MTs and “Speech Wreck”

I didn’t find much to laugh about when I read the Advance Insiders blog, Speech Wreck, by Jeanne Johnston. Basically, it’s a regurgitation of the misperceptions, inaccuracies and just plain bull-headed resistance to change exhibited in many of the medical transcription online communities. I expect better from bloggers at a site like Advance.

Let me start with what Ms. Johnston got at least partly right in her blog post:

There are incredible numbers of veteran MTs who are now crying because they are seeing their paychecks fall precipitously because there’s no way to double production to make up for half the wages.

MT wages are stagnant or falling and have been for some time. Are employers asking medical transcription speech recognition editors to work for less per line? Yes, they are. But let’s get over the victim mentality here and take some responsibility for the pay situation we’re all in. The reason MT pay rates aren’t better is because there’s a never-ending supply of people who are willing to work for less, whether they’re new to the field or whether they’re veterans. I’ve encountered very few MTs who have said “I’m not willing to work for that” – and meant it.

The fact is, there are MTs who are accepting less than half their production typing line rate and that’s where they start getting into problems.

The math does work out – if you are 2x more productive editing speech and your line rate is half what it was for manual transcription, then you are making the same amount of money. And there are MTs who are making production 2x and more of their manual typing production.

If you produce 200 lines/hour on average as a transcriptionist at 8 cpl your average hour rate of pay is $16/hour

If you produce 400 lines/hour on average as a speech editor at 4 cpl, your average hourly rate of pay is $16/hour

The problem starts if you are not more productive and if you accept a line rate that is much less than your production increase. A lot of speech recognition jobs are paying 2 and 3 cpl. C’mon people – this isn’t rocket science. You’re all smart enough to do the math. Assuming that you will actually BE 2x more productive as a speech editor, you can’t take a line rate that is less than half your current rate if you want to break even!

The other problem in this equation is the problem that has plagued medical transcription almost from the get-go: it’s a Pink Collar Ghetto job, which means it’s predominated by female workers. And studies have shown that women do not negotiate their pay like men do.

Some companies allow their MTs to trial as speech editors. If you try it and you aren’t making enough money – either go back to traditional transcription or renegotiate your pay. Some companies are paying a full line rate on jobs that require XX% retyping, acknowledging that for some jobs generated by a speech recognition engine, the accuracy is so poor that it basically has to be completely retyped.

Now let me get to what’s inaccurate and what bothers me about this blog post.

I’m not sure how Ms. Johnston can state with such utmost certainty the conditions and attitude in the industry when people who have more experience and more connection with what’s going on in the industry couldn’t make these statements with any confidence in their accuracy. It’s as if Ms. Johnston has her finger on a thready extremity pulse and is telling the everyone, including the doctor, who is monitoring the EKG, that she’s certain the patient is dying.

There are incredible numbers of veteran MTs who are now crying because they are seeing their paychecks fall precipitously because there’s no way to double production to make up for half the wages.

How does Ms. Johnston knows that there’s “an incredible number” of anybody crying over falling pay rates due to SR? I’m quite certain there’s an incredible number of veteran MTs who aren’t happy about pay rates in ANY segment of transcription, but SR hasn’t penetrated a sufficient segment of the market to impact “an incredible number” of MTs with any number of years of experience. See – I can state things with absolute certainty, as well – it doesn’t make them facts, nor does it make them true.

This statement also ignores the opportunity SR provides to veteran MTs who are embracing speech recognition editing because they are no longer capable of doing the production work required to make a living. They do far less keyboarding as editors and their knowledge continues to be utilized. It’s a welcome option for veterans who don’t want to have to learn something completely new (like, for example, cancer registry).

…no one’s ever bothered to ask for our input on the front end of this abomination.

Holding onto that thready extremity pulse, the author makes this statement like she actually knows what she’s talking about. The fact is, the medical transcription industry IS heavily involved. It was a topic in at least two sessions given by medical transcription industry professionals at a meeting I recently attended. You know all those things you say AHDI doesn’t do for transcription? Well, this is one of the things they are doing and they’ve been involved in it for years. What would be accurate is that nobody has bothered asking the author’s input – but then again, she hasn’t positioned herself to give it where it counts, either. The transcription industry acknowledges that speech editing requires a slightly different skill set than manual transcription, but the same knowledge base. Transitioning MTs to that skill set is part of the focus of AHDI as they attempt to move MTs to what is becoming the future of transcription. The fact that a lot of MTs don’t know this is part of AHDI’s perception problem with MTs. And if your idea of AHDI “doing something” about SR is to get them to make it stop, you need a bigger reality check than I can give you.

