I submit for you the more realistic scenario… absent any sales pitches for a medical transcription education.

6:40 a.m. Five minutes before her alarm is set to go off, SusieMT wakes to the sound of children fighting over cereal. She’s been working long hours all week, trying to make her minimum line count and pay the bills, and hasn’t had time to go to the grocery store. The 6-year-old and the 8-year-old are fighting over the last bowl of Sugar Frosted Flakies. From the sounds of it, the 8-year-old is winning, which makes sense because he’s older and bigger. She gets up to settle the fight between the children and tells them to hurry up – they need to get ready for school. The 6-year-old tries to convince her that he’s sick and can’t go to school today, but she’s not buying it. She reiterates that they need to hurry up and eat breakfast or they’ll be late for school. She goes back to her bedroom and throws on a t-shirt and sweatpants, scrapes her hair into a ponytail and hopes that she’ll have time for a shower sometime today.

7:30 a.m. After more than 45 minutes of wrangling children through their morning routine, SusieMT runs them to school and then returns home. She looks longingly at the bed, but her official work shift begins at 8 a.m. Instead, she starts a pot of coffee and eats the rest of the cold cereal and milk the children left behind.

7:55 a.m. SusieMT starts up her computer and finds two e-mails from her supervisor. The first is reminding her that she has been assigned a standard shift and she needs to work during those hours. She is not authorized to work overtime. The next e-mail is a beg-o-gram, advising that the Hospital Z account is backlogged and asking all available MTs to help catch up on this account. SusieMT has not been authorized to work on the Hospital Z account, although she has asked more than once because they seem to be backed up frequently, while the accounts she is authorized to work on never have enough work.

8 a.m. SusieMT logs into her employer’s secure transcription platform and checks the work queue. The majority of dictation in her queue is dictation from Dr. Marblemouth, a disorganized, mumbling dictator who is like poison to a transcriptionist’s production. The rest consists of what SusieMT calls the Motley Crew, an assortment of the worst dictators for every account SusieMT has been assigned. She checks the dictation time; all the dictation is from yesterday. How can that be? She sat on the work queue well into the night and there was little to no dictation in any of the accounts she’d been assigned. She’s desperate for lines, but this ragtag assortment isn’t going to do much for her line count.

8:15 SusieMT decides to send another request to the supervisor, asking that she be authorized to work on Hospital Z’s account. While she’s doing that, she finds yet another e-mail from her supervisor. This one is advising her work group that the overseas transcription unit was unable to complete a volume of dictation due to difficulty with the dictators and the medical trancriptionists in this group need to jump on it right away before it goes out of turnaround. She sends an e-mail to the supervisor, requesting again that she be authorized to work on Hospital Z. She marks it as urgent. She returns to her assigned work and digs in. It’s all there is and lines are lines.

10:30 a.m. By this time, SusieMT is not just ready for a break – she’s ready to break something. In a little over 2 hours, she’s managed to get a mere 400 lines done. At a pay rate of 7 cents per line, she’s made a whopping $12.50 per hour, and there still isn’t any other work in her queue. She’s checked all her accounts half a dozen times, as well as her e-mail, hoping that finally her supervisor is going to respond to her request to work on Hospital Z, which apparently has plenty of work and hopefully hasn’t been cherry-picked. With no response from the supervisor (on that topic, at least), she cleans the kitchen and starts the laundry during her “break.”

10:45 a.m. With the house a little cleaner, SusieMT returns to her desk, still frustrated. The dictation in her queue is still primarily from the Motley Crew of dictators, but there is some dictation from better dictators coming in. For a moment, she hesitates, then says to hell with it and bypasses the Motley Crew to grab the other dictation coming in.

12:30 a.m. SusieMT takes another break to do some more laundry and grab a PB&J sandwich. She eats it at her desk while checking out the online medical transcription communities for job opportunities. All she finds are similar complaints: low work volume, production-killing dictators, production-killing platforms, long work hours, poor management and lack of communication. She starts to think maybe getting her own accounts is the way to go – at least then she’d be in control of her destiny.

1:00 p.m. SusieMT is back at the computer, still fighting for what little dictation is in the queue and trying to avoid the worst dictators without really being labeled a cherry picker. Another beg-o-gram from the supervisor about Hospital Z, which is still backlogged. Another request from SusieMT to be allowed to work on Hospital Z.

2:00 p.m. It’s almost time for the kids to get home from school and SusieMT is still battling to get in her minimum line requirement for the day. Volume of dictation in the queue is picking up, but the Motley Crew dictation from yesterday is still sitting there at the top of the queue. She gets a message from QA, telling her she’s sending too many jobs to QA. She says to hell with it and cherry picks through the next hour, cranking out almost as many lines in that one hour than she’s been able to do the entire rest of the day. She still hasn’t met her quota and she still has more hours to put on the clock.

4:00 p.m. The children are home from school and SusieMT’s shift is officially over. She’s still short 200 lines on her quota, not to mention the fact that she needs to get in extra lines so she can make ends meet.

