Wow, the article on Mandatory Credentialing certainly created quite a lot of dialogue. I'm always glad if I can spark some discussion and get people thinking in different ways.
The comments (here and at my Facebook wall) became so extensive and involved, I decided to post a followup on the same topic, to address some of the issues raised in the comments.
What is the purpose of credentialing?
Well, this seems to be an issue for everyone. MTs want it to mean that they get paid more. Lea Sims, Director of Communications and Publications for AHDI, posts in one of her comments:
Credentialing should not be embraced because it earns you more money or gives you a professional advantage… (snip) Credentialing is about moving the profession forward, not the individual.
Let's take a look at the reasons AHIMA gives in support of credentialing:
Let me highlight a few points there:
- Whatever the reason, credentialing makes a professional a trustworthy and likelier candidate for gainful employment and career advancement.
- Credentialed professionals receive better compensation from their employers
- Greater chance for advancement in one’s chosen career
Can someone at AHDI explain to all us MTs “out here” why MTs shouldn't expect the same things HIMS professionals get from their credential?
I read this to my husband, who looked at me like someone had completely lost their mind, then said, “Well, what's the purpose of moving the profession forward if it isn't to make more money? It's always about the money.” You might want to disagree with that statement because he's an accountant, but he does have a point. There seems to be a big disconnect here between the esoteric philosophy and the practical reality.
Mandatory credential/licensing – again
I'm not at all opposed to credentialing. I am opposed to licensing and mandatory credentialing.
Lea also states: You don’t see nurses, therapists, techs, etc, balking about their mandatory licensing/registry exams.
This statement is based on the assumption that medical transcriptionists have as much responsibility in the patient care process as professionals who actually see the patient face-to-face. Apparently, my disagreement means I think MTs are just secretaries. Having been a secretary, I'm going to go out on a really unpopular limb and ask – what's wrong with being a secretary? I've done secretarial work, legal transcription, general transcription and medical transcription. I will note there were only 2 differences between the first 3 and the last .
- Medical transcription has a specialized vocabulary and format, just as legal transcription does.
- As a group, doctors are absolutely the most abysmal dictators I've ever encountered in my over 30 years of transcribing and secretarial work.
I'm sure this won't make me a lot of friends, but folks – I've done clinic, specialty, subspecialty, pathology, radiology, acute care, ER, operative reports – just about every type of medical transcription there is and it's just specialized secretarial work.
And I'm going to point out a reality: not only are attorneys as a whole really good dictators, I will argue that the documents they produce are JUST as important to the lives of people as the medical records and they, at least, understand that when they put their signature on a document, or advise their client to sign a document, the transcriptionist or secretary isn't the one responsible for what's in that document.
Bambi says:When I dictate my records, slowly and clearly of course, I don’t get to hang the phone up secure in the knowledge that the MT on the other end is qualified, sane, certified, or has a clue. [Emphasis added]
Let me tell you a story along those lines. Years ago, when I started my business, one of my large clients was a large insurance company. I did a lot of transcription for the risk management department. The director of that department insisted that I transcribe verbatim, with no corrections or changes. It drove me absolutely crazy. One day, when I complained to him about this, he told me something that has stuck with me ever since. He said he knows I'm smart and know what I'm doing and can make corrections and flag errors – but I don't transcribe all the reports, I won't transcribe all the reports, he has no idea which ones I will do and which ones someone else will do or how long I will even be transcribing for this insurance company – and his people need to be trained to dictate the reports so they are correct, regardless of who transcribes them.
Wow – imagine a dictator taking responsibility not only for the accuracy of the finished document, but the accuracy of the dictation! Why is it we feel we have to take responsibility off the shoulders of physicians when their dictation has far more impact than a manufacturing company's risk management assessment report? So we can feel like our role is more important? All I can say is – wow.
Are employers supporting credentialing?
My blog post started because someone stated something as fact, without supporting it. Here's another statement I'm not seeing supported in fact.
