The future of medical transcription

crystalballNot that any of us has a crystal ball or anything…

At his XY Files in an MT World blog at Advance, Jay Vance asks: Are Medical Transcription’s Days Numbered? This fairly brief blog entry includes a long quote from Nae Priest, originally at MT Chat. I’m not going to requote it or Jay’s blog – click through and read the whole thing, along with the comments.

I have to wonder where the overall job market is in the United States when the Department of Labor gives such a rosy outlook for medical transcription careers, in spite of a general negative outlook on the part of transcriptionists (and many MTSOs) themselves. And because they can point to the DOL information on medical transcription careers, the schools will continue to sell MT as a viable, vibrant work-at-home career.

Obviously, there are a lot of us with experience in the industry who disagree.

Jay brings up HITECH (see For the Record HITECH Act and HIPAA for a condensation of how this will affect medical records). After the hoo-haw surrounding HIPAA, I think a lot of MTs are thinking whatever. And, as we saw when HIPAA was passed, a few smaller MTSOs are jumping ship and selling their business before this big shoe drops. How HITECH will affect the industry overall remains to be seen, but there is a lot of discussion about whether or not it will inhibit or even eliminate overseas transcription… which, of course, leads to another discussion on how that would affect US MTs.

My opinion is that a pressing demand for more MTs in the US would not lead to higher pay rates. I think the result would be a harder push towards EMRs and point-of-care input. The way I see it, healthcare is under the gun to make records electronic and there’s a tremendous commitment of resources and money to make that happen. Short of money and already committed to spending quite a bit on EMRs, hospitals aren’t going to cough up more money to throw at manual transcription – they’re just going to find the motivation to make EMRs happen faster. Doctors who have invested in EMRs but not found the motivation to use them to their full capacity will find the motivation when faced with increased costs for manual transcription – they’re already paying for the EMR system and if it helps them eliminate or significantly reduce transcription costs, especially in the face of a rate increase, they’ll suddenly find they don’t mind using it quite as much as they did when labor was cheap.

Those of us who’ve been online for awhile will find this homily familiar: A rising tide floats all boats. The problem is, the people throwing that adage around assumed a rising tide. Guess what happens in a receding tide? You got it – all the boats are stuck in the same stinking mud. The real-world translation of that is – MTs are already seeing reduction in pay, to the point where it’s almost equivalent (and in some cases, less) than what an overseas transcription service charges. If HITECH brings all transcription back in the US, the most likely scenario (after the newfound motivation for EMRs) is that medical transcription will sink further into the pink collar ghetto, and MTs will find themselves working for rates equivalent to overseas. Possibly less – overseas companies don’t have to pay any US employment taxes or deal with the mounds of paperwork for employees that costs a company money.

And if HITECH doesn’t result in healthcare getting nervous about work going overseas (and I don’t know how it couldn’t), there’s then the cost of compliance – which includes background checks on all employees. Again, I think this is going to fuel the motivation to hasten adoption of EMRs and point-of-care documentation, simply because it eliminates the added costs and headaches.

More and more experienced MTs will bail out of the industry. Many women who entered the work force so they could be flexible and work at home while their children were young have now moved past that phase of their life and can participate in job markets outside the home. I don’t think any of this will stop the droves of young mothers and rural wives who see MT as the solution. And frankly, I sometimes wonder if companies would rather have inexperienced newbies just entering the field because they have lower expectations than those of us who remember decent pay, dictators and working conditions.

When I look at the jobs posted for MTs, it’s the same jobs, by the same companies, recycled over and over again – it’s difficult to tell if they just can’t keep MTs or if they’re signing that many new accounts, but even the #1 job site for MTs has less than half as many job listings as they did 2 years ago, and many of those are repetitive ads by the same companies.

Is there a future for MT? Sure there is – I’m just not sure it’s one many of us who’ve been around for awhile will want to continue participating in. It looks less and less like the kind of career I was looking for over 20 years ago and the changes haven’t been for the better. I have intense ennui when it comes to the concept of adapting to the changes – if I have to change, I’m going to find something that pays better for the years of experience I have. Frankly, I’d rather be paid $10 to do a mindless job like door greeter at the local supermart than bring years of skills as an MT to a job for the same pay per hour.