9 p.m. After fixing dinner, helping children with homework, finishing the laundry, bathing the children and putting them to bed, SusieMT logs back in to see if she can pick up more lines before she falls asleep in front of the computer. There’s an e-mail from the second-shift supervisor, demanding to know why she isn’t doing the Hospital Z account, which is still backlogged. She responds, telling yet another supervisor that she’s made numerous requests to be put on that account and she hasn’t received a response.

11 p.m. No longer able to stay awake, SusieMT shuts down the computer. Still no response to any supervisor about the Hospital Z account. She got in her required lines and a few more, but unless things improve, it’s going to be another lean month. She realizes that not only did she not shower, she didn’t get to the grocery store, either. To hell with it, she thinks as she falls into bed. Maybe tomorrow will be a better day.

I was speaking of change, wasn’t I?

This weekend, I am completing some changes being made at MT Desk and MT Chat. There are also going to be changes involving MT Reference, but the impact will be felt less. Some people have received e-mails about the changes, some have seen my post at MT Chat. It’s a huge change, however, and I want to make sure as many people as possible are aware of it.

MT Chat is a discussion forum for medical transcriptionists. Originally, it was part of MT Desk. I imagine the owner at that time had good reasons for making it two different names and websites, but after a lot of consideration by me, I feel it’s time to marry them back together and put the whole kit and caboodle under one roof.

Changes at MT Chat

Regular users at MT Chat will feel the change most acutely. This is a very big change for anyone who participates regularly there.

Because the software that runs the wiki at MT Desk includes a forum, I’m going to be making MT Chat a read-only forum and ask that everyone start posting in the MT Desk forums. The look and feel of the wiki forums is very different from MT Chat. However, it’s still a forum. And the plus is that if you’re already a registered user at MT Desk, then you are able to use the forums without a separate registration and login.

The forums at MT Chat will remain available for people to view while I move the most-viewed posts to the articles section of MT Desk. At some point, MT Chat will just be redirected to the forums at MT Desk.

If you are a registered user of MT Chat and you have logged in at any time this year, you will be manually added to MT Desk. When that happens, you’ll receive an e-mail asking you to validate your registration at MT Desk; once you do, you can set a password and you’ll be good to go. If you registered at MT Desk with the same e-mail you used at MT Chat, you won’t receive an e-mail.

Changes at MT Reference

The directory listings at MT Reference are being moved to the new directory at MT Desk. When that’s complete, MT Reference will be forwarded to the directory at MT Desk, and it will be effectively closed.

Changes at MT Desk

The wiki software at MT Desk has been upgraded to better handle all these changes, and the forums and directory have been added.

The biggest impact is to registered users who have never logged in or have not logged in recently. Those registrations have all been suspended. Suspended users can log in but most of the functions allowed active users have been suspended. If you log in and you cannot post in the forums, suggest a link for the directory or comment on a wiki page, most likely your registration is in this category. All you need to do is send an e-mail through the MT Desk contact form or to the MT Desk admin, requesting that your account be reactivated. If you use the contact form, please provide the e-mail address you used for the registration. If you send e-mail, please use the e-mail account you used for your registration.

MT Desk is temporarily closed to new registrations until MT Chat is closed. You can still view the wiki pages, the directory and the forums if you aren’t logged in, but you won’t be able to post anything.

There is an internal messaging system at MT Desk that allows registered users to network with one another privately. However, this feature is only available to regular forum users. There’s been a lot of complaints about spamming going on through private messaging at MT Chat. Once a user has established himself or herself as a trusted user, they will be allowed access to this feature.

Registered users will have full access to their personal bookmarks feature, which allows them to create a list of favorite websites. There is also a mini calendar.

Why the changes?

In spite of the big change for MT Chat users, having everything at one site is much better for everyone. It means I only have one site to administer. It also makes people more aware of what is available at the MT Desk reference and style guide. There isn’t a lot of cross-over between the two sites, even though they were originally the same site. There is also some confusion, with people e-mailing me about MT Desk when they actually mean MT Chat. It also seems there are a lot of MT Chat users who aren’t even ware of the style guide at MT Desk. Having everything together gives me a better opportunity to complete the style guide and start working on additional services to offer medical transcriptionists at MT Desk. MT Reference is also an oft-overlooked resource in the medical transcription community. Even though these sites all share links with one another, my research shows there isn’t much crossover between them. I hope by integrating them all, everyone will make better use of the available resources.

I’m excited about these changes. I hope everyone embraces them and participates and provides feedback. So – see you at MT Desk!

There’s at least one technical solution to every problem, then there’s a miracle solution.

For medical transcription, the technical solution would be God coming down and visiting plagues upon the medical transcriptionists’ employers, making them raise pay rates, pay for down time, provide better benefits and paid time off. He’d send a thunderbolt straight into the heart of the speech recognition engines, filling them with unresolvable bugs so they put out the worst gibberish imaginable. He’d tangle the networks hopelessly so that EMRs would constantly be down and doctors would be forced to dictate again. Doctors would suddenly dictate with clarity and without a single um or ah. Medical transcriptionists would be blessed with accuracy and speed, getting twice as much done in half as much time! The work queues would never run dry, but everyone would be in turnaround! Children would be singing in their homes about the joys of a parent who has a legitimate work-at-home job!

