Behold the poor burger. On the one hand, maligned by advocates of healthy living; on the other hand, consumed in record numbers by Americans. It seems people are saying the right thing in public - and doing something else when the rubber meets the road.

How is this like McScription... er, transcription? I am glad you asked.

Look at that burger. It's just a ground beef (we think) patty with pickles, onions, mustard and ketchup. You can probably buy this hamburger for about $1. What you see is what you get - nothing fancy. When you bite into that burger, I'll bet you know exactly what it's going to taste like. It's fast, it's cheap, it's expedient - and really, that's all you were looking for or all you could afford.

Let me tell you how I think the McScription industry came to be.

The first story is about the "industry mucky-mucks," as my friend (ahem) calls them. These are the healthy living advocates of the industry. They're active in professional organizations, they go to meetings, they have credentials. They are most often not working as production MTs, but are found in management at large companies run by men. They get interviewed in the industry magazines. They say all the "right" things. They tell us if we would just stand up for ourselves! go to meetings! get credentialed! dress right! have a better attitude! be open to change! - then our value would rise and we would make more money. They're the ones telling aspiring or new MTs that there's a severe shortage of MTs and this is a fantastic career.

They ignore the fact that they are working for McScription companies, in a world that is spawning increasing numbers of McScription companies and McScriptionists. They ignore the fact that the companies they work for aren't paying MTs any more in 2008 than they were in 2000 - and in many cases, less. They ignore the fact that an MT with 20 years of experience isn't paid much more - if any more - than an MT with 2 years of experience. They ignore the fact that all the productivity tools in the world won't help you increase your hourly rate when your per-unit line rate continues to drop and the platform you're forced to work on slows you down. They ignore the fact that it doesn't matter how you dress when you telecommute from Wyoming for a company in Florida and you will never EVER see or be seen by anyone else in the company. They ignore the fact that maintaining your credential is usually more expensive than the small differential offered by most companies that recognize it. They ignore that because of the McScriptionization of medical transcription, customers have come to expect that thin, single patty with no lettuce and no tomato and they've caught onto the fact that paying more for McScription frequently only results in more expensive incompetence. Why pay for filet mignon? If you're going to get crap, it might as well be cheap crap.

They ignore the fact that instead of using technology to allow MTs to become more productive, technology is being used to cut MT pay even further. Ask anyone who has worked on speech recognition platforms for less than half the line rate they make transcribing if they're actually 2x more productive. Most of them will tell you they make more if they transcribe.

Last, but not least, the industry mucky-mucks ignore the fact that in the McScription companies as line rates get crunched and customers are expecting to pay less (LOTS less) for transcription now than they used to, the people who are getting paid handsomely are the executives and managers, not the production MTs. They ignore that the companies they work for - or run - are doing exactly what they tell MTs not to do and accepting increasingly lower line rates just to get business. They ignore that the MTs get told "that's the best we can get" and "wouldn't you rather be working for less than not working at all?"

While they agree that McScription isn't good for you, they're serving up McScription just like everyone else.

Here's my challenge to the industry mucky-mucks, but most especially to the individual(s) who claimed in the March 24, 2008 issue of Advance that if MTs would step up their game, get a better attitude, improve their skills - and in a not-so-subtle push for the professional organization's agenda - go to meetings, get published and get credentialed, they could get a raise: I'd like to see these people get a job and work as a production MT for a month or two. I'd like to know what line rate they'd be offered. I'd like a report on how they're treated, how many lines an hour they average - and I'd really like to know what happens when they ask for a raise. What I'd really like is for them to dummy up 2 resumes, one for an MT with 20 years of experience and one for an MT with 2 or 3 years of experience, use a made-up name, and see how different the job offers are, but I doubt any of this is going to happen. Nobody has the guts to actually go out and take a look at reality. Since that won't ever happen, I am going to ask if anyone is willing to report: When was the last time your company gave an across-the-board cost of living increase to MTs? How do your pay rates compare today with the pay rates 5 and 10 years ago? Make sure you include expenses paid by the MT and not reimbursed, such as internet connections and long distance.

Here's my favorite part of the article. "You should walk in there with your head held high. Shake their hands. Act like they're going to be really lucky if they get you." Let's have comments, MTs. When was the last time you were close enough to your employer to walk into their office and shake their hand? How many years has it been since you actually laid eyes on the people you work for?

I wonder how long it's been since Betty Honkonen had an MT who works for her walk into her office, look her in the eye, shake her hand and ask for a raise.

The other story is about the people who contract for MT services. First, they buy into the "never pay more than XX per line." They hear this at meetings, they read it in publications and the funny thing is - they believe it! I actually read this in a Q&A at the web site of a publication that was aggressively soliciting me to advertise with them: "Never pay more than 9 cents per line for transcription." Why would I give my advertising dollars to a publication that gives that kind of advice about my business? This kind of advice almost never touches on billing unit definitions [1] or the other factors that affect transcription pricing. However and unfortunately, I'm quite certain that any doctor or facility taking this advice to heart will have no trouble finding a transcription service that will readily agree to this price.

When you go for cut-rate prices, you get cut-rate services. Don't go shopping at Wal-Mart and expect Nordstrom service. I actually considered at one point offering first-class and coach class service, explaining what the client would get for coach prices and what they'd get for first-class prices and letting them pick. However, price shoppers never see themselves as anything but savvy buyers. I worked in the construction business long enough to know that the lowest bid can often turn out to be the most expensive one. We put 3 roofs on one building when the owner went for the lowest bid and it cost them a lot more than if they'd just gone with the most expensive bidder. The fact is price buyers make the absolute worst customers. They will suck the life out of your business. They never, ever consider that they're shopping at Wal-Mart, even when they're standing under the big, blinking sign that confirms it. They believe wholeheartedly that they will find a bargain in the bin and seem to forget how much work real shoppers put into finding those RARE bargains.

There are a lot of factors that have contributed to the creation of the McScription industry and almost everyone has participated in one way or another. I just wonder where everyone will go when they realize McScription is fast and cheap - but not really good for you. By then, I expect all the mom-and-pops will have moved on to other businesses or other jobs, and the majority of MTs will be McScriptionists who have only known what it's like to work for McScription companies.

I'll take 2 million lines of McScription to go, please.