Friday, September 28, 2007

Fools Rush In

There’s an old joke about the businessman who became a multimillionaire and, with his newfound wealth, purchased a large and very impressive yacht. Bursting with self-importance, he flew his little old Jewish mother out to visit him and arranged to have her met at the airport by a stretch limousine. When the chauffeur delivered the old woman to the dock, she saw her son proudly standing by the gangplank in front of his yacht, decked out in the flashiest maritime uniform he could find. “Look, Ma. I’m a captain!” he boasted.

His mother (who was no fool) instantly sized up the situation. Taking her son’s hand reassuringly, she leaned over, kissed him on the cheek and whispered to him: “Darling.......By me, you’re a captain. And by you, you’re a captain. But, trust me on this one. By a captain? You’re no captain!”

In a professional world that has been flooded with inflated resumes transforming waiters into“beverage service managers” and fast food outlet counterboys into “nutritional counselors,” it has become increasingly difficult to identify and hire “the real thing.” Many job applicants, consultants and entrepreneurs feel confident that, by inflating their resumes, they can make their achievements sound more impressive and, as a result, ace out the competition. The cynics and fact checkers who know how to read between the lines no longer find much humor in such pathetic exercises in self-aggrandizement.

Recently, a friend with 14 years of experience handling affirmative action complaints for a state university described how, as part of yet another bureaucratic reorganization, the people in her department had been demoted and forced to report to a 26-year-old woman with no experience in affirmative action (who came to the job following six months as the marketing director for a winery). “The terrible thing about this situation is that she doesn’t even know what she doesn’t know! Unfortunately, the rest of us do!”

Another colleague (who has enjoyed a 20-year international career as a leading coloratura soprano) recently transitioned to teaching voice at the university level. A competitive professional singer who always learned her music and arrived prepared for any job, she is appalled by the lack of initiative and professionalism she encounters in her students. “They don’t learn their languages and they’re not musically prepared. To make matters worse, they seem to think that all they have to do is just show up and get a grade so they can then magically move on to a big money career,” she groans. “You know what makes this whole thing so pathetic? These students are suffering from delusions of adequacy!”

That term – delusions of adequacy – keeps coming to mind each time I receive a new -- and utterly ridiculous – e-mail from some Third World entrepreneur trying to convince me to subcontract work to a firm that has no experience in medical transcription. Because you have to see some of these messages to believe them, here’s a tasty little sampler of what many MTSOs have been receiving:

  • “Let me introduce myself,i am jayakeerthi,an engineer.,working with my father in interior decoration firm, I am setting up medical transcription service in india very soon, i am looking for orders from usa countries for mts We have dedicated people,having training in good medical transcription school, We will assure you of 98.5% accuracy min all the time,with 24hrs to 48hrs turnaround tim,with well documented with 5 cents per line. looking forward for your positive reply from u”

  • "Dear Sir, I have man & mechinary & big basement to start Medical transction work. Please give me all guidence.”

  • "well , i am on my way toset up a MT unit in Delhi which i have already mentioned in my last mail now i am facing couple of problems regarding the information technologies requirements. I am not much aware of the the software requirements in this field. it would be a kind enough jesture if u can let me know bout this aspect."

  • “I'm a Graduate from Pakistan. For the last week I was searching transcription companies and have found you. I'm willing to work for you, I have heard a lot about you on the internet. Although I have got no experience in the past but have good typing skills and can very well understand the American English accent. I'm sure I'll be able to this job.

  • “Today, I was browsing about the [web site]. I m very much intrested in becoming a quality transcriptionist. could please help me about voice recognition and other important features in becoming a competitive transcripitonist. And i m intrested work in u.s.a, how about the posibality? can I make it. Please help me by sending to my e-mail adress. I hope, I get some positive replay.”

  • “We would like to introduce ourselves as Exporter of Marine Products mainly to Japan with an annual turnover of approximately INR 150 milion. Now we are interested in starting Medical Transcription Business through you from India with 10 pc's. As we have to start from scratch, we need total guidance as to how to go about it including the requirement of Hardware & Software.”

When I looked at this last person’s website, I discovered that he was actually a shrimp farmer. But, what the hell! India is rapidly becoming known as the virtual back office to the world. Airlines, banks and other businesses are using Indians for data entry and customer service support calls. The logical assumption would be that, as long as you have a computer, who says you can’t do medical transcription for Americans?

