DISCUSSION
Based on a 2-year trial of medical scribes involving 18 VA Medical Center specialty clinics, we find suggestive evidence of randomization to scribes being associated with increased productivity in cardiology and orthopedics, decreased wait times in orthopedics, and no change in patient satisfaction. Our findings in the VA setting are consistent with previous non-VA studies that found associations between scribe intervention and increased productivity.Our study has several limitations. First, sites were randomly selected from a list of sites that exhibited interest in participating in the scribe pilot rather than being randomly selected from all VA facilities, potentially limiting generalizability if this intervention were to be scaled across VHA. Second, provider participation was voluntary, which again could have implications for scalability and what effects could be expected if scribes were introduced to the care process without buy-in from providers. Third, we do not account for the difference in hiring modality of scribes (VA or contractor) in our models because of insufficient statistical power. There may be differences in training between VA and contract scribe training and/or prior experience that are relevant to these outcomes. Finally, cost analysis that can help inform adoption decisions of scribe programs in the VA is not included in this article. To our knowledge, this is the first study to examine the impact of medical scribes in a multi-center randomized trial within a large integrated health care system, like the VHA. Moreover, medical scribes may increase provider satisfaction, improve the quality of provider and patient interactions, and decrease physician burnout due to the documentation burden related to electronic health records, none of which we are able to capture in this study.