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

This is an interesting question now being frequently posed in the medical transcription community on Facebook, in the forums, and elsewhere. It’s one I am frequently asked, as well.

And my answer is no – it’s not a career choice I encourage. This position has been questioned by some, especially when I say it in forums like MT Chat, because I own several websites for medical transcription (and, obviously, I blog about the medical transcription industry). My response to that is that I spent over 20 years in the medical transcription industry. I know a lot of people in the industry and support them, regardless of how I feel about the career.

But – if you’re someone looking for career choices, I am going to tell you to really do your homework before plopping down thousands of dollars on a medical transcription education.

Follow the money

For several years, my impression that medical transcription pay rates are going south has been anecdotal. Then, my friend Kathy Nicholls (who is much more data oriented than I am) did an excellent analysis of numbers, which you can read at MT Tools Online: A Salary Perspective Over 11 Years.

It doesn’t take a rocket scientist to read that information and see the writing on the wall for the working MT. Medical transcription pay rates haven’t kept up with even cost-of-living increases over the last 11 years. I don’t see that this trend is going to change. There are increasing reports from medical transcriptionists that pay rates continue a downward slide, with speech recognition editing paying half or less, while not delivering a breakeven proposition with increased productivity.

The line count pay rate isn’t the only factor affecting how much a medical transcriptionist can make. There are more and more MTs telling me that they fight a daily battle to eke out their daily line count minimum when there isn’t enough work in their employer’s system. These employees are expected to not only be available to work their scheduled hours, but to sit around and wait for work to be available on the system – without any compensation if there isn’t.

Whiners and winners

My decision to write on this topic came out of a Facebook discussion. Fortunately, you don’t have to be on Facebook because Kathy also wrote a blog post at her MT Tools site – Medical Transcription on Facebook: A Case Study. In my opinion, the most interesting response to the question posed came from Ava Maria George, the president-elect of AHDI.

In order to assure that pay is commensurate with our talents, we have to get out there and educate ourselves (yes, I mean bachelor’s degrees) and advocate for our profession. One cannot simply sit back and say, “Please Mister, give me more” and expect that will happen. Obviously, not advocating or speaking out has literally made us obsolete. So, what are we willing to do about it? Get out there or leave. Simply, those are your choices.

Call me crazy, but if someone told me I needed a bachelor’s degree to do medical transcription, I’d be laughing so hard, I’d be speechless. I mean really – if you had the time and money to get a 4-year degree, would you get one so you could be a medical transcriptionist?? I wouldn’t even do it if I had to get a two-year degree.

Now, the case might be made that even Starbucks pays more if you have a college degree and therefore we may draw the conclusion that medical transcription would pay more if practitioners had a college degree. However, it is not the degree itself that is driving higher pay rates – it’s the employers. Starbucks simply states that employees who have a college education are paid more than those who do not. It does not give preferential hiring to degreed applicants, but it does reward them for having a degree. (And it’s kind of a sad statement on the economy and the value of a college education when people with college degrees are working as baristas.) And employers in the medical transcription industry have not supported either higher education or credentialing.

Get out there or leave – seems to me that’s a predictive statement, especially when it comes to AHDI membership. Oh sure – they can point to growth, due to the KB membership, but their practitioner level membership numbers are shockingly low, just over 3000 members at the end of 2010. When I left the organization, the practitioner membership was over 7000 members. Apparently the answer to not finding your sweet spot in serving actual people is to come up with a product you can sell and tie it to a non-voting membership category so you can tell the people you used to represent that you’re tired of their whining and they can just go away.

Which brings me to the next statement made by Ava…

I’m not talking about staying traditionally an MT…we’re evolving. We will be looking at changing not only what we do, but hopefully in the process elevating our profession to one that is compensated at a professional rate. Think about it. Coders were in our position years ago. They decided to educate up, credential, and their salaries followed (higher). Now, they are at the same crossroads that we currently find ourselves…we either grow or go. It can be scary or it can be exciting. I’m betting on exciting….

