Medical Scribe: Emergence of a New Occupation?

Yesterday’s New York Times carried an article about what may be an emerging occupation: the scribe who inputs medical records while a physician interacts with a patient.

The need for these workers arose because of a provision of the Affordable Care Act: the requirement that physicians keep electronic records of patients and use these in exchanges of information. The purported reason is to reduce paperwork and administrative costs, but another important consideration is the ability of researchers to use the digitized data in (anonymized) records to study the effectiveness of various medical interventions. I could add a third reason: data security. Although it is often assumed that paper records are more secure than electronic records because of the risks of computer hacking, paper cannot be as easily stored offsite in redundant copies. (I learned of this vulnerability when my all of my daughter's medical records were lost at her pediatrician’s office.)

Before electronic records, physicians either jotted down notes or dictated comments into a voice recorder for later transcription to paper, perhaps by a medical assistant. Some physicians resent the switch to electronic records because keying data into a laptop during interactions with patients pulls physicians’ attention in two directions at once. They find that the nature of their job has moved away from the work tasks that drew them into this profession.

Medical scribes relieve physicians of these duties by being the one holding and using the laptop during interactions with patients. Scribes key in all of the information produced during sessions with patients, freeing physicians to give patients their undivided attention. Obviously, there is a monetary cost to hiring these workers, but it is offset by the amount of time scribes save for physicians (an average of three minutes per patient visit, according to one study cited in the Times article), which allows physicians to see more patients over the course of the day. That’s not to mention how medical scribes change the nature of physicians’ work tasks by removing the clerical element.

On the other hand, having a third person present during every session with a patient may reduce the feeling of privacy that exists between physician and patient. Another study cited in the article found that, in clinical settings, “roughly 10 percent of patients were uncomfortable with having the scribe present.”

One company that provides medical scribes to hospitals and medical practices estimates that almost 10,000 scribes are now at work, and businesses such as ScribeAmerica and PhysAssist Scribes have been established to meet the growing demand. These companies train the scribes in a program that takes about two or three weeks.

But is this a new occupation, or merely a specialization within an existing occupation, medical assistants? It would be easier to recognize as a distinct occupation if it had a formal educational credential. However, I would argue that it is an occupation in its own right because its work tasks are highly specific. It is unlikely that medical assistants are dividing their workdays to handle these tasks part of the time or that some of the work time of medical scribes is being diverted to doing tasks that medical assistants perform, such as measuring patients’ vital signs or scheduling appointments.

My guess is that this occupation will flourish for a few years but that voice-recognition software will eventually be adapted to the specific needs of recording data from sessions with patients. Some physicians are already using voice-recognition software in limited ways.

The Chinese Skills Disconnect: An Opportunity for Us?

The New York Times headline read “Degrees, but No Guarantees.” However, the story was not about the students graduating from American universities this season. Instead, it was about Chinese grads. It seems that Chinese businesses are swamped by job applications from graduating students but have few jobs to offer. At the risk of seeming to express schadenfreude, I want to point out that as bad as our economy seems for our own grads, their prospects are better than China’s.

The problem is not just that growth of the Chinese economy has slowed from its fever pitch of the previous several years. More fundamental is the nature of that economy. Like the postwar United States economy, it is growing mainly from manufacturing. You only have to prowl the aisles of your local Walmart to see the fruits of that manufacturing prowess. However, in an economy that has a very large share of low-tech manufacturing, such as the plants that produce plastic toys, rubber tires, kitchen utensils, or even iPads and other high-tech devices that are assembled by hand, there is a limited need for college-educated workers.

In the postwar American economy, millions of workers with only a high school diploma or even less education were able to find low-tech work in manufacturing plants and earn middle-class incomes. But more and more young people are getting college degrees now, despite the fast-climbing expense, because those low-skill jobs have largely vanished, exported to China, and the low-skill service jobs that remain are very low-paying.

But consider the implications for China. Think of it this way: We have not only exported the 1950s-style manufacturing capability, but also the accompanying 1950s-style skill requirements. Chinese universities are capable of churning out hordes of graduates, having quadrupled the number of college students in the past decade. But at this point in its development, China’s economy does not particularly need these grads.

A survey released last winter of Chinese young people age 21 to 25 found 16 percent of the college grads unemployed, but only 4 percent unemployment among those with only an elementary school education. This is the reverse of what you’ll find in the United States, where the May 2013 unemployment rate was 11.1 percent for those with less than a high school diploma and only 3.8 percent for those with a bachelor’s degree or higher.

There certainly is a case to be made that China is preparing human capital for the economic transition that will occur as wages rise, as manufacturing shifts to still lower-paying countries, and as their economy starts looking more like ours does now rather than our 1950s model. But what will the young grads pouring out of the universities find to occupy themselves until that shift occurs? And if that shift is somehow accelerated—for example, if China’s government invests very heavily in research and development activity—what will happen to today’s huge cohort of low-skilled Chinese workers?

America’s “greatest generation,” which prospered during the postwar period, has already left the workforce. They had several decades in which to enjoy the match between their skills and their nation’s economy. Among the baby boomers, who got their start in that postwar economy, many now are suffering from the shifted economy but at least had many good years of opportunity. What about China? With worldwide economic development now moving so fast, will millions of Chinese factory workers have the rug pulled out from under them as their 1950’s-style economy disappears? Or will China find some way to slow this transition and continue to disappoint the college grads? Either of these alternatives promises to cause social unrest.

There is still one more possibility: that China will do what we did with community colleges in the 1970s, only on a much bigger scale—that is, invest heavily in adult education and retool the hordes of low-skill workers for the inevitable economic shift. Online courses, in particular, could facilitate a golden age of Chinese adult education in the next decade. But consider that the online lessons won’t need to be based in China. Thousands of Chinese students are now coming to brick-and-ivy universities in the United States because of our sterling reputation for higher education. We are now pioneering online education. If we play our cards right, perhaps Chinese-language online education can be one of our hottest export industries in the next decade.