The miracle solution would be that medical transcriptionists realize that medical transcription is rapidly changing and they need to change as well, because there’s nothing they can do to turn back the clock of change.

A friend of mine on Facebook who is now a former MT noted that when she announced she took a job at a hospital, working on an EHR, she was told she was a traitor. Well okay – stronger terms were used, but you get the idea.

Ten (or so) years ago, you were a traitor if you had anything to do with overseas transcription. Unfortunately, there are still groups trying to put this genie back in the bottle, as though overseas transcription is the only cause of stagnant pay rates, increased demands and less work and if it would just go away, all US medical transcriptionists would suddenly benefit from increased pay, better working conditions, more work and fewer demands.

Then, there was speech recognition. I wish I had a dollar for every time a medical transcriptionist said it wouldn’t ever be good enough to impact transcription jobs. Now, we have large facilities reducing the volume of transcription by 50% or more with speech recognition and individual doctors using speech recognition in a variety of applications to reduce or eliminate transcription.

The new traitors are anyone who works with EMRs, which have emerged as a bigger threat to medical transcription jobs worldwide than overseas outsourcing and speech recognition combined. Unfortunately for medical transcriptionists, this threat is actually more real. In spite of evidence that doctors spend precious time working on the EMR instead of seeing patients, the cost-benefit has been weighed and apparently the benefits outweigh the costs. In spite of efforts to maintain a narrative in the record, EMRs continue to roll out with slashing or eliminating transcription costs as one of the goals.

Facing the career change fear factor

If you’re over the age of 40, your parents most likely stayed not only in the same career their entire life, but they also stayed with the same employer. According to career planning experts, that has changed drastically in the last 15 years, due to changes in technology and, more recently, the economy. The Department of Labor does not have statistics about career changes; however, career planners estimate that the average person will change careers three to five times in their lifetime. That’s careers, not jobs.

That means if you’re 40+ years old and you’ve doing medical transcription most of your working life, you’d be like any average American if you’re considering a complete career change.

Let’s face it: a career change is frightening, and the older you get, the more frightening it’s going to be. If you’re close to retirement, you just want to hang on for a couple more years until you CAN retire – and in the meantime, you have bills to pay. If you’re younger, paying for an expensive medical transcription education probably isn’t all that far in your past; not only would you like to get your money out of it, you’ve got bills to pay. Whatever group you’re in, you’re struggling more and more to find a company that pays a decent line rate, allows you to be productive so you can make a decent hourly rate, and has plenty of work so you aren’t constantly struggling to get in enough lines to make logging in and working worthwhile. Changing jobs – much less careers – is an exercise in frustration and fear. Can you find a new job before you starve to death because the company you currently work for is always running out of work? Will the new company be any better?

The biggest barrier to career change is money. Any medical transcriptionist who has gone through a medical transcription education program, struggled to get that first job, struggled to get in a couple years’ experience and finally come out the other side can probably expect to pay the rent or the mortgage or whatever other financial obligations the family has determined need to be paid from that paycheck. As long as the volume of work holds, an MT knows how many lines have to be produced to keep the job and pay the bills. A career change means starting all over – possibly schooling and the time and expense associated with that, training and job hunting, during which time there’s uncertainty about how those bills will be paid.

Another barrier to career change is the knowledge that, like medical transcription, many careers require that dues be paid. The dues paid in medical transcription is the steep learning curve, even for those who have a good education. The thought of going through another round of dues-paying with a completely new career is daunting. And, having paid your dues in medical transcription, realizing maybe this career isn’t going to help you accomplish your financial goals and you’re going to have to start over with a new one carries a huge psychic cost.

Switching careers is most difficult for those in the 35 to 55 age group. For most people in this age group, there are more financial and family obligations and considerations. Any change can upset what is already a delicate balance. It’s kind of like sticking your hand into a box and grabbing a handful of sand – you can’t hold onto the sand, but you can’t pull your hand out of the box, either.

After the miracle

Let’s imagine for a moment that the miracle happens and more and more medical transcriptionists say we’re fed up, we can’t work like this, there has to be something better. What happens next? (Hint: a union is not the answer.)

Time to evaluate what career will meet your financial and social needs. When MTs post on the medical transcription forums that they’re working more and more hours just to meet their minimum line requirements or make ends meet, I have to wonder whether they wouldn’t be better off with an office job, even with travel time. I can say from experience that the biggest problem with a home office is you never leave the office.

An office job might require that children be left in someone else’s care all day – but what are MTs who are at their desk 10 to 12 hours a day doing with their children, anyway? Is there any quality interaction going on there? I know there wasn’t in my house. I was stressed and working too many hours. Looking back, I have no doubt I would’ve spent more time with my children if I’d had a job that I could leave at the office. I wouldn’t have made as much money, but I would’ve spent more time with my children. If I was at the same point in my life today, I’m not so sure I could also say the money is better. Maybe it’s time for the MT who wants to be a work-at-home-mommy to evaluate how much mommy the kids are actually getting, and whether a career change – even one working outside the home – would result in more quality time with the children.

