MT Exchange Medical transcription exchange

In his blog at Advance, Jay Vance spotlights a story about Potential Offshore Outsourcing Catastrophe – Medical Records For Sale In India. It’s a pretty interesting read  and although the sting operation was carried out by a UK team and involved UK records, it doesn’t take much to see that the same situation could be happening with US medical records.

In short, the Economic Times article sums up the pertinent issue:

…investigations conducted by a British TV channel have come up with the stunning revelation that confidential medical records sent to India for computerisation are being offered for sale, triggering heightened concerns about breach of data security here.

I expect a pretty instant reaction. The BPO business in India is too lucrative to be threatened by something like this. In fact, an English-language Indian blog site posts a response from NAAVI (a portal on Indian cyber law). Unfortunately, whatever NAAVI has to say about this is not available due to some glitch at the web site, but the blogger posts an article related to it (or it’s the NAAVI article, reposted – hard to tell when I can’t read the original): Medical Transcription Industry in India needs to tighten its security.

Ya think?

However, it is possible for sections of the International Community which is opposed to outsourcing business to India to pick up the current incident and blow it out of proportion. They may actually try to get sanctions passed against outsourcing of business to India through the Data Protection Act in EU or through HIPAA/HITECH in USA. The problems will not stop at the small medical transcriptionists. It is likely to affect the image of the country as a “Security Conscious” country and would hurt even the larger companies.

This should be an interesting development to keep an eye on!

I always said I’d never run a discussion forum. And, as many of you who know me are aware – here I am, running MT Desk’s discussion forums at MT Chat.

Both sites have been plagued with malware and viruses in the last several weeks. To my extreme dismay, MT Desk had an attack site warning from Google plastered all over it.

I say dismay because I remember when MT Desk was first started and I have participated in the forums since their inception. From the very beginning, MT Desk was the premiere reference source for medical transcriptionists. Up to that point, Arleen, Annie, Barb Grow and several others had posted their very helpful updates at the Usenet group for medical transcriptionists, sci.med.transcription (otherwise known as SMT). A web site was a better way to disseminate information and MT Desk always had the latest reference information.

So here I am, doing something I said I’d never do.

My first priority has been to clean up the viruses and remove the attack site warning on MT Desk. As of this morning, MT Desk is free of viruses, malware and the Google attack site warning. There’s also nothing there except a notice that the site is being redesigned and the forums are open – it was the easiest and fastest way to deal with the problem. MT Chat has been something more of a challenge, for a variety of reasons. I have been working with a web hosting company I’m not familiar with and their control panel (IMO) leaves a lot to be desired. So – I muddle through that. I also muddle through the control panel for the forum software, somewhat more successfully (I hope!). My largest frustration, however, has been that a handful of people continue to tell me they are getting viruses and/or virus warnings, even after I cleaned up the files and tested both Firefox and Internet Explorer and got no warnings. The strangest of these was someone saying they were getting a warning in the header – but I deleted everything in the header earlier in the week! Argh!

I’m now in a completely different place in my life and my work and so I’m actually looking forward to the challenges presented by this opportunity. So… stay tuned!

There are some sites where you can immediately dismiss the entire thing as complete BS because it’s obviously put up by an internet marketer. That doesn’t mean I approve of the internet marketers and their crappy sites and crappy articles pushing crappy schools – but at least I get where they’re coming from and they’re pretty easy to spot.

The subject of today’s entry appears to be owned by Future MT – yes, a Crappy School with an aggressive affiliate marketing campaign. They’re all over the place. Their affiliates’ sites are all over the place. But when I stumbled on their Medical Transcription Trends site (it appears to be owned/operated by the owners of Future MT, not one of their affiliates), I didn’t know whether to laugh or cry.

But first – let me take a moment to dissect the Future MT web site. You have to love someone who will put affiliate links at their business web site! There’s nothing quite like money-making plugs for satellite dish installation and credit repair to lend credibility to a business venture. Even better, these are under “medical transcription links.” There isn’t one link there related to medical transcription – most likely because the money-making links are competitive schools. Since they appear to have an education alliance with a transcription service, why don’t they even put a link to that transcription service? And in a touch of irony, there’s an affiliate link for legitimate work-from-home jobs – apparently the owners of Future MT are covering all the possible money-making opportunities. Or are they suggesting that MT – and therefore their school – isn’t a legitimate opportunity? My other favorite on this site is that a graduate excitedly lets them know she’s landed her first job – with AM Trans Am. Apparently, they don’t bother warning their students about the various scams going on in the industry.

OK, the purpose here wasn’t to dissect yet another Crappy School – it was to comment on this site put up by Future MT. Some of the claims made are funny if you put aside for a moment that people are making decisions about their careers on the basis of what they find on the internet.

Before I begin, let me tell you that the entry is the only easy thing in the medical transcription profession.

Wha…????