I have a couple observations to make about this. First of all, I don’t know where Ava Maria George gets the impression that coders educated up. The requirement is, and always has been, a high school diploma or equivalent education.

And I’m going to argue with the interpretation of history here… coders did not, by themselves educate up and credential. AHIMA was successful in getting employers of coders to recognize the value of the credential and start demanding that coders be credentialed. The recognition of the coding credential was not a grassroots movement by the coders, but a top-level-down marketing campaign by AHIMA.

The same is true at HFMA. In the Southern states, more employers require their finance people to have an HFMA credential; therefore, there are more credentialed HFMA members in the Southern states. In the Western states, fewer employers require the credential and therefore there are fewer HFMA members in the Western states who are credentialed.

My daughter is a personal trainer. To get hired at a reputable gym, she must have a credential. No credential, no job. In addition, at the gym where she works currently, she must participate in additional inservice training in order to advance in pay. If she doesn’t participate or participates and doesn’t pass, she loses her job at that gym. Her reward for participating and doing well is not only higher pay, but continued employment.

I have a friend who works in the HIMS department of a major university hospital. She was given a drop-dead date for finishing her AA degree and passing the RHIA exam. If she did not, she was out of a job. She took the test on the Saturday and fortunately passed because after many years of working at this hospital, she would have been terminated on Monday if she hadn’t passed. And – she didn’t get a raise or a promotion, she just got to keep her job.

What AHDI seems to be missing in the entire credentialing discussion is that successful credentialing takes place from the top down, not the bottom up. The problem in the medical transcription industry is NOT that transcriptionists haven’t supported credentialing and education – it’s that employers haven’t supported it. How long do you suppose MedQuist would last if they terminated all MTs who didn’t get a credential by a certain date? The plain truth is that the transcription industry doesn’t have the guts to place such a stringent requirement on its workers, even if it had a financial incentive for doing so. And let’s face it – there’s no financial incentive. For the Record recently did an article on The MT Credentialing Debate, and this statement is indicative of why credentialing for medical transcriptionists has never gotten off the ground:

Dale Kivi, MBA, business development manager at FutureNet Technologies Corporation and a member of the board of directors for the Clinical Documentation Industry Association (CDIA), says he understands and appreciates the efforts of industry organizations that promote credentialing. However, he says organizations that purchase transcription services don’t seem to care whether the labor force is credentialed. Their interest lies in stipulating quality expectations and holding vendors to those levels, regardless of whether the staff are credentialed.

It seems all the blame doesn’t go to AHDI, but I’m tired of them point a finger at medical transcriptionists for not supporting the credential. A better use of their time and energy would be to use their partnership with CDIA (the organization formerly known as MTIA) more effectively.

Winners never quit

You know that saying: Winners never quit and quitters never win.

If you examine successful business people, you’ll find the above statement is erroneous. More than anyone else, winners know when to quit.

What really sets winners apart from quitters is the ability to escape dead ends quickly, while staying focused and motivated when it really counts. They don’t waste time and energy on a dead end. Winners do not keep chasing unprofitable ventures.

The biggest difference between quitters and winners is that when quitters quit, it’s an emotional decision. When winners quit, it’s a rational decision, based on objective data and analysis. Seth Godin has some interesting things to say about quitting and winning in his book: The Dip: A Little Book That Teaches You When to Quit (and When to Stick). Guy Kawasaki interviewed Seth about the book and asks:

Question: Other than hindsight, how does someone know when it’s time to quit?

Answer: It’s time to quit when you secretly realize you’ve been settling for mediocrity all along. It’s time to quit when the things you’re measuring aren’t improving, and you can’t find anything better to measure.

Smart quitters understand the idea of opportunity cost. The work you’re doing on project X right now is keeping you from pushing through the Dip on project Y. If you fire your worst clients, if you quit your deadest tactics, if you stop working with the people who return the least, then you free up an astounding number of resources. Direct those resources at a Dip worth conquering and your odds of success go way up.

What’s the worst time to quit? When the pain is the greatest. Decisions made during great pain are rarely good decisions.

