I was speaking of change, wasn’t I?

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

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

Changes at MT Chat

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

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

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

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

Changes at MT Reference

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

Changes at MT Desk

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

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

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

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

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

Why the changes?

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

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

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

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

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

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

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

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

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

Facing the career change fear factor

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

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

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

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

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

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

After the miracle

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

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

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

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

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

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

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

Related information:

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

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

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

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

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

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

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

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

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

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

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

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

It all apparently started with this article at Advance for HIM, Big Transcription… which got picked up and posted at the AHDI Lounge… which generated a lot of comments… which got Chad Sines thinking, so he wrote a blog post, Style Over Substance… which again got linked at AHDI Lounge.

Whew! And now, of course, I’m going to write a blog about it, because it seems my comments at AHDI Lounge never quite make it to publication – plus, I am going to be a bit long-winded.

So what’s the big deal?

The big deal is the English errors made in the original Advance for HIM article. Chad Sines seems to think MTs need to cool off a bit and pay more attention to the substance of what’s said and stop picking on the errors.

What struck me as off was that the comments seemed to suggest that since this MT made “glaring” errors, the substance of the article was not worthy of reading. The author apparently was to be shamed and discarded as seemingly irrelevant simply because of “mute” versus “moot” and other simple oopsies. While reading the comments I was almost yelling “WHO CARES??? Get off your pedestal and listen to the message!!”

Here’s the thing for me: there’s a reason for those big fat books on the shelf called “dictionary” and “Gregg Reference Manual” and that slim but oh-so-potent “Strunk & White.”

Errors such as mute instead of moot can certainly be overlooked – but as is obvious from the discussions at these websites, they’re distracting. It’s the equivalent of watching a period movie set in the 1800s and seeing an airplane fly across the sky in the background. Suddenly, you can’t pay attention to anything but the airplane, in spite of the fact that it’s a few seconds of a 90-minute film and a relatively minor event. And if you’ve ever watched TV or a movie with someone in the TV/movie business, you’d know that these types of errors are very obvious to them. Errors in spelling, grammar and punctuation are distracting and detracting for most readers, whether it’s a fiction novel or a professional journal – or a medical record.

If the Big Transcription article had been a blog post or a post in a forum or some other type of casual venue, errors could be written off – the author was tired, in a hurry, etc., whatever. But this isn’t a blog or a forum post, it’s an article in a professional publication that is widely read by everyone in the health information management chain. Is Advance for HIM no longer running articles past an editor? Or are the editors no better than the author?

Moving on, Chad compares this to the medical transcriptionist’s obsession with grammar and punctuation while overlooking glaring errors in the medical record.

The article in question isn’t a medical report. It’s a regular column published in a professional online magazine. By any publishing standard, the grammar and punctuation should be correct. Asking a group of people whose daily bread is the written word to ignore them is like asking a production assistant to ignore the airplane flying across the sky in a movie set in the 1800s.

The discussion at AHDI Lounge takes a turn in that direction, which then raises the question about Book of Style Bootcamps. Lea Sims defends the BOS as something other than a grammar and punctuation manual.

We can’t raise a fist at the use of a contraction and turn a blind eye to the clinical inaccuracy in the record that may impact care decisions. Both are necessary, but of the two, clinical accuracy can’t be sacrificed for style.

This really isn’t an either/or. There are few – very few – instances where clinical accuracy would even have to be sacrificed for style. Correct me if I’m wrong, but proper grammar, punctuation and spelling  are not exclusive of accuracy of medical terms and terminology. I can think of many instances, however, where improper punctuation, grammar and spelling have impacted the clinical accuracy of a record.

Feel the need to defend the BOS a bit (I’m biased, I know), but there is ONE chapter on grammar in the entire BOS and ONE chapter on punctuation.

The BOS is not about clinical accuracy of the medical record. It is about style. No big surprise there, given the title of the publication. As part of the MT Desk online style guide wiki project, I’ve been through the Book of Style for Medical Transcription with a fine-tooth comb. It’s a style guide, not a laboratory values reference or a word list or an anatomy guide, or anything else that would guide a medical transcriptionist to recognize accurate clinical documentation. Let me just open this book at random in some of the sections  and give you some examples – you tell me if this helps medical transcriptionists identify clinically accurate documentation. I’m going to identify Section 2, Chapter 4 (Grammar) as the ONE chapter Lea identifies as being devoted to grammar and Section 2, Chapter 6 (Punctuation) as the ONE chapter devoted to punctuation – everything else is fair game.

