This is an interesting question now being frequently posed in the medical transcription community on Facebook, in the forums, and elsewhere. It’s one I am frequently asked, as well.

And my answer is no – it’s not a career choice I encourage. This position has been questioned by some, especially when I say it in forums like MT Chat, because I own several websites for medical transcription (and, obviously, I blog about the medical transcription industry). My response to that is that I spent over 20 years in the medical transcription industry. I know a lot of people in the industry and support them, regardless of how I feel about the career.

But – if you’re someone looking for career choices, I am going to tell you to really do your homework before plopping down thousands of dollars on a medical transcription education.

Follow the money

For several years, my impression that medical transcription pay rates are going south has been anecdotal. Then, my friend Kathy Nicholls (who is much more data oriented than I am) did an excellent analysis of numbers, which you can read at MT Tools Online: A Salary Perspective Over 11 Years.

It doesn’t take a rocket scientist to read that information and see the writing on the wall for the working MT. Medical transcription pay rates haven’t kept up with even cost-of-living increases over the last 11 years. I don’t see that this trend is going to change. There are increasing reports from medical transcriptionists that pay rates continue a downward slide, with speech recognition editing paying half or less, while not delivering a breakeven proposition with increased productivity.

The line count pay rate isn’t the only factor affecting how much a medical transcriptionist can make. There are more and more MTs telling me that they fight a daily battle to eke out their daily line count minimum when there isn’t enough work in their employer’s system. These employees are expected to not only be available to work their scheduled hours, but to sit around and wait for work to be available on the system – without any compensation if there isn’t.

Whiners and winners

My decision to write on this topic came out of a Facebook discussion. Fortunately, you don’t have to be on Facebook because Kathy also wrote a blog post at her MT Tools site – Medical Transcription on Facebook: A Case Study. In my opinion, the most interesting response to the question posed came from Ava Maria George, the president-elect of AHDI.

In order to assure that pay is commensurate with our talents, we have to get out there and educate ourselves (yes, I mean bachelor’s degrees) and advocate for our profession. One cannot simply sit back and say, “Please Mister, give me more” and expect that will happen. Obviously, not advocating or speaking out has literally made us obsolete. So, what are we willing to do about it? Get out there or leave. Simply, those are your choices.

Call me crazy, but if someone told me I needed a bachelor’s degree to do medical transcription, I’d be laughing so hard, I’d be speechless. I mean really – if you had the time and money to get a 4-year degree, would you get one so you could be a medical transcriptionist?? I wouldn’t even do it if I had to get a two-year degree.

Now, the case might be made that even Starbucks pays more if you have a college degree and therefore we may draw the conclusion that medical transcription would pay more if practitioners had a college degree. However, it is not the degree itself that is driving higher pay rates – it’s the employers. Starbucks simply states that employees who have a college education are paid more than those who do not. It does not give preferential hiring to degreed applicants, but it does reward them for having a degree. (And it’s kind of a sad statement on the economy and the value of a college education when people with college degrees are working as baristas.) And employers in the medical transcription industry have not supported either higher education or credentialing.

Get out there or leave – seems to me that’s a predictive statement, especially when it comes to AHDI membership. Oh sure – they can point to growth, due to the KB membership, but their practitioner level membership numbers are shockingly low, just over 3000 members at the end of 2010. When I left the organization, the practitioner membership was over 7000 members. Apparently the answer to not finding your sweet spot in serving actual people is to come up with a product you can sell and tie it to a non-voting membership category so you can tell the people you used to represent that you’re tired of their whining and they can just go away.

Which brings me to the next statement made by Ava…

I’m not talking about staying traditionally an MT…we’re evolving. We will be looking at changing not only what we do, but hopefully in the process elevating our profession to one that is compensated at a professional rate. Think about it. Coders were in our position years ago. They decided to educate up, credential, and their salaries followed (higher). Now, they are at the same crossroads that we currently find ourselves…we either grow or go. It can be scary or it can be exciting. I’m betting on exciting….

