The latest comment that drew my interest is Lea Sim’s response to one of my comments, where she says:

…unless we can make a solid argument to someone like CMS or HHS or the Joint Commission that there is at least SOME risk to the patient in having unqualified hands in a health record, considering how inconsistently physicians actually read the records they put their signatures to.

I have disagreed with this position in the past and I’m going to keep disagreeing with it.

I want to know if there are any other highly educated, highly trained professionals preparing medical-legal documents who wouldn’t be expected to ensure that those documents are accurate before they sign them. Oh heck – I don’t know of many professionals, highly trained or otherwise, who don’t understand it’s their responsibility to ensure the accuracy of the documents they sign.

I was a secretary for years and not only are non-medical professionals as a whole more conscientious and courteous about their dictation, they all also understood that they needed to actually read the transcribed document before they signed it. After all, that’s their name on it, not the transcriptionist’s. Whoever is going to receive the document doesn’t know – and frankly doesn’t care – who typed it. If there’s a problem with it, they call the person whose signature is at the bottom, they don’t start hunting down the person who typed it.

I’ve had insurance adjusters read a transcribed letter telling a claimant that their case has been settled more carefully than some doctors read an operative report before they sign it. That’s not a reflection of how much either professional trusts the person who transcribed their dictation, either.

Now, I understand that doctors are busy. But really – what special power relieves them of the responsibility of making sure that the medical records they create and have responsibility for and to which they affix their signature are an accurate representation?

Let me quote myself, from a prior post Whose medical records are they anyway?

Let me review, in case anyone missed my comments a couple years ago in Advance for HIM. The average medical transcriptionist has a high school education. The average physician has a high school education, plus 8 years of higher education. The average medical transcriptionist is trained on the job. The average physician spends three to six years in internship and residency training programs. The average medical transcriptionist makes less than $30,000/year. The average family physician makes over $130,000 a year, and that’s the lowest-paid group; specialists can make up to $800,000 a year. Physicians are one of the highest-paid occupations in the U.S. The physician is trained, licensed and paid to make medical decisions; the medical transcriptionist is not. The records belong to the physician, not to the medical transcriptionist. When the physician signs the document – with a pen or electronically – he or she is verifying that it is a medical-legal document that is true and accurate to the best of his/her knowledge.

Which one of these people do YOU think should be responsible for making sure the documentation is correct?

As long as AHDI keeps beating this drum, I’m going to keep repeating myself. This is a dangerous, slippery slope. Making transcriptionists responsible for the accuracy and completeness of the medical record does not make medical transcription more valuable in the healthcare community.

Witness the discussion going on over at the AHDI Lounge, Let’s Talk About Credentialing Our Industry Leaders and the 75 comments that have been generated (in spite of a glitch in the public blogging platform that hiccuped one day and swallowed some comments, apparently). Quite frankly, reading all the comments made my eyes cross, but I soldiered through.

The AHDI Lounge blog post refers to the most recent entry in AHDI’s Let’s Talk About series, Credentialing Our Industry Leaders (you probably guessed that from the blog post title, right?).

Let me boil down this argument, which isn’t about experience or education or credentials from other organizations or what position a leader or potential leader holds within the industry. Or shouldn’t be, at any rate.

People in leadership are supposed to support the organization and its goals. They’re supposed to lead by example.

The organization that puts out a publication titled The Case for a Credentialed Workforce should make sure its leadership has proven the case by having the credential the organization is saying should be mandatory for the workforce. And the credential the leadership should be supporting are the ones the organization they are leading has put out as the gold standard credentials for the workforce.

Barb Marques makes this comment:

I believe it is reasonable to consider that on this journey some of us have identified a path into management of departmental workforces and standards, business owners and/or experts in the EHR, which doesn’t diminish the importance of a CMT, but perhaps makes it less of a priority in those circumstances for them personally.

What does the position someone holds have to do with any of this? A comment by Laura notes:

The CMT and the RMT exams do not test for leadership, business management, the ability to read financials, communication skills, organizational skills, and other tasks performed by members of the BOD. These are important skills needed by members of the BOD.

Again, what does that have to do with the discussion?

If you’re in a position of leadership in an organization that is promoting to its membership that the credential is something they should have, then you should demonstrate by example that it’s a good thing by having achieved that milestone yourself. But that’s just my opinion, FWIW.

