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?

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.

Let me start with what Ms. Johnston got at least partly right in her blog post:

There are incredible numbers of veteran MTs who are now crying because they are seeing their paychecks fall precipitously because there’s no way to double production to make up for half the wages.

MT wages are stagnant or falling and have been for some time. Are employers asking medical transcription speech recognition editors to work for less per line? Yes, they are. But let’s get over the victim mentality here and take some responsibility for the pay situation we’re all in. The reason MT pay rates aren’t better is because there’s a never-ending supply of people who are willing to work for less, whether they’re new to the field or whether they’re veterans. I’ve encountered very few MTs who have said “I’m not willing to work for that” – and meant it.

The fact is, there are MTs who are accepting less than half their production typing line rate and that’s where they start getting into problems.

The math does work out – if you are 2x more productive editing speech and your line rate is half what it was for manual transcription, then you are making the same amount of money. And there are MTs who are making production 2x and more of their manual typing production.

If you produce 200 lines/hour on average as a transcriptionist at 8 cpl your average hour rate of pay is $16/hour

If you produce 400 lines/hour on average as a speech editor at 4 cpl, your average hourly rate of pay is $16/hour

The problem starts if you are not more productive and if you accept a line rate that is much less than your production increase. A lot of speech recognition jobs are paying 2 and 3 cpl. C’mon people – this isn’t rocket science. You’re all smart enough to do the math. Assuming that you will actually BE 2x more productive as a speech editor, you can’t take a line rate that is less than half your current rate if you want to break even!

The other problem in this equation is the problem that has plagued medical transcription almost from the get-go: it’s a Pink Collar Ghetto job, which means it’s predominated by female workers. And studies have shown that women do not negotiate their pay like men do.

Some companies allow their MTs to trial as speech editors. If you try it and you aren’t making enough money – either go back to traditional transcription or renegotiate your pay. Some companies are paying a full line rate on jobs that require XX% retyping, acknowledging that for some jobs generated by a speech recognition engine, the accuracy is so poor that it basically has to be completely retyped.

Now let me get to what’s inaccurate and what bothers me about this blog post.

I’m not sure how Ms. Johnston can state with such utmost certainty the conditions and attitude in the industry when people who have more experience and more connection with what’s going on in the industry couldn’t make these statements with any confidence in their accuracy. It’s as if Ms. Johnston has her finger on a thready extremity pulse and is telling the everyone, including the doctor, who is monitoring the EKG, that she’s certain the patient is dying.

There are incredible numbers of veteran MTs who are now crying because they are seeing their paychecks fall precipitously because there’s no way to double production to make up for half the wages.

How does Ms. Johnston knows that there’s “an incredible number” of anybody crying over falling pay rates due to SR? I’m quite certain there’s an incredible number of veteran MTs who aren’t happy about pay rates in ANY segment of transcription, but SR hasn’t penetrated a sufficient segment of the market to impact “an incredible number” of MTs with any number of years of experience. See – I can state things with absolute certainty, as well – it doesn’t make them facts, nor does it make them true.

This statement also ignores the opportunity SR provides to veteran MTs who are embracing speech recognition editing because they are no longer capable of doing the production work required to make a living. They do far less keyboarding as editors and their knowledge continues to be utilized. It’s a welcome option for veterans who don’t want to have to learn something completely new (like, for example, cancer registry).

…no one’s ever bothered to ask for our input on the front end of this abomination.

Holding onto that thready extremity pulse, the author makes this statement like she actually knows what she’s talking about. The fact is, the medical transcription industry IS heavily involved. It was a topic in at least two sessions given by medical transcription industry professionals at a meeting I recently attended. You know all those things you say AHDI doesn’t do for transcription? Well, this is one of the things they are doing and they’ve been involved in it for years. What would be accurate is that nobody has bothered asking the author’s input – but then again, she hasn’t positioned herself to give it where it counts, either. The transcription industry acknowledges that speech editing requires a slightly different skill set than manual transcription, but the same knowledge base. Transitioning MTs to that skill set is part of the focus of AHDI as they attempt to move MTs to what is becoming the future of transcription. The fact that a lot of MTs don’t know this is part of AHDI’s perception problem with MTs. And if your idea of AHDI “doing something” about SR is to get them to make it stop, you need a bigger reality check than I can give you.

Adding to my amusement at this assertion is a recent article published by Advance for Health Information Professionals, which is the sponsor of Ms. Johnston’s Passage blog. Maybe Ms. Johnston doesn’t read Advance; maybe she just missed this article: “Creating a Definitive Guide on Speech Recognition.”

The automated speech recognition technology (ASRT) work group, which consists of a broad group representing speech recognition vendors, medical transcription service organizations (MTSOs), MTs and consumers, hopes to clear up the confusion that exists by publishing what the group hopes will be a definitive and evolving guide to speech recognition, in the form of a reference guide to the adoption of speech recognition.

