A few months ago, I received email notification at work that indicated our phones would soon be automatically downloading a generic, HIPAA-compliant artificial intelligence (AI) scribe. I was intrigued. Could an AI scribe really get all the complexities of an emergency department (ED) encounter? How would it know what to leave in—and sometimes more importantly—what to leave out?

Testing Out New Tech

With all this in mind, I tried out the generic AI scribe. I first tried it with my husband. He pretended to be a physician, and I pretended to be a nightmare historian. I’m referring to the type of person who rambles about pickleball when you are asking them about their chest pain and has a hard time staying on track. The result was surprisingly good; the program omitted non-medical information and provided a succinct non-judgmental history. I tried it next at work, with less success. I found that the generic AI scribe didn’t have as much detail as I would have wanted in some areas. It also included certain information that was extraneous or worded in a way that I did not appreciate, such as describing all pain as “severe.” I ended up spending more time editing the document than it would have taken to just come up with my own history via dictation.

So, for now, I’m not switching over. But I am impressed. I don’t doubt that AI will continue to improve, and there might be a day where AI could replace traditional ED scribes.

The profession of scribing dates to Mesopotamia and the beginnings of human civilization. Scribes have been essential throughout history in keeping a variety of documents, including historical records, legal codes, copying manuscripts, and texts. This isn’t the first time where scribes’ jobs have been challenged by modern inventions. The advent of the printing press 585 years ago caused a significant decrease in the prominence and use of scribes. However, in the past several years with the release of the electronic medical record, there has been a boom in the use of medical scribes to help with the burden of increased clinical documentation.

The American College of Medical Scribes estimated an increase in 80,000 scribes between 2015 and 2020.¹ Medical scribes have been shown to be beneficial to emergency physicians in terms of billing and coding, physician satisfaction, improved documentation in the emergency department, and patient volume.^2,3 Surveyed ED scribes have also described benefits of experiencing being a scribe in terms of mentorship, increased clinical experience and medical knowledge, and improved chances of getting into medical school.⁴

A Personal History

I became an ED scribe my senior year of college while applying to medical school. Using a generic AI scribe has made me reflect on my time as an ED scribe and what a great influence that experience had in my overall decision to pursue emergency medicine. I first fell in love with the undifferentiated patient and the scope and excitement of emergency medicine when I was a scribe. I found role models and mentorship from the attendings I scribed for and made connections that have lasted throughout my career.

Would I have even gone into emergency medicine if I hadn’t had the opportunity to be exposed to the ED as a scribe? Probably not. My emergency medicine rotation wasn’t until my fourth year after sub-internship applications were due. According to the Association of American Medical Colleges (AAMC), in 2019 only 61 percent of medical schools required emergency medicine as a core clerkship. Unless we provide medical students with early exposure to emergency medicine, they might not realize that emergency medicine is their calling.

I have reviewed hundreds of emergency medicine residency applications and personal statements over the past few years. This experience leads me to believe that early exposure to emergency medicine through experiences such as EMS and ED scribing may play a crucial role in recruiting talented individuals to pursue emergency medicine. In the 2022 Match, emergency medicine residency programs were rocked by an unprecedented 219 unmatched positions; nearly one-quarter of programs were impacted before the SOAP. This trend worsened in 2023 with initially 554 unfilled positions prior to the SOAP.5 The decline in applications to emergency medicine programs is already concerning. Transitioning to AI scribes could potentially impact the pipeline of future applicants and further exacerbate the challenges faced by emergency medicine residency programs in filling their positions.

I worry that transitioning to AI and away from scribes, who have traditionally been premedical students looking to enhance their resumes to improve their chance of gaining acceptance to medical school, will influence future applications and interest of those ultimately wanting to apply to emergency medicine in a time when applications to emergency medicine are tenuous. Although I see the potential in AI scribes for ED documentation and expect that their use will become more widespread, I think our specialty should consider the broader implications and how AI might impact the pipeline of future applicants to emergency medicine. Strategies and pipeline programs may need to be developed to make sure that medical students continue to have early opportunities to gain exposure and mentorship in emergency medicine.

Dr. Hutchison is an assistant program director for the Kaiser Central Valley Emergency Medicine Residency Program.

References

1. Geller G, Ramirez R, Webster L. The rise of the medical scribe industry: implications for the advancement of electronic health records. JAMA. 2015;7(13):1315-1316.
2. Allen B, Banapoor B, Weeks EC, et al. An assessment of emergency department throughput and provider satisfaction after the implementation of a scribe program. Adv Emerg Med. 2014;2014: Article ID 517319.
3. Dawkins B, Bhagudas KN, Hurwitz J, et al. An analysis of physician productivity and self-sustaining revenue generation in a free-standing emergency department medical scribe model. Adv Emerg Med. 2015;2015: Article ID 518179.
4. Eley RM, Allen BR. Medical scribes in the emergency department: the scribes’ point of view. Ochsner J. 2019;19(4):319-328.
5. Lewis M, Williams K, Timpe J, et al. The 2022 and 2023 Emergency Medicine Residency Match: A Cautionary Tale. Cureus. 2023;15(5):e38601.