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

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.

In a prior post, Internet Marketers and Medical Transcription, I noted how medical transcription is an attractive target for internet marketers. What I didn't talk about was flogs.

In the medical transcription world, a flog might look like this:

Hi, my name is Jill. A couple years ago, I was desperate for work I could do at home to make some extra money for our family. A friend of mine told me about medical transcription, so I checked it out and found out it's a great work-at-home career for people like me. I went to XYZ Transcription School and got my certification. When I graduated, I found a job right away and now I'm making extra money while my children are in school. I don't have to pay for daycare, either – by the time they come home from school, my work is done and my house is clean! If you want to work at home, you should sign up today to go to XYZ Transcription School and become a medical transcriptionist, just like I did!

What makes this a flog?

What would make this a flog is if the person who owns the site and posts the entries isn't named Jill, didn't go to XYZ Transcription School (or any other transcription school) and/or isn't working as a transcriptionist – and never has. The site exists solely for the purpose of attracting people who are searching for medical transcription careers, work-at-home careers, etc., convincing these people that medical transcription is a wonderful career and that XYZ Transcription School will do a fabulous job of preparing them for this career – then referring them to XYZ.

Why would they do that?

Because XYZ Transcription School will pay them $$$. This is known as an affiliate arrangement, where you have the advertiser (the MT school) and the publisher (the web site). Depending on the program, they will get paid for a lead (an e-mail address, which is why many of these have a "free" giveaway that requires signing up for a mailing list), a phone call to the school and/or a sale. Most of them pay based on a sale and the amount can be substantial. For example, FutureMT pays $160 when an affiliate site sends them someone and a sale is generated.

Don't get me wrong – I'm all for generating revenue. And there's nothing illegal or immoral about affiliates or affiliate ads.

However, not only are flogs immoral (in my opinion) – they are also illegal. And they always have been.

Pity the poor FTC, having to police the internet.

Example of a suspected flog

I came across this site that just practically sat up and announced  "I am probably a flog" to me. Somehow, I really doubt that "Kate Delaney" is really someone who went through the program and now works as an MT. If you send her e-mail and ask her questions about FutureMT, getting a job as a new graduate, is she hiring, who does she work for, how does she like it – you aren't likely to get an answer. Even though her contact page gives an e-mail address and tells you to contact her if you have questions about a medical transcription career, an e-mail I sent 2 weeks ago from a gmail.com mail account still hasn't been answered. Maybe she's busy transcribing.

Or – maybe she's busy doing other stuff because she isn't actually Kate Delaney. Look who owns the domain name: Beth Stefani of Lariat Group. (I'm going to start the timer after I post this and see how long it takes Beth Stefani to make this registration private.)

Now, it's POSSIBLE that "Kate" hired Lariat Group to buy her domain name and manage it for her because teaching businesses how to manage blogs and be profitable is one of the services offered by Lariat Group.  I would hope that if a company like Lariat Group is advising "Kate," they would certainly make sure she complies with the FTC requirements for bloggers and endorsements. But it appears to me that Ms. Stefani gains her expertise for consulting through "hands-on experience running her own network of sites," so I suspect there is no Kate Delaney and that this is actually a site in said "network of sites."

Again let me reiterate – I have absolutely no problem with people putting up websites and trying to make money. Hell – I do that. But in my opinion, what Beth Stefani is doing at this site is immoral. And I guess the FTC agrees with me, because it's also illegal.

FTC Regulations for Bloggers

False advertising has always been illegal, anywhere. The FTC has recently updated its guidelines because flogs have been a real problem on the internet. For one thing, they're lucrative. Imagine if "Kate" can get 10 people a month to sign up with FutureMT – she made $1,600. Heck, most legitimate transcriptionists I know would be happy to create a REAL blog for that kind of money!

There's just one catch and that's the FTC's guides concerning the use of endorsements and testimonials in advertising.

When the advertisement represents that the endorser uses the endorsed product, the endorser must have been a bona fide user of it at the time the endorsement was given. Additionally, the advertiser may continue to run the advertisement only so long as it has good reason to believe that the endorser remains a bona fide user of the product.

