Would you encourage someone to become a medical transcriptionist?
This is an interesting question now being frequently posed in the medical transcription community on Facebook, in the forums, and elsewhere. It’s one I am frequently asked, as well.
And my answer is no – it’s not a career choice I encourage. This position has been questioned by some, especially when I say it in forums like MT Chat, because I own several websites for medical transcription (and, obviously, I blog about the medical transcription industry). My response to that is that I spent over 20 years in the medical transcription industry. I know a lot of people in the industry and support them, regardless of how I feel about the career.
But – if you’re someone looking for career choices, I am going to tell you to really do your homework before plopping down thousands of dollars on a medical transcription education.
Follow the money
For several years, my impression that medical transcription pay rates are going south has been anecdotal. Then, my friend Kathy Nicholls (who is much more data oriented than I am) did an excellent analysis of numbers, which you can read at MT Tools Online: A Salary Perspective Over 11 Years.
It doesn’t take a rocket scientist to read that information and see the writing on the wall for the working MT. Medical transcription pay rates haven’t kept up with even cost-of-living increases over the last 11 years. I don’t see that this trend is going to change. There are increasing reports from medical transcriptionists that pay rates continue a downward slide, with speech recognition editing paying half or less, while not delivering a breakeven proposition with increased productivity.
The line count pay rate isn’t the only factor affecting how much a medical transcriptionist can make. There are more and more MTs telling me that they fight a daily battle to eke out their daily line count minimum when there isn’t enough work in their employer’s system. These employees are expected to not only be available to work their scheduled hours, but to sit around and wait for work to be available on the system – without any compensation if there isn’t.
Whiners and winners
My decision to write on this topic came out of a Facebook discussion. Fortunately, you don’t have to be on Facebook because Kathy also wrote a blog post at her MT Tools site – Medical Transcription on Facebook: A Case Study. In my opinion, the most interesting response to the question posed came from Ava Maria George, the president-elect of AHDI.
In order to assure that pay is commensurate with our talents, we have to get out there and educate ourselves (yes, I mean bachelor’s degrees) and advocate for our profession. One cannot simply sit back and say, “Please Mister, give me more” and expect that will happen. Obviously, not advocating or speaking out has literally made us obsolete. So, what are we willing to do about it? Get out there or leave. Simply, those are your choices.
Call me crazy, but if someone told me I needed a bachelor’s degree to do medical transcription, I’d be laughing so hard, I’d be speechless. I mean really – if you had the time and money to get a 4-year degree, would you get one so you could be a medical transcriptionist?? I wouldn’t even do it if I had to get a two-year degree.
Now, the case might be made that even Starbucks pays more if you have a college degree and therefore we may draw the conclusion that medical transcription would pay more if practitioners had a college degree. However, it is not the degree itself that is driving higher pay rates – it’s the employers. Starbucks simply states that employees who have a college education are paid more than those who do not. It does not give preferential hiring to degreed applicants, but it does reward them for having a degree. (And it’s kind of a sad statement on the economy and the value of a college education when people with college degrees are working as baristas.) And employers in the medical transcription industry have not supported either higher education or credentialing.
Get out there or leave – seems to me that’s a predictive statement, especially when it comes to AHDI membership. Oh sure – they can point to growth, due to the KB membership, but their practitioner level membership numbers are shockingly low, just over 3000 members at the end of 2010. When I left the organization, the practitioner membership was over 7000 members. Apparently the answer to not finding your sweet spot in serving actual people is to come up with a product you can sell and tie it to a non-voting membership category so you can tell the people you used to represent that you’re tired of their whining and they can just go away.
Which brings me to the next statement made by Ava…
I’m not talking about staying traditionally an MT…we’re evolving. We will be looking at changing not only what we do, but hopefully in the process elevating our profession to one that is compensated at a professional rate. Think about it. Coders were in our position years ago. They decided to educate up, credential, and their salaries followed (higher). Now, they are at the same crossroads that we currently find ourselves…we either grow or go. It can be scary or it can be exciting. I’m betting on exciting….