I have a couple observations to make about this. First of all, I don’t know where Ava Maria George gets the impression that coders educated up. The requirement is, and always has been, a high school diploma or equivalent education.

And I’m going to argue with the interpretation of history here… coders did not, by themselves educate up and credential. AHIMA was successful in getting employers of coders to recognize the value of the credential and start demanding that coders be credentialed. The recognition of the coding credential was not a grassroots movement by the coders, but a top-level-down marketing campaign by AHIMA.

The same is true at HFMA. In the Southern states, more employers require their finance people to have an HFMA credential; therefore, there are more credentialed HFMA members in the Southern states. In the Western states, fewer employers require the credential and therefore there are fewer HFMA members in the Western states who are credentialed.

My daughter is a personal trainer. To get hired at a reputable gym, she must have a credential. No credential, no job. In addition, at the gym where she works currently, she must participate in additional inservice training in order to advance in pay. If she doesn’t participate or participates and doesn’t pass, she loses her job at that gym. Her reward for participating and doing well is not only higher pay, but continued employment.

I have a friend who works in the HIMS department of a major university hospital. She was given a drop-dead date for finishing her AA degree and passing the RHIA exam. If she did not, she was out of a job. She took the test on the Saturday and fortunately passed because after many years of working at this hospital, she would have been terminated on Monday if she hadn’t passed. And – she didn’t get a raise or a promotion, she just got to keep her job.

What AHDI seems to be missing in the entire credentialing discussion is that successful credentialing takes place from the top down, not the bottom up. The problem in the medical transcription industry is NOT that transcriptionists haven’t supported credentialing and education – it’s that employers haven’t supported it. How long do you suppose MedQuist would last if they terminated all MTs who didn’t get a credential by a certain date? The plain truth is that the transcription industry doesn’t have the guts to place such a stringent requirement on its workers, even if it had a financial incentive for doing so. And let’s face it – there’s no financial incentive. For the Record recently did an article on The MT Credentialing Debate, and this statement is indicative of why credentialing for medical transcriptionists has never gotten off the ground:

Dale Kivi, MBA, business development manager at FutureNet Technologies Corporation and a member of the board of directors for the Clinical Documentation Industry Association (CDIA), says he understands and appreciates the efforts of industry organizations that promote credentialing. However, he says organizations that purchase transcription services don’t seem to care whether the labor force is credentialed. Their interest lies in stipulating quality expectations and holding vendors to those levels, regardless of whether the staff are credentialed.

It seems all the blame doesn’t go to AHDI, but I’m tired of them point a finger at medical transcriptionists for not supporting the credential. A better use of their time and energy would be to use their partnership with CDIA (the organization formerly known as MTIA) more effectively.

Winners never quit

You know that saying: Winners never quit and quitters never win.

If you examine successful business people, you’ll find the above statement is erroneous. More than anyone else, winners know when to quit.

What really sets winners apart from quitters is the ability to escape dead ends quickly, while staying focused and motivated when it really counts. They don’t waste time and energy on a dead end. Winners do not keep chasing unprofitable ventures.

The biggest difference between quitters and winners is that when quitters quit, it’s an emotional decision. When winners quit, it’s a rational decision, based on objective data and analysis. Seth Godin has some interesting things to say about quitting and winning in his book: The Dip: A Little Book That Teaches You When to Quit (and When to Stick). Guy Kawasaki interviewed Seth about the book and asks:

Question: Other than hindsight, how does someone know when it’s time to quit?

Answer: It’s time to quit when you secretly realize you’ve been settling for mediocrity all along. It’s time to quit when the things you’re measuring aren’t improving, and you can’t find anything better to measure.

Smart quitters understand the idea of opportunity cost. The work you’re doing on project X right now is keeping you from pushing through the Dip on project Y. If you fire your worst clients, if you quit your deadest tactics, if you stop working with the people who return the least, then you free up an astounding number of resources. Direct those resources at a Dip worth conquering and your odds of success go way up.