The other reality is that there are probably as many medical transcriptionists who have to work at home as there are ones who want to work from home. Those in rural locations, those who have health issues, those who care for elderly parents… there are a lot more reasons for working at home than just staying at home with the kids. My point is that if you have options, it’s probably not a bad idea to see what they are and whether or not a career change would be an improvement.

My husband has been pushing me to learn coding, so I’m going to put this one out here. Medical transcriptionists have skills that are transferable to coding. Coders are in demand and that demand is expected to continue. Coders have always made more than transcriptionists. There are telecommuting coding jobs. ICD-10 is being rolled out in the US, which means experience is going to be less of an issue for new coders – ICD-10 is radically different from ICD-9. I am told the current average coder is near retirement age and many of them are planning on retiring, rather than learn ICD-10. This will mean an increase in demand for coders. My hesitation about this career is that it is/will go in the same direction as transcription; i.e., overseas, commoditized, with shrinking pay rates. I am assured by many people that this is not a concern. I feel it’s something for MTs to look at, at any rate.

It takes a lot of focus and commitment to successfully change careers. It also takes planning, developing short-term, intermediate and long-term goals, and the support of your family. And in an economic downturn, it can feel like jumping out of a burning airplane. But let me pass along some wisdom my 25-year-old son imparted to me one day. We were talking about education and he said that what convinced him he needed to finish college is someone saying to him in two years, do you want to just be two years older – or two years older with a degree?

So I’ll ask the medical transcriptionists who are struggling with their fistful of sand in the box: In two years, do you want to just be two years old and still struggling as a medical transcriptionist – or do you want to be two years older with the skills to start a new career?

Related information:

1. How to switch careers in a recession
2. How to change careers without going broke

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.

In case you aren’t up on the book publishing business and missed Borders’ bankruptcy filing and shuttering of over 200 stores, the traditional book publishing establishment is going through the pangs of change; i.e., the change from paper to digital.

Sound familiar?

The change from analog to digital forced a change in the music industry and how it does business. Likewise, the change from paper to digital is forcing a change in the publishing industry. The change from analog to digital has also forced a change in the medical transcription industry and continues to change as medical records move to fully digitized medical records.

I was reading a long (too long) discussion online about the digital revolution in the book business and this got me thinking about similarities in the medical transcription industry.

Medical transcription as a niche market

One point the authors make that resonated with me was a discussion about niche markets. Before the invention of electricity and electric lighting, candlemakers were in the lighting business. We all enjoy candles but most of us don’t use them as our primary source of lighting. Candles are now used primarily for decoration and scent. Candlemaking is no longer the major industry it was and it is no longer in the lighting business; it is in the niche market of candlemaking. Candlemaking is still a business and it still generates significant revenue, but not nearly as much as it did when it was in the lighting business. That means fewer companies making candles and fewer employees making candles and fewer people selling candles.

I could go on and on about how major industries have become niche markets, but I think you get the idea.

Likewise, medical transcription is becoming a niche market. As some industry sectors are fighting for preservation of the narrative record, larger forces are fighting for a point of care digital record and its numerous advantages over traditional documentation methods. Even if the narrative record fight is won, what will most likely to retained as traditional transcription will be a niche market. The consultant will no longer dictate a past history, medical history, medication list, allergy list, surgical history, etc., when it’s already readily available and easily accessed in the digital record. The discharge summary will no longer summarize all that, plus all the labs and studies that were done during the admission because they’re already readily available in the digital record. The narrative portion of the record will shrink significantly. I’m not sure what that niche market will look like, but I know it will be a fraction of what the medical transcription market has been in the past. Like the candlemaking business, that will mean fewer companies doing transcription and fewer employees doing transcription.

Medical transcription is not dictation/transcription

In the 1930s, automobile travel began to cut into the railroad’s passenger travel market, but freighting was really the meat and potatoes of the rail system. The development of the interstate highway system dealt a blow to the railroad industry, followed by the extra punch of air travel and freighting in the 1950s and 60s. Add onerous federal regulations and stagnant labor unions and the railroad industry was on its knees. Railroad industry leaders thought they were in the railroad business, but the railroad industry wasn’t in the railroad business – it was in the transportation business. The inability to grasp the concept nearly killed the industry. In 1939, there were 132 class I (freight) railroads. Today, because of mergers, bankruptcies and major changes in regulatory classification, there are only 7.

Except for the labor unions, that sounds pretty familiar, doesn’t it?

The railroads were ultimately saved by your tax dollars, in the form of Amtrak and ConRail. ConRail subsequently privatized and the railroads were deregulated, making it possible for railroads to operate free of government regulations that had made them unprofitable.

(You can read all this at Wikipedia – I’m just summarizing for you).

In spite of the similarities between the two, don’t look for a government bailout of the medical transcription industry. The US government, in fact, is aggressively pushing digital records. If it supports any industry, it will be the electronic records industry. (Conspiracy theorists, start your engines!)

