Ambient AI Scribe vs MA-Scribe in Primary Care Clinic

This Week’s Real-Life Lesson: Ambient AI Scribe vs MA-Scribe in Primary Care Clinic

For over a decade, I practiced family medicine in a busy clinic where I had three nurse scribes supporting me daily. These were some of the most valuable members of my care team. They knew my style, anticipated my needs, and kept the wheels of clinical documentation turning. But today while I work as a FM-OB locum, I no longer have any humans in the exam room with me—just an AI scribe (Freed) silently capturing the visit.

This week, during a coaching session with a PEA primary care doctor, we unpacked the question:

“Should I invest in a Medical Assistant (MA) scribe or transition to an AI solution like DAX?”

Her dilemma mirrored my own evolution, and I thought this story might help you wrestle with the same decision.

Where You Were: The Case Study of Dr. L

Dr. L is a family physician at a large health system that recently rolled out the DAX ambient AI tool. At first, she was skeptical. She recently started with the hospital as a 0.6 FTE (for better home-work balance) and negotiated an MOU in her contract to allow for an MA-Scribe in her staffing model. She really liked the idea medical assistant scribe who would pend orders, room patients, and sometimes even close care gaps. In fact, her clinic flow depended on it. In the end, she hoped this would get her home to her family sooner after her clinic was wrapped up.

The hospital is now pushing that the DAX solution as the best option for her rather than an MA-scribe.

She also recognizes the cost and complexity of an MA-Scribe: from hiring, training, turnover, and the unpredictability of people.

She came to me asking, “Tod, if you had to choose today, what would you do?”

What Happened: My Transition from Nurse Scribes to AI

I explained that for 10 years, I had three nurse scribes working with me. It was efficient and frankly luxurious in terms of workflow. My notes were beautiful, my time after clinic was minimal, and I could focus on patient care—looking at patients eye to eye rather than the computer being wedged between us.

But with the entry of ambient AI for notes, when one of my nurses left, the hospital wanted to save money and chose not to replace my nurse and instead asked me to start using DAX as part of their new staffing plan.

That’s when I piloted DAX, and later transitioned to a hybrid staffing model of 2 nurses and DAX. I actually grew to like it.

I walked my coachee through the decision framework she had in front of her during our coaching session (see excerpt below) and it illustrates the tradeoffs:

What I Learned During My Use of DAX and MA-Scribes

Here’s the surprising truth:

1. Patient Experience Matters – Patients often prefer not having a “third wheel” in the exam room. DAX made the visit feel more private.

2. Documentation Quality Is Close – AI does a remarkable job for straightforward visits. But MAs still outperform for complex, multi-problem encounters.

3. Cost & Scale Tip the Balance – Many businesses can’t justify the hiring, training, and overhead of MA scribes. AI wins on scalability.

4. Team Roles Re-Defined – Without nurse scribes, my MAs shifted into higher-value roles: patient outreach,chart prep for patient visits, preventive care follow-up, and managing in-basket tasks and assisting me with order entry efficiency through our standing order system.

The Surprising Micro-Business Insight

This isn’t just about clinical workflow—it’s about entrepreneurial design.

When you own your micro-corporation, every staffing choice is both a care decision and a business decision. The “right answer” isn’t the same for everyone.

• If you’re an employed physician, having an MA-scribe might make sense—your time savings outweighs HR headaches.

• If you’re self-employed (like many PEA physicians), AI scribes may offer the cleaner financial model and greater scalability.

The real lesson: your clinical tools are part of your business model.

👉 If you’d like to explore how to align your clinic operations with your micro-business strategy, reach out to me for a business strategy session and I’ll be glad to help you optimize your workflow.

Is This Deductible?

I had to pay the IMLCC to get a background check for getting my IMLCC letter of support. Is that deductible?

Yes—it’s part of the expense of operating your professional business and therefore is generally deductible.

👉 Learn more in my e-book 12 Tax Secrets Every Physician Entrepreneur Should Know where I also outline deductible strategies you might be missing.

Linking Back to My Journey

I’ve written before on my Independent Physician blog about the power of micro-business autonomy and how tools like AI scribes help us stay agile. You can revisit these related posts:

• Say Yes to Self-Employment

• Creating a Practice Without Walls

• Doctor Incorporated: Stop the Insanity of Traditional Employment

Each of these connects to the same principle: your practice should serve your life—not the other way around.

Call to Action for You

If you’re wrestling with workflow, staffing, or technology decisions in your own practice, here’s what I recommend:

1. Join the PEA-SimpliMD Community – Start with an Explorer Membership for $99/year and get access to foundational tools.

2. Level Up with Coaching – Schedule a 1:1 Business Consultation to get personalized guidance.

3. Dive Deeper with Our Course – Explore Doctor, You Are A Business for step-by-step guidance on building your professional micro-corporation.

Final Reflection

For me, moving from three nurse scribes to one AI scribe was more than a workflow tweak, it was a paradigm shift. It changed how I viewed staffing, privacy, and scalability. It also reinforced my conviction that physicians must think like entrepreneurs.

Your tools—whether they’re human or AI—are part of your business model. Make those choices intentionally.