10. James G. MacKinnon & Matthew D. Webb, 2020. "When and How to Deal with Clustered Errors in Regression Models," Working Paper 1421, Economics Department, Queen's University.
    11. Paul W. Miller & Barry R. Chiswick, 2002. "Immigrant earnings: Language skills, linguistic concentrations and the business cycle," Journal of Population Economics, Springer;European Society for Population Economics, vol. 15(1), pages 31-57.
    12. Jongmoo Jay Choi & Hoje Jo & Jimi Kim & Moo Sung Kim, 2018. "Business Groups and Corporate Social Responsibility," Journal of Business Ethics, Springer, vol. 153(4), pages 931-954, December.
    13. Clément de Chaisemartin & Jaime Ramirez-Cuellar, 2024. "At What Level Should One Cluster Standard Errors in Paired and Small-Strata Experiments?," American Economic Journal: Applied Economics, American Economic Association, vol. 16(1), pages 193-212, January.
    14. Alberto Abadie & Susan Athey & Guido W. Imbens & Jeffrey M. Wooldridge, 2020. "Sampling‐Based versus Design‐Based Uncertainty in Regression Analysis," Econometrica, Econometric Society, vol. 88(1), pages 265-296, January.
    15. Andrés Elberg & Pedro M. Gardete & Rosario Macera & Carlos Noton, 2019. "Dynamic effects of price promotions: field evidence, consumer search, and supply-side implications," Quantitative Marketing and Economics (QME), Springer, vol. 17(1), pages 1-58, March.
    16. Chenchuan (Mark) Li & Ulrich K. Müller, 2021. "Linear regression with many controls of limited explanatory power," Quantitative Economics, Econometric Society, vol. 12(2), pages 405-442, May.
    17. Tsimpanos, Apostolos & Tsimbos, Cleon & Kalogirou, Stamatis, 2018. "Assessing spatial variation and heterogeneity of fertility in Greece at local authority level," MPRA Paper 100406, University Library of Munich, Germany.
    18. Reizer, Balázs, 2022. "Employment and Wage Consequences of Flexible Wage Components," Labour Economics, Elsevier, vol. 78(C).
    19. Dennis Shen & Peng Ding & Jasjeet Sekhon & Bin Yu, 2022. "Same Root Different Leaves: Time Series and Cross-Sectional Methods in Panel Data," Papers 2207.14481, arXiv.org, revised Oct 2022.
    20. Seth Freedman & Haizhen Lin & Jeffrey Prince, 2018. "Does Competition Lead to Agglomeration or Dispersion in EMR Vendor Decisions?," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 53(1), pages 57-79, August.

    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

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ucp:amjhec:v:4:y:2018:i:4:p:479-503. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Journals Division (email available below). General contact details of provider: https://www.journals.uchicago.edu/AJHE .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.