I have a couple observations to make about this. First of all, I don’t know where Ava Maria George gets the impression that coders educated up. The requirement is, and always has been, a high school diploma or equivalent education.
And I’m going to argue with the interpretation of history here… coders did not, by themselves educate up and credential. AHIMA was successful in getting employers of coders to recognize the value of the credential and start demanding that coders be credentialed. The recognition of the coding credential was not a grassroots movement by the coders, but a top-level-down marketing campaign by AHIMA.
The same is true at HFMA. In the Southern states, more employers require their finance people to have an HFMA credential; therefore, there are more credentialed HFMA members in the Southern states. In the Western states, fewer employers require the credential and therefore there are fewer HFMA members in the Western states who are credentialed.
My daughter is a personal trainer. To get hired at a reputable gym, she must have a credential. No credential, no job. In addition, at the gym where she works currently, she must participate in additional inservice training in order to advance in pay. If she doesn’t participate or participates and doesn’t pass, she loses her job at that gym. Her reward for participating and doing well is not only higher pay, but continued employment.
I have a friend who works in the HIMS department of a major university hospital. She was given a drop-dead date for finishing her AA degree and passing the RHIA exam. If she did not, she was out of a job. She took the test on the Saturday and fortunately passed because after many years of working at this hospital, she would have been terminated on Monday if she hadn’t passed. And – she didn’t get a raise or a promotion, she just got to keep her job.
What AHDI seems to be missing in the entire credentialing discussion is that successful credentialing takes place from the top down, not the bottom up. The problem in the medical transcription industry is NOT that transcriptionists haven’t supported credentialing and education – it’s that employers haven’t supported it. How long do you suppose MedQuist would last if they terminated all MTs who didn’t get a credential by a certain date? The plain truth is that the transcription industry doesn’t have the guts to place such a stringent requirement on its workers, even if it had a financial incentive for doing so. And let’s face it – there’s no financial incentive. For the Record recently did an article on The MT Credentialing Debate, and this statement is indicative of why credentialing for medical transcriptionists has never gotten off the ground:
Dale Kivi, MBA, business development manager at FutureNet Technologies Corporation and a member of the board of directors for the Clinical Documentation Industry Association (CDIA), says he understands and appreciates the efforts of industry organizations that promote credentialing. However, he says organizations that purchase transcription services don’t seem to care whether the labor force is credentialed. Their interest lies in stipulating quality expectations and holding vendors to those levels, regardless of whether the staff are credentialed.
It seems all the blame doesn’t go to AHDI, but I’m tired of them point a finger at medical transcriptionists for not supporting the credential. A better use of their time and energy would be to use their partnership with CDIA (the organization formerly known as MTIA) more effectively.
Winners never quit
You know that saying: Winners never quit and quitters never win.
If you examine successful business people, you’ll find the above statement is erroneous. More than anyone else, winners know when to quit.
What really sets winners apart from quitters is the ability to escape dead ends quickly, while staying focused and motivated when it really counts. They don’t waste time and energy on a dead end. Winners do not keep chasing unprofitable ventures.
The biggest difference between quitters and winners is that when quitters quit, it’s an emotional decision. When winners quit, it’s a rational decision, based on objective data and analysis. Seth Godin has some interesting things to say about quitting and winning in his book: The Dip: A Little Book That Teaches You When to Quit (and When to Stick)
Question: Other than hindsight, how does someone know when it’s time to quit?
Answer: It’s time to quit when you secretly realize you’ve been settling for mediocrity all along. It’s time to quit when the things you’re measuring aren’t improving, and you can’t find anything better to measure.
Smart quitters understand the idea of opportunity cost. The work you’re doing on project X right now is keeping you from pushing through the Dip on project Y. If you fire your worst clients, if you quit your deadest tactics, if you stop working with the people who return the least, then you free up an astounding number of resources. Direct those resources at a Dip worth conquering and your odds of success go way up.
What’s the worst time to quit? When the pain is the greatest. Decisions made during great pain are rarely good decisions.
