- Law Offices of Kevin J. Dolley blog post about the class action lawsuit filing.
- MT Tools Online: Enough is Enough
- Complete copy of the complaint (PDF)
Yesterday, the Law Offices of Kevin J. Dolley and the Riggan Law Firm filed a class action lawsuit on behalf of 13 named plaintiffs against Transcend (now acquired by Nuance). For details, read all the above-referenced links, including the PDF of the original complaint – I'm not going to rehash the information.
In my opinion, this has been a long time coming and I congratulate the 13 named plaintiffs who took a stand on behalf of medical transcriptionists everywhere by exposing the abuse of employees that runs rampant in the medical transcription industry.
Knowledge workers v. production workers
Part of the problem as I see it is that medical transcription has become a commodity, paid on production, with little or no acknowledgement of the wealth of knowledge a transcriptionist must have in order to perform the work.
I was doing some research for MT Desk this week and I was struck by how much a medical transcriptionist is required to know – and how little they are compensated for the value of that knowledge. It's been years since I took a medical terminology course and the difficult first year as a transcriptionist is happily a foggy memory, but I'm reminded as I do this research of how much knowledge the job requires and how much we have learned and must continue to learn as we do this job. And yet, pay rates continue to deteriorate, even as MTs are asked to do more and more uncompensated work activities.
One of the issues at the heart of this lawsuit is the amount of time a transcriptionist must spend off keyboard researching terms, communicating with the company, looking up demographic information, and making sure the document complies with company style guidelines – all without compensation. I've had MTs tell me about “style guides” for each of their accounts that are as thick as a book, with each account having its own set of guidelines that have to be followed. If this industry acknowledged the wealth of knowledge required to do this job, the amount of time spent on these activities would be compensated to acknowledge the value of the knowledge required to perform them.
Also at issue is time spent scraping for jobs that aren't in the system. This is a practice I have always taken issue with when it comes to MTs who are employees. If an MT is assigned a work shift, he or she should be paid a base rate for those hours, regardless of the availability of work or the function of equipment. And I would hope MTs wouldn't accept that the base rate should be minimum wage; in my opinion, medical transcriptionists making minimum wage is both an insult and a travesty. When I first became a medical transcriptionist in the late 80s, an MT working in-house at a hospital could expect to start at a wage of $18 per hour AND make production incentive pay. If there was no work, they didn't make incentive – but they still made the base hourly wage. Most companies that overstaff a shift will send workers home, so why is it a transcription service expects MTs to sit through their shift, checking desperately to see if there's work in the queue? And why do MTs tolerate this? As to the first question, I'll tell you why – most companies are paying those shift workers an hourly wage and they send them home so they don't have to continue to pay them to do nothing. Medical transcription services don't “send home” their telecommuting employees because they aren't paying an hourly wage for that person to sit and wait for work in the system and therefore they have nothing to lose by expecting that person to sit all day, checking the work queue. What they have to gain is awesome turnaround times, so they look good to their clients. As to the second question, I've never been able to answer it. I used to work as a temp and there were many times I wondered why the company needed a temp – I wasn't allowed to answer the phone and I was given nothing to do. Many times, I sat in a cubicle and did absolutely nothing. No skin off my nose – I still got paid the same amount of money. Having hired my services, it was the company's responsibility to see that I had something to do, not mine. And having hired my services and told me when I had to be available to deliver those services, it was also the company's responsibility to compensate me for my time – or release me from my obligation of sitting there. In the case of permanent employees, employers know full well that telling a worker that they are off shift due to lack of work can result in employees looking elsewhere for employment. People work to make a living and their pocketbook can't tolerate many days with no pay. Because medical transcription services don't pay a base hourly rate, they can keep MTs hanging around with the promise of work, even if none materializes, with the added benefit that MTs will work other shifts in order to make the minimum number of lines required to remain an employee. Talk about having your cake and eating it too! Of course, this practice has a negative effect on the MTs who are working the shifts being encroached upon by MTs who are now trying to make up lines that weren't available during their own scheduled shift, and the domino effect continues. In the meantime, MTs aren't being compensated for making themselves available to work during their shift, nor are they being compensated for working what amounts to overtime.
If medical transcriptionists were actually compensated as the knowledge workers they are, they wouldn't be paid strictly on a production basis. I feel that when I first started in medical transcription over 20 years ago, there was more value given to the knowledge an MT brought to the table; unfortunately, the industry has taken a big step backwards in that regard.
One reason companies are reluctant to pay telecommuters an hourly wage is because, quite frankly, they don't trust them. This is an issue in all industries considering allowing their workers to telecommute. You'd think that for as many years as MTs have been telecommuting, the industry would not only have figured out how to do it right, but would serve as a shining example to other industries on how it can be done. Years ago, I gave a presentation at the AHIMA Nevada state meeting. One of the other speakers gave a presentation on coding and the issues surrounding allowing coders to work at home. I was a bit flabbergasted because all the issues being raised were issues that had been discussed in the medical transcription industry for years, but this room full of health information professionals all acted like these were unique to coding and they talked about how to resolve this issues without once considering asking the people managing another branch of the health information management department – the medical transcriptionists.