Research and make your choice

Basically, medical transcription has been the one reliable (or, lately, semi-reliable) legitimate work-at-home opportunity. It works for people who don’t have other choices; they must work at home or they must have a more flexible schedule than a traditional office job allows; or they live where there aren’t many work opportunities. For those reasons, medical transcription will remain a career choice for some, while those with more and better options will choose something else. Blaming medical transcriptionists by telling them they’re a bunch of whining losers won’t make medical transcription a higher-paid career. Not only is that a lousy marketing tactic, it’s just putting lipstick on a pig and trying to convince everyone the pig is a something desirable.

So here’s officially what I think.

On the surface, this appears to be a good job for a medical transcriptionist. I see several obstacles, however, to viewing this as the saving grace of a dying career.

Scribe candidates are college graduates, many of whom are multilingual and “highly motivated,” Pierog said. Typically, the person she is looking for to join her staff is “someone who has an intense interest in medicine and is looking to go on to something else,” quite often medical school.

“It’s not hard to find scribes,” she said. “The program has a 300-person waiting list.”

The majority of the current medical transcription workforce isn’t composed of college graduates. If a college degree becomes a requirement or a preference for scribing jobs – and based on this statement by ScribeAmerica, it looks to be heading in that direction – the majority of MTs would not be candidates for these jobs.

That’s not to say it should be ruled out as an option. It’s quite possible that, given the skill set medical transcriptionists possess and how it applies to the scribing position, the preference or requirement for a college degree would be waived. The articles says that about 30% of its hires are people with secretarial backgrounds.  It’s certainly worth a shot for any MT who is interested in doing this kind of work in order to transition out of medical transcription.

Speaking of the skill set, I read this paragraph and wondered how much of the skill set is actually the same:

Esquibel said there is “a very strong correlation” between eventual success as a scribe and a candidate’s prior successful work experience in service-sector jobs, particularly as a waiter or a waitress. “There are a lot of the same patterns,” she said, in keeping multiple food and drink orders straight in a restaurant and keeping tasks and records straight in a busy ER.

Transcriptionists sit in a (preferably) quiet room and do one thing – they transcribe. One could argue that working at home requires multitasking, but it simply isn’t conducive to productivity in transcription. There aren’t many things you can do while transcribing, and be productive/accurate.

However, one of the biggest obstacles I see in medical transcriptionists transitioning to scribing is the fact that it is an in-office job. Traditionally, the allure of medical transcription has been that it is a job that can be performed from home, on a fairly flexible schedule. It’s ideal for people who:

• are caretakers for children and/or adults
• have health problems that preclude working in an office but can be accommodated in the home office environment
• live in rural areas where there aren’t a lot of job opportunities
• move around frequently and need “portable” jobs (i.e., military spouses)

All of these advantages go away with the scribing position. It absolutely requires that the scribe go to where the physician practices medicine. In my opinion, that’s going to eliminate many current MTs who might otherwise be interested in this as a career.

Even supposing that the issues of caring for children and/or other adults are removed, I know a lot of MTs who say the ability to work at home has provided them with the only available option to make money, given their rural location and lack of local job opportunities.

Then there’s the pay rate…

Although there are plenty of jobs in healthcare and the job outlook in healthcare continues to be good, there’s not a lot of money in healthcare

Starting pay for a rookie scribe is about $10 an hour, she said, while chief scribes make $14 to $16 an hour.

OK, first of all – it’s better than no job at all, right? Second of all, I know MTs who make about that. The big HOWEVER is – they’re making that while working at home, not having to go into a hospital (where most of these jobs are based).

Those are the obstacles I see to current medical transcriptionists transitioning to the scribing career. The other obstacles require me to take out my crystal ball and making some predictions about the future.

Prediction #1: Technology always gets better. That’s not a crystal ball prediction, it’s a fact. Therefore, it stands to reason that EMR software will continue to improve in functionality. Hardware will continue to improve. The two put together will be more intuitive and easy to use. (Consider Apple’s iPad a major game changer – the healthcare technology forums are going crazy over what it will mean for mobile healthcare and EMRs.) As software and hardware improve, it will be easier and easier for doctors to use the technology without assistance.

