MT Exchange Medical transcription exchange

I casually commented on my Facebook page the other day about one of my irrational work-at-home fears; i.e., that I will choke to death and there won’t be anyone here to notice. Don’t ask me where this fear comes from; I suspect it started with an episode of Six Feet Under that featured a woman who lived alone, choked to death on her dinner, and wasn’t found until days later. (And since SFU was a cable show about a family-owned mortuary, they did show all the gory details!) Apparently, that got my brain going about the hazards of working at home, especially now I’m home alone most of the day.

When I first started working at home, I was surrounded by children and their schedule and the woman who provided day care at my home. Now, I have only my youngest at home and he’s in and out with his school and work schedule.

So, I was sitting at my desk yesterday, chewing gum (as I often do) and this irrational fear rose again. Not that I choked on my gum or anything – just the spector of the possibility arose in my imagination and that was that. I spit the gum out. Posting a comment via Twitter (which feeds to my Facebook wall) is really easy – so I did.

What ensued at my Facebook wall was really very funny. (I’ll comment some other time on the useful sociability of Facebook and Twitter.) I feel comforted that I’m not the only one with irrational fears!

Margie worries that she will trip over her cat in the middle of the night and nobody will find her for days and days.

Galina wondered if her dogs would be helpful if something similar were to happen to her.

Margie wondered if maybe she needs a dog to save her from the cat.

After reassuring all of us that this kind of thing COULD happen – because it happened to her, but she was able to save herself through a somewhat modified self-performed Heimlich maneuver – Dianne shares that her dogs and cats would huddle near her body until it was cold, then go find another heat source.

Our casual comments about work-at-home hazards apparently had an effect on MTs in similar circumstances who have not – up to this point – even thought to worry about such things! Well, it should be on their minds now! I’m sure they’ll be thankful to the rest of us for sharing.

Shana wonders if our job makes us paranoid. There is a theory in hospitals about MTs and hypochondria, so it’s quite possible we’re also paranoid about the perils of isolation!

Carrie shares that if she has to take medication, she puts a note next to her on the desk – just in case she doesn’t make it through the day. I hope it never becomes necessary; but if it does, I’m sure the EMTs will appreciate the information! And I have to confess – when I’ve felt really, really lousy, I leave a note on my monitor, describing my symptoms and any self-treatment – just in case. If someone comes home and finds me dead, I want them to know the details of my symptoms prior to my expiration.

Some wag on Twitter responded that maybe I should set up a webcam. That might be a good idea, except that in the internet age, everything becomes entertainment. Within an hour of my gagging and choking in front of a webcam at my desk, the video would probably go viral on YouTube. At least nobody would be accusing my husband of killing me.

With great caution this afternoon, I unwrap another stick of gum.

I find myself dismayed – and, frankly, somewhat depressed – reading some of the comments from MTs in the discussion that my MTs and “Speech Wreck” blog post generated over at the MT Chat Hot Zone.

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.

I didn’t find much to laugh about when I read the Advance Insiders blog, Speech Wreck, by Jeanne Johnston. Basically, it’s a regurgitation of the misperceptions, inaccuracies and just plain bull-headed resistance to change exhibited in many of the medical transcription online communities. I expect better from bloggers at a site like Advance.

Let me start with what Ms. Johnston got at least partly right in her blog post:

There are incredible numbers of veteran MTs who are now crying because they are seeing their paychecks fall precipitously because there’s no way to double production to make up for half the wages.

MT wages are stagnant or falling and have been for some time. Are employers asking medical transcription speech recognition editors to work for less per line? Yes, they are. But let’s get over the victim mentality here and take some responsibility for the pay situation we’re all in. The reason MT pay rates aren’t better is because there’s a never-ending supply of people who are willing to work for less, whether they’re new to the field or whether they’re veterans. I’ve encountered very few MTs who have said “I’m not willing to work for that” – and meant it.

The fact is, there are MTs who are accepting less than half their production typing line rate and that’s where they start getting into problems.

The math does work out – if you are 2x more productive editing speech and your line rate is half what it was for manual transcription, then you are making the same amount of money. And there are MTs who are making production 2x and more of their manual typing production.

If you produce 200 lines/hour on average as a transcriptionist at 8 cpl your average hour rate of pay is $16/hour

If you produce 400 lines/hour on average as a speech editor at 4 cpl, your average hourly rate of pay is $16/hour

The problem starts if you are not more productive and if you accept a line rate that is much less than your production increase. A lot of speech recognition jobs are paying 2 and 3 cpl. C’mon people – this isn’t rocket science. You’re all smart enough to do the math. Assuming that you will actually BE 2x more productive as a speech editor, you can’t take a line rate that is less than half your current rate if you want to break even!