In the medical transcription industry, where transcription platforms can be used to track the actual time on the keyboard, it's tempting to use that as a measure of actual time spent working. However, using keyboard time disregards all other activities, such as research, phone calls related to business, and computer down time. And let's face it: if someone wants to game the system, they can game the system. Nothing is foolproof. The essential components of successful telecommuting are a clear contract and trust. At some point, companies need to trust the people who are telecommuting to report their time accurately and to be as productive as possible when they are on the clock. Does that mean an MT is going to spend 8 full hours with hands on the keyboard (assuming there are enough jobs in the system)? No, it doesn't. But that doesn't mean the MT isn't giving full value to the employer. Even in an office setting, people take breaks. They go to the bathroom, they get something to eat or drink (even if they bring it back to their desk). Nobody, in any setting, is at their desk and working for 8 hours a day and it isn't reasonable to expect to compensate anyone only for the amount of time they are; otherwise, there'd be a lot of office workers taking a big cut in pay, and they'd be as unhappy about it as MTs have been.
In addition to tracking actual keyboard time, companies use minimum line requirements to offset trust issues. The problem with minimum line requirements is it doesn't allow for company problems the transcriptionist cannot control, such as the volume of available work, failure of equipment, telephone calls or other required meetings. Minimum line requirements have to be reasonably achievable by a full-time worker and they have to be adjusted for outside factors. If a company is going to require a transcriptionist to produce (for example) 1200 lines a day, then it's the company's responsibility to see that there's a sufficient volume of work available to produce that number of lines, that the equipment is working and that supervisors aren't constantly interrupting with messaging systems, e-mail and phone calls.
Of course, medical transcription services are reluctant to pay a base salary with minimum line requirements and production incentives because of the way the client is charged. Maybe all that needs to change, and maybe this lawsuit will be the catalyst for that change.
The WAH syndrome
What is the WAH syndrome? See if this sounds familiar:
I don't need to be paid as much as someone in the office because I save money on gas, clothes and child care.
I've never interviewed for an office job where I was asked how far I had to commute because the salary I'd be offered depended on how much I might be spending on gas. Likewise, I've never been asked how much I pay for my business attire, or how many children I have that will require day care, or even how much I might expect to pay for day care. If it makes no difference in an office setting, why does it make a difference for telecommuters? Let me tell you something: it would cost these companies a fortune if they had to bring everyone in house, even if they could find enough people who were willing and able to work in house. Telecommuting has been as favorable for MT companies as it has been for the MTs themselves – so why is it even a factor in pay rates and the way employees are treated? Because there is an army of people out there willing to do literally almost anything to work from the comfort of their home.
OK, I've never heard an MT say it's okay for the company they work for to violate labor laws because, after all, there are other benefits in being allowed to work at home – but that's basically what's been happening for years. I just can't imagine that MTs think it's okay to be expected to be at their desk and working and then not be paid because there is no work. I can't imagine that MTs think it's okay to work more than 40 hours a week and not be compensated extra for it. If you worked in an office where you punch a time clock and one of your co-workers encouraged you to falsify your time card information, you'd both be fired, even if that co-worker was a supervisor. So how has this gone on as long as it has in the medical transcription industry? This isn't the first time I've heard of this practice, nor is it the first year I've heard of it. It's been going on for about as long as there have been MTs working at home as employees. I don't know why it's been allowed to go on for so long; what I do know is I'm glad it's finally been pulled out from underneath its rock and the comfort of working at home and exposed to the light of day, where it belongs.
The Stockholm syndrome
I was reading a blog post this week about how authors have something of a Stockholm syndrome when it comes to their relationship with the established publishing industry. I think there's a Stockholm syndrome among many medical transcriptionists, as well, which might provide some explanation for why it's taken so long for a lawsuit like this to come about when this type of abuse has been ongoing for years.
I admit, I have not been immune to MT Stockholm syndrome. I had abusive clients over the years. I put up with their abuse for a number of reasons, but the primary reason was I was making good money and I used that to justify tolerating the abusive behaviors. One day, I decided I'd had enough. I terminated a long-time client who represented a substantial amount of my income. I liken it to having a splinter you're afraid to remove – it doesn't seem that bad, it's not festering too much and it's not frankly infected so out of fear (or whatever reason), you just leave it alone. When you finally pull the splinter out, you realize how painful and annoying it's been and wonder why you tolerated the pain for so long just because you were afraid to pull it out. That's how I felt when I finally removed that splinter. For me, the stress relief far outweighed the loss of income. It takes a lot of courage to stand up, but at some point you have to ask yourself what do I really have to lose? Many of the MTs involved in this lawsuit are struggling to make a living – not just a decent living, but a minimum wage living. For a job that requires as much knowledge and intelligence as medical transcription, that's just not right. And I'm sure there will be plenty of people who will say (or think) well why not just get another job? First of all – why should they have to? THEY haven't don't anything wrong. Second, I suspect Transcend isn't the only company that employs these tactics or has these problems, and many MTs have gone from company to company, trying to find a fit, only to experience similar treatment.
Medical transcriptionists need to stop being afraid of what will happen to them if they speak up, and start thinking about what is happening to them because they aren't speaking up.
It will be interesting to see how many MTs join this class action and how many additional actions are filed against other transcription service companies that employ the same abusive tactics. If you think you belong to the class action against Transcend, there's a link to instructions in the Dolley law office blog. I encourage transcriptionists to stand up for themselves; in the end, it will benefit not only individual MTs, but the industry as a whole.