What is the medical transcription business?

Over the last several years, I've had quite a few discussions  about the book publishing business with my friend, author Moriah Jovan. In fact, she's the reason I bought an e-book reader (kicking and screaming and swearing I wouldn't like it as much as real books) several years ago. Now, I spend more time scouring the various sources for e-books than I ever did browsing in a bookstore. I love digital book readers and haven't bought a paper version fiction book for over a year now.

In case you aren't up on the book publishing business and missed Borders' bankruptcy filing and shuttering of over 200 stores, the traditional book publishing establishment is going through the pangs of change; i.e., the change from paper to digital.

Sound familiar?

The change from analog to digital forced a change in the music industry and how it does business. Likewise, the change from paper to digital is forcing a change in the publishing industry. The change from analog to digital has also forced a change in the medical transcription industry and continues to change as medical records move to fully digitized medical records.

I was reading a long (too long) discussion online about the digital revolution in the book business and this got me thinking about similarities in the medical transcription industry.

Medical transcription as a niche market

One point the authors make that resonated with me was a discussion about niche markets. Before the invention of electricity and electric lighting, candlemakers were in the lighting business. We all enjoy candles but most of us don't use them as our primary source of lighting. Candles are now used primarily for decoration and scent. Candlemaking is no longer the major industry it was and it is no longer in the lighting business; it is in the niche market of candlemaking. Candlemaking is still a business and it still generates significant revenue, but not nearly as much as it did when it was in the lighting business. That means fewer companies making candles and fewer employees making candles and fewer people selling candles.

I could go on and on about how major industries have become niche markets, but I think you get the idea.

Likewise, medical transcription is becoming a niche market. As some industry sectors are fighting for preservation of the narrative record, larger forces are fighting for a point of care digital record and its numerous advantages over traditional documentation methods. Even if the narrative record fight is won, what will most likely to retained as traditional transcription will be a niche market. The consultant will no longer dictate a past history, medical history, medication list, allergy list, surgical history, etc., when it's already readily available and easily accessed in the digital record. The discharge summary will no longer summarize all that, plus all the labs and studies that were done during the admission because they're already readily available in the digital record. The narrative portion of the record will shrink significantly. I'm not sure what that niche market will look like, but I know it will be a fraction of what the medical transcription market has been in the past. Like the candlemaking business, that will mean fewer companies doing transcription and fewer employees doing transcription.

Medical transcription is not dictation/transcription

In the 1930s, automobile travel began to cut into the railroad's passenger travel market, but freighting was really the meat and potatoes of the rail system. The development of the interstate highway system dealt a blow to the railroad industry, followed by the extra punch of air travel and freighting in the 1950s and 60s. Add onerous federal regulations and stagnant labor unions and the railroad industry was on its knees. Railroad industry leaders thought they were in the railroad business, but the railroad industry wasn't in the railroad business – it was in the transportation business. The inability to grasp the concept nearly killed the industry. In 1939, there were 132 class I (freight) railroads. Today, because of mergers, bankruptcies and major changes in regulatory classification, there are only 7.

Except for the labor unions, that sounds pretty familiar, doesn't it?

The railroads were ultimately saved by your tax dollars, in the form of Amtrak and ConRail. ConRail subsequently privatized and the railroads were deregulated, making it possible for railroads to operate free of government regulations that had made them unprofitable.

(You can read all this at Wikipedia – I'm just summarizing for you).

In spite of the similarities between the two, don't look for a government bailout of the medical transcription industry. The US government, in fact, is aggressively pushing digital records. If it supports any industry, it will be the electronic records industry. (Conspiracy theorists, start your engines!)

Which brings me to the publishing business. The blog I was reading noted that, similar to the railroad industry, the publishing industry thought it was in the business of publishing. With the development of digital books, it's becoming apparent that the publishing industry is actually in the business of distributing printed information and entertainment (thanks for the refinement, Moriah Jovan!). As self-publishing becomes easier and more acceptable, the necessity for a publishing company that distributes books (paper or digital) is further eroded. The publishing industry is trying to preserve its place by attempting to suppress self publication and digital book distribution, a move that just about everyone in that industry can see is a last-gasp effort that isn't going to work. Amazon (and now Barnes and Noble) are staying viable by embracing digital books, as well as self publication. In 5 or 10 years, will anyone care that an author's work has never gone through the gatekeeper of a publisher? Probably not.

If you want a blueprint for what's happening and what will continue to happen in the medical transcription industry, just take a look at the music and publishing industries. The music industry has survived, but it's not the same as it was before. Apple iTunes has become the #1 seller of music in the US. I'm not sure the traditional publishing industry will survive; at the very least, it will be radically transformed and the people who work in that industry will have to carve themselves a new place in the niche markets that spin off the publishing industry.