Section 3 is devoted to Measurement & Quantitation; i.e., numbers, percents, proportions, ratios and ranges, units of measure. I see how to decide when to use arabic numerals, Roman numerals and ordinal numbers. I don’t see any explanation of the clinical use of these numbers or how to determine whether or not what’s being dictated is within the accurate range. And oh look – there’s an entire section on punctuation when expressing numeric values in the record, covering days and times, among other things. Lots of clinical significance there. There’s another section on how to form plurals, use of numbers in proper names, use of numbers at the beginning of a sentence….

Section 4 is devoted to Specialty Standards. Surely, there’s something in this section that would help a transcriptionist make decisions about a clinically accurate document. Let’s see… commonly encountered elements in the periodic table and their symbols, how to write chemical compounds, how to write chemical names and concentrations… nothing there that would help me make decisions about whether or not the dictation was clinically accurate. The Pharmacology section devotes an entire page to the FDA approval process; while interesting, not especially helpful from either style or clinical accuracy point of view. As long as we’re being obsessive-compulsive about the little things, we could start a discussion about the clinical importance of capitalizing brand name drugs and not capitalizing generic drug names. There’s a section on the different DEA drug classes, but there’s only a short list, given as an example, of some of the drugs in that class. And while I would say it’s useful for an MT to know the forms of administration of a drug, as outlined on page 302, what would be helpful insofar as the clinical accuracy is knowing which drugs are administered by each method – but that information is missing.

I could go on and on, but you get the idea.

The Book of Style for Medical Transcription is a style guide. It may have only one chapter devoted solely to grammar and one chapter devoted solely to punctuation, but that doesn’t mean the rest of the book isn’t full of instructions for grammar and punctuation and (gasp again!) style as applied to the medical record. What it is not about is what drugs are administered by inhalation and what drugs are tablets, or what laboratory ranges are normal, or what diagnostic studies might be performed on specific parts of the body, or to rule out a specific diagnosis. In other words, it has nothing whatsoever to do with clinical accuracy. As the self-claimed author of the BOS, Lea Sims surely knows that.

The Book of Style does what it’s supposed to do – other than general grammar and punctuation, it provides a framework for how to format the terms found in medical records. The terms themselves, the anatomy, the physiology, the pharmacology, the diagnostic studies – in other words, the clinical aspect of the medical record – are not the purview of a style guide. For one thing, it would take several volumes to cover the amount of information required to ensure the clinical accuracy of a document. The medical transcription school an MT attends, subsequent training, reference manuals, quality assurance, etc. – those are the appropriate venues for ensuring that a medical transcriptionist has the information to assess the clinical accuracy of the document. And I’m not even going to climb on my soapbox (again) about the dangers of attempting to make medical transcription more important by claiming that MTs are or should be responsible for the accuracy of the medically relevant portions of the record.

As far as I’m concerned, the bottom line concerning the errors in the Big Transcription article is that this is an article by a transcriptionist, in a professional publication for health information management professionals, and therefore it represents – or should represent – the standards of the industry. Starting with the transcriptionist who made the mistakes and ending with the editor who didn’t correct them, it’s a poor reflection of the kind of skills a medical transcriptionist brings to the table. Really, if MTs can’t demonstrate that they know the difference between they’re/their/there, moot/mute, or any number of other common English language errors, how can anyone be confident that they have the ability to protect the clinical accuracy of the document? I recognize that nobody is saying the English language component isn’t as important as the clinical accuracy of the document; however, my opinion is that we have to view this in the broad spectrum. You don’t trust someone with advanced skills – and the clinical accuracy of a document is certainly an advanced skill – when they can’t even demonstrate mastery of their native language.

Unfortunately, I don’t have the original draft I had submitted, which got sent back to me for some editing because the PTB at AAMT didn’t feel I was being positive enough about the future outlook for medical transcription. That draft would have more accurately pinpointed my predictions for the industry and how I felt about the future of medical transcription. With that caveat…

Although many transcriptionists work through the internet, they may be unaware of the scope of technological changes and the jockeying for position currently taking place. Many see a threat from offshore labor, when they should be looking at the technology that resides on their own desktop. The very tools we use to enhance productivity are also available to the computer-literate physician, especially if packaged nicely and marketed aggressively by a far-sighted company. The advertising claims that physicians can replace their transcriptionists are not far-fetched. Some physicians have, in fact, done just that and are perfectly satisfied with the results. The number will increase exponentially over time, in much the same way the technology has advanced. Transcriptionists need to prepare themselves to work within the new model of  business that will be created by the available technology and the changing environment of business brought about by the internet.