What does "bona fide use" of an education mean? It means "Kate" not only must have actually done what her "blog" says she did (attended the FutureMT program and graduated), but she must also be working as a medical transcriptionist in order to endorse the product, which is an education that allegedly prepared her to be a medical transcriptionist. Even if "Kate" actually did attend FutureMT, she cannot endorse the product until she is working as an MT. And when she is no longer employed as an MT, she is no longer "using" the product of a medical transcription education.

One of the other requirements the FTC has clarified is that a blogger must disclose material connections with an advertiser, and that disclosure can't be hidden somewhere in the small print – it has to be easily apparent. Even if "Kate Delaney" is a real person who actually graduated from FutureMT and is working as a medical transcriptionist, there is no disclosure anywhere on the site.

When an advertisement is clearly an advertisement – such as a banner ad or Google block (who can possibly mistake those for anything but an ad??), no disclosure is required. Endorsements and testimonials are where people really seem to get into trouble. This is nothing new – the same rules apply for print ads and endorsements, infomercials, television and every other kind of media. For some reason, bloggers thought the rules didn't apply to internet advertising!

Can the advertiser be held responsible for what its affiliates do?

Let's look what the FTC says in their guide:

In order to limit its potential liability, the advertiser should ensure that the advertising service provides guidance and training to its bloggers concerning the need to ensure that statements they make are truthful and substantiated. The advertiser should also monitor bloggers who are being paid to promote its products and take steps necessary to halt the continued publication of deceptive representations when they are discovered.

That looks like a yes to me!

Last but not least – why do I care?

As noted in my last blog post, people who want to join the work-at-home workforce seem to be like cannon fodder – or lemmings. These flog sites are run primarily by people who make their living off affiliate sales and who know how to get to the top of the search engines so they'll be found. They don't care if someone scrapes and saves and spends their last dime to pay the tuition, then scrapes and lives hand-to-mouth during the entire time they complete the course, or that they are depending on the money they will make once they complete it and start their career. All they care about is getting more people to their site because it's a numbers game – more targeted traffic translates to more sales. And that's really what they care about – the sale. You won't find them promoting the best schools – you'll only find them promoting the schools that offer the highest dollar amount to their affiliates. By the time the prospective MT finds it's next to impossible to get that dream job, the affiliate has been paid – and isn't answering e-mails. They also don't care what this does to the industry and how it drags all of us down. First, it was "matchbook schools" we fought – now, it's internet marketers looking for the big-dollar affiliate payouts. I've made a good living from medical transcription all these years. No, I don't recommend it for anyone because of changes in the industry since I started – but I also acknowledge there are people who don't have as many options as I do, who really do need a job that's portable or that they can do at home, for a variety of reasons and not all of them having to do with having children. For those people, medical transcription may still be the best option. I just hate to see them given information based solely upon how much money the person disseminating the information will get if they can make the sale. Even if we believe in "let the buyer beware," the FTC has undertaken these guidelines to protect consumers. And for as long as I give even a small damn for the medical transcription industry, I will continue to try and not only call these people out when I find them, I will also try to outrank them in the search engines so that prospective medical transcriptionists come to sites where they are talking to real medical transcriptionists, not fake ones trying to make a sale.

Now for the disclaimer!

I am not 100% positive that the above-referenced site is a flog, I only suspect it is a flog. Heck, it may be legitimate. I will publicly retract my allegations if Kate Delaney will contact me with proof of her identity, a certificate of graduation from FutureMT and verification of current employment as a medical transcriptionist. As with everything else at MT Exchange, this is just my opinion based upon the facts availableto me at the time of publication.

I hadn’t even discussed this with Nae, so when she posted that thread, she was not aware of this MT’s e-mail to me.

Let me preface this by saying there are usually 2 sides to a story and I only have one, so my conclusions are going to be based on that. I’m not going to name names, but if any MTSOs have had a similar experience from their side, or if you’re in management and you think this is your company, I’d like to hear the “other” side.

In a nutshell, an MT who was being paid a premium line rate because of her experience and skills on multiple accounts, was demoted due to “potential reportable events” (PREs) involving privacy and security breaches.

The reason? Selecting the wrong doctor as attending, and sending a copy to the wrong physician. In the first case, the error was noted by the MT, but too late – the report had already been sent in, at which point it was immediately distributed. Even though the MT sent an e-mail, noting the error, this error was counted in the disciplinary action that was taken against her. In the second instance, the name dictated sounded almost exactly like another name – and the MT selected the incorrect name.