Adding to my amusement at this assertion is a recent article published by Advance for Health Information Professionals, which is the sponsor of Ms. Johnston’s Passage blog. Maybe Ms. Johnston doesn’t read Advance; maybe she just missed this article: “Creating a Definitive Guide on Speech Recognition.”

The automated speech recognition technology (ASRT) work group, which consists of a broad group representing speech recognition vendors, medical transcription service organizations (MTSOs), MTs and consumers, hopes to clear up the confusion that exists by publishing what the group hopes will be a definitive and evolving guide to speech recognition, in the form of a reference guide to the adoption of speech recognition.

MTs who want objective information about SR and the medical transcription industry should follow the link and read the entire article. If you’re really interested in making a difference, join the workgroup.

Like Ms. Johnston, there are MTs who see SR as a “Borg assimilation,” rather than an opportunity. And like Ms. Johnston, they may very well find other careers in healthcare information management. We saw MTs kick and scream and cry about transitioning out of DOS and WordPerfect 5.1 and into Windows. We all survived and adjusted and by golly – some of us even like it better. And now we have many MTs who wouldn’t know a DOS prompt if it smacked them upside the head. Resistance to change is a human attribute. In my experience, the personality type attracted to MT is more resistant to change than most others. But get real folks – you can’t stop progress. At some point, you have to decide whether you’re going to lead, follow or get out of the way. I’d like to think we all have the intelligence to be rational and put emotions aside.

We all get a good guffaw out of speech recognition errors, but I’ll bet MTs are less entertained when their own errors are posted or distributed in a company newsletter. If an MT gets 90% accuracy on a QA score and speech recognition gets 95% – which one would you pick? The fact that MT speech editors are seeing reports with errors doesn’t equate to the blanket statement “speech recognition doesn’t work.” If an MT consistently produces reports with 99% accuracy, is her work sent to QA? Of course not. If an MT consistently produces reports with 90% accuracy, is her work sent to QA? Of course it is. The same is true of documents produced by speech recognition – once a consistently accurate report is generated for a dictator, those reports are no longer sent to editing. Keep in mind that M*Modal, eScription and others like them aren’t in business because the technology doesn’t work. HIMs managers do talk to one another and they know salesmen are there to sell a product – the technology has to prove itself, and it has.

For MTs to be successful in making the transition to speech recognition – and make money – they need real information, not misinformation and not har-har jokes about errors.

If you are asked to transition to speech recognition, you need to know what questions to ask so you can negotiate your pay. And you do need to negotiate the conditions and pay.

  • Is there a sliding scale pay rate based on the accuracy percentage of a report? In other words, do I get paid more for a report that is only 85% to 94% accurate, versus my base rate for reports that are 95% accurate or higher?
  • If accuracy falls below 75% and I have to retype most of the report, do I get full transcription rate pay?
  • What is the average percent accuracy of speech recognition on the account(s) I’ll be working on?
  • How long has the account been on speech recognition? (The length of time will impact the accuracy – newer accounts will have a lower rate of accuracy.)

Transforming the Pink Collar Ghetto

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11 thoughts on “MTs and “Speech Wreck””

  1. I find your article very though-provoking and, after reading Ms. Johnston’s article, would have to agree with you on most points. I was wondering about how to go about joining the workgroup mentioned. I couldn’t seem to locate a link to it anywhere.

    I have a couple of points and perhaps you wouldn’t mind hearing them? I work on an account that is about 50% SR and 50% regular. I’ve been a medical transcriptionist for some 22 years. As you describe, I have grumbled about changes a few times in those years but, also as you describe, things have ultimately turned out for the better. I was not at all happy about the VR but, after grumbling, gave it a try. The voice recognition on my account is, for the most part, pretty good quality and I have really enjoyed learning it. It does give my carpal tunnel a badly needed wrist BUT I am not able to double my work. It takes pretty much as long to do most reports. Obviously, you can only listen so quickly and the same skills (other than the carpal tunnel part) are utilized. I produce about 300 lines an hour both ways, most of the time (except when I do get more difficult dictators). I am EXTREMELY lucky in that the account I work for currently pays the same for both types of reports. I am one of those rare MTs, however, that if and when they say they are going to cut that rate, I will definitely have to negotiate. I did leave my last position with another company because they said they could not give me a raise and I felt that they could and should. I DO absolutely agree that we have to quit thinking we are the victims and start standing up for ourselves and our industry.

    I do agree that a large number (hahaha, no statistics to back that up other than what I read) of MTs *seem* to prefer to grumble rather than to ask how to fix/improve things.