Which brings me to the publishing business. The blog I was reading noted that, similar to the railroad industry, the publishing industry thought it was in the business of publishing. With the development of digital books, it’s becoming apparent that the publishing industry is actually in the business of distributing printed information and entertainment (thanks for the refinement, Moriah Jovan!). As self-publishing becomes easier and more acceptable, the necessity for a publishing company that distributes books (paper or digital) is further eroded. The publishing industry is trying to preserve its place by attempting to suppress self publication and digital book distribution, a move that just about everyone in that industry can see is a last-gasp effort that isn’t going to work. Amazon (and now Barnes and Noble) are staying viable by embracing digital books, as well as self publication. In 5 or 10 years, will anyone care that an author’s work has never gone through the gatekeeper of a publisher? Probably not.

If you want a blueprint for what’s happening and what will continue to happen in the medical transcription industry, just take a look at the music and publishing industries. The music industry has survived, but it’s not the same as it was before. Apple iTunes has become the #1 seller of music in the US. I’m not sure the traditional publishing industry will survive; at the very least, it will be radically transformed and the people who work in that industry will have to carve themselves a new place in the niche markets that spin off the publishing industry.

Like my transition to digital books, doctors are kicking and screaming and swearing they won’t like it, but they are adapting digital records and they are becoming accustomed to the advantages. The technology is improving and will continue to improve; at the same time, it will become less expensive. The users are becoming more adept at the technology. I think we can count on the trend to continue. Likewise, transcriptionists are kicking and screaming and swearing – speech recognition editing, overseas competition, low pay rates – can we expect any of this to change? I don’t think so. I think that as the medical transcription industry responds to changes it’s undergoing, some medical transcriptionists and transcription companies will carve out a place in developing niche markets, others will move to related healthcare fields where some or all of their skills can be applied, and a lot will leave the industry altogether. The speed at which technology moves makes it nearly impossible to see where the medical transcription industry may end up. Right now, it seems that smaller companies are losing out, as they don’t have the financing to support the technology requirements – or even rent them. I’m hearing from more and more independent transcriptionists that even their long-term accounts have stopped dictating entirely, in favor of an EMR (regardless of well it works for them). I think the larger companies have already started making the move from the business of transcribing dictation to the business of providing technology to document healthcare records. In the meantime, the Department of Labor keeps reporting that medical transcription is a good career option (I think it’s time for an update on that one), the medical transcription schools continue to do a booming business, churning out people who soon discover that they cannot get a job or, if they do, they struggle to make minimum wage – if they finish the program at all. I think more and more transcriptionists are looking at – or have already implemented – other options because they cannot tolerate the financial instability of the shrinking market and deteriorating pay rates. You have to ask yourself – in 5 or 10 years, will anyone care that doctors used to dictate and someone transcribed the dictation?

So what is the medical transcription business? Traditionally, we’ve thought of it as the business of taking recorded dictation and turning it into typewritten records. The upheaval in the market is redefining how we think of the business of medical transcription. I’m not sure what the medical transcription business is really – I’m only certain that it’s no longer taking recorded dictation and turning it into typewritten records. 

The light at the end of the tunnel may, unfortunately, be a train.

I’m soliciting comments: what do you think the business of medical transcription is, really?

The topic at AHDI Lounge is AHDI and MTs. Basically, it’s a highlight for the more in-depth AHDI “Let’s Talk About…” series and Barb Marques’ AHDI and MTs (PDF) talk-about. While Barb Marques’ piece is interesting, for me the most interesting part of this AHDI Lounge post was the comments (as is usually the case).

The first comment refers to the impact the VBC (visible black character) standard (explaining why this isn’t really a standard is another discussion entirely) has had on medical transcriptionist’s pay rates.  To which Laura Bryan responds:

AHDI is not responsible for issuing the “VBC”. This standard was issued by MTIA and AHIMA.

Now, just to be clear: Laura Bryan has no official position with AHDI. As far as I can tell, she never has (and I’m quite certain I don’t need to invite anyone to correct me if I’m wrong, but please let me know if I am). At the very least, however, she’s a very vocal supporter.

To which I asked – why wasn’t AHDI part of the task force on the visible black character?

And Laura responds:

@Julie, the standard was intended to address BILLING, not compensation. The MTSOs and AHIMA are most involved in billing negotiations.

When I noted that billing and compensation are related, Laura elaborates:

@Julie, I didn’t say they weren’t related. But it is common knowledge that billing is not necessarily calculated the same way as compensation. The standard was not intended to address methods of calculating line rates for the purpose of compensation.

The way I understand this statement, Laura believes AHDI wasn’t involved in this task force because it was about billing, not compensation. This is a direct contradiction to the following statement by Barb Marques in the referenced Let’s Talk About… article:

We have few weapons in the arsenal to “force” employers to alter their compensation practices. As I shared above, sometimes the only way to impact something you can’t get your hands on is to chip away at the walls around it in hopes of a breakthrough. For AHDI, that means identifying and addressing marketplace drivers that impact billing, whose inarguable bedfellow is compensation. (emphasis added)

I don’t know about anyone else, but I would certainly classify the VBC white paper as a market driver that impacts billing. And let’s not get confused as to the difference between recommending compensation rates and setting standards. When the organization was AAMT, it most certainly was involved in all kinds of standards setting, including billing.