Maybe some people who know what they’re talking about?

Perhaps those professional MTs who have been doing this for a living?

I am deeply indebted to Renee M. Priest, CMT, and Carole J. Gilbert, ART, for their willingness to offer proof to America’s health information management industry of the ludicrous sales pitches and piss-poor quality of work they encountered when trying to deal with offshore subcontractors. I urge every person who reads this article to point their web browsers to to see just how outrageous the situation has become. Once you’ve finished reading the sales pitches, do be sure to click on the “Discussion” link to view the proofreading log!

Why did Priest & Gilbert feel a need to post this information on the web? “We see endless posts online assuring people that offshore services are not as bad as the massive volume of badly worded e-mail letters we all receive each day––the e-mails that are touting how much more cheaply and accurately offshore transcription can be provided. It is our hope that by sharing these files with you, you will realize that there is a great deal of important information being left unsaid about the pitfalls of utilizing an offshore company, or any company for that matter, whose sole purpose is using our profession as the latest get-rich-quick scheme for global entrepreneurs.”

Rest assured that the same problem exists in America. Throughout the past decade, business magazines have consistently touted medical transcription as a major growth industry, luring many unqualified people to the field. A client who is an attorney sent me a postcard he recently received announcing an upcoming seminar at the Learning Annex. The pitch was short and sweet. “If you know how to type and like the thought of starting a business without much hassle, medical transcription may be the business for you!......If you want to have a business at home, find employment easily, and make a living on your own, this class will get you started!”

Whether aimed at American or Third World entrepreneurs, these types of solicitations give people the false impression that all they need to do is purchase a computer and the rest will happen by magic. Having bought into the fantasy, these MTSO wannabes further assume that doctors, hospitals, clinics and experienced professional MTs will automatically want to give them tons of work (regardless of whether they are the slightest bit qualified to perform the services required). Nor do they seem to be concerned that so many similar start-up ventures have crashed and burned with astonishing rapidity.

Several years ago, an aspiring MBA who was planning to start a medical transcription business sought my counsel. She had crunched all the numbers and figured out how to make it work. She was sure of it. Besides, she was great at selling and knew how to get new clients. The fact that she had no experience transcribing didn’t seem to matter to her because, as she proudly told me, a friend of hers could do some part-time editing and she was confident that would take care of any and all problems.

How did she plan to manage her subcontractors? “Well, if a doctor wants his documents in MSWord, I’ll tell the transcriptionists to type it in Word. And if he wants it in WordPerfect, then I’ll tell them to type it in WordPerfect.”

She was supremely confident, very sure of herself and, without a doubt, dressed for success. Guess what? Six months later she called to inform me that things had not quite worked out and, since her return on investment didn’t materialize fast enough (and she was getting married), she had decided not to continue in the field of medical transcription.

Her future business plans? Spending six months honeymooning in Europe.

And what did she expect her clients to do? “Whatever!”

I mention this incident to counter some accusations of racism that have come my way as a result of my having taken such a vehement stand against offshore transcription. There are certain human traits which transcend racial and/or national boundaries. These include (but are certainly not limited to):

  • Greed

  • Arrogance

  • Incompetence

  • Ignorance

  • Stupidity

  • Deceit

  • Failure to produce

  • Lack of responsibility

  • Lack of professionalism

Doctors have been known to display these qualities with startling regularity. With industry analysts now estimating that one in every five doctors practicing in America is an Indian import (and managed care putting the squeeze on every doctor’s earnings), some physicians have decided to invest their money in the healthcare information management industry as a means of developing a secondary revenue stream.

More than one Medical Records Director has already complained about Indian physicians on staff who are constantly pressuring their hospital administrator to award transcription contracts to companies that are owned by themselves, their friends or their relatives.

This is definitely not a means that justifies the end.

Several years, ago, it was determined that potential conflicts of interest should prevent doctors from owning their own medical laboratories. With news items constantly surfacing about doctors who have been indicted for double-dipping on travel expenses -- or fraudulently overbilling Medicare – the concept of allowing doctors to be involved in the ownership of medical transcription services makes as much sense to me as permitting drug dealers to set up rehabilitation programs.

Forgive me for asking such a simple question. But exactly who is America’s healthcare system supposed to be taking care of? The patient? Or some staff physician’s relatives overseas?

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