Likewise, the expertise, education, experience, blah blah blah of the person holding the credential – whether someone in leadership or a practitioner MT – has nothing whatsoever to do with the discussion. For the purpose of this particular discussion, every person who holds an AHDI credential could be the worst transcriptionist in the world. The credential could have absolutely zip/zilch/whatever impact on employment and pay rates.

None of that is to the point.

Again, the point is that if an organization is going to demonstrate true leadership, then it demonstrates it by example.  “Do as I say, not as I do” has never been a viable form of leadership, in any organization.

I remember when it was a strong part of the AAMT culture that all leaders have the CMT credential. It was one of those many unwritten guidelines that tripped me up. Few people who didn’t have a credential would run for a Board position and those who did were actively working on getting the credential; it was understood that they would take the test and get their CMT before they took office. It was part of supporting the organization and the goals of the organization.

I’m going to go out on a limb and suggest one reason for that part of the culture falling by the wayside is the ever-shrinking number of people in the membership category that can actually vote and hold office. My impression is supported by this comment from Barb Marques:

No, I will not assure you that all future directors will hold a CMT; why would we put that limitation on our association?

You would put that limitation on your organization as part of the culture, if not an actual requirement, if you had a large pool of people to draw from for leadership positions. If supporting the credential severely limits the pool of potential leaders in the organization, you have bigger problems than whether or not the workforce or leadership or employers support the organization’s credential.

I can only conclude, as have many of the others in this discussion, that the CMT credential is just a piece of paper, with little meaning. The fact that those in leadership don’t see it as an essential component of a leadership position – and are going to great lengths to defend that position – proves that they are only giving the organization’s credential lip service as something everyone else should have. Not only that, the fact that an organization even has to write something like this particular edition of the Let’s Talk About… series should trigger some much-needed introspection about what’s really wrong here.

C’mon, leaders. Step up and actually BE LEADERS. Stop constructing your own organizational version of the Alamo.

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.

This is my surprise face

The discussion at the AHDI Lounge has taken on a life of its own. As usual, the more AHDI representatives talk, the more questions get raised.

Over the past couple of days, the conversation has raised some questions in my mind about why AAMT changed its name to AHDI. While telling medical transcriptionists they need to be forward-looking, prepare for change… blah blah blah… it becomes clear in some of the comments here that AHDI itself isn’t doing the same.

First, Lea Sims (remember, the Director of Professional Programs), states:

I think the challenge is that as an association, we don’t know enough about the scribe role to conclude that a 6-month training program is either too long or too short for this position.

Clearly, as pointed out in comments made by Kathy Nicholls, using medical scribes to facilitate physician use of an EMR isn’t a new concept. And also clearly, this occupation falls squarely within the mission statement of the organization. So why is it, at this point, AHDI doesn’t seem to know very much about medical scribing and it’s place in healthcare documentation integrity? Forget how it relates to medical transcription. The purported reason for the name change was to adapt to changes in how healthcare documentation is accomplished, and to lead those changes. But it seems that AHDI is as stuck in the medical transcription mindset  as the people it purports to lead and instead of taking a leadership role, it’s continuing to grope in the dark for relevance within the narrow definition of “as medical transcriptionists, where are we going?”

Lea goes on to say:

We certainly COULD represent the scribe occupation and most of us agree that this new role falls well within our mission, goals and objectives as an organization, but I think you’re missing the fact that we can’t just walk over to an independent workforce group that formed on its own, stamp an AHDI logo on their heads and say, “Shazam, scribes. We own you.” LOL

Here’s my question: Why not? They seem to have no qualms about claiming to represent the entire medical transcription industry. Taking a leadership role would entail identifying potential careers in healthcare documentation integrity and taking a lead in developing the job description, education and training requirements and credentialing for those careers. In fact, I was under the impression when AAMT changed its name to AHDI that doing this was the whole point. Whether or not medical scribing is a career that medical transcriptionists can transition to isn’t really the point; the point is, it falls within the mission, goals and objectives of the organization and therefore the organization should be leading the way in setting the standards. If it was leading the way, there wouldn’t be a need to tell medical scribes we own you; medical scribes or people looking into medical scribing careers would be coming to the organization, looking for information and direction.

In a press release (PDF) dated August 10, 2006, the following was given as the reason for the name change:

The House of Delegates voted on August 2, 2006, to change the name of the association to Association for Integrity of Healthcare Documentation and open the membership up to a broader sector of healthcare professionals involved in clinical documentation and data capture.