I’m pretty sure that last sentence was part of the edit. Notice that I don’t say HOW MTs need to adapt. Quite frankly, if memory serves, I couldn’t think of a way they could that would keep them in this picture. After all, I just predicted that technology would give physicians more tools to facilitate reducing or completely eliminating medical transcription.

At the time the article was written, the AMA reported that 59% of physicians weren’t even using computers. I wasn’t able to find a recent study, which suggests to me that there’s an assumption that medical practices and healthcare facilities are using computers, including mobile devices.

My updated prediction is that this trend will continue and we’ll see an even bigger spike as more computer-literate physicians enter practice. They will not only be less resistant to entering data into the computer directly, they’ll be more proficient at it than their predecessors.

I also predict that as more computer-literate patients enter the system, and as technology advances, we’ll see patients entering their history directly into an EMR, either at the doctor’s office or online. Or, if interoperability issues are resolved, retrieved from a PHR. I predict updates will take place the same way, so you can review the history the physician or facility has for you and enter any updates or changes. As EMRs evolve and improve, the information you give the doctor will be available to any other facilities or offices in the system. There are already systems that share information with providers across the system. As always, the technology will only improve over time. Young adults who have used computers most or all of their life won’t wonder why they’re being asked to type in this information themselves – they’ll wonder why it isn’t available, or why they have to enter the same information multiple times in multiple places. I think there will even come a point when speech-to-text is so accurate that this data entry will take place in the form of speech, combined with touch screen and keyboarding.

A new tool becoming available to the individual transcriptionst and smaller business owners is the application service provider (ASP)… The purpose is to provide an “enterprise” solution for physicians (in plain English – one-stop shopping). By giving physicians access to something everyone knows they utilize, the portals hope to entice them to take advantage of other services and/or goods being sold through the portal. The advantage an ASP can give transcriptionists as a by-product is more equal footing with the large services. Access to both physicians and other transcriptionists becomes a possibility, at a price that is not beyond reach. It will no longer be necessary to take a deep breath, hyperventilage, then sign a five-year lease agreement for $60,000 worth of digital dictation equipment that will be obsolete before the lease is up. ASP networking will allow transcriptionists to work with each other to coordinate coverage for peak periods and time off… The ASP model provides state-of-the-art networking and upgrades inclusive with the other services offered.

I’m not sure the ASP model has been of great benefit to the independent MT, working solo or in small groups to provide service to select physicians. I think it has been of benefit to small transcription services looking for growth opportunities. In the past ten years, a model used by some ASPs is to do the marketing and sales, then contract with various independent MTs and small MTSOs to perform the work. In this scenario, the ASP sets the price to the client, not the MT or the MTSO. Like everything else, the ASP market has continued to evolve, with multiple acquisitions, change of ownership, mergers, and some winners and losers. Very few of them partnered with portals; instead, they became transcription platforms, with interfacing on the client end for compatibility with whatever technology the client used. Companies like InterFix made it easier to interface the ASPs with the multiple hospital IT systems and recently, in partnership with AHDI, created the Benchmark KB, a desktop application for transcriptionists that interfaces with various transcription platforms. The value of the Benchmark KB is that it reduces training and learning curve for transcriptionists working for a company that uses more than one platform.

Although currently many physicians remain blissfully ignorant of templates, macros and normals, that will change as doctors become more computer literate and money gets tighter. I predict more transcriptionists will be requested to discount or not charge for templates or normals.

I think I got this one right. What I missed completely was that anyone would not count spaces! I also missed that there would be transcription services (in my experience, predominantly overseas services) that would use this as a selling point, not only discounting the characters contained in templates, macros and normals, but also undercutting prices at the same time, further eroding the rates charged by US-only companies and the earning ability of medical transcriptionists here in the US.

The next level for speech recognition will be speaker-independent recognition. Translated for the technophobe, the technology will be able to understand the dictator who is your worst nightmare, with very little user training.