What’s the worst time to quit? When the pain is the greatest. Decisions made during great pain are rarely good decisions.

Research and make your choice

Basically, medical transcription has been the one reliable (or, lately, semi-reliable) legitimate work-at-home opportunity. It works for people who don’t have other choices; they must work at home or they must have a more flexible schedule than a traditional office job allows; or they live where there aren’t many work opportunities. For those reasons, medical transcription will remain a career choice for some, while those with more and better options will choose something else. Blaming medical transcriptionists by telling them they’re a bunch of whining losers won’t make medical transcription a higher-paid career. Not only is that a lousy marketing tactic, it’s just putting lipstick on a pig and trying to convince everyone the pig is a something desirable.

KathyNicholls: AHDI proposes governance changes. What are your thoughts? http://bit.ly/dB8eeT

Now, I had nearly made a vow to leave AHDI alone. I’m not a member and haven’t been now for several years (not counting one year of corporate membership). I’d say I don’t care what they do, but by golly I run a forum for medical transcriptionists and they get discussed – so I decided to go see what Kathy was talking about.

This whole thing reminds me of a MTIA annual meeting a couple years ago, where I wanted to register in time to get the early bird discount – but there was no speaker schedule posted. Upon my inquiry (to AHDI, who is in charge of MTIA’s business), I was told one was not available yet. I then asked if the early bird discount would be pushed back so that it was available for a period of time AFTER the speaker schedule was available. I was told no, it would not. Therefore, in order to get the early bird discount, I had to buy a pig in a poke. Well, first it boggles my mind that any professional organization wouldn’t have a speaker schedule set by the time they started advertising their annual meeting; and second, that anyone would be expected to register for a meeting when they had no idea what educational sessions would be offered. Why offer an early bird discount at all, under the circumstances?

So now we have AHDI proposing another change in governance. Whether or not it’s a good change for the organization isn’t the point – I don’t know and I don’t really care. But, according to what I’m reading on Kathy’s blog, AHDI doesn’t even know the financial impact of what they’re proposing, yet it’s supposed to be taken to vote at the annual meeting the first week of August. Am I the only one who wonders why the rush?

Some of the comments at Kathy’s blog indicated that maybe members haven’t been very informed about this proposal. I consider Kathy – a former president on the national board of AAMT and a former HOD delegate and president of the HOD – to be pretty plugged in. If she doesn’t know about it, it doesn’t say much for how well information about this proposed change is being passed along to membership.

It appears the Town Hall meetings were first announced back in February – but the first Town Hall meeting wasn’t until the end of May, just 9 weeks prior to the ACE meeting and a vote on whether or not to implement this plan. Again, I’m reminded of the MTIA meeting – shouldn’t there actually BE a plan prior to announcing the plan? And what happened in the intervening months between mid-February, when this was first announced, and the end of May? According to comments made at the MT Tools Online blog, delegates were not allowed to disseminate information about these changes until a few weeks ago. Another comment was that the concept seems to change with every Town Hall meeting. There are, of course, the rah-rah posts – one commenter indicates she has been attending the BGG webinars “for several months” – which would be hard to do unless her definition of “several months” is what most of us would call a couple of months.

What I found most interesting were the comments by Miriam Wilmoth, a long-time member who has been very involved in the association for years.

Yes, there have been opportunities to ask questions – and to have some of them answered – but the “feel” of these meetings has all been one of an informational meeting and they have each projected that the BGG is a done deal, despite the fact that the House has yet to vote to move forward with it. Not once, when concerns have been raised, has anyone in leadership responded with the acknowledgement that yes, you have raised a valid concern and this is a problem with the new plan, or that anything needs to be taken back to the drawing board and re-thought. There is simply the continual message that this is the only salvation for our association and it must be done right now or we lose everything.

