I’m not paid enough

Medical transcription careersYears ago, I took the position that if someone accepts a job, at the rate of pay offered, they would be obligated to do their very best and not claim they aren't paid enough to do a good job. For a medical transcriptionist, that may mean, among other things, looking up unfamiliar words, searching for the correct spelling, and proofreading before pushing the send button.

On the other hand, I also believe that the companies hiring MTs have an obligation to make certain work is available so their employees have an opportunity to maximize their earnings. This is especially true in the environment of production pay. From the MTSO standpoint, I completely understand the ebb and flow of dictation volume, and the constraints of ever-tightening turnaround times. It's a balancing act. But shouldn't we be better at it? Shouldn't MTSOs care enough about their employees to attempt a better balancing act?

What I'm hearing from many MTs these days is that in addition to being paid less and less, they are sitting down in front of their computers, ready to work the shift hours assigned to them by their employer – and there is no work available. In fact, the lack of available work during scheduled work shifts is the complaint I hear more often than complaints about the per-line pay rate. It seems that many MTs have accepted the pay rate as being what it is (take it or find a new career), but they'd sure appreciate the opportunity to actually earn it. Hours and days of sitting and waiting for work to appear in the queue takes its toll on the finances. Likewise, finding the work in the queue is the worst of the dictators for that account, the queue apparently having been previously combed over by an industrious cherry picker, impacts the bottom line. It is frustrating, maddening and discouraging.

And when no minimum base rate is paid, and/or minimum wage and other labor laws are ignored and even consciously circumvented by the employer (see my prior post on wage theft tactics), it deals a blow to morale, usually resulting in deterioration of work ethic. “I'm not paid enough” doesn't always refer to the per-line pay rate, it encompasses the whole picture as reflected in the paycheck one receives. If you sit in front of your computer, waiting for work, industriously hitting the queue in those magical moments when work becomes available, for not only your scheduled shift hours but additional hours (in an effort to make up the lack of available work during shift hours), and your average hourly wage on payday comes out to $5/hour, then I would certainly agree with the statement “I'm not paid enough to do this.”

My daughter works as a personal trainer for a company that pays incentive bonuses. The base rate is very low – for a personal trainer, minimum wage. However, the bonuses are generous. Trainers have a huge incentive to make their goals for bonus. At the same time, it's the responsibility of the gym to see that they not only actively recruit more members, but that the gym is kept maintained and cleaned, in order to keep members. It would be impossible for the trainers to sell personal training and meet their bonus goals if the gym wasn't fulfilling its responsibilities. At the gym where she previously worked, she didn't get paid bonuses, but the gym also didn't fulfill its responsibility of maintaining the gym and actively recruiting members so she had the opportunity to do her job. There wasn't a question of whether she did her best for the clients she had, there was a question of the financial impact this gym's neglect was having on her income, and how long she could tolerate the situation.

When an employer doesn't fulfill its obligations, what are the obligations of the employees? Do you cast aside your work ethic? Do you start cherry picking, hoarding the queue, stop looking up unfamiliar terms and spelling, stop taking the time to proofread? Or do you soldier on, doing your absolute best, either because your work ethic is intact or because you're afraid you'll lose the job and not be able to find another, or because you believe all companies are like this? Which raises the question – is this job better than no job or some other job?

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7 thoughts on “I’m not paid enough”

  1. As always, you’ve touched on something that we have swept under the rug for way too long in this industry. I never understood the concept of “over hiring,” which does happen in some companies. When I was in that role, it wasn’t too hard to predict the ebb and flow of work volumes.

    I think that perhaps people are just at the point where the economy is bad, and fear runs rampant. When that happens, we tend to accept things that we might not otherwise tolerate. Unfortunately that leads to complacency and it just perpetuates itself.

    In answer to your last question, for me, no, it’s not better than another job. Which is why I chose a year ago to leave the industry. Even in my recent attempt to come back into the industry (although not as a production-paid MT), I found it pretty intolerable with the things that are expected. That just led me back to my original thoughts a year ago. There ARE better things out there and more lucrative ones too.

    1. I’d agree that things seem worse since the economy crash in 2008. And I have seen more and more experienced MTs leaving, as well as fewer people entering the field.

