Due to the intense exposure to clinical medicine and the close relationships built with physicians and PAs, scribing is an excellent position for aspiring healthcare providers. This is definitely the case for pre-medical students as scribing counts towards their clinical experience.
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However, it is slightly different for aspiring PAs. In contrast to medical schools, PA schools expect applicants to have a certain number of healthcare hours. In addition, they require many of these hours to be what they consider direct patient care experience.
Although scribing provides an outstanding clinical experience, pre-PA students may be hesitant to work as a scribe as it is not always counted as patient care experience (PCE). In this article, we will discuss what factors PA applicants should consider when deciding to work as a scribe.
What is Scribing?
A medical scribe is someone who follows a healthcare provider and documents patient-provider interactions. Specifically, scribes transcribe important information such as the history of present illness (HPI), past medical and surgical history, current medication, physical exam findings, and other information as dictated by the healthcare provider.
Depending on the work environment, scribes can also be tasked with other responsibilities, such as obtaining medical records from other facilities or departments and communicating messages to other healthcare workers or even patients. Overall, scribes improve provider productivity by taking care of documentation and therefore allowing providers to focus on medical decision making.
To become a scribe, you must undergo a rigorous orientation to learn key medical terminology and basic pathophysiology concepts. This orientation also teaches potential scribes the basics of healthcare documentation and how to use the relevant electronic medical record system.
PA School Healthcare Experience Requirements
In order to matriculate into PA school, applicants must complete several requirements including prerequisite coursework, GRE, and a bachelor’s degree. However, one of the most vital requirements for PA school is the completion of a satisfactory level of healthcare experience.
In the Central Application for Physician Assistants (CASPA), there are sections to add your various experience types and define them in categories such as healthcare experience, non-healthcare employment, research, leadership experience, etc.
Healthcare Experience: PCE Versus HCE
The application splits healthcare experience into two separate sections: patient care experience (PCE) and healthcare experience (HCE). This distinction has important consequences that prospective PA students need to be aware of before they apply.
PCE is defined as “experience in which you are directly responsible for a patient’s care”. The majority of PCE positions are paid and require the employee to have responsibility for a portion of the patient’s care. Examples of these roles include emergency medical technicians, phlebotomy, EKG tech, certified nurse, dental hygienist, or physical therapy aides.
HCE is defined as “paid and unpaid work in a health or health-related field where you are not directly responsible for a patient’s care”. Examples of this include medical receptionist, pharmacy tech, and clinical research experience.
PA schools emphasize PCE over HCE and often require a significant number of PCE hours. In fact, eight of the top twelve PA schools in the country require between 1000-4000 hours of PCE.
Each school has different requirements for the number of hours of PCE/HCE required. While some schools require a minimum of 2000 PCE hours, others, such as Yale and Baylor, do not have any PCE requirements. Schools also vary in defining what is considered PCE and certain experiences may count HCE at one school, but as PCE at another.
Patient Care Experience Comparison Table
| Required | Strong Applicants | |
|---|---|---|
|
1 year or 2,000 hours |
2 years or 4,000 hours |
|
|
None |
6 months or 1,000 hours |
|
|
1,000 hours |
Additional six months of health care experience |
|
|
1,000 hours |
2019 matriculants had 3270-7854 hours |
|
|
2,000 hours |
7,000 hours for average matriculant |
|
|
None |
None |
The classification can get confusing as some positions may consist of PCE as well as non-PCE hours (such as administrative duties). In this case, applicants should split their experience between the PCE and HCE sections in CASPA.
What Do PA Schools Think of Scribing?
Many positions are classified in a similar manner across different PA schools. For example, all PA schools will consider EMT experience as a PCE as it requires the applicant to directly care for a patient. In contrast, schools do not uniformly agree on whether medical scribing should be considered a PCE.
Although scribing offers tremendous exposure to clinical medicine, it does not require direct medical responsibility for the patient. Most scribes do not take vitals, administer treatments, or provide any other direct patient care.
However, this varies between schools. For example, the University of Florida considers scribing to be PCE, as discussed in the excerpt from their admissions page:
“Scribe work is perhaps the only example of non-professional level clinical experience we consider to be DPC which doesn’t allow for touching patients. It is the integration and application of various aspects of patient care required of a scribe working alongside a physician, PA, or ARNP that qualifies scribing as providing Direct Patient Care”
PA Schools that Consider Scribing as PCE
This position is not unique to the University of Florida. Below is a table of PA programs that count scribing as PCE.
| School | Scribing classification |
|---|---|
|
PCE |
|
|
PCE |
|
|
Yale University |
PCE |
|
PCE |
|
|
Emory University |
PCE |
|
George Washington University |
PCE |
Is Scribing Still a Good Experience for PA School?