Lea Sims: Well, many employers are making it a requirement. Our CMT numbers are on the rise. Whether we will ever see that evolve to a mandatory credential remains to be seen, but again, it’s about demonstrating a unique value to healthcare delivery.
Julie – the first step was getting MTIA to release their position statement in support of credentialing. A small step, certainly, but an important one. Since that paper was released, we have seen a big influx of employer-sponsored RMT and CMT study groups. Webmedx, for example, has made the decision to get every one of their MTs credentialed by next year and to hire only credentialed MTs after that (or so I’m told). That’s not necessarily a trend, but all trends start small. I can absolutely tell you that credentialing was on the lips of every employer I talked to at the MTIA conference last week.
I'd say it's starting really, really small. A quick review of the various web sites indicates that a few employers are offering premium pay for the CMT, some offer test prep. I only found one (All Type) that reimburses an MT after s/he has passed the test.
Very few employers state a preference or requirement for the credential beyond the premium pay. The only company requiring it was Transcend/TRS, and then only for QA positions.
I could have spent more time looking but I'll leave it on the shoulders of the people who make the claim to provide links to show it's gone beyond boardroom discussion.
The employers need to do more than talk. If they support a credentialed work force, then they need to go all-out and make a commitment to getting MTs credentialed. It simply isn't going to happen down at the individual MT level to “advance the profession.” Why should Susie Transcriptionist care about “advancing the profession” when she's having a difficult time getting work, having her pay cut, and trying to juggle bills and schedules? Let's talk about the hierarchy of needs, here. If her employer isn't demonstrating a commitment to credentialing, why should she?
Is it too late?
So, just for the sake of argument (and clarity), am I hearing you say that you perceive the role of the MT to be primarily secretarial? One only of administrative support to the physician? If that’s the case, then I would agree that no credential would be necessary. I would also argue that such a role is the least valuable to healthcare right now and the most likely to be marginalized and automated. And explains why SRT and EMR vendors have been able to quite easily convince our end-users that MT can be replaced (afterall, it’s just a secretarial/clerical role).
OK, the question here is not whether or not we're going to be marginalized and automated – the question is whether we can turn back the clock. We've already been marginalized and we're on the way to being automated.
I'm going to argue that medical transcription has always been marginalized, not only because of the low entry requirements, lack of standards and lack of credentialing – but because any sector where the work is performed primarily by women is almost always marginalized. Will credentialing change that? In my opinion, it will only change it if the large employers stop talking and start walking in support of the credential, both with the work force and with the client base. As long as they continue to contribute to the marginalization with business practices that do nothing to “move the profession forward,” it's going to continue down the same road it's on.
Is there a case FOR credentialing?
Absolutely I think a case can be made as to why credentialing is a good idea – I just take issue with the approach and the reasons given for it.
Like I've stated over and over above – the big employers, the hospitals, JCAHO all need to show a commitment to credentialing because it simply isn't going to be supported at the individual MT level otherwise. All of this will be just more blather if employers SAY one thing and don't back it up with action. (If I was actually being paid to blog, I'd probably do a flow chart on all this and it might make more sense.)
As fas as the RMT, it would serve the purpose of raising entry requirements into medical transcription. Employers would have to be on board with saying that any MT graduating after a specific date must get an RMT within XX months. This doesn't alleviate the issue of getting experience and I don't think there will be many (or any) employers who are going to be willing to commit to hire RMTs with no experience, based on my discussions with employers on this issue. However, it does raise the bar, even a little bit. It also sets the expectation from the very beginning that this is something necessary if you want to be a medical transcriptionist.
The CMT is probably most similar to the CCS credential offered by AHIMA, which has no education requirement (beyond high school diploma) and requires 3 years' experience. Most coding employers require a credential. It isn't mandatory, but applicants who don't have one are not likely to be hired or the hiring will be conditional, pending passing the credentialing exam. As long as MTs can get a job without needing a credential and as long as they can continue working without a credential, there isn't going to be an incentive for them to get one. And I'm sorry – I agree with my husband and AHIMA on the reality that it is IS about the money – and I think most MTs would agree with me.
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