The other problem in this equation is the problem that has plagued medical transcription almost from the get-go: it’s a Pink Collar Ghetto job, which means it’s predominated by female workers. And studies have shown that women do not negotiate their pay like men do.

Some companies allow their MTs to trial as speech editors. If you try it and you aren’t making enough money – either go back to traditional transcription or renegotiate your pay. Some companies are paying a full line rate on jobs that require XX% retyping, acknowledging that for some jobs generated by a speech recognition engine, the accuracy is so poor that it basically has to be completely retyped.

Now let me get to what’s inaccurate and what bothers me about this blog post.

I’m not sure how Ms. Johnston can state with such utmost certainty the conditions and attitude in the industry when people who have more experience and more connection with what’s going on in the industry couldn’t make these statements with any confidence in their accuracy. It’s as if Ms. Johnston has her finger on a thready extremity pulse and is telling the everyone, including the doctor, who is monitoring the EKG, that she’s certain the patient is dying.

There are incredible numbers of veteran MTs who are now crying because they are seeing their paychecks fall precipitously because there’s no way to double production to make up for half the wages.

How does Ms. Johnston knows that there’s “an incredible number” of anybody crying over falling pay rates due to SR? I’m quite certain there’s an incredible number of veteran MTs who aren’t happy about pay rates in ANY segment of transcription, but SR hasn’t penetrated a sufficient segment of the market to impact “an incredible number” of MTs with any number of years of experience. See – I can state things with absolute certainty, as well – it doesn’t make them facts, nor does it make them true.

This statement also ignores the opportunity SR provides to veteran MTs who are embracing speech recognition editing because they are no longer capable of doing the production work required to make a living. They do far less keyboarding as editors and their knowledge continues to be utilized. It’s a welcome option for veterans who don’t want to have to learn something completely new (like, for example, cancer registry).

…no one’s ever bothered to ask for our input on the front end of this abomination.

Holding onto that thready extremity pulse, the author makes this statement like she actually knows what she’s talking about. The fact is, the medical transcription industry IS heavily involved. It was a topic in at least two sessions given by medical transcription industry professionals at a meeting I recently attended. You know all those things you say AHDI doesn’t do for transcription? Well, this is one of the things they are doing and they’ve been involved in it for years. What would be accurate is that nobody has bothered asking the author’s input – but then again, she hasn’t positioned herself to give it where it counts, either. The transcription industry acknowledges that speech editing requires a slightly different skill set than manual transcription, but the same knowledge base. Transitioning MTs to that skill set is part of the focus of AHDI as they attempt to move MTs to what is becoming the future of transcription. The fact that a lot of MTs don’t know this is part of AHDI’s perception problem with MTs. And if your idea of AHDI “doing something” about SR is to get them to make it stop, you need a bigger reality check than I can give you.

Adding to my amusement at this assertion is a recent article published by Advance for Health Information Professionals, which is the sponsor of Ms. Johnston’s Passage blog. Maybe Ms. Johnston doesn’t read Advance; maybe she just missed this article: “Creating a Definitive Guide on Speech Recognition.”

The automated speech recognition technology (ASRT) work group, which consists of a broad group representing speech recognition vendors, medical transcription service organizations (MTSOs), MTs and consumers, hopes to clear up the confusion that exists by publishing what the group hopes will be a definitive and evolving guide to speech recognition, in the form of a reference guide to the adoption of speech recognition.

MTs who want objective information about SR and the medical transcription industry should follow the link and read the entire article. If you’re really interested in making a difference, join the workgroup.

Like Ms. Johnston, there are MTs who see SR as a “Borg assimilation,” rather than an opportunity. And like Ms. Johnston, they may very well find other careers in healthcare information management. We saw MTs kick and scream and cry about transitioning out of DOS and WordPerfect 5.1 and into Windows. We all survived and adjusted and by golly – some of us even like it better. And now we have many MTs who wouldn’t know a DOS prompt if it smacked them upside the head. Resistance to change is a human attribute. In my experience, the personality type attracted to MT is more resistant to change than most others. But get real folks – you can’t stop progress. At some point, you have to decide whether you’re going to lead, follow or get out of the way. I’d like to think we all have the intelligence to be rational and put emotions aside.