Sounds good on paper, doesn’t it? And in reading this, one would certainly conclude that the organization intended to take an active role in the broader sector of clinical documentation, not limited to medical transcription or what medical transcription might become. It was, in essence, saying “we own you” to the entire healthcare documentation sector. In spite of its own mission statement, the organization still seems mired down in the medical transcription of it all. One would think the leaders behind the name change had a plan in mind that extended beyond a different name for medical transcription.

In terms of leading the way, AHDI gets a big fail on the medical scribe issue. Medical scribing is nothing new. In July 2008, the AMA News published an article about medical scribes (One answer to EMR data entry: Hire a scribe to do it).

Scribe companies, which previously had concentrated on hospitals, say they are finding demand for their services from individual practices.

Obviously, Scribe America not the first medical scribe company. I don’t know how long they’ve been in business, but their domain name was registered in 2004. Abbott Northwestern Hospital launched a physician scribe program in 2006.

So where is this change leadership we keep hearing about? You can’t say on the one hand that you’re leading change, then turn around and say you “don’t know enough about the scribe role,” a healthcare documentation career that’s been around for over four years. What other healthcare documentation careers has the organization not identified, not taken the lead on, not informed its members about? Four years is certainly enough time to evaluate the broader sector of healthcare professionals involved in clinical documentation, but maybe they’ve been too busy trying to decide whether or not to keep the House of Delegates and otherwise restructuring the organization of the organization.

I realized during the discussion on the Plexus social networking article that the article is approved for continuing education credits (CECs) for those who are credentialed CMTs. In my opinion, this takes the discussion to a completely new level.

First, indulge me while I talk (again!) about the credential itself.

In another comment in the Mandatory Credentialing entry, Lea says:

Credentialing is about moving the profession forward, not the individual.

This comment reminds me of a time when my children were in elementary school here in the Los Angeles Unified School District and I was involved in the parents’ group for the school. At that time, the big fundraising goal was enough money to install air conditioning. Unfortunately, because of inadequate electrical wiring added to the cost of the actual A/C system, it was a daunting task. So much money was required to install A/C for even a few classrooms, few (if any) of the parents would still have children at the school by the time there was enough money. It’s next to impossible to convince people to donate time and money for something that will not reap them (or their children) any benefit.

The same is true in MT. One reason the CMT hasn’t been widely embraced is the fact that it holds little value for the practitioner MT. Head down, trying to grind out lines and scraping for work, trying to pay the bills, the average MT has little interest in advancing the profession. It’s an obscure and remote purpose with no immediate benefit. AAMT/AHDI has been telling the MT community for years that we should all be concerned about advancing the profession and that joining the organization and being involved is how we do this, getting credentialed is how we do this. For years, AAMT/AHDI has had difficulty communicating its purpose in a way that resonates with practitioner MTs and the CMT is no exception. Over and over and over, MTs hear the same mantra from AHDI leadership and CMT supporters.

Giving credit where it’s due – and because she feels I’ve been beating up on her here – Lea Sims wrote a good article on how we got to this point at the AHDI Lounge: Let’s Talk Wages. I think the article is a good start on the discussion, but I’m going to disagree with some of the assessments and conclusions (what a surprise, eh?!). For AHDI, the answer is always get more involved in the association, get credentialed. The article discusses Blue Ocean stratagies; the problem is, apparently it relied on the Wikipedia explanation and not the book. Because in the book, there is a discussion about barriers to imitation that are required for Blue Ocean Strategy to work – otherwise, even if you find or create your “Blue Ocean,” the sharks move in and you’re back in a bloodbath. For the Blue Ocean strategy to work, it needs to go without challenge for 10 to 15 years. In the medical transcription world, there have been no barriers to imitation and attempts to differentiate were quickly imitated. In fact, the very innovation that was meant to differentiate was picked up by SaaS (software as a service) vendors, who turned around the differentiating characteristic and made it available to anyone for a fee. In Blue Ocean terminology, once again the chum was thrown in the water and the sharks circled. The truly negative effect this had – along with HIPAA legislation – was to start working against smaller transcription services, who struggled with the cost of technology and the cost of compliance with HIPAA. The cost of entry for many of the SaaS platforms was prohibitive – $10,000 and up per account, more for speech technology, with minimum line requirements (understandable because of the costs associated with ramping up SRT) – and what had begun as a differentiation strategy became just another commodity, a requirement of doing business, not an added value to the service.

