A day in the life of a medical transcriptionist – the realistic scenario

I was doing my usual browsing through the internet for medical transcription topics when I ran across this self-serving article – and just couldn’t hold my tongue. (And do you notice how the MT in this article starts work at 7 a.m. and doesn’t finish until 10 p.m.? At least THAT part is realistic!)

I submit for you the more realistic scenario… absent any sales pitches for a medical transcription education.

6:40 a.m. Five minutes before her alarm is set to go off, SusieMT wakes to the sound of children fighting over cereal. She’s been working long hours all week, trying to make her minimum line count and pay the bills, and hasn’t had time to go to the grocery store. The 6-year-old and the 8-year-old are fighting over the last bowl of Sugar Frosted Flakies. From the sounds of it, the 8-year-old is winning, which makes sense because he’s older and bigger. She gets up to settle the fight between the children and tells them to hurry up – they need to get ready for school. The 6-year-old tries to convince her that he’s sick and can’t go to school today, but she’s not buying it. She reiterates that they need to hurry up and eat breakfast or they’ll be late for school. She goes back to her bedroom and throws on a t-shirt and sweatpants, scrapes her hair into a ponytail and hopes that she’ll have time for a shower sometime today.

7:30 a.m. After more than 45 minutes of wrangling children through their morning routine, SusieMT runs them to school and then returns home. She looks longingly at the bed, but her official work shift begins at 8 a.m. Instead, she starts a pot of coffee and eats the rest of the cold cereal and milk the children left behind.

7:55 a.m. SusieMT starts up her computer and finds two e-mails from her supervisor. The first is reminding her that she has been assigned a standard shift and she needs to work during those hours. She is not authorized to work overtime. The next e-mail is a beg-o-gram, advising that the Hospital Z account is backlogged and asking all available MTs to help catch up on this account. SusieMT has not been authorized to work on the Hospital Z account, although she has asked more than once because they seem to be backed up frequently, while the accounts she is authorized to work on never have enough work.

8 a.m. SusieMT logs into her employer’s secure transcription platform and checks the work queue. The majority of dictation in her queue is dictation from Dr. Marblemouth, a disorganized, mumbling dictator who is like poison to a transcriptionist’s production. The rest consists of what SusieMT calls the Motley Crew, an assortment of the worst dictators for every account SusieMT has been assigned. She checks the dictation time; all the dictation is from yesterday. How can that be? She sat on the work queue well into the night and there was little to no dictation in any of the accounts she’d been assigned. She’s desperate for lines, but this ragtag assortment isn’t going to do much for her line count.

8:15 SusieMT decides to send another request to the supervisor, asking that she be authorized to work on Hospital Z’s account. While she’s doing that, she finds yet another e-mail from her supervisor. This one is advising her work group that the overseas transcription unit was unable to complete a volume of dictation due to difficulty with the dictators and the medical trancriptionists in this group need to jump on it right away before it goes out of turnaround. She sends an e-mail to the supervisor, requesting again that she be authorized to work on Hospital Z. She marks it as urgent. She returns to her assigned work and digs in. It’s all there is and lines are lines.

10:30 a.m. By this time, SusieMT is not just ready for a break – she’s ready to break something. In a little over 2 hours, she’s managed to get a mere 400 lines done. At a pay rate of 7 cents per line, she’s made a whopping $12.50 per hour, and there still isn’t any other work in her queue. She’s checked all her accounts half a dozen times, as well as her e-mail, hoping that finally her supervisor is going to respond to her request to work on Hospital Z, which apparently has plenty of work and hopefully hasn’t been cherry-picked. With no response from the supervisor (on that topic, at least), she cleans the kitchen and starts the laundry during her “break.”

10:45 a.m. With the house a little cleaner, SusieMT returns to her desk, still frustrated. The dictation in her queue is still primarily from the Motley Crew of dictators, but there is some dictation from better dictators coming in. For a moment, she hesitates, then says to hell with it and bypasses the Motley Crew to grab the other dictation coming in.

12:30 a.m. SusieMT takes another break to do some more laundry and grab a PB&J sandwich. She eats it at her desk while checking out the online medical transcription communities for job opportunities. All she finds are similar complaints: low work volume, production-killing dictators, production-killing platforms, long work hours, poor management and lack of communication. She starts to think maybe getting her own accounts is the way to go – at least then she’d be in control of her destiny.