Research and make your choice
Basically, medical transcription has been the one reliable (or, lately, semi-reliable) legitimate work-at-home opportunity. It works for people who don’t have other choices; they must work at home or they must have a more flexible schedule than a traditional office job allows; or they live where there aren’t many work opportunities. For those reasons, medical transcription will remain a career choice for some, while those with more and better options will choose something else. Blaming medical transcriptionists by telling them they’re a bunch of whining losers won’t make medical transcription a higher-paid career. Not only is that a lousy marketing tactic, it’s just putting lipstick on a pig and trying to convince everyone the pig is a something desirable.
I always enjoy reading your viewpoint.
I enjoy reading these as well, Julie certainly knows how to turn a phrase or two 🙂
Nae
“The biggest difference between quitters and winners is that when quitters quit, it’s an emotional decision. When winners quit, it’s a rational decision, based on objective data and analysis.”
Yes, yes, yes!
I love this post, Julie! 🙂
Thanks for putting together such an informative and well-written post. Now when people ask me if they should become an MT I can point them here instead of flailing about with my own inept explanations. Keep up the good work!
I’ve seen several fields where accreditation has become the “standard,” and it was one of the things that drove me nutsabout AAMT (now AHDI)! They were basically sitting back and saying “everyone should be accredited,” because there was some vague notion that if there were enough people floating around with their certification, that good things would happen. That’s not the way it works, and yes, I did tell them that back when I was in the field.
What they never did was to push, not just as Julie mentioned, employers, but also the greater AHIMA group and the regulatory agencies that this was a “good thing” and should be a requirement, as well as selling it to employers as a “value added” item.
As I said, I’ve been through this before in a few fields. It always starts when the group which creates the certification/accreditation pushes to get it accepted, and it becomes something required. There’s a value to the employers to have their employees with it, either to meet regulatory requirements or because it enhances their bottom line – or both. AAMT never did that, and to be honest, most employers regard it as a piece of paper which isn’t of great concern to them.
This is a very informative and I think realistic view of what is now going on in the medical transcription world. I myself have a bachelor’s degree in business, but I also have done transcription for over 12 years. I basically “fell” into MT right out of college – I applied for a job at a local hospital for a job as a MT doing pathology/cytology/histology transcription. That was my very first MT job. Fortunately for me, I’ve always been a very good speller and pick things up quickly. I discovered that this is my natural “nich” and something which I really love doing. As the years went on, I’ve worked at various positions using my degree. I’ve discovered recently that unfortunately, degree or no degree, transcription pay is going down the tubes.
I think the crux of the issue is the fact that these private transcription companies are sending work overseas to people who are willing to work for mere pennies, which in turn drives down the pay for uS-based MTs. As long as this is happening, MTs will make next to nothing. I guess my question is how can people who can’t understand English can do such a technical job such as transcription and do it correctly?
The fallout from all of this is devastating, to say the least: With the lower pay US-based MTs get, quantity wins over quality; I don’t care what anyone says, that’s the truth of the matter. And, as we all know, most doctors do not read their reports before signing them. And, the hospitals/clinics seem to be at a loss as to how to force these doctors to actually read their reports before they sign them. This all culminates in very, very bad (and in certain circumstances deadly) patient care.
So, the question is: How do we get quality transcriptionists, quality reports, and better patient care? Stop sending work overseas, start paying our US-based transcriptionists a fair wage so they can spend the time necessary to make sure their reports are correct, and hold doctors and/or the facilities they work for accountable to be sure their reports are correct. I myself have already been the vicitm of a bad transcription with a dosing error in my chart. One big question is this: If the doctors rely on the MTs to be perfect, then why are we being paid such awful wages?
I could go on and on with this discussion. I may just go back into the business world and get a job where at least I have a set wage and none of the BS that MTs have to put up with. Sad to say, MTs have a very, very technical and responsible job, but the pay certainly doesn’t reflect it.