This doesn’t surprise me because this is de rigeur communication of the association to its members. I’ve said it before and I’ll repeat it: AHDI doesn’t actually hold discussions with members, they talk at them. The AHDI board has been very mother knows best with members, especially in the last couple of years. While I understand the need for the BOD to present a united front to membership and to keep its doubts and disagreements private, the united front seems unable to acknowledge the concerns of members or make members feel as though their input is valued, appreciated – or will even be considered. The end result is the feeling by membership that it’s being bludgeoned and the purpose of the Town Hall meetings isn’t actually to solicit input in order to formulate a plan – it’s window dressing for a decision that’s already been made and that will be rammed through because mother knows best.The fact that most of the people who serve in leadership at AHDI work very hard and are very passionate about what they’re doing is beside the point (the road to hell being paved with good intentions, and all).

Barb Marques, who is the current President-Elect to the AHDI BOD, says in her comment:

A couple of points I would make is that (1)perhaps all individual members have not heard first hand about the proposal, even though Townhalls have been open to any member. (2)I suspect the grassroot members will be hearing much more about this now that the component and state/regional association leadership, and the HOD, has been given several looks at the plan, several times now, and I hope ready to speak to their members on he subject with an assurance of understanding. Meetings with specific regional leadership (and anyone else they care to invite) will be held this and next week. The FAQs are available on the website for anyone to access.

I see no FAQ associated with that BGG. WHICH DOESN’T SURPRISE ME! After all, this is the same group of folks who start selling admission for a meeting with no agenda and asks people to vote on a plan that appears to still be in the planning stages. Link, please?

Of course the Town Halls were open to all members – but were all members adequately informed of them? Or are even members past the point of caring how AHDI reinvents its governance?

Keep in mind that the meeting where this vote is to take place is August 4-7, so all this discussion that’s going to take place is during the remaining two weeks before the vote. How many changes can be made after input from members in that short time?

If AHDI really feels it’s on the brink and needs salvation, and if it really wanted input from its members, it would have a frank discussion about the status of the association and present several alternatives, rather than offering up one “solution” to the problem for a vote in a few weeks’ time, especially when the proposed idea seems to be half-baked at this point. If the association is in such dire straits, surely it would be better served by a concrete plan and financial statement. The phrase out of the frying pan and into the fire comes to mind here, as does “a stitch in time saves nine.”

I’m going to go back to the proposal that got me into so much trouble with AAMT/AHDI several years ago and suggest that it’s past time for medical transcription to roll back into medical records. The case for this is even stronger now than it was the first time I brought it up. The evolving role of medical transcription in the medical records documentation process is bringing it more and more into the health information management sphere of influence. The people who really make the decisions about what happens in medical records – and in medical transcription – are in AHIMA, not AHDI. Let’s forget about MTIA for now – it’s a self-serving alliance of transcription service owners. The only comment of value about MTIA members I can make is to note that many of the C-level executives are most likely also members of AHIMA because they know the value of that organization to their business. At this point, AHDI seems to be spending a lot of time and energy struggling to make itself relevant, and reorganizing itself just to stay afloat. When it comes to legislation, it duplicates many of the efforts of AHIMA – only with less money and less effect. Doesn’t it make sense then to just roll it all into one organization? As a therapist I know once said: Sometimes a good divorce is better than a bad marriage. AHDI has, in my opinion, been a bad marriage for some time.

As I had predicted – there’s no method that can’t be manipulated.

Whether the issues arise from manipulation or from the fact that the “Joint Task Force on Standards Development” issued a white paper, not a standard, and failed to use actual standard-setting methodology, is debatable. But – I was catching up on my reading and came across For the Record‘s article: “Buyer be Aware.” I’m sending a great big thank you to them for putting this online so everyone can read it.

My first bone of contention in this article is some of the quotes attributed to Dale Kivi, director of business development at FutureNet Technologies.

