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!

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.

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.

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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.

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.

Here’s the gem that was posted yesterday after I got busy doing other things and forgot to go back and check to see what else was going on over there. This is by Ava Marie George, a member of the AHDI Board of Directors and the president-elect.

Here we have change in our profession offering opportunity (albeit at a low rate of pay) to document patient encounters firsthand.

Various blog posts about medical scribes (my post From Medical Transcription to Scribing?, and Kathy Nicholls’ MT Tools Online) make it clear that it’s very questionable at this time whether or not this is a career transition or change for medical transcriptionists.

Even more important, we’ve been battling perceptions about medical transcriptionists for years, ones that have resulted in deteriorating pay and work conditions. I have a fundamental disagreement with the direction AHDI has taken in an attempt to increase the value of medical transcriptionists (i.e., that MTs have a responsibility to ensure the accuracy of the record). Is she really saying that MTs should be jumping up and down to do this job all for the joy of being in the same room as the doctor and the patient? Because that, to me, seems like a giant leap in the wrong direction.

In reading that statement, I get a mental image of some scene from the 1950s (the woman, of course, is wearing a dress, high heels and an apron). Golly gee, doctor! You don’t have to pay me much, I’m just so happy to be here working with you! Excuse me a minute while I drag out my virtual barf bucket.

Unfortunately, Ava Marie doesn’t stop there.

Are we willing to change our point of view and take a lower rate of pay to assure that the documentation is correct?

Here’s a news flash for Ms. George, and anyone else who thinks this line of thought is worth pursuing: I work for the money and no other reason. I don’t care what slippery slope AHDI has committed itself to, those records belong to the physician and it is the physician’s responsibility to make sure the documentation is correct.

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?

I’m just flabbergasted that the president-elect of AHDI would think this way, much less say it in public. At least the college students who take this low-paying job are doing it because apparently it looks good on their resume and there’s a motive behind the madness. Not so with MTs who would transition to this job. You’d just be trading one low-paying job for another – only now you have to get dressed and drive to work. I don’t know about anyone else, but I don’t love medical records documentation enough to do that. If I was going to pay the kind of money TRSi is charging for this 6-month program, it wouldn’t be so I could get a job that pays $8 an hour. If you just think it’s thrilling to work in a doctor’s office, there are a number of jobs that require little to no education and/or training and here where I live, they start at $10/hour.

Let the train leave the station, Ms. George. Some of us would rather pick a new train than stay on one that’s just headed in the same wrong direction as the one we’ve been on.

They have a communication problem.

And my response to him was something along the lines of…

They communicate, but people don’t seem to understand their message.

His response was very succinct, and accurate.

That sounds like a communication problem to me.

That was many years ago, but I remember it like it was yesterday. Because nearly every time I read a communication by an AHDI official spokesperson, I’m reminded of it. In fact, I think it’s gotten worse, because now they’re communicating in social media, and with about the same success rate.

Today’s case in point: AHDI Lounge – TRSi to Train Medical Scribes.

Let me say to start: congratulations to AHDI for what appears to be a bigger effort to allow a conversation on their blog. Either they hit a particularly hot topic here, or they’re allowing more of a conversation than they have in the past. I’m going to give them the benefit of a doubt and say it’s probably a combination of the two.

On the negative side? Jay Vance’s “blogging” style, which consists of nothing more than copying and pasting a large part of a news item or someone else’s blog post. Jay? This is not blogging. It’s not even reporting. If you have nothing original to say, then just syndicate content from other blogs and stop pretending that you’re blogging. And look up Fair Use copyright laws while you’re at it.

Someone in the AHDI office is probably still scratching their head, trying to figure out how they came under fire for something TRSi is doing, something AHDI has no oversight over. Allow me to try and give some insight to that: Jay copied and pasted part of a press release to the AHDI Lounge blog with absolutely NO original content; nothing to indicate how he feels about medical scribes, TRSi, Scribe America, the entire process, or any indication that he has any thought about it at all. He didn’t write a blog post about the concept of medical scribes, or how scribing relates to medical transcription, or what he thinks about the transition possibilities for MTs. In short, he didn’t communicate. Therefore, this ends up looking like some kind of official announcement by AHDI about a corporate member of AHDI that has an approved school. Is it any wonder readers took it as some kind of endorsement by AHDI?

As I’ve so often seen at the AHDI Lounge, the focus of the conversation deteriorates via the comments section, as AHDI members and staff become defensive about AHDI rather than attempting to keep the conversation on track. My guess about the lack of any original thought by Jay in these posts is that they are an intentional conversation starter and he doesn’t want to inject his (or AHDI’s) opinion. The problem with that strategy is that it leads to the kind of comments we see here, because there is no point of focus. The typical purpose of a blog is for the blogger to HAVE and EXPRESS an opinion, not just regurgitate news feeds (otherwise, it’s a news feed, right?).

But what really frosted my keyboard in this conversation was this comment from Lea Sims.

Anyone who can’t engage here within those parameters is welcome to take the desire for blood-letting to any of the many other forums where that kind of dialogue is not only tolerated by encouraged.

Here’s a fact for Lea: when you say something like this, you’re engaging in the same kind of blood-letting. Oh, you can tell yourself you’re not, and you can try and dress it up and make it look nicer, but it’s still a pig in lipstick and most of us recognize that. And the sad thing is, you could have easily made your point without the backhanded slap or even bringing up anyplace you’d like to send the rabble to (virtually, of course). It’s the responsibility of official staff members and elected officials of any organization or company to take the high road in any conversation, not the high horse.

I can hear the but… but… but… all the way across the internet. But Julie you do this all the time. Yes, I do! But I don’t represent anybody or anything, officially or unofficially. I’m not a member of anything and I don’t hold any elected office. I’ll be the first one to say I’m just an opinionated loudmouth with a couple of websites and a lot of bandwidth. I get to say whatever I damn well please in that capacity.

However, the person signing comments as “Director of Professional Services, AHDI,” is most certainly posting in that capacity, not as an individual. And the Director of Professional Services needs to be… well, professional… online and off, in any venue where you either present yourself in your official capacity, or can be seen as functioning in your official capacity.  When you represent an organization that is pounding out the platform of professionalism and higher standards, then by golly – your staff members and leadership should be the shining example of professionalism and higher standards in all communications, regardless of personal opinions or biases. You don’t get to tell people to go to hell, even if you envision hell as a forum where “blood-letting” is encouraged.

What I’m see in this communication style is a lack of respect for medical transcriptionists and a decidedly unprofessional approach to communication. Medical transcriptionists participate in those forums that Lea so willingly denigrates, medical transcriptionists own or run those forums, and medical transcription schools, vendors and companies advertise on them. The hallmark of online communication is would you say that in a face-to-face conversation? Unfortunately, for AHDI I think the answer is yes. And that should tell medical transcriptionists everything they need to know about the organization presenting itself as the professional representative of the industry.