Oh… this is why it’s so darn easy. You’re going to notice there’s absolutely no mention of how hard it is to get that first job:

You don’t need to possess a formal qualification to enter the field. No, this does not mean that medical transcriptionists are not qualified. They acquire the professional qualifications as they enter the industry. You don’t need any degree or certificate to make your way into the industry though. [emphasis added]

It seems they have (uncharacteristically) overlooked the opportunity to plug the need for an education – preferably the one they’re selling. I’ve bolded my favorite part. Enter the industry and BAM! You have professional qualifications! It’s that easy!

You don’t need to possess any kind of working experience. Yeah, you can make an entry even if you are a high school grad. It does not matter if you have ever worked in your life.

I like that “yeah” – kind of folksy, although I can’t help but picture Michael Cain in “Miss Congeniality,” telling Sandra Bullock – “It is always yes, never ‘yeah.’”

Notice how the issue of work experience is completely glossed over? Those of us who are actually working in medical transcription know that while the above statement is true, it’s only half true. I dare any of ya (see the folksy touch there?) to find a job listing for a medical transcriptionist that doesn’t require a minimum of 1 year of experience as an MT. If you do, send me the link. I have never, in 20 years, seen anyone care whether or not a prospective hire had work experience that wasn’t in medical transcription.

Then, they lose me with the conclusion of this article…

The easy entry into the profession has been mocked by many and the profession has been looked down upon. But just because there are no stringent prerequisites, you cannot become a medical transcriptionist. If you don’t have analytical skills or the willingness to study along with work or the commitment to meeting deadlines on a daily basis, this profession is definitely not for you. So, make sure you gauze your potential before entering this field.

Someone needs to proofread better…

Actually, the articles at this site read like many I’ve seen all over the internet that have been written by services, most of them operating overseas. It would surprise me if all these entries were actually written by someone at Future MT.

Jason Trusler, is listed as a principle at Future MT (and the contact for the various web sites I’ve found that are owned by them) and is a somewhat prolific writer of MT-related (and credit, which may explain the affiliate link at the business web site) articles. I have to say that Future MT has done its homework on internet marketing and they seem to be effectively employing the same tools as internet marketers to promote their school. Interestingly, Trusler’s bio states:

Worked in the Medical Transcription industry for over 12 years in many different fields. Currently does consulting for medical transcriptionist course training schools.

As far as I can tell, he isn’t consulting for Future MT – he’s one of the owners. And I’d be surprised if there was any consulting being done for other training schools, unless he’s counting affiliates for Future MT. I’m also wondering how many different fields there are in medical transcription.

As a fine example of what you’ll see in internet marketing articles, Trusler writes an article on How to get medical transcription training, where he states:

One of the great elements of medical transcription is that experience in the field is not a requirement to have a good chance of finding employment, although it definitely helps.

See my challenge above to find a job that doesn’t require experience in medical transcription. Don’t hold your breath waiting for anyone from Future MT to provide objective evidence to back up this claim, however.

Then there’s this statement:

It will not typically matter to a potential employer where you have taken your certification course because many of them will test you before they choose to hire you.

Uh, ok – let me clarify for anyone who is researching MT schools and hasn’t made a decision yet… Potential employers do care where you have completed your medical transcription coursework. While it is true that they will test you before they choose to hire you, whether or not you even get as far as a test will often depend on where you got your education. Testing takes time and costs money and employers are only going to test people they believe have a reasonable chance of passing the test. Trust me – if they have to choose between an application from someone who went to an AHDI-approved school and someone who went to a cheap online program – like Future MT – they’ll test the people who went to an AHDI- approved school.

The more practice you have at transcribing and the longer you study the skill through your course training, the higher the chance you will have of an employer hiring you without any on the job experience, so it is important to take the course seriously.

In my experience, this statement doesn’t have even a half grain of truth to it – it’s completely false. There are only so many hours of available practice recordings available. Repeating them over and over again isn’t going to make a prospective MT more employable. Professionally-recorded practice tapes aren’t even close to real experience. The only experience that matters is real live experience.

Unfortunately, Future MT isn’t the only school to employ internet marketing tactics and make outrageous and/or false claims. They’re just the school du jour. So… it bears repeating because I know a lot of people come to this blog, looking for information on MT schools and MT careers:

• Don’t even consider a school that isn’t approved by AHDI
• Don’t rely on the FAQs – call and ASK specific questions about placement rate (percentage of graduates hired) and the placement program.
• Check with experienced transcriptionists in the medical transcription forums and at Facebook and ask about the school.
• Make sure anyone who responds positively doesn’t have a monetary incentive for selling you on the school – many, many schools have affiliate programs and they also pay current students and graduates for referrals. Call the school and verify that the person is actually a graduate of their MT program – no school should have any problem giving this information.
• If someone tells you a school is wonderful, get specifics. Are they working as an MT? Where? How long did it take them to get a job? How long have they been working? What did they think was great about the program?

Not 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.

I’ve been meaning to write about the American Transcription Association (ATA) since the Advance editorial, Inshoring jobs for MTs – and then again when For the Record published their article, Transcription group opposes offshoring.