But the biggest problem underlying all of this is not just the commoditization of medical transcription – it’s the commoditization of healthcare in general, rising costs and reduced reimbursements, coupled with the push for electronic records. There simply isn’t any evidence that credentialing would monetarily benefit the MT work force in an environment where there are increasing cost constraints and a huge push towards eliminating or significantly reducing the need for manual transcription. I realize AHDI has to remain positive about the outlook for medical transcription in an electronic record environment, but I don’t feel the need to put on rosy-colored glasses, so I’ll say what they can’t – I’m not optimistic about it. I don’t think there’s going to be a blue ocean any time in the future of the industry. I think a lot of people are going to drown if they don’t start thinking about an exit strategy. And let’s face it – who is going to come out ahead in the competition for business in an electronic record environment? Again – the large companies that have the money to put into the technology.

So, after evaluating the industry as a whole, and the place of transcription in it, I’ll move on to the value of credentialing. We’ve all heard Albert Einstein’s famous quote: “The definition of insanity is doing the same thing over and over again and expecting different results.” For years, AHDI leadership has stated over and over and over again, that if enough people get credentialed or credentialing is mandatory, perceived value will increase and wages will increase. Even if we believe this to be true, the problem is getting everyone in the supply chain not only to believe it to be true (see the paragraphs above), but to “buy in” for that long haul. And AHDI has never seemed to understand that in order to get people to buy in for the long haul, there have to be immediate benefits that carry through. There’s only so much people are going to be willing to sacrifice to promote the profession when they not only don’t see any benefit after years of being credentialed, but they see no benefit from the organization that supports the credential.

And if AHDI sounds like a broken record on this point, I feel like I’m a broken record as well. I’ve said it in other posts here – for MTs to see a benefit from credentialing, the employers have to start preferring or requiring it. If there was actually preferential hiring of CMTs, more MTs would get the credential. But the employers need to see a benefit, as well. And part of that benefit is that CMTs are more qualified than non-credentialed MTs and/or that there is a benefit to the client that creates sufficient differentiation that the service can either obtain the contract over an outsourced service whose workers aren’t credentialed or that they are able to charge more for the service, thus offsetting the cost of preferential hiring and pay incentives for the credentialed MTs. In my opinion, the commoditization of medical transcription has progressed beyond the point of no return. Healthcare industry factors simply aren’t conducive to any scenario that increases the cost of labor for transcription. Hospitals aren’t making money – they’re operating at deficits that run into millions of dollars per year.

But let’s suppose for a minute that we believe credentialing adds sufficient value to accomplish the stated goals of increased recognization, reversal of commoditization and increased pay. I’m going to ignore the RMT credential – it’s an entry-level credential. If we’re talking about a CMT credential that has sufficient meaning to gain preferential hiring and pay incentives, then as an employer, I’d want to believe that those people are worth it; i.e., the best of the best. I want to know that the continuing education they get adds to their knowledge base and skill level.

All this discussion leads me back to the Plexus social networking article and the fact that it was deemed worthy of CECs.

Let’s look at the AHDI web site and the requirements for qualifying for getting an article, presentation, webinar, etc. approved for CECs:

Let me emphasize a few points here and how they relate to the comments made in the other entry…

“… must be formally presented by qualified professionals…”

That leaves open a pretty wide door – qualified in what? I would hope that means qualified in some way to speak on the topic being presented, yet that doesn’t seem to be the case here. A gastroenterologist is a qualified professional but probably wouldn’t be the best person to write an article on plastic surgery, no matter how well researched it was. Anyone who really wants to support the credentialing process should be confident that the qualified professional is, indeed, qualified in the subject matter being presented. Otherwise, Nae Priest (no offense, Nae!) could have written this article and been deemed a qualified professional. And I’m pretty sure she’ll admit she’s not qualified to write an article on social networking!

There are all kinds of articles, including invesigative and research pieces written by staff writers who are not “authorities” on their subject matter – they are simply reporting what they have researched. If there was a standard suggesting that in order to write about something in public media you had to be an authority on it, very little writing would get done by an one.