While many companies such as SPi say they prefer that providers adopt the VBC method, Kivi suggests that a good deal of the resistance has come from transcriptionists themselves. “Whereas HIM directors have been coming up to speed on adopting VBC, the understanding and acceptance at the MT [medical transcriptionist] level has not progressed as rapidly,” he says. “Some transcriptionists are wary of changing because there have already been so many changes to their compensation. They see any change as something that could reduce their pay for the same volume of work. And because the VBC method eliminates payment for spaces, they worry it will eliminate something from their salary as well, which of course it does not.”

Dale, obviously you don’t work in the trenches. Let’s count the number of MTs who comment on this and tell me that they were asked to convert to the VBC and either (a) didn’t get an increase in line rate to compensate for the lost characters, (b) weren’t advised that a change to the VBC without a compensatory increase in the rate paid per line would result in reduced pay for more work and/or (c) weren’t even advised that their company’s line counting software was being changed to the VBC.

And here we have a promotion of the biggest lie perpetuated by those promoting the VBC:

One of the most important benefits of converting to the VBC method is that it allows documents to be easily verifiable. With previous methods, there was room for improper billing practices to take place.

I have to keep beating this drum:

• There are no methods that can’t be manipulated
• Unless someone is counting – manually – all the visible black characters (note the importance of the word in bold), this method is no more accurate than any other method that uses software to count the billable units.

The assertion made by Kivi and others is that the VBC is much easier to audit because “what you see is what you pay for.” I would like to know from the industry leaders how many companies are auditing by actually counting the visible characters with no software. Because the bottom line is – the VBC is only more accurate if you actually sit and count each visible character on the document you are auditing and only easier if you were using an abacus to verify your invoices prior to going to the VBC.

Oh – but wait! Read on in the article and you see where the cracks are starting to show in the stressed-out “standard.”

Of course, nothing is ever 100% foolproof, and there are some bones of contention even when using VBCs.

Do tell!

“Headers and footers are one issue,” says Cohen [president of SPi Healthcare]. “Some clients are OK with counting headers and footers across all pages, since they are visual characters, while others may insist on counting the first page only.”

What a surprise – some people want to have their cake and eat it, too! Look, folks – either you pay for all the characters you see on each and every page – or this “standard” starts on that slippery slope to join the calculated line. It seems the demographics are joining the headers and footers on that slippery slope. It doesn’t at all surprise me that this issue has come up. There were reasons why the calculated line was abused and those reasons still exist in the industry. Those reasons didn’t go anywhere just because a joint committee got together and came up with a new way of counting billable units. At fault are both parties involved in the transaction (you know who you are).

Now here’s what I find to be the real kicker in the whole article:

Kivi agrees that it’s important for both parties to be clear about these types of details to avoid the perception that the transcription service is attempting to sneak something under the radar. In that regard, he considers communication to be a key to better billing.

No s***, Sherlock. And if this was the case across the board, there wouldn’t be a need for the VBC.

Back to my bottom line: you can use any method of calculating a billable unit as long as it is transparent and verifiable.

Oh yeah – and I’m just never going to understand how any of these people can claim the VBC is easier to verify. I’m begging Kivi or anyone else to explain it to me.

Let’s focus on another shady area of transcription: the “certified medical transcriptionist.” I’m going out on a limb and expressing my opinion that any organization, other than AHDI, that claims it awards a “certified medical transcriptionist” or “CMT” designation or “credential” that is recognized in the industry is a scam. And I find this practice so reprehensible that I’m going to name names.

This is a real-life story about how these scams and substandard programs affect individuals. I’ve also used her real information, with her permission – she’s made no effort to hide who she is online and a search will bring up several of the complaints she’s filed in the online media.

Disclaimer on my research

It’s difficult (but obviously not impossible) to find out what a web site used to look like. I’ve included what I feel are pertinent screen shots of the old web sites for the companies I’m discussing, but there are gaps and I can only piece things together based on the information I’m able to obtain in the internet archives. I’m not going to claim that I have all the information – but I think I have enough of it to support the conclusions.