As amusing as it is to say “we can’t read your mind, doc,” I’m wondering if some of the people responding to that post at MT Chat want to rethink their answer. Although Nae’s example is “send a copy to Dr. Patel,” in a case where there are multiple doctors with that name, it could have easily been “send a copy to Dr. Smith,” where there are not only multiple Dr. Smiths on a list, but Dr. Smyth, Smythe and etc. All it takes is one large university hospital or VA account to realize there are many, many ways to spell names we all thought had a common spelling, for both patients and physicians. With no training and no physician list, it would be obvious to an MT that picking the correct one among a number of Dr. Patels is impossible and needs to be flagged to QA – but what about Dr. Carter v. Karter? If someone says “send a copy to John Carter” and you find a John Carter on the roster – would you look any further to see if there was also a John Karter and therefore flag the report to someone up the food chain?

In my opinion, there were a couple of errors that occurred prior to the MT making the error.

1. It was a new account and no training was given.
2. No physician list was provided, including a list of attendings and their fellows or residents.
3. The MT company has no written policy regarding PREs and how they will be handled.
4. The MT company has no written policy regarding disciplinary action to be taken in the case of MT errors of this kind.
5. No software safeguards are in place.
6. As is usually the case, training for dictators at the facility also appears to be substandard – GIGO.

Some of these seem like no-brainers, don’t they? I don’t know how anyone can be expected to perform with minimal errors on a new account without any direction or instructions, regardless of how experienced they are. An experienced MT may be able to pick up and transcribe any dictator at any facility – but years of experience is going to give an MT the ability to somehow instinctively grasp account specifics.

This is not a small company, this MT is not an independent contractor. The disciplinary action taken cut the MT’s pay by 20% to 25% yet there’s no written policy in place. No inservice on HIPAA, no training on the account, no written disciplinary policy – but with no warning, the company takes action that cuts pay 25%.

Hello, MT employees – have you asked your employer what the written policy is for your company? What happens when a mistake like this happens? What are your responsibilities? What disciplinary action may be taken against you? What recourse do you have?

Technology being what it is, why doesn’t the EMR software – that same software that immediately routes the transcript to all interested parties upon completion by the MT unless it’s flagged – have some safeguards built in? I realize that EMR technology is evolving, but is anyone doing anything to ensure that copies don’t go to Dr. Carter if he’s not involved in the patient’s care and Dr. Karter is? If not, why not? You’d think that while everyone is out spending money on streamlining the process and reducing labor costs, they’d also be doing something to ensure security is more automated. Even a delay of a certain number of minutes would be helpful (something like the 7-second delay on newscasts), so if errors are caught shortly after the report is completed, there’s some hope of rerouting it before it’s gone out for distribution.

Are MTs paid enough to take on this kind of responsibility? Are YOU paid enough to take on this kind of responsibility? What I see happening is that more and more MTs will send every questionable physician name to QA or to the hospital staff to deal with. Then, someone will get mad – probably at the MTs. Because it seems nobody is willing to hold the dictators responsible. So here’s a tip for all you working MTs out there – unless you’re 100% certain, flag that report. The sooner these questions start piling up on the desks of people who are actually paid enough to deal with PREs, the sooner the problem will be resolved.

This situation was a FAIL of epic proportions, primarily on the part of the transcription service for not having policies in place, by not having in-service sessions for employees to train in HIPAA compliance and on account specifics. Well, shame on management for taking its shortcomings out on the transcriptionist.

It seems that just about every discussion revolves back to how medical transcriptionists are paid – and how they feel about it. Jeanne Johnston’s Advance HIMs Insiders blog, Speech Wreck seems to conclude that MTs can’t make a living working on a speech technology platform. Well – that’s not an issue of speech technology and whether or not it works, it’s an issue of compensation for a job.

Jay Vance has now chimed in at his Advance for HIM blog: Is speech rec wrecked? This blog has some more objective information, gleaned from a survey of MT editors.