1:00 p.m. SusieMT is back at the computer, still fighting for what little dictation is in the queue and trying to avoid the worst dictators without really being labeled a cherry picker. Another beg-o-gram from the supervisor about Hospital Z, which is still backlogged. Another request from SusieMT to be allowed to work on Hospital Z.

2:00 p.m. It’s almost time for the kids to get home from school and SusieMT is still battling to get in her minimum line requirement for the day. Volume of dictation in the queue is picking up, but the Motley Crew dictation from yesterday is still sitting there at the top of the queue. She gets a message from QA, telling her she’s sending too many jobs to QA. She says to hell with it and cherry picks through the next hour, cranking out almost as many lines in that one hour than she’s been able to do the entire rest of the day. She still hasn’t met her quota and she still has more hours to put on the clock.

4:00 p.m. The children are home from school and SusieMT’s shift is officially over. She’s still short 200 lines on her quota, not to mention the fact that she needs to get in extra lines so she can make ends meet.

9 p.m. After fixing dinner, helping children with homework, finishing the laundry, bathing the children and putting them to bed, SusieMT logs back in to see if she can pick up more lines before she falls asleep in front of the computer. There’s an e-mail from the second-shift supervisor, demanding to know why she isn’t doing the Hospital Z account, which is still backlogged. She responds, telling yet another supervisor that she’s made numerous requests to be put on that account and she hasn’t received a response.

11 p.m. No longer able to stay awake, SusieMT shuts down the computer. Still no response to any supervisor about the Hospital Z account. She got in her required lines and a few more, but unless things improve, it’s going to be another lean month. She realizes that not only did she not shower, she didn’t get to the grocery store, either. To hell with it, she thinks as she falls into bed. Maybe tomorrow will be a better day.

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33 thoughts on “A day in the life of a medical transcriptionist – the realistic scenario”

  1. Thanks Julie for another splendid effort at honesty in the MT world. As usual, your time line of many MT’s day is more accurate than the original article. Even if some of us are past the point in our lives that involves the chaos of young children or teenagers (not that those days weren’t also tons of fun), a lot of wasted unpaid time does seem to be a part of this business. Thus creating a longer workday.

    E-mails (beg-o-grams), IMs, and possibly phone calls from MTSOs or staff about TAT, but there are no reports in the pool. Urgent messages about updates to account specs, only to realize after comparing the new with the old specs that there has been only one minor change — more wasted time. Some companies insist on conference calls – unpaid and usually loaded with company propaganda, not something useful to improve an MT’s production, not value added.

    I could spend an entire day discussing “reverse cherry picking” – how an MTSO can set various parameters on an MT’s queue/pool so that you are not really getting first in-first out based on TAT, but rather based on the fact that some MTs cannot handle all job types or all dictators, so you may actually be getting that bottom of the barrel work every day, just as you suspect. When you’re paid by the almighty line, this alters your income.

    And to think there was a time when I loved this job and my family swore I would die at this keyboard. Gosh, I hope not.

    1. How many lines is the ususal quota?
      I am from Canada and considering outlaying $6015.00 for a course from a college in my province.
      Is spending $6015.00 worth it? Can I expect to make the tuition back from taking this MT course??

  2. Julie: Oh, so many of us identify with your scenario. In my case, the kids are grown, but the cows are out, and other animals are demanding care, people want to be fed, the power is out, and I need to water the garden but the well won’t pump without electricity, so I cannot even make use of my down time because of this, but I have to keep on schedule and the get line counts and play the TAT game. I have your marblemouth’s brother on my account. Can’t make rate with him, but maybe I can squeeze in an hour here and there with a secondary account where they speak distinctly. Empathy for your working with little people needing care. It’s tough. Bless you. Thanks for sharing.

