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). Guy Kawasaki interviewed Seth about the book and asks:
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.