It seems that just about every discussion revolves back to how medical transcriptionists are paid – and how they feel about it. Jeanne Johnston’s Advance HIMs Insiders blog, Speech Wreck seems to conclude that MTs can’t make a living working on a speech technology platform. Well – that’s not an issue of speech technology and whether or not it works, it’s an issue of compensation for a job.

Jay Vance has now chimed in at his Advance for HIM blog: Is speech rec wrecked? This blog has some more objective information, gleaned from a survey of MT editors.

Here’s what I remember when Jay posted this information back in 2006 – most editors achieved only 25% increase in productivity. I know you’re all smart enough to do the math:

200 lines/hr @ 8 cpl = $16/hour
200 lines/hr x 25% = 250 lines/hr; $16 ÷250 = 6.4 cpl
250 lines/hr x 4 cpl = $10

It’s pretty obvious that you have to be doing a LOT better than 25% increase in productivity to justify a 50% cut in pay! Even if you are 50% more productive, the loss in income is still $4/hour, based on the above assumed averages.

So let’s focus on the REAL problem here: MT compensation. Why are MTs accepting this? We can get some insight from checking the message boards.

Judy Lichtenberger, another Advance HIM Insider Blogs regular, posted a good article: CYA – Cover Your Assets! And what does the lone comment say?

I am sorry to say that this career is falling by the wayside because no one will step up to the plate to give us a hand here in North Carolina.

Wow – and double wow. I’d like to know who the author of this comment thinks is supposed to take on this role on her behalf.

Then we hop over to the MT Chat Hot Zone discussion on the topic. I’m going to summarize, rather than quote, some of the comments because I don’t want to get in (more) trouble with the folks over there.

We don’t have a choice.

Pay isn’t negotiable.

I’ve bitched about it and it didn’t do me any good.

I’d be replaced by someone less experienced and I don’t want to have to start all over again somewhere else.

It’s better than nothing.

This isn’t a victim attitude?

I’d understand this better if it ONLY happened in an economic downturn – but this has been the status quo for MT through good times and bad and a large contributing reason to why compensation has remained stagnant.

So I ask all these people – how low will you go? If you’re working 8 to 10 hours a day, you’ve cut your expenses to the bone and you’re barely treading water financially – how many more excuses are you going to make for staying where you’re at, either the company or the career?

Let me play out a scenario for you.

You take a job with a company at 8 cpl because it’s the best offer you can get – everyone else you applied with is offering 7.5 cpl and you just KNOW you can’t make enough money at that rate. You’d like more than 8 cpl (obviously!), but this is the best you could get, so you take it. A year later, instead of being offered any kind of raise – however small – you’re told your rate is being cut to 7.5 cpl. What?! This is the rate you had decided you couldn’t afford to work at when you started here! You’re out looking for work again. You find a couple companies paying 8 cpl or maybe more, but you see a lot of MTs online saying they run out of work and they can’t get their lines in. The company you work for has lots of work; besides, now you’re used to the dictators on the accounts and you don’t want to start all over. You take the cut in pay. It’s better than not having a job.

A couple months later, you notice your accounts are running low on work. Turns out the clients have installed EMRs and they’re dictating less and doing more direct computer entry. You’re offered another account, but it’s on the speech recognition platform. You don’t really want to work on an SR platform, but what choice do you have? It’s that, or not have enough work. You say yes and start working. You get your next paycheck and find out you weren’t paid as much per line on the SR platform as you are when you type! When you point out to your supervisor that you weren’t told you would be paid less, her reply is “you didn’t ask and I thought you knew.”

Now what? You can go back to typing but that account doesn’t have enough work for you to get in your lines, especially now you’re making less per line for typing. You decide to keep working on the SR platform and hope things get better there. You’ve checked jobs for other companies, but nobody is paying much more than you’re making; and besides, you’re used to this company and these accounts. It’s better than nothing.

I think you get the idea. How many times is this MT’s pay going to be cut before she has enough? And what does she plan on doing if and when that happens? For anyone who points out “well, she at least has a job and her children aren’t starving!” – I have to ask, for how much longer? Do MTs have a line they’re willing to draw, or are they going to wait until they’re making less than overseas contractors are charging and they’re working 14 hours a day instead of 8 just to make the same amount of money?

In the book, Women Don’t Ask: The High Cost of Avoiding Negotiation–and Positive Strategies for Change, the authors report the finding that women have lower expectations and lack knowledge of their worth.