  3. Abuse seems to be all the MTSOs can dish out anymore. I left a hospital environment to work for an MTSO 16 years ago. In those 16 years I was treated in a variety of ways, none of which even remotely resembled respect. And just to be clear – I was a model employee. Always logged on at my designated time, great QA scores, worked my full shift, blah, blah. On my last MTSO job I called my supervisor one day to ask about something. I had been working on her team for 2 years. When she called me back, she asked “Who ARE you?” Yeah, that made me feel all warm and fuzzy. One MTSO I had worked for for 7 years had her hench man call me 10 days before Christmas to tell me my services were no longer needed. No severance pay, nothing. Just see ya. In April 2010, I was sitting here working and trying to remember the last time I had a good job, a job for which my skills, work ethic and 30+ years of experience were appreciated. It was my last hospital job in 1996, so I decided to look for such a job again, in spite of the fact very few of those types of MT positions exist any longer, and guess what? I found it. It is the most wonderful job/employer I have had in all my years in the field. Editing VR for an hourly wage – with shift and weekend differential – with overtime – with annual raises – with incentive pay – with a generous leave time accrual rate. I feel like I’m in MT heaven every day when I come upstairs and log on. So for everyone who is unhappy with their job, don’t give up, keep looking. It might be just down the road from where you live – mine was!

    1. You have no problem being an editor versus a typist?

      Hourly wage, if you don’t mind my asking, what did you START at? We are switching to Nuance (forced) and our acting manager (in charge of accounts) has no clue how we should be paid. A Union rep was contacted and had never heard of us and had no clue she was our rep. So I’m trying to send her as much information to help her determine this very heated issue. Long story.

      What is the base rate of pay? (don’t need to know what you actually get paid, just need some ballpark) On the Nuance site on one page, they said by the line, but we all know with this sort of software that would make us rich and institutions do not want that to happen!

      Thank you for your time.

    2. NICE. So happy for you! I worked as an MT for a local hospital for almost 11 years, and our department got outsourced to an MTSO. (Their stock is worth something in the negative numbers). We could accept a position with the MTSO at 60% less pay and a loss of all our benefits. – Thanks but no thanks. I am retraining as a nurse and am halfway through my studies. A lot of nurses get a lot of the disrespect that Medical Transcriptions do, so I have a lot of experience with that aspect (lol). I started my clinicals and am finding that bedside care is very rewarding for me. I see the disrespect that our clinical group receives and realize that we can’t take it personally. It’s the people handing out the disrespect who have the problem.

  4. I have to admit I basically laughed my way through the original article. What a farce, lol. At least there weren’t many mistakes which is torturous to me when reading, lol. I agree your article is an actual depiction of an MT’s day. I can really relate with being stuck with all the *&^% dictators as it happens every day, working from a pool. It’s beyond frustrating! I have very high accuracy, so I would definitely see why MTSOs would give certain people certain doctors, but we have mouths to feed.

    Thanks for another great article, Julie.

  5. Yes, very accurate in terms of those working for nationals. Luckily I don’t but one of my first jobs was for a lesser known national. They were good about adding accounts though when mine dried up (yes they outsourced at night), and my backup account had plenty of work. That was a good job until they changed the pay scale and incentive (if you had half a brain you could see there was a way around the pay scale that was in place before and you could maximize your hourly rate by holding work and submitting it all at once to give yourself the higher cpl based on lph submitted….they got wise to it and changed the pay scale so unless you really produced a lot of work you were down at 0.06 cpl), and they yelled at you for sending more than 5% of your work to QA a month (averages to about 1 report a day,…yeah, right,…it was 80% hard ESL, talking at the speed of light too). You could cherry pick to some extent and I admit I did at times, I had one cardiologist that I could only understand about 1:10 words so there was not much point to trying, I did do him some but QA basically would end up doing 80% of the report so what was the point. I had a family illness come up and they were not happy I was not meeting my quota, so we parted ways. I lost 2 jobs at the same time because of uncaring MTSOs, so I had to deal with a serious illness of my child and two losing my job(s) at the same time because they would not bend a little bit for a month or so; my third job (yes 3) was very understanding and worked with me, so at least I was still able to have some money coming in, luckily it was additional income for our family but very much need though. I now work for a small MTSO doing hospital clinic, love it. They are quite understanding too about any family emergencies/illness too so that is wonderful, not too many of them around. About the only down side is the TAT is not 24 hours, and on a sort of sliding scale, all due back at the same time the next day, so that is added pressure and can make for some very late nights if I don’t get at least half of the work earlier in the day, unfortunately most of my docs wait until 3-5pm to do their dictation, thereby making me work very late. But that is the breaks, TAT is my only issue to really worry about so compared to many others that is not bad. Good luck to us all.