Here’s what I remember when Jay posted this information back in 2006 – most editors achieved only 25% increase in productivity. I know you’re all smart enough to do the math:

200 lines/hr @ 8 cpl = $16/hour
200 lines/hr x 25% = 250 lines/hr; $16 ÷250 = 6.4 cpl
250 lines/hr x 4 cpl = $10

It’s pretty obvious that you have to be doing a LOT better than 25% increase in productivity to justify a 50% cut in pay! Even if you are 50% more productive, the loss in income is still $4/hour, based on the above assumed averages.

So let’s focus on the REAL problem here: MT compensation. Why are MTs accepting this? We can get some insight from checking the message boards.

Judy Lichtenberger, another Advance HIM Insider Blogs regular, posted a good article: CYA – Cover Your Assets! And what does the lone comment say?

I am sorry to say that this career is falling by the wayside because no one will step up to the plate to give us a hand here in North Carolina.

Wow – and double wow. I’d like to know who the author of this comment thinks is supposed to take on this role on her behalf.

Then we hop over to the MT Chat Hot Zone discussion on the topic. I’m going to summarize, rather than quote, some of the comments because I don’t want to get in (more) trouble with the folks over there.

We don’t have a choice.

Pay isn’t negotiable.

I’ve bitched about it and it didn’t do me any good.

I’d be replaced by someone less experienced and I don’t want to have to start all over again somewhere else.

It’s better than nothing.

This isn’t a victim attitude?

I’d understand this better if it ONLY happened in an economic downturn – but this has been the status quo for MT through good times and bad and a large contributing reason to why compensation has remained stagnant.

So I ask all these people – how low will you go? If you’re working 8 to 10 hours a day, you’ve cut your expenses to the bone and you’re barely treading water financially – how many more excuses are you going to make for staying where you’re at, either the company or the career?

Let me play out a scenario for you.

You take a job with a company at 8 cpl because it’s the best offer you can get – everyone else you applied with is offering 7.5 cpl and you just KNOW you can’t make enough money at that rate. You’d like more than 8 cpl (obviously!), but this is the best you could get, so you take it. A year later, instead of being offered any kind of raise – however small – you’re told your rate is being cut to 7.5 cpl. What?! This is the rate you had decided you couldn’t afford to work at when you started here! You’re out looking for work again. You find a couple companies paying 8 cpl or maybe more, but you see a lot of MTs online saying they run out of work and they can’t get their lines in. The company you work for has lots of work; besides, now you’re used to the dictators on the accounts and you don’t want to start all over. You take the cut in pay. It’s better than not having a job.

A couple months later, you notice your accounts are running low on work. Turns out the clients have installed EMRs and they’re dictating less and doing more direct computer entry. You’re offered another account, but it’s on the speech recognition platform. You don’t really want to work on an SR platform, but what choice do you have? It’s that, or not have enough work. You say yes and start working. You get your next paycheck and find out you weren’t paid as much per line on the SR platform as you are when you type! When you point out to your supervisor that you weren’t told you would be paid less, her reply is “you didn’t ask and I thought you knew.”

Now what? You can go back to typing but that account doesn’t have enough work for you to get in your lines, especially now you’re making less per line for typing. You decide to keep working on the SR platform and hope things get better there. You’ve checked jobs for other companies, but nobody is paying much more than you’re making; and besides, you’re used to this company and these accounts. It’s better than nothing.

I think you get the idea. How many times is this MT’s pay going to be cut before she has enough? And what does she plan on doing if and when that happens? For anyone who points out “well, she at least has a job and her children aren’t starving!” – I have to ask, for how much longer? Do MTs have a line they’re willing to draw, or are they going to wait until they’re making less than overseas contractors are charging and they’re working 14 hours a day instead of 8 just to make the same amount of money?

In the book, Women Don’t Ask: The High Cost of Avoiding Negotiation–and Positive Strategies for Change, the authors report the finding that women have lower expectations and lack knowledge of their worth.

• Women are so grateful to be offered a job, they accept what’s offered and don’t negotiate.
• Women often don’t know the market value of their work: women report salary expectations between 3% and 32% lower than those of men for the same jobs. Men expect to earn more than 13% more than women during their first year of full-time employment and 32% more at their career peaks.
• Women are more pessimistic about the how much is available when they do negotiate and so they typically ask for and get less when they do negotiate – on average, 30% less than men.
• Twenty percent of adult women (22 million people) say they never negotiate at all, even though they often recognize negotiation as appropriate and even necessary.