This prediction was accurate, in fact. Not that no training at all is required, but companies providing server-based (also known as back end) speech recognition do train the speech recognition engine, but they do it using a library of digital dictation files obtained from the system. Physicians are not required to sit and train the engine. Most of them are told they don’t need to change their dictation habits, which is more for the purpose of getting them to adapt to the system than anything else because there certainly would be a benefit to the accuracy of the documents if the physicians were willing to make some changes.

The question for transcriptionists is: will it matter if recognition accuracy is 100% when grammar, punctuation, syntax and language usage are not (how shall I say this?) – exactly representative of a strong foundation in English? My prediction is that it won’t. I believe as long as the document says what the dictator means it to say in a relatively clear (i.e., defensible) fashion, it will be accepted… While we may wring our hands that the quality of patient care is being compromised, who is actually compromising it – the physician, the transcriptionist, or the software used to create the transcript? Ultimately, the responsibility belongs to the physician. The more we try to take ownership of this responsibility, the more liability we expose ourselves to – a questionable tactic for assuring job security.

Well, I feel my crystal ball was working really well on this one and I probably don’t need to add anything to this.

If you don’t know the difference between DOS and Windows programs, it’s a reasonable conclusion that brushing up on your tech knowledge is necessary. I predict a future where computer literacy will be tested along with English literacy, and not just in the MT profession.

I found the following excerpts in current job listings for medical transcriptionists:

Cerner experience preferred. No satellite.

Meditech Client experience.

Are you reasonably computer literate? (This may be tested.)

Familiarity with transcription platforms (M*Modal, eScription, DocQScribe, and Spantel) a plus.

We are looking for editors who have had experience with the M*Modal platform.

You must have the necessary software (EditScript MT) and equipment (IN-DB9 or IN-USB pedal) in place with Microsoft word and a current electronic medical spell check loaded, ready to work.

Computer that is no older than 3 years. High-speed cable or DSL connection. Air card and satellite will NOT be supported. Internet service with AOL is not supported. RAM (memory) – 512 MB minimum. Hard Drive – 40 GB minimum. External computer speakers with volume control knob and headset plug-in. Good quality headset. USB port foot pedal. CD-ROM drive.

You MUST know how to use a FTP program to download and upload work. … Please DO NOT APPLY if you do not hve the required equipment or know how to use a FTP program.

I think it’s pretty obvious that computer literacy has become an essential part of the job, and we’re way past having to differentiate between DOS and Windows! What’s also become important is having a computer that has up-to-date software and current software. It would be difficult to find a job listing that doesn’t include software and hardware requirements, as well as internet connection requirements.

The article also completely neglected any mention of how technology would impact US medical transcription by facilitating overseas competition. Because digital technology and file transfer was available in 2000, I know overseas competition was a big concern for US MTs at that time. I’m not sure why I left out any mention of it – whether I was asked not to, or whether it was based on my opinion that there’s nothing you could say about overseas medical transcription that you couldn’t also say about onshore medical transcription, or whether I felt it had no place in a discussion that was about technology – I’m not sure. My memory isn’t what it used to be.

My crystal ball says that medical transcription as we know it will continue to deteriorate in both value and pay, and that advances in technology and a burgeoning population of computer literate physicians will contribute to that. We keep hearing that medical transcriptionists need to change their skill set and adapt in order to survive, and I agree with that. However, I see it evolving to an increasingly clerical position, with pay rates comparable to a clerical position. What MTs need to decide is whether or not they want to continue to work in the evolved position, at the evolved pay rates.

Hopefully, I’ll be around in another 10 years to see if the predictions I’m making here will take place.

Granted, AHDI is being technically accurate when it represents itself as the largest organization for medical transcriptionists. What does that make the thousands of MTs who aren’t members? The largest disorganization for medical transcriptionists?

AHDI now counts among its membership over 10,000 members as a result of requiring KB users to be associate members of the organization.

Associate members are those individuals who have qualified for membership under a third-party vendor contract and have received this membership offering through the purchase of a contracted product or service, such as Benchmark KB. Only users/purchasers of those products and services qualify for this membership category.

Unfortunately, AHDI doesn’t go into detail about what associate members get with their membership, but it’s my understanding they cannot vote and they cannot hold office. In effect, therefore, there are only roughly 5,452 members in other categories. According to MT Tools Online, reportedly 30% of the total membership number is in the student category (also unable to vote or hold office), but that number is mixed with students who receive the KB as well. Subtract an unknown number of corporate, institutional and educational members and who knows how many that leaves in the individual professional category – those who can vote and hold office. Certainly, less than 5,000 and probably closer to 4,000. That’s down significantly from the 7000 individual professional members reported several years ago; and it is certainly a smaller and smaller pool of people who are eligible to hold office, much less vote.