Prediction #2: I think the demand for scribes will decrease as older doctors retire and are replaced more and more by doctors who can’t remember what life without a computer is like. Keep in mind that the youngest doctors already in practice probably remember not having a PC at home, but likely had one by the time they were in their teen years, depending on their family circumstances. Medical students currently close to graduation are very likely to do their internships and fellowships at hospitals that already have EMR technology. The “computer generation” of doctors will be comfortable with technology, likely more so than with dictating.

Prediction #3: Whether or not hospital  and clinics are going to want to add the expense of scribes will depend on how much they see billings drop as a result of doctors trying to deal with the documentation on their own, and how much value the scribes add and whether that all balances out. It appears to me from the article and the ScribeAmerica website that they’re specializing in ERs and in EMR transition. Is there longevity in a service that’s offered on such a limited basis; and, in the case of EHR transition, for a finite period of time – will healthcare providers be willing to continue the expense of a scribe post-EHR transition?

Medical transcriptionist to scribe

I think for MTs looking to transition to a different career, the decision to become a scribe depends on a number of things. First and foremost would be whether you are able or willing to work in an office, and whether you live in an area where this kind of job is available (or other jobs that are just as good or better).

Second, do you want to transition to a career that doesn’t pay much better (or any better) than MT and may be just as short-lived? If you believe my predictions are fairly accurate, then you’re looking at a career life that’s approximately equal to MT. It might be worthwhile if no additional expense for schooling is necessary.

Since the article states they have difficulty finding people who will stay or can do the job, I have to wonder if the same inverse supply-and-demand that has resulted in stagnant pay in medical transcription is going to take place in scribing as well. The pay rate doesn’t seem to be in alignment with the statement that good people are difficult to find and keep. Maybe there’s a lesson there that ScribeAmerica needs to learn, or maybe its due to the financial constraints of healthcare being in play again, I’m not sure.

While I just don’t see this as being a promising transition career in the long term, I think whether or not it’s a better option than MT will depend largely on the individual circumstances of the MT.

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.

The subject of today’s entry appears to be owned by Future MT – yes, a Crappy School with an aggressive affiliate marketing campaign. They’re all over the place. Their affiliates’ sites are all over the place. But when I stumbled on their Medical Transcription Trends site (it appears to be owned/operated by the owners of Future MT, not one of their affiliates), I didn’t know whether to laugh or cry.

But first – let me take a moment to dissect the Future MT web site. You have to love someone who will put affiliate links at their business web site! There’s nothing quite like money-making plugs for satellite dish installation and credit repair to lend credibility to a business venture. Even better, these are under “medical transcription links.” There isn’t one link there related to medical transcription – most likely because the money-making links are competitive schools. Since they appear to have an education alliance with a transcription service, why don’t they even put a link to that transcription service? And in a touch of irony, there’s an affiliate link for legitimate work-from-home jobs – apparently the owners of Future MT are covering all the possible money-making opportunities. Or are they suggesting that MT – and therefore their school – isn’t a legitimate opportunity? My other favorite on this site is that a graduate excitedly lets them know she’s landed her first job – with AM Trans Am. Apparently, they don’t bother warning their students about the various scams going on in the industry.

OK, the purpose here wasn’t to dissect yet another Crappy School – it was to comment on this site put up by Future MT. Some of the claims made are funny if you put aside for a moment that people are making decisions about their careers on the basis of what they find on the internet.

Before I begin, let me tell you that the entry is the only easy thing in the medical transcription profession.

Wha…????

Oh… this is why it’s so darn easy. You’re going to notice there’s absolutely no mention of how hard it is to get that first job:

You don’t need to possess a formal qualification to enter the field. No, this does not mean that medical transcriptionists are not qualified. They acquire the professional qualifications as they enter the industry. You don’t need any degree or certificate to make your way into the industry though. [emphasis added]

It seems they have (uncharacteristically) overlooked the opportunity to plug the need for an education – preferably the one they’re selling. I’ve bolded my favorite part. Enter the industry and BAM! You have professional qualifications! It’s that easy!

