The 50% Solution

One of my favorite quotes comes from the final scene of “Hello, Dolly!” at the moment when most of the principal characters have gone upstairs to get their money out of Horace’s safe. Left alone in Vandergelder’s Hay & Feed Store, Dolly Levi lovingly wraps her arms around the cash register, turns to the audience, and utters Thornton Wilder’s famous words:

“Money, money, money, money, money! It’s like the sun we walk under. It can kill and it can cure. Horace Vandergelder never tires of saying that 99% of the people in this world are fools and, in a way, I suppose he’s right. We’re all fools. Himself, Irene, Cornelius, myself. We’re all fools – and we’re all in grave danger of destroying the world in our folly. Yet the surest way to keep us safe from harm is to give us those few things in life which will make us happy – and that takes a little bit of money!

“Now, the difference between a little bit of money and no money at all is enormous –and it can shatter the world. And the difference between a little bit of money and an enormous amount of money is very slight. But that, too, can shatter the world. It’s all a question of how it’s used. As my late husband, Ephraim Levi, always used to say: Money-- you should pardon the expression -- is a little like manure. It doesn’t do anyone a bit of good unless it’s spread all around, encouraging young things to grow.”

Financial pressures are weighing heavily on two nonprofit organizations devoted to the needs of medical transcriptionists. Although the American Association for Medical Transcription has been in business for many years, its membership keeps dropping. By contrast, the American Medical Transcription Advocacy Group is a fledgling operation whose membership has no choice but to grow. Whereas AAMT’s structure has been based on a strict if rather sluggish hierarchy of local, state and national chapters, AMTAG was recently launched as an Internet-based organization, using current technology to reach the on-line community of medical transcriptionists. Under Jay Vance’s leadership, it seems as if the organization’s policies will be determined from an Internet-enabled membership that can quickly respond to requests for ideas, input and action.

The contrasts between the two organizations are easy to spot. While AAMT has welcomed offshore vendors to its fold (causing many to wonder why the word “American” remains a part of its name), AMTAG stresses that its organization is comprised of America’s medical transcriptionists, conceived by America’s medical transcriptionists, and designed for America’s medical transcriptionists. One of its goals is to make sure that jobs held by American MTs are not lost to transcription firms in India and other Third World nations (such as those that have recently become members of AAMT and of the Medical Transcription Industry Alliance.)

While AAMT’s stated mission is “to represent and advance the profession of medical transcription and its practitioners,” one reason AAMT has continued to lose members over the years has been the nagging suspicion that AAMT does not do an effective job of speaking out for America’s medical transcriptionists. Many American MTs take exception to AAMT’s willingness to include offshore vendors as corporate members (the organization claims that its vision is “to direct the evolution of the medical transcription profession”) as well as AAMT’s eagerness to seize upon teaching opportunities in foreign nations for its former board members and CMTs. When the debate heated up over the risks of compromising patient confidentiality by sending dictation overseas, one of the questions most frequently asked was “Where was AAMT?” When serious concerns were voiced about the impact on the wages of American MTs by Third World entrepreneurs determined to underbid contracts with American vendors, people wanted to know where AAMT stood on the issue. Because the organization’s silence was nothing short of deafening, many MTs have grown to resent AAMT’s continued attempts to position itself as the official voice of medical transcriptionists.

As the economy has gained strength, the costs of doing business have risen. Simultaneously, a string of mergers and acquisitions has drastically reduced the number of AAMT’s corporate sponsors. Although AAMT has never spent money recklessly, it is an expensive organization to maintain. Bimonthly issues of the Journal of the American Association for Medical Transcription (JAAMT) are costly to produce. Travel expenses for association executives attending chapter meetings (as well as a year-round schedule of HIM-industry conferences and committee meetings) are not cheap.

When push comes to shove, it’s all about money. In February, 2001, AAMT is raising its dues by 50% in all membership categories along with cost of living increases planned for each subsequent year. News of AAMT’s hike in membership rates (announced at the organization’s annual conference in Portland last August), brought mixed reactions throughout the MT community. Some readily accepted the explanation by AAMT’s treasurer that, in order for the organization to remain financially viable, this was a necessary albeit painful step.

For some, however, the announcement of a 50% hike in membership dues was the straw that broke the camel’s back. Citing the availability of information that is offered online for free, some decided to vote with their wallets by refusing to renew their memberships (few medical transcriptionists have received a 50% raise from their employers in one year). Faced with the challenge of paying 50% more for no perceivable added value in member benefits, others announced their intent to redirect funds they would have spent on their AAMT membership to pay for computer supplies. MTSOs and independent contractors wondered: “How many clients would we lose if we raised our rates by 50% and told our clients to expect an additional cost of living increase every year?”