    I think the one point that perhaps you are missing is that many of us are too busy making a living to join groups and attend meetings – so we cannot stand up for ourselves. Perhaps we should make time and, as I get older and don’t have children at home, etc. I do have more time, which is the crossroad I am at now – interested in making a difference, not just for myself but for the profession. But, a lot of those who are attracted to this job are busy raising families and earning a living and don’t have the money and/or time to be able to exert themselves and make a stand – if that makes sense?

    So, maybe the rest of us, who are in circumstances that allow, need to make that stand, as obviously you are doing. I enjoy your blogs and you are DEAD ON regarding the profession and I look forward to hearing more, reading more and maybe you can mentor me a little in showing me how I can make a difference, also?

    Thank you for all that you do for MTs.

  2. Of course you are welcome to post your comments! That’s what the box is here for.

    It looks like currently the workgroup is composed of members of MTIA, AHDI and AHIMA. It sounds to me like they will open the group up to more members after they publish the first white paper, slated for some time in August. However, you can take the industry survey:

    http://www.surveymonkey.com/s.aspx?sm=i8iCjKXavWiYdeYi6EzEaQ_3d_3d

    I don’t know what to tell you about time. I understand it’s an issue, as is money. There’s a lot you can learn online and by electronic communication with industry leaders, but the reality is that even that takes time. I go to as many local seminars and meetings as I can. AHDI has an online chapter. AHIMA’s workgroups and committees are all conducted online and over the phone. All I can say is – you make the time for the things that are important to you. I know that sounds smug and condescending but it is true and I don’t know how else to say it. I’m immersed in it because it interests me and I don’t have much of a social life otherwise. 😀

  3. Julie,

    Thanks for the food for thought. If i were an MT employer, I’d rather hire someone cautiously optimistic about new technology than someone who refuses to accept change at all. Johnston’s attitude is quite poisonous to a MT community that is trying to adapt to change. Our profession is not the only one to assimilate to “Borg” tendencies; if one accepts change is the only constant, then I would think employers would be more willing to keep them hired.

  4. I’ve posted on MTChat about my thoughts on SR based on my experiences with a few different SR platforms. Although it’s not for me, or perhaps I’m not for it, at least in the capacity of the proprietary platforms I’ve used, I’m really neither for or against it. I wasn’t opposed to learning and I did the best I could in the short period of time I had to become acclimated enough to reach the 2x criteria in order to make an equivalent wage. That being said, my ONLY gripe about it and agreement with Ms. Johnston is in regard to the “awkward key commands.” Oh, that and, although production with SR is higher, I don’t believe 2x is an accurate box to try to fit all MTs into to justify half the wage. I’d like to see some real statistics that show the average MT can produce twice the volume of work on an SR platform versus straight transcription…I think it’s closer to about a 30% increase in production. Even from that perspective, the SR sales gurus should still be able sell their product with a more accurate statement of X% saved on transcription costs.

    But here is the thing…SR wasn’t developed to make OUR lives easier! It wasn’t developed to INCREASE the pay of the MT. It wasn’t developed with the MT in mind at all, and other than as a buzz word to a targeted audience – doctors who have paid huge transcription bills for years – the MT was an afterthought.

    It’s not about US.

    Before I was an MT, I did coding and billing, played receptionist, was a secretary, did some admin and management work, and it seems just about every other thing that came up in a doctor’s office over the span of nearly 20 years. If you would have asked me about SR (and EMRs) during those years, I’d have been all over it. How cool – Let me learn some kind of new technology (I’m a little geeky at heart). Then again, I was a salaried employee with full bennies that didn’t depend on a production number. However, I also understand the benefit it can provide in a medical office setting. Noboby is thinking about the benefit it can provide in your spare room/home office setting. It’s geared for the benefit of the target audience who is buying it. Unless we’re going to buy it and use it, why would we have any prior say in it? We’re just going to be trained on it, period. BTW, I do own a copy of Dragon 8.0. I’ve never had the time to train it. V 10.0 is out now.

    Julie is quite right about how we will settle for lower wages and poor conditions (i.e. employee status requirements for bennies). I have always said we (at home MTs) have sold our worth for the “privelege” of working from home. I say I won’t, but I have, and am…17 years’ experience and working for 8 cpl. The only way I keep doing this account is that it’s straight transcription, easy dictators, lots of normals, plenty of work, and I can use my own tools (no funky platform)…about as close as I’ll ever get to the best IC job I ever had 🙂

    We have choices: Gripe about SR and go on our way. Find another line of work. Embrace it and be part of the future of MT. Or just throw our hands in the air and be bitter all around.