We all get a good guffaw out of speech recognition errors, but I’ll bet MTs are less entertained when their own errors are posted or distributed in a company newsletter. If an MT gets 90% accuracy on a QA score and speech recognition gets 95% – which one would you pick? The fact that MT speech editors are seeing reports with errors doesn’t equate to the blanket statement “speech recognition doesn’t work.” If an MT consistently produces reports with 99% accuracy, is her work sent to QA? Of course not. If an MT consistently produces reports with 90% accuracy, is her work sent to QA? Of course it is. The same is true of documents produced by speech recognition – once a consistently accurate report is generated for a dictator, those reports are no longer sent to editing. Keep in mind that M*Modal, eScription and others like them aren’t in business because the technology doesn’t work. HIMs managers do talk to one another and they know salesmen are there to sell a product – the technology has to prove itself, and it has.

For MTs to be successful in making the transition to speech recognition – and make money – they need real information, not misinformation and not har-har jokes about errors.

If you are asked to transition to speech recognition, you need to know what questions to ask so you can negotiate your pay. And you do need to negotiate the conditions and pay.

• Is there a sliding scale pay rate based on the accuracy percentage of a report? In other words, do I get paid more for a report that is only 85% to 94% accurate, versus my base rate for reports that are 95% accurate or higher?
• If accuracy falls below 75% and I have to retype most of the report, do I get full transcription rate pay?
• What is the average percent accuracy of speech recognition on the account(s) I’ll be working on?
• How long has the account been on speech recognition? (The length of time will impact the accuracy – newer accounts will have a lower rate of accuracy.)

Without exception, the #1 question I get via e-mail from MT Registry goes something like this:

I graduated and I can’t get a job. All the job openings require experience. How do I get experience when nobody will hire you unless you have experience?

It’s like traveling back in time to when I was looking for MY first job. Not much has changed in 21 years. And I have to give credit where it’s due – AHDI has been attempting to address this issue for many years. I think the fact that it’s still an issue isn’t due to a deficiency their efforts, but has more to do with the nature of the business.

Medical transcription is extremely labor intensive. Speech recognition software attempts to alleviate the labor, but remains only somewhat successful. Couple that with low profit margins, hospitals and clinics constantly trying to cut costs, the commoditization of transcription – and you have a formula that just doesn’t allow much room for training people who come to the job unprepared to do it right out of the gate. When I was doing production transcription services, I tried to hire new graduates and found the experience costly and discouraging.

• Some people shouldn’t be transcriptionists. They’re doing it for all the wrong reasons; they don’t have the skills required and they’ll never have the skills required, but they have forged ahead because either they felt it was their only option to earn money or they had a great desire and confused that with ability. And of course, they can always find a school that will accommodate their desire/need.
• Some programs simply don’t adequately prepare MTs to work and the amount of time, retraining and education required to bring them up to speed is too costly for a transcription service.
• Even if an MTSO is willing to spend the time and money on someone, there’s nothing to stop them from leaving to go somewhere else or out on their own before the MTSO has recouped the investment made in them. My personal opinion was that new trainees should have to make a deposit, which wouldn’t be refundable until they’d met certain goals and completed XX number of lines after meeting those goals. If they left before doing that, they’d forfeit the deposit. (And I’m not talking a small deposit here, either.) I just don’t see MTs willing or able to do that, however.

And I am tired of the answer given in many of the forums: “You should’ve gone to this or that other school.” It isn’t helpful. For a variety of reasons, not everyone can go to this or that school – it doesn’t meet their needs, they didn’t pass the screening exam, they didn’t research it before signing up with the school they went to – whatever the reason, they’ve paid their money, completed the program they paid for and they can’t find a job. It isn’t productive or useful to tell them they should start all over again.

Let me talk about the people who pursue MT as a career against all advice to the contrary. I had a doctor who once stated: “The indications for a hysterectomy are no longer the presence of a uterus and the presence of Blue Cross.” The same is true for career goals. The need to work at home so you can be with your children and have a flexible schedule isn’t an indication for becoming a medical transcriptionist. The desire to work in the medical field isn’t an indication for becoming a medical transcriptionist. Love of medical language isn’t an indication for becoming a medical transcriptionist. If someone has told you that this isn’t really the right career for you – don’t insist that they’re wrong and plunk down your money to go to school to learn it! Because have no doubt – there will be a school happy to take your money, even knowing that you will either never complete the program; or if you complete the program, you will not be able to get a job because you can’t pass the screening exams; or if you actually do get a job, you won’t be able to keep it and your “career” will consist of one job after another. I mean really – you can’t make a career out of being terminated, and it’s going to be depressing and discouraging for you.

