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	Vera Pyle’s Current Medical Terminology, 9th Edition Like new condition Price: $10
	Vera Pyle’s Current Medical Terminology, 8th Edition I actually have 2 of these. One was misprinted – the cover is on upside-down and backwards. In every other respect, the book is perfectly acceptable. Please specify which book you want. Price (each): $10
	Vera Pyle’s Current Medical Terminology, 7th Edition This book is like new, with very little cover wear. Price: $10
	Vera Pyle’s Current Medical Terminology, 5th Edition This book is worn around the edges and the spine. I can’t find any writing inside, but it wouldn’t surprise me if I made notes in it. Price: $5
	Stedman’s ASP parasite names Excellent condition, with very little wear Price: $3
	Saunders Pharmaceutical Xref Book 2003 (Drake & Drake) This book is like new Price: $3
	Saunders Pharmaceutical Word Book 2003 (Drake & Drake) This book has some dog ears from shelving Price: $3
	Saunders Word Book in Pathology & Laboratory Medicine (Sloane/Dusseau), 2nd Ed. This book is like new Price: $8
	Stedman’s Alternative & Complementary Medicine Words, 2nd Ed. There is fading on the spine cover; otherwise, like new. Price: $5
	Elsevier/Saunders The Surgical Word Book, 3rd Ed. (Tessier) This book is like new and is the latest edition. Price: $25
No Image	The Surgical Word Book, 2nd. Ed. (Tessier) The newer edition is available above. This book is more worn, with some water staining, the cover is more worn, and the pages are yellowed. Price: $2
	Dorland’s Illustrated Medical Dictionary, 30th Ed. Includes CD with spell-check software (I’m not sure what), never opened. The latest edition is 31st; this edition is a steal at this price. Price: $25
	Dorland’s Illustrated Medical Dictionary, 28th Ed. This book is more worn and an older edition. Price: $5
	Stedman’s Medical Dictionary, 27th Ed. Like new, with very little shelf wear Price: $20
	Medical Typing and Transcribing: Techniques and Procedures by Diehl/Fordney This book is like new Price: $25
	Medical Terminology Essentials (2001 publication) This paperback book is literally like new. The CD included has never been removed from the plastic wrapping. It is a 2001 Edition but medical terminology never goes out of date. This book was written to familiarize medical office staff with medical terminology and includes numerous pictures, illustrations and worksheets. Price: $50
	Legal Secretary’s Complete Handbook, Fourth Edition (Hardcover) Some shelf wear on the dust cover; otherwise, like new. Price: $20
	The Independent Medical Transcriptionist, 3rd Ed. (paperback). Avila-Weil/Glaccum This book is like new, with no wear on the cover or the pages. Price: $20
	Stedman’s GI & GU Words including Nephrology, 2nd Ed. There is a newer edition of this book. The pages in this book are slightly yellowed, some are dog-eared, but overall it’s in really good condition. Price: $3
	Stedman’s Abbreviations, Acronymns & Symbols (Stedman’s Word Book Series) This book is in very good condition, with little cover wear. Some dog-eared pages from shelving. Price: $3
	Stedman’s Ophthalmology Words (1993) This book is in excellent condition. Price: $2
	Stedman’s Neurosurgery Words (1993) Very little cover wear, no dog-earing; this book is in excellent condition. Price: $3
	Stedman’s Medical & Surgical Equipment Words, 2nd Ed. This book is in excellent condition, with very little wear. Price: $5
	Stedman’s Radiology & Oncology Words,Including HIV-AIDS Hematology This book is like new, with very little cover wear. Price: $5
	Stedman’s Orthopaedic and Rehab Words, 2nd. Ed. Including Podiatry, Chiropractic, Occupational Therapy and Physical Therapy This book is used, in good condition, with wearing and dog-earing on the cover. The pages are in very good condition. Price: $3
No image	AAMT Book of Style, 2nd. Ed. There is a newer edition of this book. FREE – Shipping only

I wrote an article titled 2001: A Transcription Odyssey that was published in the July-August 2000 issue of the Journal of the American Association for Medical Transcription (JAAMT). It’s now 10 years later, a good time to revisit that article and some of the predictions I made.

