Settings: mixed specialty (6 encounters), baseline 6 min/note, 1.5 s/word edits, 390 encounters/month, 10% patient declines, 20% trainee-led, promise 5 min/note saved.

Edit rates: generic SOAP drafts 78% word-level edits; specialty-customized drafts 27% — customization roughly triples how much text survives unchanged.

Net minutes per note: generic +1.5 min saved, customized +3.3 min saved (vs 6-min baseline); omissions and format errors dominated errors in generic drafts.

Hours/month ladder: promise 4,550 h → pilot reality 6.6 h (MC 90%: 2.7–11.5) → +customization 14.2 h → +remove barriers 19.7 h → +all enrollees active 40.3 h → full adoption 2,178 h.

Adoption at the paper's 0.94% median usage drives nearly all of the 4,544-h gap between promise and reality; improving note quality alone adds only ~7 h/month at current uptake.