I know it really should be the role of a school to see that (a) there are companies that will hire their graduates and (b) their graduates are prepared to take the jobs they’re offered. But let’s face a little bit of reality here: schools are a business, just like the medical transcription companies, hospitals and clinics. They have absolutely no motive to tell eager prospective students that the pay is lousy, the benefits are terrible to nonexistent, they will be working at home but their hours will be nights, weekends and whenever they can grab enough lines, the dictators can be horrible and and and… If you go to the web sites of some of the highly regarded schools (ahem!), you’ll see cautious optimism sprinkled with reality checks that are touched on about as lightly as a butterfly landing on a delicate flower. From there, you go to the school sites that tout “high demand = high income!” and place a lot of emphasis on “work at home! no commute! save on child care!” Every school is going to claim that employers are clamoring for their graduates, just like every transcription service claims to deliver the fastest TAT and best quality, all for the cheapest price. I’m not saying it’s right or the way it should be – it’s the way business is. Nobody is going to tell you what’s WRONG with what they’re selling.

That said, “high income” is all relative, I suppose, especially in this economy. I’m pretty sure I couldn’t be motivated to roll out of bed for 7 cpl on an account laden with crappy dictators, cherry pickers and vague directions. However, I can see situations where someone else would be, so to each his/her own.

But I digress.

In looking through some of the resumes and contact letters sent at MT Registry – some of them to me, as the administrator – I think some people could use some help in writing their resumes and cover letters (and following the directions posted in the job listings). But then it occurred to me that isn’t enough, because it still doesn’t give them the experience and it still doesn’t move them forward in getting that first job.

I’m going to ask the employers to come together and tell me what you’d like to see: what would it take for you to hire new graduates? I’d like to add value to what’s offered in the TranscriptionConnections network, but I want to make sure it’s value to the MTs and value to the employers. Is this something that could be fixed or at least made a little easier for everyone; and if so, how?

For the newbies (new graduates without experience), here’s my question to you: after graduating from whatever school you went to, would you be willing to put more time and money into something if you could see a job at the end of that road?

An inquiring friend on Facebook asked me these questions and my response was that I’ve been meaning to blog about some of these things, so I’m going to bring it here and answer.

Thanks for your comments. I was curious what your take is on the state of the profession in light of the trend to offshore transcription work. Do you think there are enough nightmare overseas transcription stories to keep work stateside or will the trend only get worse? I ask, as I have seen others whine and complain about their jobs being shipped overseas, but their work product leaves a lot to be desired.

As you’ve noted, there are enough nightmare stories stateside to keep it going overseas. There’s nothing you can say about offshore companies/MTs that you can’t say about US companies/MTs. This gives rise to (one of) my mantra: If people are going to get crap, they’re going to go for cheap crap.

The fact is demand remains high for QUALIFIED transcriptionists and it will remain high, although I don’t predict we’ll see better pay rates. There seems to be a weird bubble in the supply/demand theory when it comes to MT. This is only partly attributable to the overseas companies, something US MTs don’t seem to understand or don’t want to take the time to understand.

In my opinion, at least half of the US MTs who decry the poor quality of overseas transcription and pound their breasts in nationalist fervor would be surprised (and outraged) if you tell them they aren’t doing that great a job themselves. They have jobs, they’ve been MTs for years (many of them) – how could they possibly NOT know what they’re doing? (See my prior post: Not so dark, just cloudy, side of medical transcription). When I was trying to find another MT company to subcontract some work to a couple years back, we trialed 6 transcription services and found only 1 that met our standards. I was told I was too stringent, that words that didn’t change the medical meaning shouldn’t be counted as errors (even though they were quite plainly spelling or English word errors), that the client’s requirements were picky, etc. etc. – yet all I was asking was: (1) all the words be the RIGHT ones, (2) all the relevant words that had been dictated be included in the transcription, and (3) all the words (English and medical! radical concept, I know) be spelled correctly. That was “crap” on a large scale – if the MT company owner has the attitude that the work they do is fine and my service is “just too picky,” then you can bet they have X number of MTs whose work wasn’t all that great, too. Extend that down to the finer level – only 1 out of every 10 MTs we trialed made it through the initial QA process. Unfortunately for the medical records industry, those other 9 had no trouble going out and getting a job with someone else who “wasn’t as picky” – and trust me, most of them had no problem letting me know that the problem was not THEM – it was ME.

Want samples? I have plenty. In the “just plain sloppy typing” category:

T: She feel about a month ago
E: She fell about a month ago

T:  loss of vision of acute eye pain
E:  loss of vision or acute eye pain

T: see my noted from
E:  see my note from

T:    difficulty with bend forward
E:    difficulty with bending forward

T: some ibuprofen and Vicodan.
E: some ibuprofen and Vicodin.