One goal of the white paper was to provide a standard that would give the customer base the ability to compare apples to apples when evaluating proposals from outsourced medical transcription services. However, that was only one goal.

The goal was to implement a standard for content measurement that health information management (HIM) practitioners can use to evaluate in-house transcription staff and external transcription service suppliers.

And makes the recommendation:

The task force recommends that this definition be adopted by all organizations producing medical transcription, including those using in-house staff to transcribe dictation.

That’s pretty clear intent, wouldn’t you say? Anyone who thought it wouldn’t impact transcriptionists working for the outsourced services is either brain dead or sleeping at the wheel.

AHIMA subsequently issued a FAQ (frequently asked questions) about the white paper, where it states that the white paper does not call for MTSOs to change compensation methods for medical transcriptionists.

Though adoption of the VBC unit for compensation of medical transcriptionists was neither the intent nor recommendation of this paper, we recognize that some will choose to adopt it for compensation and strongly encourage those service owners to engage in the same research and analysis outlined in this paper, as well as dialogue with their transcriptionists, in transitioning to this new methodology.

I read this as AHIMA backing down from what was actually published in the white paper. I question why the white paper would recommend adoption by all organizations and specifically include in-house staff if the intent wasn’t to apply the VBC to calculating compensation.

Additionally, let me point out something maybe Laura has forgotten: not all medical transcriptionists – not all members of AHDI, even – work for a hospital or transcription service. I’m not quite sure how Laura could forget this, since she runs a medical transcription service and is obviously a member of AHDI. The suggestion that AHDI would decide to bow out of a task force attempting to set standards involving billing units because it didn’t involve compensation suggests that AHDI isn’t representing the interests of all its members.

Perhaps AHDI didn’t bow out; maybe it was never invited to the table. If that was the case, it demonstrates the weak position AHDI has in the healthcare documentation community.

In all fairness, Laura does make the point that the “standard” is being applied in a detrimental way that was most likely not intended and that AHDI did say it was not in favor of the VBC without adjusting equivalent pay. This is, in fact, stated in the white paper:

Financial analysis must be completed to establish the equivalent VBC pricing in comparison with the existing rate and unit of measure. The company must then ensure the counting and financial applications are properly configured to support the new method for consistency and verifiability. As mentioned previously, comparative modeling showing each method side-by-side on invoices will more than likely be required.

The same problem came into play when the 65-character standard was enacted. But that doesn’t excuse AHDI from taking a back seat in any attempt to set standards that impact the industry. The fact that there were problems associated with the 65-character line standard, which AAMT ultimately backed away from as a result of these issues, isn’t a reason to bow out of any further attempts to set standards that will impact transcriptionists, the industry and compensation. I would argue, in fact, that it was an opportunity (now lost) to take the lead to make sure billing standards that could impact compensation would not be used to the detriment of transcriptionists.

Donna Littrell questioned the use of my time in addressing the issue. I’ve been in the discussion forums online for a long, long time – and questioning someone’s effective use of time in pursuing a line of discussion is intended to stop a conversation, similar to Godwin’s Law:

As an online discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches.

Were I to posit Julie’s Law (well, Laws, since there has to be more than one), it would be that as soon as someone reaches the point where they cannot logically defend their position, they will call into question the use of time of (a) the original poster, (b) other participants in the conversation, and then declare THEY don’t have time for this nonsense, so they’re done discussing it.

So, I decided to address a topic that is surely dear to the heart of the founder of ATA and its members: anti-offshoring attitudes and policies in the medical transcription community.

Let me start by relating an incident that happened to me many years ago, when offshoring first became an issue. At that time, I was paying for a listing in a publication that listed medical trancription services. (I believe this publication is now defunct, but I have the 2003 and 2004 directories, which is like looking through a registration of gravestones.) I received a solicitation in the mail about listing my service, filled it out and sent a check. I was subsequently contacted by the editor, who told me they would be unable to list my business in the directory because they had a policy against listing companies that were involved with offshoring work and they believed I was sending work overseas. I asked the editor to point out to me where in their contract this policy was stated. She stuttered and stammered a bit before admitting the policy wasn’t written. She also couldn’t tell me when the policy had been put into place. Then, I asked her how they were verifying whether or not a company sent work overseas. Signed affadavits? Audit? Not to my surprise, there was no verification process. Obviously, with no verification process and no written policy, the policy was being unevenly applied. In fact, I had the prior year’s directory and I pointed out to her all the companies that were listed that were sending work overseas and/or doing training overseas. I asked her if she really wanted to go down this road, at which point she decided that maybe, in fact, they would allow my business to be listed in the directory.

The editor admitted that her reason for attempting to deny my listing was based on posts I’d made in medical transcription forums that she felt were supportive off offshoring. Aside from that, whether or not I was sending work overseas isn’t the point. Even if this editor had had a written policy, there was no way to verify the accuracy of any information. And, as I’m going to discuss, application of any policy is, by its very nature, difficult to impossible to uniformly apply.