Unfortunately, I don’t have the original draft I had submitted, which got sent back to me for some editing because the PTB at AAMT didn’t feel I was being positive enough about the future outlook for medical transcription. That draft would have more accurately pinpointed my predictions for the industry and how I felt about the future of medical transcription. With that caveat…

Although many transcriptionists work through the internet, they may be unaware of the scope of technological changes and the jockeying for position currently taking place. Many see a threat from offshore labor, when they should be looking at the technology that resides on their own desktop. The very tools we use to enhance productivity are also available to the computer-literate physician, especially if packaged nicely and marketed aggressively by a far-sighted company. The advertising claims that physicians can replace their transcriptionists are not far-fetched. Some physicians have, in fact, done just that and are perfectly satisfied with the results. The number will increase exponentially over time, in much the same way the technology has advanced. Transcriptionists need to prepare themselves to work within the new model of  business that will be created by the available technology and the changing environment of business brought about by the internet.

I’m pretty sure that last sentence was part of the edit. Notice that I don’t say HOW MTs need to adapt. Quite frankly, if memory serves, I couldn’t think of a way they could that would keep them in this picture. After all, I just predicted that technology would give physicians more tools to facilitate reducing or completely eliminating medical transcription.

At the time the article was written, the AMA reported that 59% of physicians weren’t even using computers. I wasn’t able to find a recent study, which suggests to me that there’s an assumption that medical practices and healthcare facilities are using computers, including mobile devices.

My updated prediction is that this trend will continue and we’ll see an even bigger spike as more computer-literate physicians enter practice. They will not only be less resistant to entering data into the computer directly, they’ll be more proficient at it than their predecessors.

I also predict that as more computer-literate patients enter the system, and as technology advances, we’ll see patients entering their history directly into an EMR, either at the doctor’s office or online. Or, if interoperability issues are resolved, retrieved from a PHR. I predict updates will take place the same way, so you can review the history the physician or facility has for you and enter any updates or changes. As EMRs evolve and improve, the information you give the doctor will be available to any other facilities or offices in the system. There are already systems that share information with providers across the system. As always, the technology will only improve over time. Young adults who have used computers most or all of their life won’t wonder why they’re being asked to type in this information themselves – they’ll wonder why it isn’t available, or why they have to enter the same information multiple times in multiple places. I think there will even come a point when speech-to-text is so accurate that this data entry will take place in the form of speech, combined with touch screen and keyboarding.

A new tool becoming available to the individual transcriptionst and smaller business owners is the application service provider (ASP)… The purpose is to provide an “enterprise” solution for physicians (in plain English – one-stop shopping). By giving physicians access to something everyone knows they utilize, the portals hope to entice them to take advantage of other services and/or goods being sold through the portal. The advantage an ASP can give transcriptionists as a by-product is more equal footing with the large services. Access to both physicians and other transcriptionists becomes a possibility, at a price that is not beyond reach. It will no longer be necessary to take a deep breath, hyperventilage, then sign a five-year lease agreement for $60,000 worth of digital dictation equipment that will be obsolete before the lease is up. ASP networking will allow transcriptionists to work with each other to coordinate coverage for peak periods and time off… The ASP model provides state-of-the-art networking and upgrades inclusive with the other services offered.

I’m not sure the ASP model has been of great benefit to the independent MT, working solo or in small groups to provide service to select physicians. I think it has been of benefit to small transcription services looking for growth opportunities. In the past ten years, a model used by some ASPs is to do the marketing and sales, then contract with various independent MTs and small MTSOs to perform the work. In this scenario, the ASP sets the price to the client, not the MT or the MTSO. Like everything else, the ASP market has continued to evolve, with multiple acquisitions, change of ownership, mergers, and some winners and losers. Very few of them partnered with portals; instead, they became transcription platforms, with interfacing on the client end for compatibility with whatever technology the client used. Companies like InterFix made it easier to interface the ASPs with the multiple hospital IT systems and recently, in partnership with AHDI, created the Benchmark KB, a desktop application for transcriptionists that interfaces with various transcription platforms. The value of the Benchmark KB is that it reduces training and learning curve for transcriptionists working for a company that uses more than one platform.