While I agree with that statement, not all articles are approved for CECs, either. Yet – this article was. I can think of at least one communications director for a major healthcare organization who offers a free tutorial on effective use of Facebook for both personal and business use and how to keep the two separate. And since he has spent the time to do that, as well as the time to engage in telephone conversations with me about it, I’m pretty confident that he would allow use of some of his materials for free and he might even be willing to write an article for the publication that was more authoritative and helpful. How did I connect with him? Social networking. Even within the AHDI membership network, there are qualified professionals with experience in social networking – the Keystrokes Transcription Service group on Facebook has almost as many members as the OA-AHDI, which would also have been a good resource for laying this foundation.

The requirements also indicate:

“Articles, presentations and workshops directed to lay audiences or the general public are generally not creditworthy.

This particular article earned CMTs one credit towards the “MT Tools” (4 total credits required in a 3-year recredentialing period).

By a really loose interpretation of the above, it’s possible that the basics of social networking might fall under “MT resources and references.” I say loose because the article was so general – it made no mention of MT groups on MySpace, Facebook, LinkedIn or anywhere else, or how they might be utilized to better connect with other MTs. At best, it could be described as being directed towards lay audiences. There was nothing in it that was directed towards medical transcription in particular. There are no specific healthcare documentation resources listed. It could have been in any publication.

According to Lea Sims:

The value of a social networking article for MTs (and why it was assigned credit) was simply to help the at-home, isolated MT who may be clueless about social networking get a little more comfortable with it.

OK – I get that. But I’m still critical of why this was approved for CECs. Members at AHDI may have been interested in knowing more about social networks – I’m sure there are a lot of things AHDI members are interested in, but that doesn’t automatically translate into a responsibility by the association to fill the void and give CECs for it. I’m not seeing the leap of logic that indicates telling them more in a very generalized way falls in the category of “MT Tools.” Actually bringing in the MT resources in social networking instead of making the article very general would, in my opinion, have moved the article from one directed towards laymen to one that was actually about MT resources in the social networks. If the organization feels its members aren’t ready for such specific information, that’s understandable – but don’t give CECs for teaching them how to crawl, for heaven’s sake! One would hope that the CMT credential is for people who are running, not crawling, and that the continuing education actually enhances their MT abilities.

I am sure the argument could be made that it’s just one CEC among many. The problem is that once a credibility gap occurs, we all start wondering what other flaws exist in the system. The CMT already has credibility issues. Fluff CECs that could best be described as “Social networking for Beginners” add little to the credential that’s supposed to be the hallmark of excellence. Most employers would consider social networking for their MTs to be a personal thing, best engaged in during off hours. Nobody wants their MTs spending time in the social networks when they should be working. What, specifically, is there in the social networks that makes my MTs better MTs, able to do their work more accurately or faster? And why should I pay them more to learn how to be more sociable online? To put not too fine a point on it, employers may not really care that their MTs are socially isolated – in fact, they’d probably point out that many people become MTs because they prefer to be isolated.

Maybe I could get some of my blog entries approved for CECs.

The April 2009 Vol. 19 No. 5 issue of Advance has an article on mandatory certification of MTs (“One Way or Another”). I’d link it but you have to subscribe to see the online issue.

Just the facts, ma’am

Here’s the statement that got me fired up:

Woodrow [Dave Woodrow, Vice President of Business Development with DSG, a Jacksonville, FL-based medical transcription service, formerly with SPI and Precyse] noted he sees about half of MTs in favor of mandatory credentialing.

Why would a journalist pass this along in an industry publication without getting or giving more information? The big question pertaining to that statement by Dave Woodrow is: Half of what group of MTs? How was this information gathered?

What’s irresponsible about this is that this “fact” will now start floating through the medical transcription community and industry. Shoot, it was published in a well-recognized industry magazine, so it must be correct! Nevermind that we have no information as to how Woodrow obtained this number, so we have no idea whether it’s even close to accurate.

Now about that credential…

The mandatory certification being floated is the RMT (Registered Medical Transcriptionist) credential. Of course – because AHDI wants us to think the CMT requires more experience. In truth, the CMT does not require two years of experience – it is suggested. But how would it look if new graduates could pass that CMT test? And you can’t require certification and then say only people with 2 or more years of experience can be certified, can you?

How much does anyone think it would add to the profession if the entry-level certification was required of all MTs? Let’s get real here – the CMT has been a tough sell and most people will tell you it doesn’t add any value for either the MT or the employer. But – this isn’t even a CMT we’re talking about! This is the RMT, an entry-level certification. All I can say is – I’m less than excited about this and more than a little cynical about the value it adds to the industry as a whole.