In addition to the cost to you, the worker, there’s a cost to the employer. Other studies show that women who are dissatisfied are more likely to leave an employer than to negotiate for an improved situation. The cost to employers is estimated to range from 30% to 150% of annual pay. Based on what is reported to be an average salary for MTs ($32,000/year) and calculating a midrange cost of 60%, the cost to the employer is $19,200! Even if you went with the low range of 30%, that’s $9,600. Wouldn’t you think that knowing this would give you some leverage in your negotiation? Anyone in management should know that turnover costs money. At some point, it costs less to negotiate with the MT than it does to just let them go.

Let me put it another way: If a company gave you a raise of 1 cpl, you’d have to transcribe 2630 lines per day, every single day of the year, for it to cost them as much as the minimum cost of replacing you.

One thing MTs don’t seem to realize is that there is a strategy and a game to be played. I believe that this lack of realization is due largely to the fact that this isn’t women’s forté in the first place and because we’re working from a remote location. Unlike many other workers, there isn’t a central place where we meet and greet each other. You would have a difficult time parking yourself outside your supervisor’s office to get a face-to-face if he or she was avoiding you on the phone or by e-mail. And let’s face another truth – many of us are just more comfortable with electronic communication. Well, sometimes that doesn’t cut it. You just have to pick up the phone and make a phone call. Face-to-face and telephone communication gives you a completely different connection to people that you don’t get in e-mail, text, instant messaging, etc.

The rules for playing the game aren’t any different just because it’s transcription or just because you work at home and not an office. You have to give your employer a reason to keep you and pay you more. Did you attend any seminars pertinent to your job (online or off)? Did you seek out and participate in any company opportunities that would raise your profile? This is not something women do well – men equate it to battle and playing sports (and of course, what’s the point of keeping score if it doesn’t matter if you win or lose?) and women equate to going to the dentist to have teeth pulled.

MTs need to start realizing that they have options and choices and some power. Honestly, very few employers are going to initiate a raise for you. In any company, in any job, you’d have to be a real standout, high-profile, top performer for that to happen. If you’re at home, slogging away through the day’s dictation then bitching on the boards before fixing dinner and falling into bed – it just isn’t going to happen for you.

And I have to say something about the “they’ll miss us when we’re gone!” crowd. Maybe they will (whoever “they” might be) and maybe they won’t – why do you care unless you’ve actually moved on and placed yourself a position of power from which to negotiate a potential return? Or not – maybe you have no desire to come back, under any circumstances. But nobody’s going to miss you if all you’re doing is making this declaration while trying to pound out your lines – you have to actually LEAVE first. In order to leave, you have to make plans and act on them. Nothing is going to happen for you unless you do something to make it happen.

It takes a lot of motivation and time to turn around a ghetto situation. But – if you don’t start it, it’s never going to happen, is it? Whether you plan on improving your position within medical transcription or whether you plan on moving on to a new career, here are some web sites that might help you in your new resolve to take control of your career and your future.

Your On Ramp: This is a great site for women to connect, transition to new careers and businesses.

Ladies Who Launch: If you’re feeling entrepreneurial – or want to connect with businesses that might have use for your skills – check out this site.

Women Work: This is a national network for women’s employment. Women Work! envisions a nation where all women have educational and employment equity, personal and economic security, and social equality throughout their lives.Their expertise is employment, career training and education.

Advancing Women: Leveling the field for women in careers and business.

Women Employed: The mission of Women Employed is to improve the economic status of women and remove barriers to economic equity. Enforcing fair workplace policies, advocating for paid leave, increasing access to education and training, creating innovative tools for women earning low wages to learn about and advance in careers with higher pay.

Wider Opportunities for Women (WOW): WOW works nationally to build pathways to economic security for America’s women and their families. For more than 40 years, WOW has helped women learn to earn, with programs emphasizing literacy, technical and nontraditional skills, welfare-to-work transition, career development and retirement security. Today, WOW is recognized nationally for its skills training models, technical assistance and advocacy for women workers.