Life kind of intervened – and it was summer and hot and I really didn’t feel like saying much about anything.

Well, the weather has cooled down (for now) and I’m catching up.

I like the ATA’s enthusiasm but I’m kind of confused about their direction and plan of action. (Then again, I’m not privy to it and I’m sure the web site only scratches the surface.) On the other hand, Donna Littrell, founder of the organization, seems to have put a lot of thought into it and more organization than I’ve seen in past efforts to start a new trade organization.

Until I went and re-reviewed the web site as research for writing about them, I didn’t realize they were including VAs (virtual assistants) and other types of transcription services. I understand that overseas competition is a concern for those people, as well. I understand that including them in the scope of what the ATA hopes to accomplish boosts the membership and vendor base. I am concerned, however, that it will blur the focus of the organization.

The medical transcription industry has been difficult to get a grasp on; even industry experts are only able to roughly estimate the number of medical transcriptionists in the U.S., the number of lines generated, the amount of revenue generated annually by the industry. On top of that, no one company has ever been able to capture more than a very small share of the estimated total industry. Part of the reason for this is because it’s largely a fragmented industry with a large number of mom-and-pop businesses and independent MTs, many of which are invisible in the industry – they don’t join organizations, they don’t go to meetings and if they are in the forums that attracted MTs, they stay pretty silent (but many of them aren’t even there).

If MT is still fragmented after all the consolidation that’s gone on the last 10+ years, the general transcription and VA industries are even more fragmented. And – because there’s absolutely no way of knowing how many potential customers there are for those services and approximately how much business they might generate in a year, it’s just impossible to even guess an estimate of either the amount of revenue generated in those industries or the number of people who might be engaged in working in those industries. When I put up Transcription Registry, I thought I had a fairly good grasp of what kind of transcription services were being offered. And yet – some of the specialty areas surprised me. (For example – I had no idea people recorded church sermons and had them transcribed!)

That’s all great – but does including such a diverse and fragmented (and potentially huge) group distort ATA’s focus? One of my criticisms of the old AAMT was that they tried to be all things to all MTs. The association was originally started by acute care MTs. I think AAMT would have gone a lot further than it ever did if they had just focused on that segment of the medical transcription market. I have to wonder if ATA is headed down that same road when they include such a diverse group unless they develop a really good, really concrete plan for handling it; i.e., dividing into sections and putting someone with a lot of experience in the section industry in charge of it.

The education and training requirements for entry into the medical transcription industry are also much different from those of the other industries. Are board members and general members who aren’t involved in the medical transcription industry going to want to spend the time and money needed to address issues regarding medical transcription education, training, job placement and credentialing? There are also going to be issues that arise from leaning heavily on the privacy and security issues of overseas transcription. There’s a lot of work being done by VAs and general transcriptionists that doesn’t involve anything that exposes privacy or security. There’s also a question of whether or not HITECH will take care of these issues in the medical transcription industry – I spoke with an attorney at TEPR prior to HITECH being passed – he told me if it passed, he would advise his MTSO clients not to use overseas contractors at all because the exposure is too great. (HITECH is another topic altogether or I’d get into it.) I’m not sure if privacy and security issues are much of a plank, much less enough to build a platform – and it’s especially weak when diluted by other types of transcription that don’t deal with these issues at all.

I vehemently disagree with the organization’s assertion that there are enough medical transcriptionists in the U.S. to meet the requirements. There’s absolutely no evidence to support this. There may be enough people in the U.S. who want to be MTs, or who would be MTs if the money was better – but if all work overseas was pulled back into the U.S. tomorrow, I don’t think there would be enough MTs to get the work done, even if they all worked 24/7.

In For the Record, Transcription group opposes offshoring, Scott Faulkner made some comments about the focus of the group being shortsighted. I agree with Scott on the issue that globalization is an irreversible component of our modern world. I disagree that ATA is implying that one group of workers is inherently more skilled, more responsible and therefore ultimately superior to another group of workers. I am going to guess that in the former reference, he means U.S. MTs and in the latter, he means overseas MTs. I don’t get that message from the ATA and there’s certainly a precedence in business for promoting domestic services and workers. There are overseas trade organizations for MTs that US workers can’t join – why not a US trade organization? Someone explain to me why it’s okay to have a trade organization for medical transcription in India or Pakistan or New Zealand or the Philippines – but not the US.

I encourage transcriptionists of all kinds to check it out, at least. It’s always exciting to see a new group that’s passionate about a cause and it’ll be interesting to see how the ATA progresses and where it goes. See below for how to find them.

For my own part, I’d like to see ATA leadership be a little more transparent. Bios of the Board members would be a nice start, as well as a statement of the legal status of the organization. I hope they continue standing on higher ground when it comes to other organizations, credentials, policies, etc. For the ATA to be successful, they have to send a positive message and build a solid platform that promotes the benefits of a domestic work force.

Related Links

1. American Transcription Association web site
2. American Transcription Association on Facebook
3. American Transcription Association on Twitter