You don’t need to possess any kind of working experience. Yeah, you can make an entry even if you are a high school grad. It does not matter if you have ever worked in your life.

I like that “yeah” – kind of folksy, although I can’t help but picture Michael Cain in “Miss Congeniality,” telling Sandra Bullock – “It is always yes, never ‘yeah.’”

Notice how the issue of work experience is completely glossed over? Those of us who are actually working in medical transcription know that while the above statement is true, it’s only half true. I dare any of ya (see the folksy touch there?) to find a job listing for a medical transcriptionist that doesn’t require a minimum of 1 year of experience as an MT. If you do, send me the link. I have never, in 20 years, seen anyone care whether or not a prospective hire had work experience that wasn’t in medical transcription.

Then, they lose me with the conclusion of this article…

The easy entry into the profession has been mocked by many and the profession has been looked down upon. But just because there are no stringent prerequisites, you cannot become a medical transcriptionist. If you don’t have analytical skills or the willingness to study along with work or the commitment to meeting deadlines on a daily basis, this profession is definitely not for you. So, make sure you gauze your potential before entering this field.

Someone needs to proofread better…

Actually, the articles at this site read like many I’ve seen all over the internet that have been written by services, most of them operating overseas. It would surprise me if all these entries were actually written by someone at Future MT.

Jason Trusler, is listed as a principle at Future MT (and the contact for the various web sites I’ve found that are owned by them) and is a somewhat prolific writer of MT-related (and credit, which may explain the affiliate link at the business web site) articles. I have to say that Future MT has done its homework on internet marketing and they seem to be effectively employing the same tools as internet marketers to promote their school. Interestingly, Trusler’s bio states:

Worked in the Medical Transcription industry for over 12 years in many different fields. Currently does consulting for medical transcriptionist course training schools.

As far as I can tell, he isn’t consulting for Future MT – he’s one of the owners. And I’d be surprised if there was any consulting being done for other training schools, unless he’s counting affiliates for Future MT. I’m also wondering how many different fields there are in medical transcription.

As a fine example of what you’ll see in internet marketing articles, Trusler writes an article on How to get medical transcription training, where he states:

One of the great elements of medical transcription is that experience in the field is not a requirement to have a good chance of finding employment, although it definitely helps.

See my challenge above to find a job that doesn’t require experience in medical transcription. Don’t hold your breath waiting for anyone from Future MT to provide objective evidence to back up this claim, however.

Then there’s this statement:

It will not typically matter to a potential employer where you have taken your certification course because many of them will test you before they choose to hire you.

Uh, ok – let me clarify for anyone who is researching MT schools and hasn’t made a decision yet… Potential employers do care where you have completed your medical transcription coursework. While it is true that they will test you before they choose to hire you, whether or not you even get as far as a test will often depend on where you got your education. Testing takes time and costs money and employers are only going to test people they believe have a reasonable chance of passing the test. Trust me – if they have to choose between an application from someone who went to an AHDI-approved school and someone who went to a cheap online program – like Future MT – they’ll test the people who went to an AHDI- approved school.

The more practice you have at transcribing and the longer you study the skill through your course training, the higher the chance you will have of an employer hiring you without any on the job experience, so it is important to take the course seriously.

In my experience, this statement doesn’t have even a half grain of truth to it – it’s completely false. There are only so many hours of available practice recordings available. Repeating them over and over again isn’t going to make a prospective MT more employable. Professionally-recorded practice tapes aren’t even close to real experience. The only experience that matters is real live experience.

Unfortunately, Future MT isn’t the only school to employ internet marketing tactics and make outrageous and/or false claims. They’re just the school du jour. So… it bears repeating because I know a lot of people come to this blog, looking for information on MT schools and MT careers:

• Don’t even consider a school that isn’t approved by AHDI
• Don’t rely on the FAQs – call and ASK specific questions about placement rate (percentage of graduates hired) and the placement program.
• Check with experienced transcriptionists in the medical transcription forums and at Facebook and ask about the school.
• Make sure anyone who responds positively doesn’t have a monetary incentive for selling you on the school – many, many schools have affiliate programs and they also pay current students and graduates for referrals. Call the school and verify that the person is actually a graduate of their MT program – no school should have any problem giving this information.
• If someone tells you a school is wonderful, get specifics. Are they working as an MT? Where? How long did it take them to get a job? How long have they been working? What did they think was great about the program?