Wow.

Actions this week at ACE that make it look like AHDI leadership has been taking their cues straight out of the Tricky Dicky book of Dirty Tricks. The House of Delegates’ (HOD) vote to retain the present members of the HOD for another year gives me flashbacks to an illegal secret Board meeting held in California years ago and reinforces the screw the membership mentality. If you don’t think your delegate is adequately representing your region – too bad. Like it or not, members will not get to hold an election of new delegates for next year.

Regardless of the reasons for this action, it’s illegal and a violation of AHDI’s own By-Laws, and possibly California law, where AHDI is incorporated. Niggling little things like that never seemed to stop this sort of thing in the past, so I guess nobody should be surprised that the dirty tricks continue. It should be frightening to realize that this is the same group that gives leadership seminars.

Frankly, I found Miriam Wilmoth’s comments on emergent resolutions before the HOD to be… well, enlightening.

… It is unfortunate, too, that any efforts to speak for members who are still confused, torn, or outright opposed to the way current issues before the House have been handled are met with accusations of dishonesty, that any dissenting opinion is met with an association-sponsored blitz of ad hominem attacks like none we have ever seen in this association – from the CEO, to selected (not all) board members, and even the Speaker of the House.

I’m having déja vú all over again.

I’m sure the response of the AHDI faithful will be – if you don’t like it, join and change it. OK, first of all – with no new delegates being voted in for next year, how much change can there be? I rather suspect the real purpose behind that move is to make sure the only changes made are the ones Dirty Tricks club wants made. And my personal response to that would be – been there/done that, got the T-shirt and what I experienced was eerily similar to what’s currently going on – burn the By-Laws, damn the torpedos and to hell with what the membership wants (what do they know, anyway?).

If we encourage our members to talk to us, to tell us what they think, to become engaged in the purposes of the association – yet when they open their mouths to speak effectively they find their integrity called into question – do we really think they will continue to speak?

And after reading this comment – again made by Miriam Wilmoth – is there any question that you would plop down your $135 annual membership fee only to be told screw you very much? Because that’s what’s already happened to current members.

I’ve already seen a slew of long-time members – members who were active in leadership positions – drop their membership and leave AHDI. And yet the insanity continues. Obviously, the number of core members – those in the individual membership category – has dropped drastically over the last couple of years. And instead of addressing the issues and concerns of members and former members and asking what they could possibly be doing wrong – many of those who remain at AHDI write off criticism as sour grapes or negativity and then drop their heads back into the sand. Because as long as you can write off the people who bring up the issues, you don’t have to actually take responsibility and address the issues. And I’m not even going to get into how AHDI has ignored the fact that nonmembers could be potential members. (More on that in another post, where I’ll talk about a publication by an AHDI staff member that makes it clear what the attitude is about us.)

In my opinion, this organization has been on a course that is detrimental to practitioner medical transcriptionists since they changed the name of the organization and got into bed with MTIA. They say they want to get online and into social networks. Great. I say the largest disorganization of medical transcriptionists in the world use the same social media to let the world know that this organization does NOT represent us.

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.

Can anyone tell me if it makes a difference which online program you use? I’ve heard that potential employers look for someone that’s been trained by an AHDI approved program. But when I asked Future MT, a non-approved program, they said that their program was as good as the others on AHDI’s list but you have to pay to get on that list and they simply choose not to, so as to pass that savings on to the student.

I found that an interesting response from FutureMT because it’s wrong on so many levels. Well – I suppose it makes sense if you’re trying to justify to prospective students why you aren’t on that list. I wonder how many people fall for it (probably quite a few). Because if you go read that discussion at MT Chat, you’ll see that Mike DeTuri broke down the cost per student based on XX number of students and it’s pretty negligible. And aside from that, schools don’t pay to get on the list, they pay a fee to apply to be on the list – big difference. A school can pay the fee and submit the required information and if they don’t meet the requirements, they still aren’t approved – and they don’t get a refund of their application fee.

So I moseyed on over to the FutureMT web site to see what their web site says about them. And I discovered something else interesting about FutureMT:

Future MT is not an accredited medical transcription course as a university within the state of incorporation, but rather a nationally recognized online education course using similar guidelines of major Universities.

