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How to Become a Medical Scribe

Are you a good listener and enjoy taking notes? Do you do well at following specific directions? If so, being a medical scribe may be the perfect job for you. 

Medical scribes enter the patient room with the physician and observe the interaction while taking meticulous notes and inputting those into the patient’s electronic medical record. When the physician is done with the patient, the medical scribe leaves the room with the physician. 

This allows the physician to focus on the patient. It also allows physicians to bypass the menial computer work and attend to other more important tasks more closely suited to their level of knowledge and experience. Medical scribes are closely supervised by their attending physicians. They may also be expected to handle entering orders or referrals for patients on behalf of the physician.

Sample job description

[Your Company Name] is seeking a detail-oriented medical scribe to work at our facility. You will be working very closely with our physicians when they meet with patients and transcribing patient notes into their digital medical records. The scribe provides real-time charting by shadowing the physician throughout their schedule and performs a variety of tasks including recording the patient’s history and chief complaints, transcribing the physical exam, ordering X-rays, recording diagnostic test results, and coordinating with departmental resources regarding tests, orders, radiology, and results. Our ideal candidate has experience working in the medical field and comes to work with a friendly attitude every day.

Typical duties and responsibilities

  • Observe patient-physician interactions and document each patient’s electronic health records
  • Enter orders or referrals on behalf of the physician
  • Gather information from the patient’s visit that’s important to document
  • Partner with the physician to deliver efficient patient care under the direction of a nurse or other medical professional
  • Assist the physician when asked
  • Document procedures, lab results, dictated radiographic impressions made by the physician, and more
  • Adhere to HIPPA laws

Education and experience

  • High School Diploma
  • College Degree or Certification (CMSA or CMSP) a plus
  • At least 1 yr experience with electronic health records
  • Experience in urgent care preferred
  • Recent medical scribing experience preferred

Required skills and qualifications

  • Must be familiar with medical terminology in the field you’re working in
  • Capable of precisely transcribing patient care and appointment details
  • Up to date computer skills
  • Ability to keep patient details confidential and private
  • Excellent navigation of multitasking, organization, and time management skills
  • Must respond well to high-pressure situations in an efficient manner
  • Possess advanced communication skills (both written and verbal)
  • Good people skills 
  • Capabile of keeping up in a fast-paced environment
  • Ability to work in a team with colleagues
  • Ability to type at least 60 words per minute

Preferred qualifications

  • Experience with transcption
  • Familiarity with most medical terminology across medical fields
  • Intermediate working knowledge of Microsoft Office applications
  • Knowledge of medical EMR software

Typical work environment

The typical work environment of a medical scribe can best be described as fast paced and high pressure with a need for calm precision. Medical scribes work within doctors’ offices, hospitals, and smaller medical practices. In this work environment, medical scribes must perform with precision and accuracy in a calm and efficient manner. Even when faced with difficult colleagues, worried patients and a heavy workload, they must be able to step away from the chaos to be able to report accurately and write notes without bias. They often work alone, staying in the background as physicians and patients talk. 

Typical hours

Medical scribes usually work 8 to 10-hour shifts, but will sometimes need to work 10 to 14-hour shifts. They can also work during the daytime, evening, weekends or holidays depending on their location.

Available certifications

Medical scribes may benefit from getting one of the many available certifications for scribes. This can help increase the chances for you to secure a higher-paying position in the long run and will help job seekers stand out from the crowd.

  • Ophthalmic Scribe Certification (OSC). Created to assess the skill level of an individual in transcribing and maintaining patient records under the supervision of an ophthalmologist, an OSC requires the passing of the exam and recertification every three years.   
  • Certified Medical Transcriptionist (CMT). In order to obtain a CMT, two-plus years of education or training after high school is required. You also need two years of work experience and to pass the exam. Recertification is not needed. 
  • Registered Health Information Technician (RHIT). RHIT requires that you have two plus years of training or education after high school and that you pass the RHIT exam. Recertification is required every three years.

Career path

While it is not necessary to obtain a college degree to become a medical scribe, a degree can help you stand out from the rest of the crowd. A medical scribe is also a good opportunity for students to familiarize themselves in a medical environment while working toward medical school or another similar career. Certifications like those mentioned above are excellent credentials to have under your belt and expand your knowledge of the medical records field, making you more desirable to employers.

US, Bureau of Labor Statistics’ job outlook

SOC Code: 31-9094

2020 Employment52,400
Projected Employment in 203048,500
Projected 2020-2030 Percentage Shift 7% decrease
Projected 2020-2030 Numeric Shift3,900 decrease

In spite of a 7% decrease in the projected number of medical scribe jobs in the year 2030, there is still expected to be 6,600 openings for medical scribes each year. This is because it is common for this field to be a rung on the ladder of the medical field. Most use it as a stepping stone to then move on to other medical field careers.