I live and breathe to enlighten you.

What follows is a cautionary tale to those who search the internet for information on how to work at home as a medical transcriptionist. The rest of us – you know, the choir – can only look on in horror.

How Google ads work

It helps to have some knowledge of how Google ads work. You see them everywhere you go; maybe you’ve wondered how they work (maybe you haven’t!). There are two sides to Google ads: advertisers, who want to place ads (Adwords) and publishers, who run the ads on their sites (Adsense). When an advertiser runs an ad campaign in Adwords, they pay Google. When a publisher places Google Adsense ads on their site, they get paid by Google when someone clicks on a link in the ad. High-volume publishers get enough people to the site to also be paid per 1000 impressions, or the number of times the ads are displayed to users. Low-volume publishers don’t get enough page impressions to make much money this way – they rely on the ad clicks to make money. Google, of course, takes a cut in the middle. The entire system is based on keywords, keyword phrases – the perceived value of the keywords (i.e., the number of people searching that keyword) and the traffic of a publishing site.  Advertisers can select keywords relevant to their product (in this case, medical transcription) and they can target specific web sites that get a lot of traffic. The more advertisers there are competing for a keyword phrase, the higher the cost goes because it’s a bidding process. Likewise, the more traffic a site gets and the more advertisers competing to be seen on it, the more it’s going to cost the advertiser.

I could spend days on this, but I’ll try and keep it simple because that’s not the focus of this topic.

Let’s say I want to place ads for my MT jobs site on a bunch of MT-related web sites that run Google ads, using the keyword phrase medical transcription. And let’s say that specifically, I want my ads to display at MT Chat. I start an ad campaign in my Google Adwords account and specify the keyword phrase medical transcription, then I select the option to target specific web sites. Google will retrieve a list of sites for me, but I don’t need them to – I know I want my ads to run at MT Chat. I then bid on how much I want to pay per click and what my daily budget is for the campaign. Now, I can bid whatever I like – I can say I’ll pay $0.25 per click. And Adwords will let me do that – but they’ll also pop up a message saying that my ad has a slim-to-none chance of ever showing up on MT Chat. Why? Because medical transcription is a high-value keyword phrase and MT Chat is a high-volume site, so there are a lot of advertisers targeting not only the keyword phrase, but the web site, as well. The more you’re willing to pay, the better chance you have of your ads showing up on the specified web site. Adwords lets me know that other advertisers are paying more for that phrase and makes a suggestion as to how much I might have to pay to have my ad show up there. The more I’m willing to pay, the better my chances are of having my ad seen. There are keywords that are paying advertisers a handsome amount (mesothelioma was a popular one for quite awhile and paid upwards of $30 per click!). If I choose not to target a specific site, it’s cheaper – my ads will show up on any page where the term medical transcription is found, which is why you see ads related to the topic in a discussion forum.

How this translates to medical transcription and matchbook schools

There is a thriving business on the internet known as internet marketing. Some people are very good at it, some are very bad at it, but what is pertinent to the readers here at MT Exchange is this: medical transcription careers is a very lucrative niche for internet marketers.

If you search the term medical transcription in Google, what you get in return is a mixed bag of sites about medical transcription services, medical transcription training and medical transcription courses. In the Google search results world, medical transcription is a very competitive term. People who want to work at home seem to be one of America’s greatest renewable resources; and as we all know, medical transcription has been an attractive work-at-home career for a very long time. There are approximately 18,000 searches a day for the term medical transcription.  That’s a lot of searches. To give you an idea of how competitive this term is, there are over 1.8 million web pages that contain the term and over 800,000 pages that contain the term in the title.