MTs who want objective information about SR and the medical transcription industry should follow the link and read the entire article. If you’re really interested in making a difference, join the workgroup.

Like Ms. Johnston, there are MTs who see SR as a “Borg assimilation,” rather than an opportunity. And like Ms. Johnston, they may very well find other careers in healthcare information management. We saw MTs kick and scream and cry about transitioning out of DOS and WordPerfect 5.1 and into Windows. We all survived and adjusted and by golly – some of us even like it better. And now we have many MTs who wouldn’t know a DOS prompt if it smacked them upside the head. Resistance to change is a human attribute. In my experience, the personality type attracted to MT is more resistant to change than most others. But get real folks – you can’t stop progress. At some point, you have to decide whether you’re going to lead, follow or get out of the way. I’d like to think we all have the intelligence to be rational and put emotions aside.

We all get a good guffaw out of speech recognition errors, but I’ll bet MTs are less entertained when their own errors are posted or distributed in a company newsletter. If an MT gets 90% accuracy on a QA score and speech recognition gets 95% – which one would you pick? The fact that MT speech editors are seeing reports with errors doesn’t equate to the blanket statement “speech recognition doesn’t work.” If an MT consistently produces reports with 99% accuracy, is her work sent to QA? Of course not. If an MT consistently produces reports with 90% accuracy, is her work sent to QA? Of course it is. The same is true of documents produced by speech recognition – once a consistently accurate report is generated for a dictator, those reports are no longer sent to editing. Keep in mind that M*Modal, eScription and others like them aren’t in business because the technology doesn’t work. HIMs managers do talk to one another and they know salesmen are there to sell a product – the technology has to prove itself, and it has.

For MTs to be successful in making the transition to speech recognition – and make money – they need real information, not misinformation and not har-har jokes about errors.

If you are asked to transition to speech recognition, you need to know what questions to ask so you can negotiate your pay. And you do need to negotiate the conditions and pay.

• Is there a sliding scale pay rate based on the accuracy percentage of a report? In other words, do I get paid more for a report that is only 85% to 94% accurate, versus my base rate for reports that are 95% accurate or higher?
• If accuracy falls below 75% and I have to retype most of the report, do I get full transcription rate pay?
• What is the average percent accuracy of speech recognition on the account(s) I’ll be working on?
• How long has the account been on speech recognition? (The length of time will impact the accuracy – newer accounts will have a lower rate of accuracy.)

Thanks for your comments. I was curious what your take is on the state of the profession in light of the trend to offshore transcription work. Do you think there are enough nightmare overseas transcription stories to keep work stateside or will the trend only get worse? I ask, as I have seen others whine and complain about their jobs being shipped overseas, but their work product leaves a lot to be desired.

As you’ve noted, there are enough nightmare stories stateside to keep it going overseas. There’s nothing you can say about offshore companies/MTs that you can’t say about US companies/MTs. This gives rise to (one of) my mantra: If people are going to get crap, they’re going to go for cheap crap.

The fact is demand remains high for QUALIFIED transcriptionists and it will remain high, although I don’t predict we’ll see better pay rates. There seems to be a weird bubble in the supply/demand theory when it comes to MT. This is only partly attributable to the overseas companies, something US MTs don’t seem to understand or don’t want to take the time to understand.

In my opinion, at least half of the US MTs who decry the poor quality of overseas transcription and pound their breasts in nationalist fervor would be surprised (and outraged) if you tell them they aren’t doing that great a job themselves. They have jobs, they’ve been MTs for years (many of them) – how could they possibly NOT know what they’re doing? (See my prior post: Not so dark, just cloudy, side of medical transcription). When I was trying to find another MT company to subcontract some work to a couple years back, we trialed 6 transcription services and found only 1 that met our standards. I was told I was too stringent, that words that didn’t change the medical meaning shouldn’t be counted as errors (even though they were quite plainly spelling or English word errors), that the client’s requirements were picky, etc. etc. – yet all I was asking was: (1) all the words be the RIGHT ones, (2) all the relevant words that had been dictated be included in the transcription, and (3) all the words (English and medical! radical concept, I know) be spelled correctly. That was “crap” on a large scale – if the MT company owner has the attitude that the work they do is fine and my service is “just too picky,” then you can bet they have X number of MTs whose work wasn’t all that great, too. Extend that down to the finer level – only 1 out of every 10 MTs we trialed made it through the initial QA process. Unfortunately for the medical records industry, those other 9 had no trouble going out and getting a job with someone else who “wasn’t as picky” – and trust me, most of them had no problem letting me know that the problem was not THEM – it was ME.