When it comes to voluntary programs designed to evaluate a school program, FutureMT doesn’t seem willing to waste its money, as it isn’t accredited by the state of Florida, where the company is based, either. Not unlike the transcription sites that all claim “best, fastest, cheapest,” making a claim of nationally recognized online education course is pretty easy. It can’t be verified, certified or accredited – but it sounds good! (Maybe I should change the MT Exchange tag line to nationally recognized online blogger.) There are a number of nationally recognized accreditations for distance learning programs, including the Distance Education & Training Council (DETC), Accrediting Council for Independent Colleges & Schools (ACICS) and Accrediting Commission of Career Schools and Colleges of Technology (ACCSCT). Accreditation by any one of these would at least give proof to the claim of nationally recognized online education.

In fact, this is one of the requirements to become an AHDI-approved school:

The school/program must be accredited or licensed through a governmental body.

So in terms of as good as, strike one for FutureMT.

What I like is the consistent theme: we’re saving money for our students!

Another benefit of Future MT’s course is that we do not have the large overhead needed to run a college, so we are able to pass those savings to our students and offer the same course at a more affordable cost.

I don’t know how prospective students read this, but it makes me wonder whether they have other cost-saving measures that might be cutting corners a tad too close – you know? Like – instructors. Like – curriculum.

Speaking of which…

Another requirement for AHDI approval is that the school must follow the Model Curriculum for Medical Transcription. And it’s really difficult to tell from the FutureMT website exactly where their coursework comes from.

The book Future MT uses is written by the staff of Health Professions Institute, which is the top name in the field, and extremely reputable. In fact, the founder of the American Association of Medical Transcription (AAMT) also founded HPI. Their materials are used widely among the most respected institutions.

As far as I can tell, the coursework (curriculum?) consists of handing you a book that can be purchased straight from Health Professions Institute (HPI) and the SUM Program practice recordings, which can also be obtained directly from HPI.

But wait – there’s more!

You get unlimited live mentoring with experienced MTs! I’m not hearing the word “instructor” or “teacher” there. For all I know, their definition of an experienced MT is someone with 2 weeks’ experience.

Students, at the appropriate time from Future MT instructors will be given access to the transcript keys and compare their work to the keys in a split-screen format, giving them immediate feedback on their errors.

Oh look – NOW we have “instructors.” Let me tell you something about giving students answer keys – they don’t learn much and it renders the rest of the exercise useless once someone has the answers.

But wait – there’s more!

I felt this part was worthy of a screen shot. Please comment if any of this makes sense to you.

Huh?

And in the FAQ titled How Long Will the Course Take to Finish?, I found this gem:

Future MT’s medical transcription training focuses on helping students find work quickly instead of spending more time training.

Yes, we certainly wouldn’t want future MTs to spend too much time training! Let’s focus instead on getting a job!

But wait – there’s more!

There’s an Employment Service!

And it’s part of the Guarantee!

So let me see if I understand… if taking a list of potential employers and bombarding them with resumes for 60 days doesn’t elicit any offers of employment – they’ll help you do it for another 12 months, hoping for a different response? (What are their affiliate transcription companies, anyway? I hope this isn’t just a list of transcription services they scrounged off Google.) Does everyone here understand the definition of insanity?

And every flippin’ page at FutureMT ends with this:

I have to wonder how much value there is to that guaranty when I’m getting bombarded with messages from graduates who can’t get a job. Money back? You can claim it within the first 30 days of enrolling. Of course, by the time you graduate and can’t get a job, the 30 days is long past.

Do I really need to keep going? Unfortunately, there seems to be no limit to the number of people willing to be the fodder for cheap programs that will take their money, turn them loose – and then fill up my mailbox with pleas for help getting that elusive job.Which is why I keep blogging about it – someday, I’d like to believe my yammering made a difference.

I think it’s pretty clear that: (a) not all transcription schools are equal and (b) FutureMT is not as good as a school that is licensed or accredited by a governmental body and approved by AHDI. Let me be clear – I don’t think AHDI approval is the be-all/end-all – but it is a distinction, a step up and frankly, all we’ve got. Given that, I think it’s essential that the medical transcription community supports that program.

But that’s not all…

OK, I have to save the very best for last. This just had my jaw dropping. I went to the LINKS page at FutureMT, expecting to find links to MT resources and information. Instead, I found this:

Is it just me – or is this about the tackiest thing ever for a professional website? The only MT site listed there is one owned by FutureMT. I mean, really – credit score reports and satellite dish links on a professional site?