TechSkills owns the three top domain name extensions for their site: dot-org, dot-edu and dot-com. All the sites are identical, both currently and in the archives, and versions in the internet archives have the same logo and contact information

If you’re having trouble seeing the screen shots, click on them for the full-size version.

Like everything else on my blog, these are my opinions unless otherwise stated and referenced.

The School: TechSkills

Cathy thought she did her homework. She investigated medical transcription and medical transcription education. She chose TechSkills, a vocational school with multiple programs and locations in multiple states.

The state in which Cathy resides lists TechSkills as an approved school offering medical transcription education. There are only 4 schools on their list: Kaplan University, At-Home Professions, Rasmussen College and TechSkills. For those of us who’ve been in the industry for awhile, that list says about all there needs to be said about the value of the state approval. It should also provide a precaution for those beginning their search: state approval of a program can be pretty meaningless. In this particular instance, all it means is the school is approved to operate in the state. The state site makes it clear that approval and accreditation are two different things, and what they do is provide approval. TechSkills is an approved school, not an accredited school. Approved schools undergo the following process:

…staff evaluates program and teaching location applications, advertising, enrollment and school catalog documents, refund policies and financial statements. Approval is granted after a school has submitted all required information and forms and the school is in compliance with state law.

The state establishes a standard and makes every effort to ensure that a school meets the standard. They respond to complaints. They are also supposed to monitor a school’s success rate; i.e., whether students are graduating and getting jobs. This all kind of begs the question: who is watching the watchers?

Cathy also checked out the TechSkills web site and information provided there. In January of 2005, this is what the TechSkills web site said about their medical transcription program (ignore the “Careerstep” on this site – it’s what they call one of their programs and has nothing to do with the transcription school by the same name):

The program also prepares our Students for the Certified Medical Transcriptionist exam, which enables them to earn a widely recognized industry certification.

They don’t say who performs this certification, but as Cathy found out – it wasn’t AHDI. I’m going to put that part of the story on hold for a minute, however, so we can finish up with TechSkills and move on to the organization that was administering the referenced certification.

The reference to the certification appeared some between January 2004, when the site looked like the screen shot below, and January 2005 (screen shot above).

You note there’s no reference to a certification of any kind; however, one difference I am noticing is this one:

…with access to a professionally-certified instructor in person, via telephone or electronically.

I can’t find any information at the current TechSkills site about their instructors, including what professional certifications they might have. In fact, Cathy tells me that the instructor at the time she took the course was a recent graduate with no medical transcription experience. Am I being too cynical if I wonder why they aren’t terribly forthcoming with this information?

Fast forward to December 2007. Somewhere in this time frame, TechSkills changed their web site. In November 2006, AAMT (now AHDI) sent a letter to TechSkills, notifying them of the misuse of “certified medical transcriptionist” and “CMT” and requesting that they stop using the terms, as the use implies that individuals have actually received the industry-recognized credential and it’s confusing. In addition, Cathy responded to the schools’ feedback form for graduates, and indicated that she had contacted over 50 employers and 48 of them had never heard of the organization issuing the “certification.” She was told by prospective employers not only is the NHA certified not widely recognized; it is, in fact, not worth the paper it’s printed on.

As you can see, the site now specifies that the Certified Medical Transcriptionist (CMT) exam is through AHDI.

But wait – there’s more! As those of us in the industry know, new graduates are not eligible to sit for the CMT exam. Just this year, AHDI sent TechSkills correspondence and informed them that this is misleading, as students and post-grads are not eligible to sit for the exam.

Finally, TechSkills changed the site, indicating:

You’ll also prepare for the Registered Medical Transcriptionist (RMT) exam, enabling you to earn a widely recognized industry certification from the Association for Healthcare Documentation Integrity (AHDI).

Going way, way back in time, it appears that TechSkills started out as a computer technology school and then branched out into other vocations some time in the early 2000s.

In the interest of disclosure, Cathy did get her money back from TechSkills after she filed complaints about their program, claims and “credential.”

So what about that”certified medical transcriptionist” or CMT?