Although currently many physicians remain blissfully ignorant of templates, macros and normals, that will change as doctors become more computer literate and money gets tighter. I predict more transcriptionists will be requested to discount or not charge for templates or normals.

I think I got this one right. What I missed completely was that anyone would not count spaces! I also missed that there would be transcription services (in my experience, predominantly overseas services) that would use this as a selling point, not only discounting the characters contained in templates, macros and normals, but also undercutting prices at the same time, further eroding the rates charged by US-only companies and the earning ability of medical transcriptionists here in the US.

The next level for speech recognition will be speaker-independent recognition. Translated for the technophobe, the technology will be able to understand the dictator who is your worst nightmare, with very little user training.

This prediction was accurate, in fact. Not that no training at all is required, but companies providing server-based (also known as back end) speech recognition do train the speech recognition engine, but they do it using a library of digital dictation files obtained from the system. Physicians are not required to sit and train the engine. Most of them are told they don’t need to change their dictation habits, which is more for the purpose of getting them to adapt to the system than anything else because there certainly would be a benefit to the accuracy of the documents if the physicians were willing to make some changes.

The question for transcriptionists is: will it matter if recognition accuracy is 100% when grammar, punctuation, syntax and language usage are not (how shall I say this?) – exactly representative of a strong foundation in English? My prediction is that it won’t. I believe as long as the document says what the dictator means it to say in a relatively clear (i.e., defensible) fashion, it will be accepted… While we may wring our hands that the quality of patient care is being compromised, who is actually compromising it – the physician, the transcriptionist, or the software used to create the transcript? Ultimately, the responsibility belongs to the physician. The more we try to take ownership of this responsibility, the more liability we expose ourselves to – a questionable tactic for assuring job security.

Well, I feel my crystal ball was working really well on this one and I probably don’t need to add anything to this.

If you don’t know the difference between DOS and Windows programs, it’s a reasonable conclusion that brushing up on your tech knowledge is necessary. I predict a future where computer literacy will be tested along with English literacy, and not just in the MT profession.

I found the following excerpts in current job listings for medical transcriptionists:

Cerner experience preferred. No satellite.

Meditech Client experience.

Are you reasonably computer literate? (This may be tested.)

Familiarity with transcription platforms (M*Modal, eScription, DocQScribe, and Spantel) a plus.

We are looking for editors who have had experience with the M*Modal platform.

You must have the necessary software (EditScript MT) and equipment (IN-DB9 or IN-USB pedal) in place with Microsoft word and a current electronic medical spell check loaded, ready to work.

Computer that is no older than 3 years. High-speed cable or DSL connection. Air card and satellite will NOT be supported. Internet service with AOL is not supported. RAM (memory) – 512 MB minimum. Hard Drive – 40 GB minimum. External computer speakers with volume control knob and headset plug-in. Good quality headset. USB port foot pedal. CD-ROM drive.

You MUST know how to use a FTP program to download and upload work. … Please DO NOT APPLY if you do not hve the required equipment or know how to use a FTP program.

I think it’s pretty obvious that computer literacy has become an essential part of the job, and we’re way past having to differentiate between DOS and Windows! What’s also become important is having a computer that has up-to-date software and current software. It would be difficult to find a job listing that doesn’t include software and hardware requirements, as well as internet connection requirements.