      As always, I appreciate your input. 🙂

  2. Talk about hitting it on the head. Thank you for a brilliant article! I am president of an MTSO who truly subcontracts and does not employ other MTSOs. I do, in fact, meet DOL requirements for subcontractors and have been challenged by the DOL and was found that indeed our company does this correctly. What makes me crazy is this HUGE movement about not having subcontractors. I get it, but you know what, there would be flexibility if they subcontracted (according to DOL requirements)! Employees are restricted to do other things during “working hours.” What is required from our company is to meet turn around time and daily line counts when the work is there. If the work is not there, certainly they cannot meet their line counts. We deliver our clients the highest quality standards possible. My company has lost accounts due to the EHR and the work we still have has been both chipped away at (some physicians decreasing cost and even HANDWRITING again) and/or we have had to renegotiate. In October 2012 our largest long-term client asked for us to drop our cost to a rate that would have resulted in my company having to renegotiate to almost half of what I can afford to pay a good quality MT now. That told me they had NO IDEA what was going on in this industry. We still do traditional transcription with this account. What I did is went back to my business associates and asked what their bottom line was. Of course, I explained what we were up against. I also incorporated the help of an industry leader, Brenda Hurley, CMT, AHDI who is our compliance coordinator, who told me it was time to educate the client on all of the services we provide for no charge above “words on a page.” I had saved all of our “added-value service” emails between the client and I over the years and put together a beautiful report. Each of my business associates got back to me with their bottom line. I had all I needed. The attitude going forward was here is our bottom line. It was so far above what they proposed, I was nervous as could be, but strong and confident at the same time. I had the whole team behind me but I also had our whole team’s future at the table of negotiation. No pressure! What I presented to them was everything we do for them that, to my knowledge, other transcription services are not going to do and they do not pay extra for. On top of renegotiating the rate, there were other things that would be helpful to be more productive, like access patient’s lab work, medications, allergies, and such in their electronic health record to save us sending emails to our client’s liaison when we have questions. I also explained very clearly that all this “extra value” service would end if not negotiated in our favor. They would need additional staff to handle all of questions we had in patient reports as we would just leave a blank. They would have to go back and listen and/or figure out what the blank or area in question was without any explanation from us. Basically, if all they want is “words on a page” we can deliver it, but we would not be proud to do it that way. Knowing this client, I felt that would not be at all what they would want to do! In the end, we were able to negotiate a fair rate, obtain some additional access to save us time and my company was able to meet all our business associates’ bottom line. We kept the account and I did not lose one transcriptionist/fellow business owner as a result of this process. Over the years (16) I have been asked why I do not focus on becoming larger than we are. Why would I want to become what I despise? I cannot compete with the big MTSOs as far as some things, but they cannot compete with me when it comes to quality, integrity, communication and attention to detail. This is what we love about transcription! The details! We truly care about the outcome of our “words on a page.” The client obviously does as well. It is 1-1/2 years later and we are still at it. Most of our other accounts have whittled down and we are also getting less volume on this one and have had 5 leave for better opportunities (none of them transcription) over the last year. Our clients have been generous enough to give us plenty of notice when there is going to be a decrease in volume, thus giving our team members time to decide what their next move is. Of note, because they are business associates and have to meet a turn around time they can work other “jobs” or take on their own clients. I considered selling this business for a few years but last year made my final decision. All that myself and my BAs have worked so hard for I will not willingly put into a large MTSO’s hands to destroy and pick away at. Our team is not going to be expected to do the same work at half the price. It will be time for us to do something else, and many of my BAs are doing just that. Some have other jobs to supplement for the decrease in work, some are back in school for coding, nursing, etc. In my opinion, when there comes a time that what we do is threatened we can either hold on for dear life, kicking and screaming all the way or we can find our own individual ways to do what is best for us. If that means out of this industry, so be it. Isn’t your health, well being, household budget and dignity worth doing what is necessary? I could understand if the money was there and everything else was terrible, but everyone is saying the same thing, no money. Why hold on? The MTSOs cannot operate without YOU (hint, hint, nudge, nudge) As one door closes, another opens. Been my motto for 16 years and it has never proven wrong. Would I love to continue doing this for 20 more years? Absolutely, this is my passion! Can I do something else? Sure! Will I? Sure, when the time is right. In my opinion, if you cannot change the outcome then move on (then again, if we all moved on it would change the industry’s outcome, right?) If you are a good medical transcriptionist there are other areas you will be needed, whether your client or facilities know it or not, but it is time to reeducate and network and get moving again. Let people know who you are. We have been behind the curtain far, far too long with our clients only seeing the end result (not what it took to get there). I’m not close to retirement, nor am I new to the industry, but I am not dead yet. I can still learn and so can everyone else. We have to have the can-do attitude no matter what. Anyone who is going to work with us in a new environment (or even transcription) does not want to hear our woes and complaints. They want to see intelligent and quality-driven individuals ready for change! And…some of our clients will be calling us after they let us go…when they see how the big MTSOs and/or the EHRs handle what we do now…then negotiations will get REAL interesting!

  3. Ultimately, there are two compensation measures that matter, and those are:

    1. The hours of work available per pay period.
    2. Hourly rate of pay.

    For the vast majority of jobs in the US, both of these figures are known at the time of hiring, and in that case I would agree that if you hire onto a position you shouldn’t turn around and complain about the compensation. You KNEW what it was when you were hired.

    For transcriptionists, the situation is very different – not only because they’re paid by production, but because there are many nearly imponderable variables entering into the production environment itself, any one or combination of which can and do impact the MT’s productivity, regardless of knowledge, skill, work ethic, grit, determination or any other personal or professional qualities that she brings to the keyboard.