AHDI envisions mandatory certification on a state-by-state basis. Pennsylvania has already shot down licensing of MTs, although I’m having a difficult time telling if they were talking about licensing or certification or if a credential would be required to get the license. (You can read the Advance article here.)

Pennsylvania denied the request on this basis:

The Department of State Sunrise Evaluation Team wrote that MTs didn’t show a “compelling state or public interest in that there are no identifiable benefits to the public,” and cited that physicians read over the documentation “to prevent misdiagnosis or medical errors and to protect the patient.”

I would certainly agree with that, but Carol Croft, the MT who brought the request to the state of Pennsylvania, disagrees with the findings.

As far as the patient not benefiting, as the state wrote, Croft found that untrue. The patient would benefit the most from having a credentialed MT transcribe the record, she explained, and mandatory credentials would bring a new level of professionalism to the field. “I think we will all benefit, but No. 1 would be the patient,” Croft said.

While that sounds good, Croft doesn’t really explain HOW this benefits the public or the patient. If a “new level of professionalism” is the best she could come up with, then I’m not surprised the state of Pennsylvania found as it did. There’s absolutely nothing to support any argument that an entry-level certification will add anything of value to patient care.

It seems that AHDI, in its efforts to instill value in the process of medical transcription, is willing to overlook the fact that the physician is the one who provides the care, the physician is the one who documents the record and the physician is the one who is responsible for what is contained in the record. I’ve noted many times in the past that trying to lay responsibility for accuracy of the record on the transcriptionist is a very slippery slope. If there’s a question as to whether or not MTs will support the cost of certification, the bigger question is whether or not MTs – and MTSOs – will support the cost of malpractice insurance.

And what happens if a state does buy into this nonsense and require mandatory certification? That’s where the confusion begins. Will it apply to MTs living in that state, or MTs in any state working on an account geographically located in that state? The article does bring this up. Regarding pending action in the state of Washington, Kim Buchanan, Director of Credentialing and Education at AHDI, is quoted as saying:

Buchanan said the best way to do it, if a state were to approve mandatory certification of MTs, would be to have all work for that state’s hospitals done by certified MTs, no matter where those MTs might be based.

“[If] you said any health care documents in the state of Washington have to be produced by certified individuals, I think outsourcing nationally could be called into question,” Buchanan said. “We may end up seeing Washington hospitals bring their dictation either back in house or at least more local because they would have more control over it.”

Some of the comments made by MTs in the online forums are directed towards the hope that mandatory certification would mean the end of overseas outsourcing. That would only be the case if the state requirement meant that all health care documentation done for practitioners and facilities in that state had to be performed by a certified individual.

The article then raises the question of how this would affect the work force shortage. Let me go on record as saying that the work force shortage in the US is primarily caused by the work conditions and pay rates in MT, which have been impacted by outsourcing offshore. It simply isn’t an attractive career for people with the education level and intelligence required to do it. IF the pay rates and work conditions improved, it’s my opinion that there wouldn’t be a work force shortage in the US

Woodrow explained that service organizations are already operating under tight budgets and having MTs pay for their own credentials also seems like a difficult choice, as maintaining the credential can be pricey.

OK, so why are budgets and operating margins so tight? Because nobody has the guts to just come out and say “we need to charge more for this service – you simply can’t get what you want at that price.” Instead, the ambiguous line game continues to play out and outsourcing companies engage in cutthroat competition, apparently willing to bleed right along with everyone else. Would healthcare facilities be willing to pay more? Ten years ago, when Diskriter was performing benchmarking of what it costs per line to maintain a medical transcriptionist as an employee, the cost per line was 30 cents. So why are MTSOs undercutting to less than half that? If it can be demonstrated that employees cost 30 cpl, then isn’t 20 or 22 cpl still less expensive? I simply don’t understand the business model that says undercutting has to be drastic in order to be successful – unless the outsourced MT business has also bought into the healthcare model of “we’re not making any money, but we’re making up for it in volume!” In addition to cutthroat pricing, the outsourced services have practically thrown the kitchen sink into the mix as “added value” to the actual transcription, all while charging less and less. And when an MTSO has to provide ever-increasing technology – or offers it to get a leg up on the competition – without actually charging more for the service, guess where the difference gets made up? It has to come from somewhere and as long as MTs are willing to continue working for less and less, that’s where it comes from. Is it any wonder that more and more experienced MTs are walking off the field? This shouldn’t come as a surprise to anyone.