Reading the Tea Leaves at the Department of Labor

What are the emerging occupations that will offer job opportunities for young people and career changers? One way to get a clue is to look at how our government, especially the Department of Labor, classifies occupations.

You’ve probably been told since childhood that there are two kinds of elephants: African and Indian. Now it turns out, from genetic evidence, that there are actually two species of African elephants: the forest species and the savannah species. This discovery will mean changes in conservation practices.

Something similar happens among the labor economists in the U.S. government: Every so often, they change the way they classify occupations. Most of the time, they split up occupations, just as the biologists have split up elephant species. Two practical results are that we get (1) more career information and (2) indications of how our economy is changing.

Last year, the government changed the Standard Occupational Classification taxonomy, which is what organizes the occupational titles that appear in all reports generated by all branches of government (Labor Statistics, Census, Economic Analysis, and so forth). SOC 2000 was replaced with SOC 2010.

We’re able to see the specific impact on SOC 2010 on career information now that the National Center for O*NET Development, which prepares the nation’s chief occupational database, has announced its plans for how (in an interim release, next month) it will align the O*NET database with SOC 2010. Several occupational specializations have now become occupations in their own right. Some previously unrecognized occupations have been added. And these changes indicate the directions our economy is taking as the second decade of the 21st century begins.

Green energy is one field where the change is particularly visible. Solar Photovoltaic Installers and Wind Turbine Service Technicians used to be two specializations within Construction and Related Workers, All Other. Now they’re distinct occupations, for which BLS will need to collect workforce and wage statistics and make employment projections. I can’t wait to see these figures! For my books about green jobs, I had to rely on industry sources (historically susceptible to boosterism) for these figures.

The same result has happened in other fields as well. Health care, our fastest-growing industry, provides many examples. Genetic Counselors, which used to be a specialization within Healthcare Practitioners and Technical Workers, All Other, is now an occupation in its own right. Similarly, Nurse Anesthetists and Nurse Practitioners, which used to be confined within Health Diagnosing and Treating Practitioners, All Other, have been promoted to full occupational status. Nurse Midwives and Hearing Aid Specialists have broken free of Health Technologists and Technicians, All Other. (Two new specializations that O*NET is adding to this catch-all occupation are Ophthalmic Medical Technologists and Surgical Assistants.) Some completely new occupational titles in this field are Exercise Physiologists, Magnetic Resonance Imaging Technologists, Ophthalmic Medical Technicians, Phlebotomists, and Community Health Workers.

These changes reflect the effort to reduce health-care costs by shifting some tasks from doctors to highly-skilled nurses and technicians.

In high technology, you can find Web Developers no longer slotted within Computer Specialists, All Other. Computer Security Specialists used to be a specialization within Network and Computer Systems Administrators but now steps out on its own under a modified title, Information Security Analysts. Some entirely new titles are Computer Network Architects, Computer Network Support Specialists, and Radio, Cellular, and Tower Equipment Installers and Repairers.

In the business world, some new faces are Funeral Service Managers, Labor Relations Specialists, Fundraisers, and Credit Counselors.

The presence in SOC 2010 of new or newly-promoted occupational titles means the government is betting that these occupations are likely to expand. Most of them involve new or upgraded skills, which means limited competition for job openings. If you are thinking about your future career or advise people who are, you should pay attention to these occupations.

Three Kinds of Green Jobs

You've probably been hearing people tossing around the term "green jobs." This can be a slippery term, so in my forthcoming book Quick Green Jobs Guide: Six Steps to a Green Career I make a point of explaining what a green job is. It's important to understand that the term applies to a lot more jobs than just installing solar panels.

Every big shift in the economy creates many new job opportunities. Think about what happened when computers arrived. They created many new occupations, such as computer programmers and computer systems analysts. But more important was the way technology changed existing occupations. By 2001, 56 percent of all workers were using computers, but only a small fraction of these workers had the word “computer” in their job title.

Something very similar is expected to happen to careers as we shift to a green economy. The U.S. Department of Labor identifies three kinds of occupations that will contribute to the green economy:

Green Increased-Demand Occupations: These existing jobs will take on many new workers as green practices and technologies expand. The work itself and the skill requirements will not change much. Examples: Boilermakers, Chemists, Electricians, Forest and Conservation Workers, Locomotive Engineers, Power Distributors and Dispatchers, Rough Carpenters, Structural Metal Fabricators and Fitters, Zoologists and Wildlife Biologists.

Green Enhanced-Skills Occupations: These existing jobs will experience changes in work tasks and skill requirements as we shift to a green economy. They may or may not see increases in employment. Examples: Aerospace Engineers, Construction Managers, Financial Analysts, Geological Sample Test Technicians, Landscape Architects, Machinists, Marketing Managers, Plumbers, Storage and Distribution Managers, Urban and Regional Planners.

Green New and Emerging Occupations: These jobs are being created to do new kinds of work or meet new skill requirements. Examples: Biofuels Processing Technicians, Biomass Production Managers, Chief Sustainability Officers, Energy Auditors, Fuel Cell Engineers, Logistics Managers, Methane/Landfill Gas Generation System Technicians, Precision Agriculture Technicians, Solar Photovoltaic Installers, Weatherization Installers and Technicians.

These definitions point to an important truth: Most green work opportunities will be in existing occupations. That’s why it's important to become informed about green jobs even though the green economy has not fully emerged yet.

To see the information the Department of Labor has about green jobs, go to the O*NET site at http://www.onetcenter.org/green.html.