    1. My rate for VR is 0.046..edited line and 0.085…typed. It truly sucks! Horrible dictators kill you. I am looking for another career. 2% raise in 4 yrs! More work, work types and more bad dictators. I think all the dictators should be rated and weighted depending on how good or bad they are. If they are bad then I do not see why Escription (Nuance) cannot plug in the dictator’s i.d. and then multiply his lines at a higher rate. I am told this cannot be done but I have been around computers long enough to know this is bull. They just like to keep us poor.

  6. Thank you for this! This has been my laugh for the day. I couldn’t have created a better word portrait if I had done it myself.

    I’ve just emailed this article to EVERYONE I know in my family/friend circle who swears that I’m exaggerating about the number of hours that I work and the lack of money that I make.

    Now if I could only stop laughing I could get back to work.

  7. Hello to all!

    I finally got out of this absolutely crazy business after 20 years. Enough is enough, I couldn’t take it any longer. “I was mad as hell and not going to take it anymore”, as the old saying goes. I saw enough and heard enough throughout all these years, I was crazy to get into this business in the first place. These co-called MT companies started out as “agencies”. When the hospitals decided to shut down their medical records department for “cost effective” reasons, it didn’t take long for these agencies to mushroom overnight. Then, the bidding wars started. Of course, the hospitals would take the lowest bidder. When the contracts between hospitals and agencies, here would come the hounds again, promising the hospitals all kinds of goodies and telling them anything they wanted to hear. Once the contract granted, the pressure was on. The pressure was transferred to the poor medical transcriptionist…of course! I love to read these MT company ads in MT Daily. I just laugh my head off with what they promise you. They’re hear today, gone tomorrow. They merge with another company, change names, or just simply get the hell out of town. They promise you’ll make beaucoup, beaucoup monies, you’ll never be out of work, they have the best dictators, the best hours…ha, ha, ha…Gosh almighty, I’m glad to be out!! On top of that, they want you to strap yourself to your chair!! You eat while working, ( I choked once and seriously), you wait to pee ’til you can stand it any longer, etc. It’s who types the fastest if you’re working at the company, and that girls can make you very, very nervous. You think, oh my God, this transcriptionist must be making loads of money!! But she’s not…she’s struggling too. It’s a vicious environment. And, PAY BY THE LINE? ARE YOU NUTS? This job needs to be paid by the hour and be paid GOOD! You have to know what you’re going to get in two weeks. You have to budget. This is YOUR RIGHT! Ladies, I could talk and talk…I think I said enough. Think especially about yourselves. That’s what they’re doing. They don’t care about you one iota. You’re not appreciated for all the knowledge they demand of you regarding the anatomy. Even doctors don’t have the knowledge that you are expected to have! For Heaven’s sake, give me a break! I decided to give me a break and get a life! I refused to put up with these shenanigans, deception, promises, fraud in some cases, bankruptcy in other cases, money-hungry, deceitful, have their pet favorites…on and on and on I could go. Think about YOU and decide FOR YOU!

    Wish you all much luck. I didn’t mean to sound negative, just realistic. If you can trick ’em somehow, do it! They’re doing it to you.



    1. AMEN Monique! Glad you got out. I hope I can too as well. The worst mistake of my life was becoming a MT. I make now what I made 21 years ago when I left to stay home with my kids. I made more than my husband at the time and now he makes double what I make. Figure that one out… this job is and has made me ill. I know I am not the only one. Thanks for sharing and hopefully lighting a fire under some of us. I really think we should unionize. Then what would those greedy @#$%!^#@ do?

  8. I needed to edit my article but it’s obvious I can’t. There are a few errors in the above submitted comment. I hope you’ll be able to read through the lines. Tx!

    I hope MT Daily will not censor these comments – They did once before. Of course, they are getting paid by the MT companies. They don’t want to look bad. Are you starting to get it….?

  9. Oh, Oh…this is not MT Daily…this is Medical Transcriptionist Exchange! No matter, they’re all alike…where they come from anyway?


    1. As you’ve noticed, this is not MT Daily.

      I’m not sure who you think is getting paid off, but maybe you don’t notice that MT Exchange has no advertising. This is my personal blog on the industry and I call it how I see it.