The elusive “CMT”

The organization providing the testing and credentialing of “certified medical transcriptionist” or CMT to new graduates of TechSkills is/was National Healthcareer Association, “the benchmark in Allied Healthcare Certification.”

How can you be a “benchmark” when nobody has heard of you? I called a couple HIMS managers I know, at large hospitals (including a couple University medical centers) and none of them have even heard of this organization or its certification. I called several clinics, with the same results.

I like the broad ambiguity of this statement. It doesn’t say these organizations require the National Healthcareer certification – but since NHA has “national certifications,” it is implied, in my opinion. Even if we ignore that, the statement is patently false. Let’s look at the administrative healthcare certifications offered through NHA.

• Medical transcriptionist – no brainer. We all know there’s no certification required; most of the time, it isn’t even preferred.
• Billing and coding specialist – hospital coders are usually required to have the AHIMA credential. Medical billers aren’t required to have a certification of any kind.
• Certified medical administrative assistant – not required in any office I’ve ever been in, in any state.

What does NHA do when Cathy forwards them the letter from AAMT? A response from Jon Brandt (whose function is unclear – it’s not on his e-mail signature and their web site doesn’t have ANY information about principals) first claims they had never received the letter from AAMT. He then states that the term “certified medical transcriptionist” and the initials “CMT” are not trademarked by AAMT – which is is true. However, these have been in use by AAMT since the late 1970s. NHA claims to have used it since 1986. But the best part of the e-mail sent Cathy, in my opinion, is this:

nor have we ever had an organization not accept the NHA certifications…

I’m not going to call Mr. Brandt at NHA a liar because he was – I would guess purposefully – vague about which organizations and which certification. If there’s a lie in that statement, it would be that this has never happened. I would, however, like to see if he could make the same statement with specific reference to the NHA “CMT” and still keep a straight face. He then goes on to speculate that this is an effort by a competitor to discredit a company that’s clearly ahead in the game. (Where are my eyeballs? They rolled right out of my head!)

The matter could be resolved in court, but that costs money and AHDi doesn’t have any spare cash. So – it appears that the folks over at NHA will continue to cash in the bucks by offering a credential that is worthless in THIS industry.

What do we learn from this?

I called TechSkills today and said I wanted information about their program and fees. Apparently, they’ve learned some things, but not as much as we might think.

The individual I spoke to actually had to rustle around in papers to provide me with information. I guess this gets confusing when you offer so many different programs at so many different locations. He even had to look up how much the medical transcription program costs.

Are you sitting down? $7400. Yep, you read that right. I have been researching MT school tuition for another article I’m working on and the only AHDI-approved schools charging anything close to that are the universities and colleges – and that’s the out-of-state tuition.

Although their site refers to the RMT by AHDI, the representative told me I could get a credential from either NHA or “the other.” He said (and this is word-for word):

The other is offered by a little network in the industry, so it’s preferred.

He also told me that both are valid and both are well known. Well, I’ve been in the industry for over 20 years and this is the first time I’ve ever even heard of NHA.

In addition, TechSkills has an NHA testing center in their facility, with a monthly testing schedule, and graduates can arrange to take the NHA test there. In my opinion, that’s still an endorsement of NHA certifications, in spite of the fact that it wouldn’t be difficult to prove to them that the NHA “CMT” is worthless to aspiring transcriptionists.

What I would like medical transcription hopefuls to learn from this is that there is only one organization offering any credentials that are recognized in the medical transcription industry, and that is AHDI.

Class Action

Cathy is trying to find other graduates from TechSkills, as well as others who have received the NHA “CMT” so she can start a class action lawsuit. The clock for her is ticking – the statute of limitations on her claim runs in a month.

These sort of practices affect both individuals and the industry. I’m helping Cathy spread the word and get her class action together because she lost a lot of time and money in this process.

Interested parties should Contact Cathy directly. (Her e-mail is included with her permission.) If you have any questions, please comment.