AAMT’s 50% solution is not without precedent. For the past quarter century many nonprofit organizations (opera companies, symphonies, museums) have been forced to tweak their subscription bases and membership lists for greater yield. By linking more member benefits to higher levels of giving, they have widened the gap between the dedicated arts lover and the patron who can (and frequently does) write a check. Whether higher levels of giving deliver preferred seating, first crack at tickets to special events, private showings, or any other perks, membership definitely has its privileges.

The goal, of course, is to move individual and corporate members up the pyramid of philanthropy to higher levels of involvement in the organization, higher levels of financial support, and a greater zeal for recruiting new members to follow in their path. When necessary, those who cannot progress to higher levels on the pyramid of philanthropy must be relegated to a lesser status of appreciation and involvement. Often known as the single ticket buyer or impulse attendee, these people are not necessarily less knowledgeable or less appreciative of the art form they are supporting. Their only fault is that they have less disposable income.

With its list of corporate donors shrinking and a slow but steady attrition of its rank and file, AAMT has chosen to concentrate on strengthening its core membership by asking them to increase their investment in the organization. The irony, of course, is that at the very moment that AAMT is raising its individual membership rate from $100 to $150, membership in AMTAG is free. Having been born in the era of web-based technology, the chances are more likely that AMTAG will find solutions to the challenges of networking and mentoring that are based in electronic media. The FAQ on its website defiantly states “AMTAGwas formed to benefit its members, not to make money off of them.”

While, for many years, AAMT has followed atraditional academic approach to continuing medical education for medical transcriptionists, AMTAG seems headed toward trying to define new ways of mentoring MTs so that they can compete and thrive in today’s electronic workplace. How well either organization will succeed in pursuing its goals remains to be seen. But with an eye toward making information accessible to as many people as possible, I’d like to make some suggestions.

Take a look at what AHIMA is doing with its Interactive Learning Campus. Pay particular attention to the use of interactive teaching modules and audiofiles. Then, try to rise above any and all territorial pissing contests between nonprofit organizations that might be vying for membership and income.

• Try to imagine what it would be like if – regardless of their location – medical transcriptionists had access to the kinds of lectures delivered by doctors speaking at AAMT symposia and/or continuing medical education seminars for their colleagues.

• Try to imagine the library of teaching tools that could be built if such presentations were digitally recorded and made available on the Web (I’m not just talking about individual specialists discussing their particular area of expertise, but also product reps discussing new treatment techniques, new surgical instruments, and new medications that are entering the medical marketplace).

This is much easier to accomplish than most people imagine. A program like Macromedia’s Flash 5 fuses the precision and flexibility of vector graphics with bitmaps, audio, animation, and advanced interactivity to create brilliant and effective Web experiences. As web design continues to evolve into more sophisticated presentation concepts, it becomes easier for companies to use a product like Flash 5 to create video demonstrations of their products and/or services. Once the web page has been created, all that is needed is a link from a standard resource for medical transcriptionists– such as Arleen McGovern’s www.mtdesk.com – to bring the viewer to a web-based infomercial or teaching tool.

Just look at all the television and print advertising purchased by America’s pharmaceutical companies and imagine what could be possible if a smidgen of that budget went to achieve this goal. From a marketing perspective, it’s a no-brainer.

With more and more physicians having their own websites, a logical step would be to convince surgeons that developing a web-friendly Flash 5 presentation for potential patients would offer a powerful teaching tool abouta procedure the patient might need to undergo. Think how useful it would be for the patient to sit in front of a computer in the doctor’s office (along with family members) and watch this kind of presentation before meeting with the surgeon. Not only does it present a more cost-effective approach than a videotaped presentation, the software is easy to edit and can be viewed from any computer which can access the physician’s website.

Doctors, drug companies and medical equipment manufacturers can easily afford this kind of marketing (after all, it’s a tax deductible expense) And within a year, many such web-based presentations could be available as teaching tools for healthcare providers and medical transcriptionists who have the power to access the World Wide Web at any time of day or night.

I personally don’t care which organization gets the ball rolling in order to make these teaching tools available to medical transcriptionists. It could be AAMT, AMTAG, AHIMA or the AMA. My point is that instead of asking medical transcriptionists(who are not getting hefty raises) to fund the costs of keeping a struggling nonprofit afloat, we should instead be looking to corporate entities whose deep pockets can fund a new way of providing easily accessible continuing medical education materials for healthcare providers, medical transcriptionists and patients alike. Remember Ephraim Levi’swords of wisdom:

“Money -- you should pardon the expression -- is a little like manure. It doesn’t do anyone a bit of good unless it’s spread all around, encouraging young things to grow.”