Like my transition to digital books, doctors are kicking and screaming and swearing they won't like it, but they are adapting digital records and they are becoming accustomed to the advantages. The technology is improving and will continue to improve; at the same time, it will become less expensive. The users are becoming more adept at the technology. I think we can count on the trend to continue. Likewise, transcriptionists are kicking and screaming and swearing – speech recognition editing, overseas competition, low pay rates – can we expect any of this to change? I don't think so. I think that as the medical transcription industry responds to changes it's undergoing, some medical transcriptionists and transcription companies will carve out a place in developing niche markets, others will move to related healthcare fields where some or all of their skills can be applied, and a lot will leave the industry altogether. The speed at which technology moves makes it nearly impossible to see where the medical transcription industry may end up. Right now, it seems that smaller companies are losing out, as they don't have the financing to support the technology requirements – or even rent them. I'm hearing from more and more independent transcriptionists that even their long-term accounts have stopped dictating entirely, in favor of an EMR (regardless of well it works for them). I think the larger companies have already started making the move from the business of transcribing dictation to the business of providing technology to document healthcare records. In the meantime, the Department of Labor keeps reporting that medical transcription is a good career option (I think it's time for an update on that one), the medical transcription schools continue to do a booming business, churning out people who soon discover that they cannot get a job or, if they do, they struggle to make minimum wage – if they finish the program at all. I think more and more transcriptionists are looking at – or have already implemented – other options because they cannot tolerate the financial instability of the shrinking market and deteriorating pay rates. You have to ask yourself – in 5 or 10 years, will anyone care that doctors used to dictate and someone transcribed the dictation?

So what is the medical transcription business? Traditionally, we've thought of it as the business of taking recorded dictation and turning it into typewritten records. The upheaval in the market is redefining how we think of the business of medical transcription. I'm not sure what the medical transcription business is really – I'm only certain that it's no longer taking recorded dictation and turning it into typewritten records. 

The light at the end of the tunnel may, unfortunately, be a train.

I'm soliciting comments: what do you think the business of medical transcription is, really?

Medical Transcription Blogs

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8 thoughts on “What is the medical transcription business?”

  1. Great piece as always – it reminded me a lot of something I wrote back in 2003 for Advance: The Future of Healthcare Technology. I asked the question then and its relevant today:

    Who’s driving the train and who’s on board

    The technology and innovation train has left and you are either on board or watching it leave the station.

    As Julie points out:

    transcriptionists are kicking and screaming and swearing – speech recognition editing, overseas competition, low pay rates – can we expect any of this to change? I don’t think so

    There is no putting those innovations back in the bottle, no matter how much we might dislike some of the consequences the positive value exceeds the negative consequences.

    This analysis is interesting as it looks at the business in a different way – what exactly is the business. Like the publishing business:

    trying to preserve its place by attempting to suppress self publication and digital book distribution

    Is seen for what it is and as you put it “last-gasp effort that isn’t going to work

    I wonder what you need to be to be the Amazon of the Medical Transcription Industry to stay viable and embracing the technology and being part of the revolution taking place in healthcare

    Nick van Terheyden, MD
    CMIO
    [email protected] and drnic1
    Nuance
    Follow me on Twitter: drnic1
    Navigating Healthcare

  2. I guess right now I am so busy feeling like the stupid armadillo frozen there on the middle of the track, staring at that stupid light, fixin’ to be squashed flat … that I could not begin to tell you what I “think” the business of transcription is these days 🙂

    Nae

  3. @Nick – This blog post kind of also grew out of the discussion of medical transcription career potential (http://www.mtexchange.com/sqn). I’d like to know what you think about the comment by Ava George (discussed in that entry)

    “…we have to get out there and educate ourselves (yes, I mean bachelor’s degrees)…”

  4. (Waving Hi to Nick. Not sure if you remember me, but you interviewed me a decade ago in Redwood City.)

    Jules, I’m tired (and lazy) is the quote by Ava?

    Because while I’m 100% for education, I don’t see that a Bachelor’s degree is going to save anyone’s transcription bacon, well not many, let’s put it that way.

    The more experienced (aka older) crowd is not likely to feel the impetus to go back (or start) school.

    I just finished my Master’s and I have $100k in student loans. In my field, the most I can make is $40k. (Yes, I *did* know that ahead of time but idealism and being at a point in my life where I thought change was important were more important.) That’s why I’m still in MT. I make more money. But I do spend (a lot) of time, trying to figure out a niche. My entreprenaurial mind is constantly in overdrive as I spend hours cranking out lines. I know in a decade I will still be self-supporting and I know the job I’m doing today won’t likely be available. (Nor will the student loans be paid off.)

    I’ve been preaching online for a while now, that MTs need to stay abreast of the changes and not just to be AWARE of them but know what they really mean and how to make them work for the MT.

    MT boutiques… that’s what we’ll see 😉

  5. There’s no question the world that is known as medical transcription is changing, fast and drastically. I believe unless we work to figure out new roles for the skill set of the medical transcriptionist, the industry will indeed be left at the station.

    While some balk on embracing the technology, that’s not true of everyone. I agree with both Julie and Nick that those things we hear complaints about aren’t going away.

    I still hope that someone is striving to make all of these things provide good things for patients. In many discussions, you just don’t see the patient at the table. I think there’s something wrong with that picture. And patients are becoming more vocal and speaking out more about how they are impacted. I think that’s a good thing. I also think there are some roles that we haven’t even thought through yet that will be things MTs can do. The question, of course, will be whether they are willing to embrace the change and make it happen. It won’t happen by continuing to sing the same old song to the choir.

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