The article also completely neglected any mention of how technology would impact US medical transcription by facilitating overseas competition. Because digital technology and file transfer was available in 2000, I know overseas competition was a big concern for US MTs at that time. I’m not sure why I left out any mention of it – whether I was asked not to, or whether it was based on my opinion that there’s nothing you could say about overseas medical transcription that you couldn’t also say about onshore medical transcription, or whether I felt it had no place in a discussion that was about technology – I’m not sure. My memory isn’t what it used to be.

My crystal ball says that medical transcription as we know it will continue to deteriorate in both value and pay, and that advances in technology and a burgeoning population of computer literate physicians will contribute to that. We keep hearing that medical transcriptionists need to change their skill set and adapt in order to survive, and I agree with that. However, I see it evolving to an increasingly clerical position, with pay rates comparable to a clerical position. What MTs need to decide is whether or not they want to continue to work in the evolved position, at the evolved pay rates.

Hopefully, I’ll be around in another 10 years to see if the predictions I’m making here will take place.

Go on any medical transcription forum and you will find a war raging about medical transcription schools. The common opinion among the most vociferous is that there are only two choices one should make and no other school or program is worthy of consideration.

I’m not going to name names but let’s call those two schools Harvard and Stanford.

Everyone wants to go to Harvard and Stanford, don’t they? Well, of course. Who wouldn’t want to go to the #1 schools in the country? Who wouldn’t want to make the lifetime connections and have the prestige on their resumes?

There are only two problems with this:

Harvard and Stanford have exclusionary admissions.

Not everyone can afford to go to a prestigious private school.

Not everyone who applies is admitted to a prestigious school

Just like the real Harvard and Stanford, the two schools generally considered to be the top programs have screening processes. Why? Because not everyone is cut out for their program. Heck, not everyone is cut out to be a medical transcriptionist. Screening improves the program completion rate and ensures that the people who attend the program and graduate are in the Most Likely to Succeed category. It’s self-fulfilling policy that, although difficult to practice at first, ensures that the reputation of the school grows with every class that graduates.

The additional benefit is that there are fewer people admitted to those programs who pay their money and THEN discover they’re in the wrong career or school. They may be told at the time they’re rejected that this isn’t the career for them, but what they do with that information is up to them – Stanford and Harvard will not be taking their money and attempting to massage them through the program so they can finally (marginally) graduate and proclaim that they are now a graduate of the fine institution. This is good for the school because someone who has to be massaged hand-held throughout the program most likely isn’t going to be the most successful MT and Stanford and Harvard have a reputation to maintain when it comes to their graduates. It’s good for MTs because they aren’t wasting their money – at least not at that particular institution.

There’s another aspect to exclusionary admissions: not everyone who wants to go to Stanford and Harvard ought to go there. Every school teaches in a particular style and some students aren’t suited to that teaching style. A student who might fail miserably if admitted to Harvard or Stanford might thrive on the teaching style at a community college. The reason variety is the spice of life is because we are all unique and uniquely human. Experience is not a one-size-fits-all proposition; what worked or didn’t work for one person produce the same outcome for someone else. And frankly, it’s pretty easy to say “I could’ve done better if I’d gone to Harvard” – but we’ll never know, will we?

Not everyone can afford to attend a prestigious school

Let’s face it – the top institutions can charge more because of their reputation. And not everyone has the means to pay for a top-grade education. That’s why public universities, junior colleges, community colleges and vocational schools exist.

But! but! but! We hear the school war mongers cry: they won’t do as well if they go to a lesser school! they should be willing to sacrifice, pay the extra to get so much more!

Well, there’s reality and there’s reality. If part of the reason we’re trying to steer people right is because we don’t want women who are already struggling financially “waste their money” on a substandard education, I’m not sure I see the justification for the argument. I don’t want to see them waste their money, either, but you’d have to define a substandard education. I’m sure the community colleges would assure you that although they know they aren’t Stanford or Harvard, they provide a perfectly adequate education, especially for the price. And they graduate people who are able to find jobs. Is it easier for people with a Stanford or Harvard degree to find jobs? Probably. Is it impossible for people with community college degrees to find jobs? No. That’s the reality.