• Women are so grateful to be offered a job, they accept what’s offered and don’t negotiate.
• Women often don’t know the market value of their work: women report salary expectations between 3% and 32% lower than those of men for the same jobs. Men expect to earn more than 13% more than women during their first year of full-time employment and 32% more at their career peaks.
• Women are more pessimistic about the how much is available when they do negotiate and so they typically ask for and get less when they do negotiate – on average, 30% less than men.
• Twenty percent of adult women (22 million people) say they never negotiate at all, even though they often recognize negotiation as appropriate and even necessary.

In addition to the cost to you, the worker, there’s a cost to the employer. Other studies show that women who are dissatisfied are more likely to leave an employer than to negotiate for an improved situation. The cost to employers is estimated to range from 30% to 150% of annual pay. Based on what is reported to be an average salary for MTs ($32,000/year) and calculating a midrange cost of 60%, the cost to the employer is $19,200! Even if you went with the low range of 30%, that’s $9,600. Wouldn’t you think that knowing this would give you some leverage in your negotiation? Anyone in management should know that turnover costs money. At some point, it costs less to negotiate with the MT than it does to just let them go.

Let me put it another way: If a company gave you a raise of 1 cpl, you’d have to transcribe 2630 lines per day, every single day of the year, for it to cost them as much as the minimum cost of replacing you.

One thing MTs don’t seem to realize is that there is a strategy and a game to be played. I believe that this lack of realization is due largely to the fact that this isn’t women’s forté in the first place and because we’re working from a remote location. Unlike many other workers, there isn’t a central place where we meet and greet each other. You would have a difficult time parking yourself outside your supervisor’s office to get a face-to-face if he or she was avoiding you on the phone or by e-mail. And let’s face another truth – many of us are just more comfortable with electronic communication. Well, sometimes that doesn’t cut it. You just have to pick up the phone and make a phone call. Face-to-face and telephone communication gives you a completely different connection to people that you don’t get in e-mail, text, instant messaging, etc.

The rules for playing the game aren’t any different just because it’s transcription or just because you work at home and not an office. You have to give your employer a reason to keep you and pay you more. Did you attend any seminars pertinent to your job (online or off)? Did you seek out and participate in any company opportunities that would raise your profile? This is not something women do well – men equate it to battle and playing sports (and of course, what’s the point of keeping score if it doesn’t matter if you win or lose?) and women equate to going to the dentist to have teeth pulled.

MTs need to start realizing that they have options and choices and some power. Honestly, very few employers are going to initiate a raise for you. In any company, in any job, you’d have to be a real standout, high-profile, top performer for that to happen. If you’re at home, slogging away through the day’s dictation then bitching on the boards before fixing dinner and falling into bed – it just isn’t going to happen for you.

And I have to say something about the “they’ll miss us when we’re gone!” crowd. Maybe they will (whoever “they” might be) and maybe they won’t – why do you care unless you’ve actually moved on and placed yourself a position of power from which to negotiate a potential return? Or not – maybe you have no desire to come back, under any circumstances. But nobody’s going to miss you if all you’re doing is making this declaration while trying to pound out your lines – you have to actually LEAVE first. In order to leave, you have to make plans and act on them. Nothing is going to happen for you unless you do something to make it happen.

It takes a lot of motivation and time to turn around a ghetto situation. But – if you don’t start it, it’s never going to happen, is it? Whether you plan on improving your position within medical transcription or whether you plan on moving on to a new career, here are some web sites that might help you in your new resolve to take control of your career and your future.

Your On Ramp: This is a great site for women to connect, transition to new careers and businesses.

Ladies Who Launch: If you’re feeling entrepreneurial – or want to connect with businesses that might have use for your skills – check out this site.

Women Work: This is a national network for women’s employment. Women Work! envisions a nation where all women have educational and employment equity, personal and economic security, and social equality throughout their lives.Their expertise is employment, career training and education.

Advancing Women: Leveling the field for women in careers and business.

Women Employed: The mission of Women Employed is to improve the economic status of women and remove barriers to economic equity. Enforcing fair workplace policies, advocating for paid leave, increasing access to education and training, creating innovative tools for women earning low wages to learn about and advance in careers with higher pay.

Wider Opportunities for Women (WOW): WOW works nationally to build pathways to economic security for America’s women and their families. For more than 40 years, WOW has helped women learn to earn, with programs emphasizing literacy, technical and nontraditional skills, welfare-to-work transition, career development and retirement security. Today, WOW is recognized nationally for its skills training models, technical assistance and advocacy for women workers.

(You notice I don’t say anything about AHDI. I understand that AHDI cannot negotiate pay for MTs but for reasons unknown/not understood by me, in my opinion they have completely missed the boat on giving MTs the tools they need to have the confidence to advocate for themselves on pay issues.)

P.S. My apologies to the men in medical transcription, but you are the minority. If you feel any of this applies to you – you have my sympathies.