  5. Thanks for responding to this misinformed piece that attempts to perpetuate myths and resistance for a technology that represents an opportunity to change the discussion from how cheap can I get the service to the more fruitful and relevant discussion of what value can I bring. If I recall there was a similar reaction to outsourcing with equal effect. This train like the outsourcing train has already left the station and you are either on board or watching.

    Nick van Terheyden, MD
    Chief Medical Officer
    M*Modal
    http://www.mmodal.com
    http://twitter.com/drnic1
    http://navigatinghealthcare.wordpress.com

  6. Chris, your thoughts are right on. SR is not for the benefit of the MT community. I always thought that the privilege of working at home (what with avoiding child care costs, “saving the environment” by telecommuting and working without having to don the pantyhose or scrubs was outweighed by whatever the doctors could throw at my ears.

    The fact that we as a community need to remind the medical community powers-that-be that we’re still human and need to feed our families with fair cpl compensation, whether it’s for straight MT or SR editing, will only come from a united front. It certainly won’t come from complaining about the unfairness of the changes. After all, if anything is unfair, it’s that many of my friends envy me for being able to work in my pajamas. (Luckily, the discipline required to be self-employed outweighs any responsibility I had when I had to dress up for my project management career outside the home.)

  7. The condition of working at home as being a *privilege* is not one we could or should embrace. A few years ago, I applied for an employee position and on acceptance, they sent me a huge inbox of pdf files, including the employee manual. On one of the pages in that file, this company made a huge issue of work ethic, etc., emphatically stating that it is a “privelege” to work at home. BS! I’ve never felt it was a privilege. It’s to all our benefit across the board, especially the cost the employer saves on space (office rent is a huge overhead expense), equipment, utilities…the list goes on.

    I was thoroughly offended and totally livid after I read that statement. I turned down the job. I could see their philosophy was one of “motivation by intimidation.”

    I’ve had clients asked where my MTs worked – at home? I hated that question. First of all, it doesn’t matter (except in terms of security/privacy). It does not decrease their value or my value in offering a much-needed service to the client.

    We, as MTs have, and will, settle for “less” because we justify it by saying – well, I don’t have to pay childcare, or I don’t have to buy fancy clothes, or I don’t have to pay for gas or lunches, etc. But you DO have to pay for reference materials and keeping them up to date. You DO have to pay for equipment, furniture, and supplies. And the space, and overhead of maintaining that space. You may have to pay for health or other insurance. You may have to pay for retirement savings. You may have to pay back on a tuition loan… working at home does not mean you are entitled to less money. The sooner WE stop trying to justify the reasons we can accept less pay, perhaps the sooner we can see pay scales start to rise again.

  8. Chris, I wholeheartedly disagree with you. I take the full responsibility for writing off my own expenses on my taxes every year, a responsibility I am willing to do and keep track of. I HAVE worked in a public workplace before. I HAVE paid my own health insurance. All these things I accept because I have chosen to, not because I have laid down and taken a beating from the medical community for continually asking me to earn less while performing the same amount of work.

    I repeat: Working at home is a privilege for me. I know what it’s like to put my child in daycare, pay for it, work in an office, come home and do it all again the next morning. Perhaps this kind of attitude is exactly what other MTs dread, but please notice I never said that I would accept less compensation because of these things.

  9. Becky – I never meant to discount your feeling the benefit of working at home. That’s not what I was saying at all. My sentiment starts with an employer’s attitude that “allowing” us to work from home is somehow a privilege – and they also use that to convince us we should be paid less and/or somehow treated differently. My post was not directed at you personally by any means, but more of General MT population. And there are many, many MTs who will settle for less compensation for the “privilege” to work at home. Perhaps we are using differing degrees of importance on the definition of privilege in terms of being able to perform this job at home. My term is one of the “benefits” to a career in MT is the ability to work from home. I defer the use of the word “privilege” to something of a higher degree of special favor.

  10. Ahh, semantics! I do agree that working at home is a benefit. Perhaps I am seeing the privilege for the ability to run my own business (which happens to be a transcription business) and the fact that I’m not forced to work for a corporation, a military, or not be allowed to work at all. But then again, “rights,” “privileges” and “benefits” tend to get muddled when looking at what I am able to do because of where I live.

    I wonder if the original author of “Speech Wreck” feels that she is entitled (has a right) to working out of her home without the threat of new technology taking over her lines. That attitude is not the kind of attitude I’d expect from an MT, especially if she is an IC. Indeed, if anything, the challenge of SR will need some sort of human interaction, and that adapting to these changes will help MTs keep their voices heard and skills needed. If there’s anything I have learned about entrepreneurship it’s the fact that this country gives you the privilege of working on your own, but certainly not a right to keep your job at status quo!

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