One last thing: I am telling EVERYONE I know to get copies of their medical records, because I would bet that about 90% of the dictation out there is incorrect. What’s it going to take to get this changed?
I think offshoring has been a factor but there are a lot of things going on that have contributed to the stagnant and declining pay rates for medical transcription.
“One big question is this: If the doctors rely on the MTs to be perfect, then why are we being paid such awful wages?”
Just a shot in the dark, but my guess is MTs are paid poorly because they keep working at the rates offered. Yes, offshoring has impacted pay rates but if every MT in the US took a stand and said “I’m not working for 3rd world rates any more,” pay rates would go up. That’s never going to happen, however. It’s been said you can’t get 10 MTs to agree to leave a burning building. Well, even if you could, there are 20 wannabe MTs rushing in another door, telling temselves the building isn’t really on fire or someone will put it out soon and everything will be okay.
I just read this article and cannot believe how much I agree with it. Credentialing MTs is only going to move forward if employers WANT it, and they don’t want it. EMR, VR, outsourcing has DEFINITELY hurt MT pay. I remember when a decent MT could earn 10 cpl and the work was coming out your ears. Now, you work until the pool runs dry and are lucky to get 8 cpl w/o having to do VR editing for 3-4 cpl.
I SO MUCH agree with the thought that MT is still a good career choice for someone who must have the flexibility and MUST work at home. Having said that, legal transcription is doing quite well. I suggest to all of my MT students to cross-train into LT, too. LT is paying $3.50 per page, the training time is very short, and there is work available. A page in LT consists of 25 lines, 12 PT Times New Roman Font. Do the math. It’s not a bad at-home gig. Plus, I’ve found the dictation for LT is much easier to transcribe than medical.
Back on topic, also as Julie stated, MTs are paid low because they accept that. It does seem nearly impossible to get 10 MTs to agree on, well, anything. Plus, if there was a mass effort to hold out for better pay, there would be a zillion people who “want to work at home” who would rush in and do the work, albeit not at quality standards.
Great article.
Im canadian and in my 40s now. I entered the field when they trained ON THE JOB, but I also went to college to learn it. I am also a coder of health records and a health records manager.
I have had little work at all in the past 4 years. The last time I had a ft job was in 2008 when I was employed FT as a medical transcriptionist for a private company that is pretty big (they are all over canada and are buying clinics in the usa as well). I have over 10 years experience in medical transcription. I have worked in hospitals, universities, and private clinics. I am top of my field although there are always more fields of medicine I could learn! (radiology was always my favourite).
I just applied to a compand that is now international and I am debating to even work for them. They pay by the page and with the new technology that is suppose to make things BETTER its slows down a transcription to a turtle’s pace. It took me 4 hours to type 5 pages mind you I had to learn 3 software packages at once plus a new foot pedal and there were interuptions in the training! You would be considered self-employed but this company does not even pay for your training (which would take 2 weeks) and I would have to pay the internet from home as well as have a home office. The tax rate in canada would be quite high, I figure 20% so it would not be worth getting into, as the top rate is 5.00 (they are for reports out of quebec and you dont get them everyday!). You also have to figure in your travel expenses and the time it takes to get back and forth. THe place I am moving the bus will cost me 22 a day and I wont make over 22 a day for quite awhile! So I told the employer to put this on hold as I am trying to investigate and find out if its worth it. Also the nature of the work is highly stressful as you are dealing with alot of people who have foreign accents and poor english, which means backtracking and redoing the report the proper way in proper english.
This company was family run for years but they sold the company to an IT company, people who have no background in our field and have no clue about the medical field or what the going rate should be in Ontario. In my province in the private sector a transcriptionist makes 20 an hour and in a unionize job at the hospital- it would be 26.00 an hour! So I feel it is the IT people taking over the field of medical transcription and they dont care and h ave no clue about our skills and what our wages should be nor do they seem to care! They would be making thousands from each contract, as we do government depts like the Ontario Police, Justice Dept, Native Affairs etc………….it just sickens me that my years of knowledge seems to be worth nothing because of technology……..what do you all think???????????