And in the “it doesn’t make sense to me but that’s what it sounds like so I’ll guess” (aka “brain off, fingers on”) category, which assumes that the MT even knows enough to realize what’s being typed is complete and utter nonsense:

T: Advair discuss,
E: Advair Diskus,

T: in case it might be the beginning of adult palsy.
E: in case it might be the beginning of Bell palsy.

T: finger reveal a nondisplaced volar placed, avulsion fracture
E: reveal a nondisplaced volar plate avulsion fracture

T: Favors test is negative bilaterally.
E: FABER test is negative bilaterally.

T: TMs are clear, with cerumen.
E: TMs are occluded with cerumen.

T: minimal form rotation
E: minimal forearm rotation

T: transit history
E: transient history

T:    with modality with unstretch exercises.
E:    with modalities and stretch exercises

T:  is no lag of thalamus noted
E:  is no lag ophthalmus noted

Now I bet anyone reading this would not disagree with me that – sloppy or ignorant – these are errors, plain and simple. So why is it most MTs blame QA when errors like this are pointed out to them?

And what really gets me is this: probably only 1 in 10 MTs was appalled. The other 9 became defensive and argumentative. If someone pointed out errors like this to me, I’d sink straight into the ground. In fact – someone did at one time. At a point when I’d been out on my own for several years, I went to work for a small company. I thought I knew my stuff – until QA got done with me. I was mortified, not only at the errors they pointed out to me, but at the realization that my training hadn’t been as complete as I’d thought and that I had, for years, been making these mistakes. I took as much correction as they were willing to give me, for as long as they were willing to give it to me. I learned a LOT from those 2 QA experts and I thank them for it.

But what happens to the other 9 MTs who become defensive and argumentative? They move on to a company that’s “not so hard to work for,” that’s what. Do they learn anything from it? (No.) The fact that they can get another job with someone else who doesn’t tell them they do a crappy job only reinforces their belief that the problem isn’t them. This delusion continues despite the fact that they know nobody is actually looking at their work.

OK, back to the topic of overseas transcription – anyone who still wonders why hospitals and doctors went for the cheap crap overseas, feel free to comment.

On another note, do you see voice recognition really making inroads in the field or is the technology still too far off and too annoying to “train” to make a difference in the business?

There have been no significant advances made in speech recognition technology in the past 10 years (or more). There are technologies that make it easier to use, but the recognition engines themselves haven’t changed much over that period of time. Companies like M*Modal and e-Scription require a certain (and significant) volume in order to make it worth their time to do the preliminary work required to achieve any kind of success. It will be used to increase productivity for MTs in certain sectors, but it won’t eliminate jobs.

There are doctors who use it to dictate directly and there are studies that show this slows them down, resulting in either fewer patients seen or more time spent in the office. I’m not going to take the time to dredge up the references, but the information is available. From my own observations of CSR used this way, most of them aren’t using it properly, which only increases the errors and the amount of time required to fix them.

The EMR is more likely to eliminate transcription jobs, especially as younger doctors enter the field. They’re used to keyboarding and using computers. As the EMR software developers incorporate more blended technologies – speech, touch screen, templates, point and click – all in one package, there will be a higher adoption rate. Right now, EMRs are struggling to sell themselves. Unfortunately for them and us, they’re using elimination of transcription costs as a sales point, pointing out that the system pays for itself because overall it will cost less than the practice or hospital spends on transcription. The fallacy in this is that highly-skilled, highly-paid professionals then perform the task of a medical transcriptionist – which makes absolutely no sense. Physicians struggle enough with the financial justification for an EMR; coupled with resistance to change, it has pretty much guaranteed slow adoption of EMRs, especially in smaller practices. I suggest reading the Accelerating Adoption of Healthcare IT blog, by Nick van Terheyden, MD. He made this point in his presentation at the recent TEPR conference. To put a point on it, you wouldn’t find Jack Walsh typing his own annual reports or Warren Buffet manually entering stock values into the computer (well, maybe Warren does – but I’ll bet Jack doesn’t). Ultimately, however, the technology and programming will improve and the number of younger doctors who haven’t spent the past 20 years dictating will exceed the number of physicians who have – and we’ll see a greater impact on our business.

To answer the question, I see technology making inroads, but slowly. I see the cost of technology, as well as privacy and security regulations, making it more difficult for small MT services and independent MTs to stay in business.