Medical transcription trends

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15 thoughts on “The future of medical transcription”

  1. In what state do you live in where they’d pay you $10 to be a door greeter? Certainly not in Ohio. Trust me, there will be a place for MTs when EMR is going full-swing everywhere. We just won’t be transcribing like we used to, but doing more data entry and proofing. Also, there are medical lawyers that could use our knowledge. Just looking at the positive and not dwelling so much on the negative. You know?

    Thanks for your info.

  2. I have to agree with Emy. I may not be an MT yet, but technology isn’t perfect. Medical transcriptionists will always have a place in the medical field. And personally, I’d rather be doing something where I can use my mind, rather than doing a mindless job like being a door greeter.

  3. @Emy – the kids flipping burgers at In ‘n’ Out get over $9 an hour. I can make $11/hour if I make coffee at Starbucks, more if I want to be a manager.

    You don’t say how long you’ve been in the industry – I’m interested to know where you’re at.

    @Erica – good to know your school did its job selling you on the industry. Yes, there may be MTs, but there won’t be as many of them, their jobs will become more and more clerical and they will be paid less and less.

    To put some historical perspective behind this – 5 years ago, I could’ve started at Kaiser as an MT at $17/hour. At the time, it wasn’t considered very good pay. MTs were part of a union and they had trouble hiring experienced people for that pay. For the last year, Kaiser has been laying off MTs and there are no MTs at my local facility.

  4. Julie,

    There are people at offshored countries willing to work for a meager $100 or less a month as a newbie, and a few hundred dollars more with years and years of experience. FYI, the outsourcing trend started only post HIPAA enactment, post 1996. Was HIPAA able to stop outsourcing? If you retain back all those offshored work, do you have people in the US to work for such low rates? In this scenario, think of the money made/saved by those who outsource the work. Think of the expenditure it could incur in these years of cost savings and recession if you retain back the work. Do you think outsourcing is a reversible phenomenon with these facts? Coupled with that gun point compulsion for adoption of EMRs. Hence, as long as the offshoring trend continues, do you think there is a future for the US MT? I have been cluelessly watching these facts all these years especially after somebody said speech recognition technology would outphase MTs. Only time has the answer on the how the situations would evolve into, and I think we will have a definite answer for these questions in the months to come but not years.

  5. Ok, there are no In ‘n’ Out burger joints around my area. I live in Ohio, in a small community with smaller hospitals and physicians’ offices. I want proof that I can make $11/hr @ Starbucks in Ashland, Ohio. I bet you they don’t pay that; otherwise, I’d be there in a flash. Also, they won’t let anyone just be a manager @ Starbucks, will they? I believe you need a degree nowadays, or at least about 10-15 yrs working there.

    I’ve been in the industry for 5 1/2 yrs and absolutely love it. I have no family around to help out with my kids, so this job has been PERFECT. I make more doing this than anything, when you factor the gas $ I don’t pay to drive to work everyday, babysitting fees, and the hassle of worrying how my kids are getting to and from their events. My husband works 60 hrs a week, so I have to be around.

  6. @Raj – outsourcing predates HIPAA by quite a few years. HITECH and HIPAA are not the same thing.

    Since most large companies do not contract directly with individual MTs overseas, I used the “company” rate as an example. Even if a US company has its own operation in India, it costs them approximately 6 cpl to produce (last I heard, anyway).

    All of your other questions ignore the possibility that HITECH will create such a significant liability for sending work overseas that companies will choose not to take that risk – whether or not there are enough MTs here and whether or not it will cost more.

    @Emy – people who live in rural and isolated areas without a lot of job options will still flock to MT. Because of the conditions you describe, MTs in this situation will roll over every time pay is cut or they are required to do more without a pay increase. MTs with other options will leave the industry.

    I have told a friend of mine for several years that MTs will lose jobs to technology and she called me a negative nelly. The day she had a colonoscopy and her doctor handed her the complete report before she left the office, she became a believer.

  7. I hear you. I, too, have witnessed the doctor entering all the information right in front of my eyes @ my daughter’s neurology appointment.

    However, you won’t see me roll over for a pay cut…lol. I have a Business Administration degree under my belt with extensive computer knowledge (16 yrs), so I know, if it comes to it, there is a place for me out there. As for now, I enjoy working from home and being able to watch/help my kids grow.

    I’m a ‘believer’ that my skills being an MT, independent contractor, and full-time mom/housewife will get me far in the future. I love change. I love technology and can’t wait to see where my career will go next with everything.

    Not many woman know how to fix computers on their own when they start having issues, but I do, and that makes me very proud.