Other links:

Cathy’s Rip Off report

Just a little bit about AHIMA. It’s a great organization in many ways and I’ve met a lot of people I really like. Now for the big HOWEVER… as a business in the transcription industry and a member of AHIMA, I felt like the red-headed stepchild of medical records and I know I’m not the only one. It was a recurring theme among the MTSOs and MTs I talked with who were also members of AHIMA. Ms. Looney’s feeling that MTs are undervalued in the medical records cycle is, in my opinion, validated by the way AHIMA – and its members – ignore transcription.

Case in point – back to that meeting I attended…

At that time, digitalization of records was advancing and there was talk of perhaps expanding the available pool of (very much in demand) coders by allowing telecommuting of jobs and how that might successfully take place. There then ensued a long discussion between particpants in the conference about the possible issues for coders telecommuting: isolation, child care, supervision, compensation. The conclusion? “We’ll have to study this and proceed very carefully.”

I wanted to stand up and wave my hands in the air and say, “Hey, over here! All you have to do is look at transcription!” At that point, MTs had been telecommuting for years. And yes, experienced all the problems associated with working remotely from home. And yet – not one person acted as though they had any idea that all they had to do was talk to the transcription industry, with its many years of experience!

Moving on – same meeting – I happened to be giving a presentation on speech recognition. During the presentation, I did a live demonstration of how speech recognition works for both live dictation and recorded (back end) recognition. I used a snippet of actual physician dictation for the demo. After the meeting, more than one person came up to me and said they’d never listened to a recorded dictation before! I was absolutely floored.

Is anyone still confused as to why MT is undervalued and misunderstood?

Flash forward to 2009 and I’m at another conference on electronic medical records, personal health records, Health 2.0 and health information technology in general and not much has changed except we’re more digitized. Still commoditized and marginalized, but digitally. I didn’t get the sense so much from people who asked questions in the transcription-related sessions that THEY felt this way – but everyone pretty much agreed that at most facilities, the general feeling is: (1) anyone can do transcription and (2) even if they believed it takes special skills to do transcription, those skills are no longer necessary when editing speech recognition. In fact, Nick van Terheyden showed, in his presentation, that the intrinsic value of a medical transcriptionist is that s/he isn’t the equivalent of a “dumb terminal,” but what we do is taken for granted because we do it so well. We make sense of the jumble, garble, frank dictation errors (well, most of us do) and turn it into a usable document which the doctor then looks at and says “Yes, that’s what I dictated!”

Wouldn’t they be surprised if we actually transcribed verbatim?

Part of the problem in the transcription industry is the upside-down supply/demand model. Even though demand is high, pay rates have gone down. (And yes, I do plan on getting around to commenting on the Advance salary survey one of these days.) Because demand remains high, even the worst MTs have no problem getting jobs as MTs, which doesn’t do a lot for the overall impression of the value of MTs. Top that off with the fact that the better MTs are better because they have higher levels of motivation, skill, intelligence – whatever constellation of assets you want to put together – which means they are also more employable in other sectors that utilize the same or similar skill sets. If someone who has been an MT for 20 years gets offered the same rate per line as someone fresh out of school, what is her incentive to remain in the transcription industry? And yes, I know I shouldn’t suppose that 20 years ipso facto makes one a better MT, but let’s just pretend it does. Why did she enter MT? Because she had children at home and wanted flexibility in her work. Twenty years later, those children are grown and she no longer needs the flexibility, which gives her more options when it comes to looking to take her skills to other jobs. The MT whose skills are marginal is more likely to remain in the industry, leaving behind the reluctant and unqualified, regardless of years of experience. In what other industry can someone be completely unable to do the job well and still remain employed at that job?

No wonder medical transcription gets no respect.

I’m not pointing the finger at any one group – there are plenty of factors that led medical transcription down this dark path. I do feel Ms. Loosey pretty much hit all the nails right on the head. I just hope those nails weren’t going into the lid of a coffin.