(Look for my followup article next week on Medical Transcription Schools and the FTC)

Teeny tiny disclaimer: Like everything else at MT Exchange, this is only my opinion. Take it for what it’s worth.

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.

When it comes to the business side of MT, many MTs lose all sense of  perspective. Although there is a general derision for hobby MTs, the flip side is that the same (or more) level of derision is applied to the corporate aspects of the business. It sends a message that small business is okay, big business is not and that my small business is better than your small business because I run a serious business, dammit! There’s an aura of superiority put off by those who look down on the hobby MT because s/he doesn’t treat MT like the business it is and make business-like decisions. They undercut prices, they aren’t adequately trained – golly, sometimes they aren’t even real MTs! However, while the attitude is that we should be business-like, there is a fair amount of derision heaped upon being too business-like. All that business rah-rah goes down the drain when it comes to the large MT businesses and even the not-so-small MT businesses. Men are suits and women who are too business-oriented are bitches.

What got me writing is a thread at MT Chat about the sale of M-TEC and changes taking place at that school.

I am not thrilled with the corporatization of MT or the fact that what used to be an industry of primarily women has been taken over by men in suits. Men don’t think the way women do and they don’t do business the way women do. That’s not necessarily a bad thing, but sometimes it’s difficult for women to deal with, much like the toilet seat that’s left up. Unfortunately, any business dominated by women is going to look a lot like medical transcription; i.e., marginalized and commoditized and that has little to do with “the suits” and the corporations. I’ve been stiffed and mistreated just as often by the small local MTSO run by a woman as I have been by a large corporation run primarily by men. I’d rather work for a corporation run responsibly and by the book than a poorly-run small outfit and I don’t care whether a man or a woman is at the helm of either. Suits ≠ bad bad bad.

There is an attitude in the MT community that a transcription service owning/operating a transcription school is automatically A Bad Thing. Let’s apply some intelligence to this. First of all, M-TEC was originally owned and operated by owners of a transcription service. Maybe everyone has forgotten that in the intervening years. I don’t know how long Kathy and Susan ran a transcription business along with the school, but I know they ran a transcription service simultaneously with the school at some point. Second of all, the origins of this objection were based on small services with local clinic accounts that charged exorbitant sums of money to “school” people in MT. The curriculum (and I use the term loosely) was geared towards that service’s specific needs and was not even close to adequate for educating a well-rounded MT. The MTs who completed these “programs” were only employable by the service that ran the “school” they attended. This worked fine for both parties as long as the transcription service actually had work for the MTs completing the “school.” The problems arose when those people, thinking I R A MT, lost or left that job and represented themselves in the wider MT community as a trained medical transcriptionist with experience. Which – by every definition – they were! However, because their education, training and experience were so narrowly confined to that one service, they found they were simply unemployable elsewhere – and had to start all over again. That is not the case with M-TEC, whether we’re talking about past or present owners. WebMedX, in fact, would be able to provide an excellent training ground for MTs because they have contracts with a wide variety of facilities. If they intend to employ many of the MTs who attend M-TEC, then it’s a win/win situation for MTs and for WebMedX. On top of that, M-TEC gets a real boost to its placement numbers. Any MT who has completed the M-TEC program and worked for a year or two for WebMedX would most likely have no more trouble finding another job than any Andrews School graduate. So – get a grip, people! Transcription Service + Transcription School ≠ Bad bad bad, either.

The next big criticism was the shortened time allowed to complete the program before additional fees are assessed. I think what many of the participants in that discussion are not realizing is that there are many, many community colleges offering medical transcription certificate programs and that’s really the competition. I don’t have numbers, but based on my discussions with a lot of educators at those programs, the college programs are a bigger competitor than other online schools. Most of these colleges have 9-month programs and many of the requirements are regulated by the community or state education system. I was at a meeting of educators earlier this year and the college educators said that if they made the MT certificate program a 2-year program, they wouldn’t get any students. Several months ago, I did a spreadsheet of what the schools charge and some of the community colleges were the most expensive (depending on location), especially for out-of-state students. The number of credits required to complete the certificate program and the cost per credit jumped some of these well over the $5K range for tuition. While the prior owners ran a good business, the new owners have an investment (i.e., the purchase price) that the prior owners didn’t have and they need to see return on that investment. Therefore, their focus is going to be a little different and more aggressive than the prior owners’.