  8. Ahhh the Death Knell toll-eth. 🙂

    Having done this gig for working on 4 decades, I have oh so many opinions. In 2001, burned out (yet again) from MT, I finally went back to school and got a degree in addiction counseling. LOVE IT. Course, I was looking at $28-32k after 4 years of school, a salary I’d left well behind in MT some years earlier. Then I got sick. And I thanked the Goddess I had MT to fall back on. I quickly learned, though, that the industry had stopped standing still salary-wise… it had, in fact, begun the earnest downslide. I’ve interviewed for many MT companies…worked for several including my own. I’ve had to accept that I need to work harder and smarter to make what I did in 1985. There are some companies, those very ones Julie references as recurrent want ads, that have crap for clients, crap for platforms, crap for pay, and crap for support staff. I’m not willing to work for peanuts for all that crap. I’ve been lucky to find some of the gems that do still exist, and remain grateful.

    Now to EMR. I do think HITECH will have an impact. And I do not think it will be finally paying an MT a livable wage. For a few years, I worked as a program analyst and was given a glimpse of the impact of our medical records. They have such a more significant half-life than I’d ever realized. Data-mining and disease protocols are just 2 of those uses. WHen I first started that job, we sifted through bazillions of scanned in manually created records. Then we started to see a significant impact of STRUCTURED DATA. This data that comes from point and clicks, voice, or whatever other non-MT generated source you can think of. The quality was significantly better. No longer did we have to spell hemoglobin every way conceivable to search on that one word. (You’d think there was only 1 way right?? No, we had to anticipate every misspelling an MT could give it!)

    So if you consider cost and the fact that yes, docs will kvetch, but they WILL adapt, EMR by non-MT means will get a stronger and stronger foothold. People like myself, who are trained in another industry but who must work from home, those who are rural, etc, will accept that we are not well paid and finally make it true, that one of the biggest perks to the job is we get to do it from home.

    I’ve seen quality from MTs that makes me want to cry. I’ve seen MTs in the company I currently work for give advice to other MTs, with that advice/spelling being 100% WRONG. Once upon a time, I’d have seen that as a challenge. Now I see it as the industry getting what it pays for. For me personally, I still do a good job regardless of pay, I just care less 🙂

    And I do think in the next decade we will see the most significant slide we’ve ever seen in MT…. down of course.

  9. Yep, HITECH and HIPAA are not the same thing but HITECH gives more teeth to HIPAA, if I’m correct. The water will be clear by Feb 2010, have to wait and watch until then.

    Many of those large companies finish their jobs for as low as 2 cpl at the MT level, the rest 4cpl or whatever left is their overhead cost and profit. As Bambi said, you get what you pay for.

  10. I live in India and both Raj & I contract from the same US Company. We see things differently, our target companies are the smaller ones with huge backlogs and multiple demanding accounts that drive them nuts…that works for us !

    But I second Julie & Bambi in part. After a decade(WAHD 6 yrs) and multiple burn-outs already…come a receding tide…I personally would jump shore and become an entrepreneur in an industry of my liking instead of moving onto another J-O-B ! I am sure it won’t be Engineering…which i abandoned 11 years ago….Raj & I are (Civil and Mechanical Engineers respectively) I like Bambi have started to care less these days.
    Either way….People with options are blessed indeed, lesser qualms…

    From an overseas offshoring standpoint….No matter what happens…6 cpl is still and will continue be good money for ppl in India the “x factor” works like a charm (every red cent made multipled a golden 50 times or more before it reaches our hands !) its like you made 4 dollars/line in your country…that’s how it is for us…which ain’t half know…lots of takers around here like it or not & the US companies willing to outsource couldn’t really complain much and have us to fall back to !

    1. That’s one of the things that is ruining America, outsourcing to other countries. You seem to get a kick out of it, you shouldn’t.

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  12. Jay,

    Thanks for your insight and confirming what I have suspected for quite a while. In fact, it has crossed my mind to just chuck it all and become a door greeter myself.

    Instead though, after 25 years as an MT, I am beginning school to obtain an associates degree, then bachelors degree in Health Information Management Technology. If I am still alive after I graduate, I may even go for my Masters.

    I believe I worked with you at the large Ohio hospital system (you were IT, I was a Transcriptionist)

    Hats off to you for speaking the truth , which most of the MTs who have been in the industry for years have figured out. Take care of yourself.

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