    Some of these variables arise on the client’s side. Some of them originate with the MTSO, or even with the MT. But at the end of the day, SINCE FEW OR NONE OF THESE VARIABLES ARE USED TO ADJUST THE LINE RATE IN ORDER TO COMPENSATE THE MT FAIRLY (for their adverse impact on her productivity) it’s simply “How many hours was I able to work?” and “How much was I able to earn per hour?” that are the critical questions. These two questions, taken together, subsume all of the variables that ultimately come to roost on “the bottom line” of the paycheck.

    That being so, it would seem that two questions an MT might ask during a hiring interview would be these – or some variant of them:

    1. On average, how much production time per week are your full-time MTs able to realize?

    2. On average, once they are familiar with your clients and your system, how much per hour do your experienced MTs earn?

    The answers to these questions – if accurate – would put the MT on at least a somewhat even footing with anyone else in the labor force who is hired for an hourly wage. She would have – as does anyone applying for a job even as a burger-flipper – the information she needs to judge the dollar value of one job opportunity versus another.

    But try asking these questions, which you would think any MTSO could rattle off the top of her head, and you’ll almost invariably be met with SILENCE, because no one at any of the MTSO’s with which I’m familiar are even analyzing the REAL (as opposed to THEORETICAL) earning outcomes being experienced by their MTs day after day and week after week.

    Oh, yes – they see the paychecks going out the door, but they don’t bother to analyze the total amount of their MTs’ TIME is being expended generating those lines.

    Time spent doing non-production things (attending “meetings”, answering email, reviewing QA, etc.).

    Time reading YASOSR (yet another set of “site requirements”).

    Time maintaining computer and other equipment.

    Time waiting for work that isn’t available.

    Frankly, I regard the fact that an MTSO cannot tell an applicant with some degree of assurance what they can reasonably expect to earn at the end of a pay period to represent a degree of indifference to the question. And this is perhaps understandable because the MTSO isn’t trading time for dollars. The MTSO is simply trading lines for dollars, and if it takes a total of X MT hours to produce those lines or Y MT hours makes little difference to the MTSO so long as there are enough people on staff to provide the required number of hours to get the work done within TAT.

    The MTSO’s interest in productivity – i.e., lines produced per hour – is, shall we say, a “macro” interest, viewed in the aggregate. The MT’s interest in productivity is personal, on the “micro” level, viewed from her desk, expending the hours of her life.

    Hours which are, once gone, forever irretrievable.

    I’d like to see the situation change to the point that an MT who is looking at a potential opportunity – or perhaps several opportunities – had a reasonable shot at making an intelligent judgment about the relative VALUE of each opportunity in terms of the dollars and cents that they have a reasonable assurance of banking.

    And on the MTSO side, I think you’d see a lot less of the “musical chairs” that we see in this industry, at least some of which arises simply because people don’t have the information needed BEFORE they’re hired to make choices that are better not only for them, but also for you.

  4. Dear JulieW8 and Others,
    I occasionally like to come back here and read or re-read the topics that have been presented since 2010. Professionally my longevity as an MT was about 15 years. To the major players in my role as an MT, It did not matter that I had been an MT since 1998, as things were measured by lines per hour and accuracy percentage, which in my case ranged from 97% to 99%, given those imponderable variables, spoken of by an earlier comment.
    I am now a “former MT” and worked in the industry until April 22, 2014 when I was terminated due to both quality issues and lines per hour. Since then, I have been developing my skills as a fiction writer and involved on LinkedIn with a couple groups that cater to that interest.
    One of the subgroups within Writers 750, is one called 2k Anthology, which includes one hosted by me called, Healing For Self And Others: Professional and Life Experiences. Writers tell their tale in a fictional style and I told mine. Its title is “From Termination to Transition”.
    Interestingly, “terminate” was the word used by my former supervisor, and the synonyms found therein are quite telling. I invite you to consider them from a reputable thesaurus on or off line.
    In my not so humble opinion, “transition” would have been a more politically correct term but also inviting the person to still retain their dignity through it all!
    I have not had numerous stories presented, but thank this URL for giving me the idea to invite others to fictionalize their experience, and therein provide healing for self and others.
    The thread is under the linked-in group, Writers 750 in the subgroup, 2K Anthology.
    You need to be a member of both Linked-In, and Writers 750, in order to add your story per the policy of LinkedIn.

    Presently, I am transitioning personally from nearly two years of perceived professional belittling to self-belief and desire to be a reasonably successful freelance writer in the senior years of life!
    Oh, by the way, in sending an email to the immediate supervisor and her QA person a month after termination, I was advised to not contact her or anyone from said company about anything. That was a real nice additional dehumanizing tactic by a “human being, or perhaps better described, human doing”.
    Thank you for this forum, thread, and being a part of my ongoing transition; and wish each of you well with your current season of life both professionally and personally.
    Respectfully,
    David Russell

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