How far is someone who is anti-offshore willing to go to stand by their principles and walk the walk? This is where things get sticky.

First of all, how does an individual or organization verify the uniquely nationalist work ethic and policies of a company or individual? Take their word on it? Ask for copies of contracts? Not having a process in place to verify the truthfulness or accuracy of claims is the same as having a contract with no early termination penalty; it’s a nice framework for working together, but pretty toothless. The organization formerly known as MTIA based its membership categories (and dues) on revenue, and members were required to submit financials. At least they’re asked to prove a positive – how do you prove a negative?

In spite of my belief that absent a method of independent verification, these policies are worthless, I’ll continue…

How far is an organization or individual willing to go to walk the walk and back up their beliefs and/or policies? Refuse to work for a company that sends work offshore? Boycott publications that accept advertising from companies that send work offshore? Boycott websites that are owned by offshore interests and/or have advertisers that are offshore or send work offshore? Refuse to accept advertising from companies that are involved with offshore transcription? Boycott vendors that sell their products and services to offshore companies or companies that send work offshore?

The possibilities seem endless, don’t they?

Over the years, anti-offshore sentiment has evolved to center around privacy and security issues. HIPAA and HITECH have strengthened this argument – and I believe it is a valid concern. Looking at significant HIPAA breaches over the past year reveals that out of over 260 incidents reported that affect 500 or more individuals, only 3 involved transcription services. For more information, you can read Brenda Hurley’s summary. Right now, I’m feeling like I ought to contact Gair Transcription and offer to do some consulting about their online presence – aside from their address (in the US), Google search results returned only information about this breach. But here’s my favorite part – they exposed PHI on the internet for over 2 years! <thud> I don’t even know if any of these companies are involved with overseas transcription, but since these breaches occurred on their servers, it’s really a moot point.

Quite frankly, I’m more concerned about hackers in Russia than I am about transcription contractors in India.

To drive the sticky wicket in even further, we might be able to make an issue over whether or not these companies utilized overseas website maintenance and programming. Whether or not there was a breach, any overseas contractor maintaining the website would have access to the same information a transcriptionist would have – probably more. Is that something medical transcriptionists object to, or are they leaving that issue for the US programmers? In fact, according to Dr. Ahmed, he worked on the website design and programming for MT Stars. Is anyone concerned that their personal information is being exposed to someone in Pakistan who might do God-knows-what with it, or are they all using fake and throwaway e-mail addresses, so they don’t care? Does anyone ever wonder if their company website is programmed overseas? Maybe ATA should add a membership restriction that includes using offshore programmers, since they’re concerned for the security and privacy of American’s data.

There are healthcare providers who don’t have a problem with the privacy and security issues of sending transcription overseas. There are medical transcription companies that feel the privacy and security measures they have in place meet the requirements, even for overseas employees and/or contractors. The fact that there has been no large breaches involving overseas contractors supports the confidence these companies have in their policies and procedures for dealing with offshore workers. Where I do feel problems may arise are in situations where a small MTSO or an independent MT may not have adequate measures in place when transmitting PHI to small MTSOs or independent contractors offshore. Ultimately, however, the US entity will be the one on the hook – and the US entity will have to decide whether or not the risks are worth the benefits.

When I look at the So What Can We Do? recommendations in the ATA’s open letter on offshoring, I see an effort that is well-intentioned, but rather naïve. In reality, what Americans (in fact, most people worldwide) are willing to give up in terms of privacy is changing at an incredible rate of speed. You could close your social network and e-mail and all other online accounts and log off the internet permanently – and there would still be a huge volume of information about you available on the internet. It might even all be contained on servers within the borders of the United States of America. The fact is, you can’t control what others do and how they conduct their business. Your information is being tracked in hundreds, if not thousands, of different ways. If we limit the conversation to only your medical information, your doctor, the hospital, the laboratory, the pharmacy and your healthcare insurance carrier are only the starting point. The largest reported HIPAA breach so far this year is being reported by HealthNet – a large insurance carrier.

When we bank online, watch the pharmacist verify our insurance information and medication record on the computer and watch the doctor send our records to the hospital with a push of the button, pay a credit card online, hand a discount card to the cashier at the grocery store – and a host of other electronic events that have become ubiquitous in our day-to-day lives – we are relying on the company we’re entrusting with our personal and financial information and that it has made every effort, even extraordinary efforts, to safeguard that information. Not just because they can be sued, but because their interests in safeguarding that information align with our own. Even though we are aware that there is a possibility that our information could be stolen, we have consciously or unconsciously weighed the risks and decided the benefits are greater than the risk.

Which brings me back to that sticky wicket. It’s pretty obvious to me that at some point we have to accept that in the medical transcription industry, we can’t possibly boycott everything that touches the offshore transcription industry. And we can’t prove a negative. At whatever point a person or organization comes to that realization, they have to either set limits they can live with – or start rationalizing and defending the inconsistency between their actions and their stated principles.