I’m not saying it would be easy to find quality MTs here in the US if the pay rates were better or that it would be easy to find outsourced companies doing a better job just because they charge a higher rate than anyone else. Sometimes, all you get is more expensive incompetence. However, the probability of getting better service would be greater and over time, as MTSOs and facilities demanded better performance from MTs in exchange for better pay, there would be more attraction of better candidates overall. In the current environment, there simply is no incentive for US MTs to do a better job than they’re doing. By the same token, there isn’t any incentive for MTs to get an entry-level credential that presents additional costs to them with no subsequent reward.

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

Please don’t get distracted by AHDI here – I’ll comment in another blog post about AHDI and some discussions I had with those present that were pertinent to AHDI.

Already, you’re noticing something different – the job title, right? Everyone in the room agreed that the scope of medical transcription is changing. I think there are few business owners and working MTs who would disagree with that. More and more clinics and hospitals are moving to electronic medical records (EMRs) and either discontinuing dictation altogether or attempting to integrate transcription with the software. They’re also demanding that outsourced medical transcription services utilize technology to decrease costs and turnaround times, with speech recognition (although it seems the newest term for this is speech understanding), turning medical transcriptionists into editors.

The medical transcription industry is struggling with these changes. These changes don’t affect only transcriptionists; they affect the entire chain, from the physicians and the facilities where they must document healthcare to the outsourced service owners to the information technology services and support. Right now, nobody is quite sure where we will all end up – we’re all just pretty sure the demand for someone who wants to just sit and transcribe from voice will go down and some sort of blended job will emerge.

Probably the best thing that could happen in this blended job would be for technology to tie the actual documentation process in with the coding and billing process (the revenue cycle). This would place the documentation process itself (rather than the document) into the revenue cycle – that “missing link” that MT has always struggled with in order to find value for itself. It’s very possible that as the EMR technology advances, the MT (a term I’m going to use just because it’s easier and I don’t want anyone to get confused) may be looking at coding a document at the same time it’s produced; it’s also possible there won’t be any audio dictation, or very little audio dictation, or that the record will be transcribed by SR and sent to the MT for editing and coding verification. In spite of the fact that many in the industry believe that it will be necessary to include dictation to get more physicians to adapt to the technology – and because, quite frankly, it’s usually faster than alternatives – this still doesn’t address the demand for point-of-care documentation. Dictated records for handling by another person (i.e., the MT) will never provide point-of-care documentation. I’m not disagreeing that dictating is usually faster and a better use of physician time or that it will speed adoption of EMRs – I’m just pointing out that it won’t ever be a point-of-care documentation solution.

And no matter how many people with years and years of experience in the industry sit in a seminar and discuss these topics – it’s all theory at this point. Nobody knows any of this for sure. We do know what the current job is; we also know we need to prepare the people who are currently MTs and the people who want to be MTs for a future that may require a broader scope of job skills. Kathy Striebel, from Mira Costa College, said she has many more people now enrolling in the coding and medical billing courses than the medical transcription ones; part of the reason for the seminar was to discuss curriculum for preparing people for a blended job.

And frankly, I think it’s about time. We aren’t any of us making much money in the traditional medical transcription industry. Compensation is going down, costs are going up, and competitors continue to drive down pricing in crazy cutthroat competition (argh!) that doesn’t benefit anyone.

Skill Set

We had an interesting discussion about the skill set required by the knowledge-based worker in the emerging healthcare documentation environment. I’m interested in knowing how MTs feel about this.

• Hardware and software proficient
• Content and technology enabled medical editing
• interpersonal business skills targeted towards distributed virtual workforce (telecommuters)
  - time management and discipline
• Critical thinking/problem solving
• Knowledge of pathophysiology, anatomy, physiology and body systems, diagnostic procedures, laboratory data, pharmacology
• Critical and interpretive listening
• Digital and internet proficiency
• Knowledgable about privacy, security and ethics
• Knowledgable about healthcare compliance and risk management
• Awareness and knowledge of medical-legal issues
• Familiar with documentation workflow
• Coding skills
• Billing practices understanding
• American English language and regional syntax proficiency

Keep in mind that the curriculum being developed is for students who are just entering a college program that takes almost 2 years to complete.