Although some schools do not accept scribing as PCE, it is still a great opportunity that every PA school applicant should consider. It is one of the best ways to learn about clinical medicine and experience what it is like to work as part of a medical team.
Scribes work closely with physicians or PAs and accompany them while they take patient histories. They will regularly observe healthcare providers interviewing patients, performing physical exams, and performing follow up work.
One of the biggest advantages of scribing is that it will provide students with skills relevant to their future PA career. As a scribe, you will be forced to improve your listening and communication skills as you jot down notes and double-check them with healthcare providers. Scribes are also required to be well-versed in medical terminology.
These skills translate very well to PA school, as well as an actual career as a PA. Learning how to properly structure a patient’s chart, especially components such as the history of present illness (HPI), is a vital skill that every PA must know. Scribing will provide students with these documentation skills and prepare them to become more efficient clinicians.
Another advantage of scribing is that it is an excellent way to prepare for the content of PA school. Students will observe medical conditions and the resulting decision-making process in the clinic with their own eyes. Scribes will observe disease presentations and the subsequent physical exams, lab and imaging orders, and treatment options.
This real-life connection is helpful in familiarizing future PAs with the material they will learn in PA school. Many students who worked as scribes find that they can learn the material and recall it better by having a real-life connection, rather than simply learning about it from a textbook or lecture.
For instance, an ER scribe gets exposure to a wide variety of conditions and their corresponding follow up care. Common examples include abdominal pain, physical trauma, psychiatric conditions, drug overdose, wound care, heart attack, and stroke. Scribes at specialty clinics will not have as diverse experiences but will be provided more in-depth exposure to the conditions they do see.
Throughout this time, scribes will work closely and build relationships with healthcare providers. They will interact with multiple PAs and physicians, meaning that there are many opportunities to find mentors and secure a strong letter of recommendation.
To top it off, most scribing positions are paid jobs with flexible hours, meaning they can be a great job for college students. This is especially true for ER scribes, who can also work evening and night shifts. Depending on the clinic, the pay can be competitive compared to other hourly jobs available for college students.
Starting compensation can range from minimum wage to $17-18 an hour.
How to Become a Medical Scribe
There are two main ways to become a scribe: applying to a medical scribe company or directly applying to local opportunities. Examples of medical scribe companies include ScribeAmerica, ProScribe, and HealthChannels. These companies usually list positions on their website. Local opportunities can be found by searching job boards such as Indeed.com or by checking a clinic’s website.
In both cases, most employers require applicants to be undergraduate students on a premed/pre-PA track. At medical scribe companies, training can be rigorous in order to weed out applicants that are unable to provide quality service up to the standards of the company. Prospective scribes go through a formal orientation that consists of both classroom and clinical components. In the classroom, they must pass tests on medical terminology, typing speed, and basic pathophysiology. The clinical orientation trains scribes to write efficient, accurate, and thorough notes. Scribes must pass these metrics to start working.
Local clinics often have more informal training, during which applicants are paired with current employees. Scribes are expected to learn on the job and are directly evaluated by healthcare providers and evaluations, instead of company representatives.
Conclusion
Healthcare experience, specifically PCE, is an important component of the PA school application. However, the requirements for the type and amount of healthcare experience vary significantly between different programs and even within students at the same school.
For example, in Yale’s 2019 class, the healthcare experience of matriculants ranged from 512 to 10,565 hours. While Yale is flexible in terms of clinical hours, other schools such as Duke and Emory prefer applicants with 7,000+ hours of clinical experience.
Likewise, schools have different opinions on whether medical scribing should be considered PCE. When taking into account the number of clinical hours needed to be a competitive applicant and the fact that some schools will not consider scribing as PCE, applicants may ask if scribing is even worth it.
The reality is that scribing can be an extremely useful experience for all PA school applicants. As a scribe, you will be trained to write patient notes, a skill you will need throughout your career as a PA. You will also work closely with healthcare providers, allowing you to learn more about diseases and the clinical workflow. You will also build relationships with physicians and PAs, setting you up with letters of recommendation for your application.
For these reasons, scribing can be an extremely valuable experience. In addition, a decent number of schools do count scribing as PCE. Depending on your school selection and the strength of application, you may not even need to worry about schools not accepting your scribe experience as PCE.