And while higher fees may push some people to the less expensive schools, I don’t think it’s going to make that much of a difference. Someone who price shops their education doesn’t even get as far as M-TEC or Andrews – they think Career Step is too expensive and they’re agonizing over that or one of the $900 programs.

Andrews can’t – and won’t – take everyone who applies. As I’ve said in prior posts about transcription schools, the stance that it’s “M-TEC or Andrews” (and now if you take M-TEC out of the equation, it’s just Andrews) is just unrealistic. If your dream is to see every other transcription school shut down, consider the consequences – a mass shrinkage in the labor force. We can’t even say that’s a good thing, since the MT industry has been defying the usual influences of supply and demand for years now. I’m not sure what anyone thinks would be the positive consequences of this, or what MTs who believe in “M-TEC or Andrews” think would happen to the quality of education at those schools if they started expanding to take more candidates. (Hint: There’s a reason Harvard and Yale are so expensive and have higher admission standards. They don’t take just anyone, either.)

Can an MT program be completed in 9 months? Of course it can. Just because an MT who took longer “can’t imagine” completing the program in less time doesn’t mean it isn’t possible. Someone who is truly desperate to get into the job market can complete a self-study course in much less time than that, even. It takes focus and hard work – but I know more than one MT who eschewed Andrews in favor of a self-study course they could get through quickly so they could get a job faster. Take your pick – be broke for 2 years because you’re working part time and going to school part time, be really broke for 2 years because your school won’t let you complete faster and there aren’t any local jobs available or you live in a rural area – or be really broke for 9 months or less because you’re going all out to complete a program so you can get a full-time job and stop being broke. There’s a reason community colleges can’t “sell” a 2-year program. For one thing, the pay rates don’t justify it and for another, most people wanting to enter MT need to get into the job market faster than that.

It costs money for a school to carry people who are poking along in the program. What WebMedX is doing is requiring people to make a real commitment to their education. Having to expend considerable money and a significant amount of time speaks to motivation and commitment.

I’m going to share with you one of my first experiences about learning the value of money and commitment. I joined a martial arts class at the university in the town where I lived. The instructors were volunteers and the university let the group work out in a room in the physical education building. Although the stated fee was $5 per month, it was like it was voluntary – nobody really made an effort to collect it and most students didn’t pay it. When I had gained some seniority, I told the senior instructor I was taking over the treasury – then I started aggressively collecting the fee. Oh, the whining! Even the instructor whined, telling me these were poor college students who couldn’t afford $5 a month for martial arts. I looked him in the eye and told him “they spend more than that on beer every Friday night.” Then I looked them in the eye and told them “you spend more than that on beer every Friday night.” Did we lose students? No, we didn’t. In fact, we had a resurgence of participation. Paying $5 per month was enough to motivate these students to make a real commitment to studying martial arts and working out. People who had previously come to class only when they felt like it now attended every class. For $5 a month, they didn’t try to find time for class – they made time for class. People who had worked out with a modicum of effort either dropped out altogether or started working harder. The club finally had money to buy equipment and have social events (read: parties) at the end of the quarter after belt testing.

Someone who is having financial difficulty will either decide they simply can’t complete the program in 9 months and they’ll go elsewhere – or they’ll knuckle down and work twice as hard to finish the program before having to pay more money to extend the education – 0r pay more money to extend the education. The MT benefits by getting into the job market faster. WebMedX benefits by getting more potential candidates faster. And if WebMedX considers itself the #1 employer of its graduates – do you really think they’re going to do anything that results in their getting less qualified graduates? If employers won’t hire their graduates, if they find their own graduates aren’t adequately trained to work for them – they’ll suffer the consequences of their own decision and make adjustments.

WebMedX made (presumably) a huge investment in M-TEC. From a business standpoint, it’s in their best interest to do what is most profitable and will get them the best return on their investment. Whether or not they feel preserving the reputation of the school is a necessary part of that investment remains to be seen, but they could’ve bought any of a dozen lesser schools if they didn’t care about name recognition and reputation.

I’ve said it many times over the years when a group of MTs criticizes the decisions of a business – if you don’t like the way a business is run, feel free to start your own. You can run it any way you like, including making decisions that eat into your profit so you can please the masses of faceless MTs criticizing you in the forums.