The web site that gets to the #1 spot in the Google search engine results (SER) is the big winner, capturing a huge portion of the traffic. Currently in that spot is Gatline Education Services. Gatline is not an AHDI-approved school and some of you probably haven’t even ever heard of it. So what do they get for being in the #1 spot? They will get 45% more clicks than the #2 site, which is currently the Department of Labor site. All I can say is Gatline must have some awesome people working on their search engine optimization because Google weighs government sites ahead of commercial sites in their results. The farther down the list a site is, the less likely it will be seen – the drop in clicks between the #1 and the #2 spot is bad, worse for #3 and progressively worse down the list, so that if a site isn’t in the top 5 results, it has a very small chance of being seen. While Gatline doesn’t run Google ads, being in the #1 spot means that anyone searching for medical transcription is more likely to click on their site than any other – which means they get more traffic.

In the internet marketing world, it would be foolish to try and compete for the #1 (or even #2-5) spot for this keyword phrase. The advice is – pick something that has fewer searches but also less competition. Sure, the ad revenue will be less, but your chances of getting to the #1 spot are much better – and something is better than nothing.

Here’s an example: if you were an Adsense publisher in the #1 spot for the keyword phrase medical transcription, the anticipated revenue you’d receive from having Google ads on your site would be (drumroll please) – nearly $27,000 per day. That number is based on the number of searches and the statistics for searchers not only clicking through to view that #1 site, but also clicking on the ads (and believe me – Google is all about statistics and therefore so is anyone with a serious web-based business).

On the flip side of that, medical transcription schools is searched only approximately 250 times a day and the site holding down the #1 position could expect Adsense revenue of approximately $1,000 per day. While nothing close to the $27,000 per day for medical transcription, it’s still nothing to sneeze at, and there’s less competition. There are only approximately 30,000 sites mentioning the phrase and only 16,000 sites using the phrase in the page title. That’s why, if you search the specific term “medical transcription schools,” you get a lot of crappy sites dedicated to nothing more than providing Google ads and affiliate sales for one of the schools that offers a high affiliate payout. (Google isn’t the only way to make money on the internet.) Currently sitting in the #1 spot is an affiliate site for Allied – which is also not an AHDI-approved school.

The obvious benefit to someone like Gatline Education – which doesn’t run Google ads – is capturing a huge share of the search market and selling to them directly. They’re capturing people who are already interested in what they’re selling and they are getting more of them than any of the other sites selling similar products/services.

Apparently, the more credible schools don’t feel the need to improve their search engine rankings – or they just don’t know how all this works. If there were more of them showing up in the top 5 spots for the search engines, there’d be fewer hopefuls shunting off to the questionable schools.

The site that got me started

No, I’m not going to give them the pleasure of a link. But it was an awful/funny exercise in targeted keywords by an affiliate marketer. The site is owned by someone in India. I could’ve guessed that, even without checking the domain name registry. It’s targeting medical transcription keyword phrases (the low-lying fruit ones). They’re giving away an “Easy Cash Blueprint” e-book – but you have to provide an e-mail address to get it, which means that address will be spammed from a mailing list in the hopes of selling you products. At the very least, they’re hoping visitors will click on the Google ads at the site.

There’s the really awful content (I’ve italicized the obvious keyword phrase being targeted by this marketer):

I am sure your quest for Medical Transcription Book has come to an end as you read this article. Yes, gone are those days when we have to search endlessly for Medical Transcription Book information or other such information like protein protein comparison, free voice to text software, transcription desk or even group transcription services. Even without articles such as this, with the Internet all you have to do is log on and use any of the search engines to find the Medical Transcription Book information you need.

If this article still doesn’t answer your specific Medical Transcription Book quest, then don’t forget that you can conduct more search on any of the major search engines like Search.Yahoo.com to get specific Medical Transcription Book information.

A career in medical transcription has a lot been going for it. Here we are facing an economic downturn and this field is only likely to thrive in these times. The medical transcription industry is set to steadily grow as the population ages.

All that useful information crap was packed into one article! First of all – would you read that garbage and then buy something? Better yet – would you want someone who read it and then paid for it to be working next to you?