For someone who is having difficulty buying groceries, wondering if she will even make enough money to pay back what seems like a huge sum, it’s not realistic (and perhaps a bit arrogant) to tell her she needs to cinch up a little bit tighter and pay 30% more to attend a school that will get her a job that won’t pay any better than the one she’ll get when she graduates from “the other” schools. The reality is, she can get a job with a certificate from the less expensive school. The reality is that someone who is motivated and has the basic skills will probably do well for themselves whether they go to Harvard, Stanford or the local community college. The reality is that there are some very decent vo-tech and community college MT programs in operation that don’t cost thousands of dollars.

Picking battles and soldiers

Every parent knows it’s important to pick your battles. The wars being fought in some of the MT forums are, for the most part, over schools that have a legitimate place in the industry. I concede some have aggressive (and tacky) marketing techniques but that doesn’t make them de facto “matchbook” schools or invalidate the education they provide. At the same time opinions and insults are flying back and forth over the decision to attend a third- or fourth-choice school, there’s someone over on Ebay selling a 20-page “e-book” on how to become a medical transcriptionist and the Google ads at the same site where the discussions rage are advertisements for yes – matchbook schools, alongside “lowest prices for medical transcription!” Do you even need to ask which I find more offensive?

There seems to be a great desire to make sure no misinformation is spread (indeed, this is frequently given as the reason why someone continually harps on a topic every time it’s raised), yet many who say they only want to correct misinformation are spreading misinformation themselves. People reading the forums need to know who the poster is, their motives for saying what they say and the experience that qualifies them to be an expert. Maybe as a working MT someone has a unique perspective on their own experience getting hired; however, that doesn’t equate to experience in hiring transcriptionists. “National companies aren’t likely to hire someone from a community college program.” I’m sorry – an MT with no management or hiring experience just doesn’t know enough to make such a generalized statement. I said this on the internet forums 10 years ago and I’m still saying it: know who you’re talking to online, the background of the person giving advice, and take that into consideration because a lot of them are talking off the top of their head, which seems to explode with regularity. I’ve been in this business for over 20 years. I’ve hired literally hundreds of MTs and had thousands of resumes cross my desk. I run a job site for MTs. I’m pretty sure I know what I’m talking about versus someone who’s worked as a production MT for a couple of years, never seen a resume besides her own and never been in a position to hire anyone except a babysitter.

If you really want to hear my pet peeve on this topic, it’s this: I’d really really like to know the purpose of telling someone who has already paid for school (non-refundable) that they picked the wrong one and they need to dump that investment and go to a different school. I’d especially like to know how the people who claim they’re looking out for the financial interests of women who can’t afford to make mistakes justify this position. To say it isn’t helpful is a huge understatement and the badgering that goes on does nothing more than create doubt and anxiety. If you want to be helpful, try something along the lines of: I think you could’ve gone with a better school but since you’re already there and paid up, here are some suggestions for overcoming what I feel are the shortcomings of that particular school.”

Conclusion

It would be great if everyone who wants to be an MT could get into Stanford and Harvard and had the means to do so. It would be great if every MT school aspired to be Stanford or Harvard. It would be great if everyone who wants to be an MT was actually qualified. It would be great if people who are told they shouldn’t ever become an MT would actually listen to that advice. Any other dreams you want categorized?

This article was originally published at MT Exchange on September 9, 2008.

I’ve been following reports from the meeting as reported by Kathy Nicholls at her MT Tools Online blog, as well as the ACE365 website at Ning and I find myself wondering if medical transcriptionists can afford to let this organization continue to represent to legislators and the health information management community that it is the voice of the industry.

Granted, AHDI is being technically accurate when it represents itself as the largest organization for medical transcriptionists. What does that make the thousands of MTs who aren’t members? The largest disorganization for medical transcriptionists?

AHDI now counts among its membership over 10,000 members as a result of requiring KB users to be associate members of the organization.