(You notice I don’t say anything about AHDI. I understand that AHDI cannot negotiate pay for MTs but for reasons unknown/not understood by me, in my opinion they have completely missed the boat on giving MTs the tools they need to have the confidence to advocate for themselves on pay issues.)

P.S. My apologies to the men in medical transcription, but you are the minority. If you feel any of this applies to you – you have my sympathies.

Organized to emphasize the necessary return of United States citizens’ patient information to United States-based Medical Information Specialists, Medical Transcriptionists and Medical Language Specialists, furthering the continuation of these health care careers, furthering education, and providing appropriate compensation and job benefits for Medical Information Specialists, Medical Transcriptionists, and Medical Language Speciaists, thereby fostering our status as vital links in the chain of quality health care delivery and the protection of patient privacy.

Don’t go searching the WHOIS registry to find out who is behind this – it’s got a privacy shield on it. And the domain name is freshly registered this month (January 9th).

The medical transcriptionist in me is finding all the grammatical and typographical errors in this site and I’m trying really hard to concentrate on the stated purpose of the site – but c’mon people. Basically what this site is showing people is that they were right to go overseas for cheap crap (see my Quotes section) if this is the best USMTs can do!

The United States Medical Language Speciaists Union Initiative was conceived by a group of independent Medical Language Specialists, Medical Transcriptionists, and Certified Medical Transcriptionists, who cannot sit idly by as sensitive United States’ citizens’  patient  information, and U.S. jobs, disappear beyond U.S. borders, beyond U.S. legal and HIPAA enforcement jurisdiction, beyond our control.

(Pssst! If you’re looking for someone who will find and fix all the errors in your site, I can refer you to a very excellent web site editor!)

Moving on to the issues – this is one of my favorite parts:

As patient privacy has been disregarded, so have Medical Language Specialists.  We have been manipulated by fear tactics, threatened that our work will be sent overseas if we do not accept drastic pay and benefit cuts.  We have been forced to work as independent contractors, when we are actually employees, to save service owners the cost of Social Security contributions, and we are one of very few technically skilled trade groups who earn only half of what we earned 15 – 20 years ago while the cost of living has continued to rise.

Folks, nobody has forced you to do anything. You chose to accept the conditions. Do we need to send everyone to Al-Anon?

The cascade of circumstances that have led us to the current condition in medical transcription would take a series of blog posts, but let me point to a major contributing factor: nobody can take advantage of you unless you give them permission.

This seems to be an organized group of determined people so I’m really disappointed to see this kind of codependent – and yes, juvenile – whining.

I have to say that while usually you can’t get 10 MTs to agree to leave a burning building, these people are to be applauded for getting together 50 MTs to promote their agenda in front of decision makers in Washington, DC.

Fifty independent American MTs are traveling to Washington during the last week of January.  We have been invited to present proof, to health care administrators, clinicians, patient omsbudsmen and members of Congress (who are patients themselves) of the horrific “quality” of overseas medical record transcription, revealing the “before U.S. MT QA” product which MTs edit for pennies from offshore companies every day.

My primary concern here is – where are they obtaining these records and do they have permission to use them in this case?

My secondary interest is whether or not they will also present evidence of the kind of work done here in the U.S. Maybe they aren’t aware that there are plenty of MTs here in the U.S. doing crappy work that has to be cleaned up by extensive editing. Or maybe they are – it’s certainly in their best interest to present a one-sided story, isn’t it?

Another concern I have is why this group has chosen to remain completely anonymous. The domain name registration has a privacy shield and there is absolutely no information at the web site about the principles in this organization or whether it’s an organization with a legally recognized structure. Hopefully, someone involved will come forward with some information.

I’d like to wish them the best and encourage everyone to join the cause but I’m afraid it’s a lost cause without a lot of merit. Oh, and then there’s the codependent whining factor that makes us all look bad.

Folks, overseas transcription is here to stay. It isn’t going to go away. I’ll make every effort to blog my thoughts on why transcription pay (and rates) have gone down but it doesn’t have as much to do with overseas transcription as US MTs would like to think. And I’ve always said everything you can say about overseas transcription can be said about US transcription, so there isn’t a moral high ground here. Proponents of US-only transcription need to stick with one issue and ignore all the other shiny objects. If the issue is privacy, then make that the issue and don’t bring in pay rates and quality.