Just as a note, medical transcription book gets a little over 100 searches a day. If this bozo captures the #1 spot in the search results for that term, there’s a good chance of making about $100/day from the Google ads. Heck, there are MTs who don’t make that much! Unfortunately for this hapless marketer, this site doesn’t even turn up in the top 10 of the results (although it is on the first page). With a little more work, it might make it there!

Here’s another one:

Title: Free Medical Transcription Helpful Information

As you devour this article, remember that the rest of it contains valuable information related to Free Medical Transcription and in some way related to home based medical transcription jobs, transcription from home, medical transcription position or global medical transcription for your reading pleasure.

(skip to the end) It might interest you to know that lots of folks searching for Free Medical Transcription also got information related to other medical billing, sirna delivery, and even transcription services bangalore here with ease.

Again, the obvious keyword stuffing that tells you nothing and frequently doesn’t even make sense. In one article at this site, the keywords were actually preceded by the word keyword. (where’s my rolling eyes icon?) I don’t even know what sirna delivery is – but I know it makes no sense in this article.

And my personal favorite wins the award for complete nonsense. This is the first paragraph:

If your major interest is information related to Learn Medical Transcription or any other such as medical transcription job opportunities, transcription systems, allegiant transcription services or dictation services, this article can prove useful.

Nonsensical use of keyword phrases is a sign of a novice who found the keyword phrases with low competition, but didn’t use half a brain cell in applying them to the article. I’d rather think that than think this person’s English is so awful this actually makes sense to them.  In addition, this bright marketer apparently researched the keyword phrases that were low competition and discovered that Allegiant transcription services fit the bill – and so it was included in this garbled paragraph!

The next time someone online asks you about a matchbook school, ask them where they learned about it. Chances are, it was through the internet version of  a matchbook.

When I first started working at home, I was surrounded by children and their schedule and the woman who provided day care at my home. Now, I have only my youngest at home and he’s in and out with his school and work schedule.

So, I was sitting at my desk yesterday, chewing gum (as I often do) and this irrational fear rose again. Not that I choked on my gum or anything – just the spector of the possibility arose in my imagination and that was that. I spit the gum out. Posting a comment via Twitter (which feeds to my Facebook wall) is really easy – so I did.

What ensued at my Facebook wall was really very funny. (I’ll comment some other time on the useful sociability of Facebook and Twitter.) I feel comforted that I’m not the only one with irrational fears!

Margie worries that she will trip over her cat in the middle of the night and nobody will find her for days and days.

Galina wondered if her dogs would be helpful if something similar were to happen to her.

Margie wondered if maybe she needs a dog to save her from the cat.

After reassuring all of us that this kind of thing COULD happen – because it happened to her, but she was able to save herself through a somewhat modified self-performed Heimlich maneuver – Dianne shares that her dogs and cats would huddle near her body until it was cold, then go find another heat source.

Our casual comments about work-at-home hazards apparently had an effect on MTs in similar circumstances who have not – up to this point – even thought to worry about such things! Well, it should be on their minds now! I’m sure they’ll be thankful to the rest of us for sharing.

Shana wonders if our job makes us paranoid. There is a theory in hospitals about MTs and hypochondria, so it’s quite possible we’re also paranoid about the perils of isolation!

Carrie shares that if she has to take medication, she puts a note next to her on the desk – just in case she doesn’t make it through the day. I hope it never becomes necessary; but if it does, I’m sure the EMTs will appreciate the information! And I have to confess – when I’ve felt really, really lousy, I leave a note on my monitor, describing my symptoms and any self-treatment – just in case. If someone comes home and finds me dead, I want them to know the details of my symptoms prior to my expiration.

Some wag on Twitter responded that maybe I should set up a webcam. That might be a good idea, except that in the internet age, everything becomes entertainment. Within an hour of my gagging and choking in front of a webcam at my desk, the video would probably go viral on YouTube. At least nobody would be accusing my husband of killing me.

With great caution this afternoon, I unwrap another stick of gum.