Associate members are those individuals who have qualified for membership under a third-party vendor contract and have received this membership offering through the purchase of a contracted product or service, such as Benchmark KB. Only users/purchasers of those products and services qualify for this membership category.

Unfortunately, AHDI doesn’t go into detail about what associate members get with their membership, but it’s my understanding they cannot vote and they cannot hold office. In effect, therefore, there are only roughly 5,452 members in other categories. According to MT Tools Online, reportedly 30% of the total membership number is in the student category (also unable to vote or hold office), but that number is mixed with students who receive the KB as well. Subtract an unknown number of corporate, institutional and educational members and who knows how many that leaves in the individual professional category – those who can vote and hold office. Certainly, less than 5,000 and probably closer to 4,000. That’s down significantly from the 7000 individual professional members reported several years ago; and it is certainly a smaller and smaller pool of people who are eligible to hold office, much less vote.

Wow.

Actions this week at ACE that make it look like AHDI leadership has been taking their cues straight out of the Tricky Dicky book of Dirty Tricks. The House of Delegates’ (HOD) vote to retain the present members of the HOD for another year gives me flashbacks to an illegal secret Board meeting held in California years ago and reinforces the screw the membership mentality. If you don’t think your delegate is adequately representing your region – too bad. Like it or not, members will not get to hold an election of new delegates for next year.

Regardless of the reasons for this action, it’s illegal and a violation of AHDI’s own By-Laws, and possibly California law, where AHDI is incorporated. Niggling little things like that never seemed to stop this sort of thing in the past, so I guess nobody should be surprised that the dirty tricks continue. It should be frightening to realize that this is the same group that gives leadership seminars.

Frankly, I found Miriam Wilmoth’s comments on emergent resolutions before the HOD to be… well, enlightening.

… It is unfortunate, too, that any efforts to speak for members who are still confused, torn, or outright opposed to the way current issues before the House have been handled are met with accusations of dishonesty, that any dissenting opinion is met with an association-sponsored blitz of ad hominem attacks like none we have ever seen in this association – from the CEO, to selected (not all) board members, and even the Speaker of the House.

I’m having déja vú all over again.

I’m sure the response of the AHDI faithful will be – if you don’t like it, join and change it. OK, first of all – with no new delegates being voted in for next year, how much change can there be? I rather suspect the real purpose behind that move is to make sure the only changes made are the ones Dirty Tricks club wants made. And my personal response to that would be – been there/done that, got the T-shirt and what I experienced was eerily similar to what’s currently going on – burn the By-Laws, damn the torpedos and to hell with what the membership wants (what do they know, anyway?).

If we encourage our members to talk to us, to tell us what they think, to become engaged in the purposes of the association – yet when they open their mouths to speak effectively they find their integrity called into question – do we really think they will continue to speak?

And after reading this comment – again made by Miriam Wilmoth – is there any question that you would plop down your $135 annual membership fee only to be told screw you very much? Because that’s what’s already happened to current members.

I’ve already seen a slew of long-time members – members who were active in leadership positions – drop their membership and leave AHDI. And yet the insanity continues. Obviously, the number of core members – those in the individual membership category – has dropped drastically over the last couple of years. And instead of addressing the issues and concerns of members and former members and asking what they could possibly be doing wrong – many of those who remain at AHDI write off criticism as sour grapes or negativity and then drop their heads back into the sand. Because as long as you can write off the people who bring up the issues, you don’t have to actually take responsibility and address the issues. And I’m not even going to get into how AHDI has ignored the fact that nonmembers could be potential members. (More on that in another post, where I’ll talk about a publication by an AHDI staff member that makes it clear what the attitude is about us.)

In my opinion, this organization has been on a course that is detrimental to practitioner medical transcriptionists since they changed the name of the organization and got into bed with MTIA. They say they want to get online and into social networks. Great. I say the largest disorganization of medical transcriptionists in the world use the same social media to let the world know that this organization does NOT represent us.