One employer stated that when she had to outsource some of her transcription, she was unable to use the smaller service she would have preferred because they didn’t have the technology capability required to service the hospital. It isn’t just individual MTs who will need to be tech-enabled; the outsourced services need to be, as well.

Recently passed legislation now holds anyone handling PHI to the same standards and penalties as a covered entity. Whether or not you think the doctors and clinics you work for, or your clients, care or whether or not you think there will ever be a problem in your small corner of the world – there are a lot of mom-and-pop long-term care facilities that are now out of business because they never thought the Medicare auditors would come down on their heads.

Look at the list of skills and ask yourself – is there much in there that can’t be described as knowledge based? Can these skills take us to a job description that will place more value on what we know than how many widgets we can produce?

Job Title

Medical transcriptionist simply doesn’t adequately describe this evolving blended job. In addition to being more descriptive, I think that a new job title focuses more on the knowledge skills of the job and less on the current production-based commodity of medical transcription.

Healthcare documentation technician: This describes the most basic level of the job, probably comparable on skill level to what the Hay Group study describes as a level 1 transcriptionist.

Healthcare documentation specialist: This is probably where many in the industry are currently at, or what the Hay Group study describes as a level 2 transcriptionist.

Healthcare documentation analyst: This job title excites me. Just the term “analyst” makes a strong statement about the knowledge level of the person with this education and experience. This is level 3 and beyond, encompassing all the skill sets.

Credentialing

Someone asked me in another discussion why AHIMA has been so successful in getting its credential accepted, where AAMT/AHDI has not. I don’t know the answer to that, but I’ve made myself a note to ask someone in AHIMA leadership. Whenever you see a job advertised for HIM, the employer usually specifies that a credential is required. This “requirement” is internal – there is no external requirement that these positions be credentialed. However, there are enough people who value the credential that when a job is posted with this requirement, there will be more credentialed applicants than noncredentialed applicants.

The problem in MT is that the opposite is true. Even if employers specified “credential preferred” in their ads – and they don’t – there are so few credentialed MTs that everyone knows it’s not really going to make a difference. If 9 people with 10 years’ experience and 1 person with 2 years’ experience and a credential apply for the job, do any of us really believe the person with the credential will be given “preferential” hiring? (No.)

I’ll save the deep discussion on credentialing for another blog, so start thinking about it. I think it’s something MTs really need to consider if they’re going to make any progress – whether it’s the CMT from AHDI or the RHIT from AHIMA.

Getting Experience

Continuing on the subject of credentialing (kind of)…

The reason I went to this seminar was to talk with people in education about what can be done to help MTs get into the job market post graduation and if there’s a way I can help employers and new graduates by offering something through MT Registry and what that might be. This isn’t an area of transcription I’ve really kept up on, especially in terms of what AHDI is doing in this regard, but I knew this has always been an issue and that it’s one AAMT/AHDI has tried to address.

Which brings us to the apprenticeship program. After years of hard work, AAMT/AHDI was finally able to get the Department of Labor to recognize MT as an apprenticeable job. Unfortunately, this has been a huge failure, for a variety of reasons. However, I’m told by employers that nobody can afford to pay a new graduate an hourly rate for 2 years, which makes employers reluctant to take on an apprentice.

Then, there are internships. An internship is an unpaid position and my guess is that this wouldn’t be terribly successful either, as most people can’t afford to work for 90 days without making any money. On the flip side of that, the employer can’t afford to put someone on the books for 90 days at at least minimum wage so they can train them, either.

Mira Costa College is going to add 10 hours of dictation to their curriculum, which a student must complete before completing the program. Still – that’s not a lot of dictation. In reality, if you convert lines to minutes at 10 lines/minute and realize that a company requires an MT to produce 1000 lines/day as an employee, that’s only 6 days of work. It’s going to be a start, but that’s all it is.

In my opinion, the ideal would be for schools offering medical transcription programs to add a module to do transcription on dead files for 3 months, with the requirement that productivity and quality guidelines be met prior to program completion. And anyone who can’t meet those guidelines within the 3 months wouldn’t graduate.

So where does that leave us?

Unresolved, I’m afraid! I’m going to save further comments for another post – I wanted to keep this one focused on the actual seminar I attended and I think there’s enough here to keep readers thinking for a week or so.