Want samples? I have plenty. In the “just plain sloppy typing” category:

T: She feel about a month ago
E: She fell about a month ago

T:  loss of vision of acute eye pain
E:  loss of vision or acute eye pain

T: see my noted from
E:  see my note from

T:    difficulty with bend forward
E:    difficulty with bending forward

T: some ibuprofen and Vicodan.
E: some ibuprofen and Vicodin.

And in the “it doesn’t make sense to me but that’s what it sounds like so I’ll guess” (aka “brain off, fingers on”) category, which assumes that the MT even knows enough to realize what’s being typed is complete and utter nonsense:

T: Advair discuss,
E: Advair Diskus,

T: in case it might be the beginning of adult palsy.
E: in case it might be the beginning of Bell palsy.

T: finger reveal a nondisplaced volar placed, avulsion fracture
E: reveal a nondisplaced volar plate avulsion fracture

T: Favors test is negative bilaterally.
E: FABER test is negative bilaterally.

T: TMs are clear, with cerumen.
E: TMs are occluded with cerumen.

T: minimal form rotation
E: minimal forearm rotation

T: transit history
E: transient history

T:    with modality with unstretch exercises.
E:    with modalities and stretch exercises

T:  is no lag of thalamus noted
E:  is no lag ophthalmus noted

Now I bet anyone reading this would not disagree with me that – sloppy or ignorant – these are errors, plain and simple. So why is it most MTs blame QA when errors like this are pointed out to them?

And what really gets me is this: probably only 1 in 10 MTs was appalled. The other 9 became defensive and argumentative. If someone pointed out errors like this to me, I’d sink straight into the ground. In fact – someone did at one time. At a point when I’d been out on my own for several years, I went to work for a small company. I thought I knew my stuff – until QA got done with me. I was mortified, not only at the errors they pointed out to me, but at the realization that my training hadn’t been as complete as I’d thought and that I had, for years, been making these mistakes. I took as much correction as they were willing to give me, for as long as they were willing to give it to me. I learned a LOT from those 2 QA experts and I thank them for it.

But what happens to the other 9 MTs who become defensive and argumentative? They move on to a company that’s “not so hard to work for,” that’s what. Do they learn anything from it? (No.) The fact that they can get another job with someone else who doesn’t tell them they do a crappy job only reinforces their belief that the problem isn’t them. This delusion continues despite the fact that they know nobody is actually looking at their work.

OK, back to the topic of overseas transcription – anyone who still wonders why hospitals and doctors went for the cheap crap overseas, feel free to comment.

On another note, do you see voice recognition really making inroads in the field or is the technology still too far off and too annoying to “train” to make a difference in the business?

There have been no significant advances made in speech recognition technology in the past 10 years (or more). There are technologies that make it easier to use, but the recognition engines themselves haven’t changed much over that period of time. Companies like M*Modal and e-Scription require a certain (and significant) volume in order to make it worth their time to do the preliminary work required to achieve any kind of success. It will be used to increase productivity for MTs in certain sectors, but it won’t eliminate jobs.

There are doctors who use it to dictate directly and there are studies that show this slows them down, resulting in either fewer patients seen or more time spent in the office. I’m not going to take the time to dredge up the references, but the information is available. From my own observations of CSR used this way, most of them aren’t using it properly, which only increases the errors and the amount of time required to fix them.

The EMR is more likely to eliminate transcription jobs, especially as younger doctors enter the field. They’re used to keyboarding and using computers. As the EMR software developers incorporate more blended technologies – speech, touch screen, templates, point and click – all in one package, there will be a higher adoption rate. Right now, EMRs are struggling to sell themselves. Unfortunately for them and us, they’re using elimination of transcription costs as a sales point, pointing out that the system pays for itself because overall it will cost less than the practice or hospital spends on transcription. The fallacy in this is that highly-skilled, highly-paid professionals then perform the task of a medical transcriptionist – which makes absolutely no sense. Physicians struggle enough with the financial justification for an EMR; coupled with resistance to change, it has pretty much guaranteed slow adoption of EMRs, especially in smaller practices. I suggest reading the Accelerating Adoption of Healthcare IT blog, by Nick van Terheyden, MD. He made this point in his presentation at the recent TEPR conference. To put a point on it, you wouldn’t find Jack Walsh typing his own annual reports or Warren Buffet manually entering stock values into the computer (well, maybe Warren does – but I’ll bet Jack doesn’t). Ultimately, however, the technology and programming will improve and the number of younger doctors who haven’t spent the past 20 years dictating will exceed the number of physicians who have – and we’ll see a greater impact on our business.

To answer the question, I see technology making inroads, but slowly. I see the cost of technology, as well as privacy and security regulations, making it more difficult for small MT services and independent MTs to stay in business.

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

Case in point – back to that meeting I attended…

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

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

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

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

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

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

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

No wonder medical transcription gets no respect.

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