Professional fission in medical routines: Medical scribes and physicians in two US hospital departments

Ann L. Bryan, John C. Lammers

Research output: Contribution to journalArticlepeer-review


In this study we argue that professionalism imposed from above can result in a type of fission, leading to the ambiguous emergence of new occupations. Our case focuses on the US' federally mandated use of electronic health records and the increased use of medical scribes. Data include observations of 571 patient encounters across 48 scribe shifts, and 12 interviews with medical scribes and physicians in the ophthalmology and digestive health departments of a community hospital. We found substantial differences in scribes' roles based on the pre-existing routines within each department, and that scribes developed agency in the interface between the electronic health record and the physicians' work. Our study contributes to work on occupations as negotiated orders by drawing attention to external influences, the importance of considering differences across professional task routines, and the personal interactions between professional and technical workers.

Original languageEnglish (US)
Pages (from-to)265-282
Number of pages18
JournalJournal of Professions and Organization
Issue number3
StatePublished - Oct 1 2020


  • Occupation
  • electronic health records
  • medical scribes
  • physicians
  • profession
  • professional fission

ASJC Scopus subject areas

  • Business and International Management
  • Strategy and Management
  • Organizational Behavior and Human Resource Management


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