Being the digital packrat that I am, and being a subscribing member to historic domain name ownership records, I think I can adequately answer that question. And it’s a good review for everyone who wasn’t around in 2008, when there was a question regarding the site ownership. And, I hope, an eye-opener for all the flag-wavers over at MT Stars who seem to believe it’s a site that supports medical transcriptionists against offshoring work.

The domain name was registered on August 5, 2002. While the domain registration history isn’t available quite THAT far back, it is available beginning on May 19, 2003.

Click on image to view full size

What’s interesting about this information is that although the domain name is registered to Zeshan Ahmed, the address and telephone number are in Glendale, Arizona – which is near Peoria, AZ, where Sheri Steadman lives (or lived at the time). In a public post at MT Stars, Dr. Ahmed explained his involvement with Sheri Steadman (more on this later) and how he lived in Arizona for a short time.

However, in June of 2004, the domain name ownership changes to show Sheri Steadman as the owner of MTStars.com.

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Back to that post at MT Stars where Dr. Ahmed explains what happened… this post has been removed from the MT Stars site. Isn’t it fortunate that I happened to have printed it, as well as Sheri Steadman’s relevant posts on the internet, to a PDF file at the time it was available?

On February 27, 2008, Sheri Steadman posted at MT Stars that the MTStars.com domain name had been hijacked and taken over by an offshore entity. On March 3, 2008, she posted at MTStars.net that Dr. Ahmed “turned the site over to me” when he returned to Pakistan. She claims he was selling space on her server without her knowledge or consent, and she ended their relationship. He then “took the site over.” I’m not sure quite how that happened, when the domain name was registered in her name, unless he had access to the domain name registration account.

Dr. Ahmed explains that the domain name was registered in his name since its initial registration in 2002 (true, as far as I can tell) and that he worked with Sheri, developing her business web site while he was in Pakistan. In January 2003, he came to the US and met Sheri in AZ. At that time, she offered him a job working as an MT and web developer for her company. He remained in the US for 5 months, then returned to Pakistan, for some odd personal reasons [sic]. He claims Sheri handled the domain name renewals and income from MT Stars because he he no credit card and could not get Paypal in Pakistan. He invites the reader to verify with the registrar that he transferred the domain name to himself:

Finally, the domain was shifted to my account in August, 2007. She did it herself, with her own consent and there was no hijacking or cyber squatting etc. involved in this process. The rest of it can be verified from GoDaddy as they keep track of each transfer IPs etc.

There are two small problems with this invitation: (1) Godaddy is not going to verify this information to anyone except ICANN, unless they have court order and (2) early in 2006, the domain name registration was privatized, which hides the ownership from public records. Breaking through the privatization would, again, require a court order. There is absolutely no way for any of us to verify any of this information. What I do know from the registration history is that from June 2004 until the domain name registration was privatized in early 2006, Sheri Steadman was listed as the owner.

But then, in early 2009, something interesting happens – for about 2 weeks, the registration privacy shield is lifted and we can see the registration information:

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Who the heck is Najeeb Iqbal? In his 2008 post, Dr. Ahmed claims:

She owed me $7000 in October, 2007, when I sold the domain (for $7000)  to one of my friends with a promise that the domain will be sold back to me by Feb1st, 2008 and I will return his money

I’m not sure if the registrant above is the friend Dr. Ahmed refers to, but this registration information is almost a year past the date Dr. Ahmed states the site would be sold back to him. There’s no way of knowing when the ownership was transferred back, because the privacy veil was drawn again after only 2 weeks.

Fast forward to April 10, 2011 and the privatization drops again. Coincidentally (maybe), this is the date when posters at MT Stars started questioning the ownership of the site. If Dr. Ahmed wished to give us all a peek at his name so the questioning parties could see that he still owns the site, maybe he missed the point of the questions – because what we can also see (in case anyone missed it back in 2008), the owner of MT Stars is, in fact, a Pakistani national living in Pakistan.

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Let me tell you why I find all this blog-worthy (because I’m sure you’re wondering!). I’m blogging it (a) because I was asked about it and (b) because I love irony, such as:

• The big red, white and blue American flag flying across the site header
• The job board, which warns that “MTs outside of the US are restricted from this site – do not solicit!“
• A full board devoted to Offshore Concerns
• A post from Moderator, titled What is Wrong with Offshoring Transcription?

All this on a site owned by a Pakistani national who lives in Pakistan and has, as detailed in the 2008 post, worked as an MT, outsourcing work from the US. I guess he has no problem owning a site where he and his countrymen are constantly bashed, just as long as he gets advertisers.

All this anti-offshore stuff gets rather murky, doesn’t it? I guess if you’re Sheri Steadman, it’s not okay to put US medical transcriptionists out of work by offshoring work – but it’s okay to put US web developers out of work by offshoring work. And if you’re a medical transcriptionist who is against offshoring work, I guess it’s okay to post that at your favorite site – even if it’s owned by one of the same people participating in doing the very thing you’re against. As long as it’s convenient, of course. And I guess if you’re the American Transcription Association, it’s okay to pay someone in Pakistan for advertising on their flag-waving site, because it gets your message out to the right people.

Talking the talk without walking the walk is nothing new in the MT world, unfortunately.

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.