  10. “Loved” the article. Very funny!!! I have been an MT since 1996 and started out in a hospital setting. Since 2000, I have been working from home. I love the ability to work from home, but not the line pay. I have gone from 12 cents a line to 7 cents a line in the 11 years I have worked for this company. Hands have changed so much that I worry about the stability of any transcription company. I love my supervisor, but also realize she has a job to protect and will say what the company expects her to say if she wants to keep her job. I am a stat MT and therefore get all and any jobs to transcribe or edit. It seems to me that what they are doing is trying to push the more experienced and “higher paid” MT’s out the door and keep the MT’s who will work for less. Boy, are them MT’s in for a big surprise. They will some day realize how they are being used. I only have 5 years before retirement and just pray to God that I can last that long. May keep working part time, but not sure. Transcription just is not what it used to be. My company does not require that we type allergies in ALL CAPS, which really worries me about the safety to my patients. Rules, rules, rules and none of them make a bit of sense or are very realistic. I do 2-3 hundred lines per hour and was told that I need to take training to increase my line count. I line quota is 150 lines per hour. I believe I am already increasing my lines. Okay, I will get off my soap box. Thanks for listening. Good luck to you all.

  11. This article is SOOO true! (…well except for the kids fighting over cereal, since my kids are now grown…) Been an MT for over 17 years, and it was great to stay home and raise the kids, etc., but I’m making the least amount of money now then ever. Currently with Webmedx-recently-turned-Nuance, the voice-recognition company of the future — So I feel like I’m working for the enemy; like I’m just digging my own grave. Good accounts evaporate into Voice Recognition. Ugh! Time to make a move into another line of work…Wish me luck!

    Thanks for the laugh though! Too true!

  12. I was employed as an MT for a hospital for 20 years. Our work was recently outsourced to a transcription company that was obviously assured that we would sign on at approximately 50% less in take-home pay….how grossly insane is that? Rent, utilities, groceries, insurance premiums, gas, etc., all continue to escalate and 50% less in pay is supposed to be acceptable and understood??? Listening to ESL doctors who slow down one’s productivity, equipment problems, the insane demands regarding TAT and line count bring far too much unhealthy stress into one’s life and those at the top are in no way concerned about the transcriptionist’s stress level. Deciding not to seek re-employement as a medical transcriptionist truly has been life-changing and has allowed me to exhale. Would a pay-check be nice…yes. Is keeping my sanity (not feeling stressed 24/7 and feeling the need to pop happy pills to function) when I am on and off-the-clock of utmost importance…ABSOLUTELY! The best to EVERYONE struggling to “make it” as an MT.

  13. Hi all. After reading this article and everyone’s comments, I’m wondering whether it’s worth finishing my schooling with CareerStep. I will need to purchase an extension to finish the course, as the practicum is taking longer than I expected. I really don’t want to go back to working for a law firm as a legal secretary. I want to work from home. No kids. Only 2 dogs. My husband has a good job, but we need a second income. Is it really worth continuing my education to become an MT? I’m 49 y.o. Can’t wait too much longer to figure out the 2nd half of my working life! Thanks.

    1. I don’t recommend medical transcription for anyone who has other options. In other words, if you live in a rural or depressed area and there aren’t a lot of options, you have health issues and difficulty working outside the home, have to care for parents or etc. If you have other options and you just WANT to work at home, I think you’re going to be disappointed with the career requirements and pay rates.

      I used to do work for attorneys as an independent contractor working at home. Why don’t you find clients or see if any of the legal transcription services are hiring?

    2. Dawn,

      Neither would I recommend medical transcription to anyone, it is very stressful work and if you have other options by all means pursue them. I was overjoyed to begin working at home, however one still has to work hard even though you are not having to deal with the hustle and bustle of working outside the home. I was in the field for 23 years without a break until 2 months ago when our work was outsourced for cheaper labor. With transcription being a production-based profession it will most definitely take its toll on the body physically and mentally. The workload became overwhelming during the last 5 years and one is expected to keep the work within turn-around time with anywhere between 97 and 98% accuracy required. The transcriptionist is not valued as is evidenced by the pay being offered these days – expectations are very high and the pay is quite low. With the multitude of english as a second language (ESL) docs you will indeed be challenged with regards to meeting productivity and staying within turn-around time (TAT). The very best of luck to you should you decide to pursue this profession.

  14. I was looking into the MT field but am having second thoughts when I read the majority of entries recommend against it. I am on disability SS due to cancer and since I have done MT in my past, I thought I would do it again. But, this time I thought I would do it at home to supplement SS. Unfortunately, now I am having a change of heart. I don’t want to invest the time and money to get up to speed only to become stressed which will cause further illness. I guess I’ll just have to think of something else to do at home for pay.

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