Monday, September 17, 2007

Is It Really Better At Half The Price?

“I’m thinking of making a career change and am interested in getting into medical transcription. What do you think?” Most of these emails arrive from people who are wildly unqualified to do medical transcription. Many have been laid off from corporate jobs and remain convinced that, as long as they have a computer at home, they are qualified to do anything. Some are full of bravado and confident that they can pick up “this medical transcription thing” in a week. Others have worked as nurses or physical therapists and are sure they can transition into transcription with ease.

Most of these people are focused on two clearly-defined goals: (1) they want to work at home, and/or (2) they need to be close to their children. Unfortunately, neither of these goals qualifies anyone to work as a medical transcriptionist. People think I’m kidding when I ask them if they can really afford to enter the field. I’m not just talking about buying all the accessories that are necessary to perform the basic tasks. I’m asking if they are ready to enter a field where the average rate per line has barely risen in nearly 20 years and is being forced downward by offshore competition. Where the chances of professional advancement are questionable, at best. Where incentives often lose their incentive when confronted with lost time and nit-picking penalties. Where, despite the amount of time and energy you put into training yourself for a new career, you can’t get no respect.

The bigger question for myself – and for many others who have been working in this field over the years – is whether, given the current economic climate, we would truly encourage anyone to embark on a career in medical transcription. This being an election year, perhaps it’s time for every medical transcriptionist to take a good, hard look in the mirror and ask: Am I better off than I was four years ago? After a quick look in their wallets, I don’t think too many MTs will be pleased with the answer.

Whereas medical transcription once looked like a stable and respected profession, things are not very pretty in the trenches these days. After several years of mergers and acquisitions in order to gain market share, even the large national MTSOs are feeling competition from offshore transcription services. Although the seductive lure of new technologies (ASPs, speech recognition, automated coding, etc.) keeps medical transcription a hot topic in the minds of budding entrepreneurs, things look a lot different for the aspiring medical transcriptionist at entry level.

To appreciate the delicacy of the situation, it’s necessary to take a cold, hard look at the business world’s legendary triangle of expectations. This tool pits three key variables against each other: cost, speed, and quality. Transcription is one of those professions where you can get things done cheap and fast, but the results might not be of top quality. Often, you can get quality work done fast, but it won’t be cheap. You might even be able to get quality work done cheap, but it probably won’t arrive too fast.

Now let’s take a look at the economy in which healthcare organizations are struggling to survive. Hospital administrators, as usual, are desperate to cut expenses. The costs of maintaining computers, network systems, and other IT considerations are going to take precedence over the cost of medical transcription. And then, of course, there’s always HIPAA to consider.

With offshore competition attempting to cut line rates in half, the profit margins of American MTSOs are under more pressure than ever. Although many of us joked about working in the electronic sweatshop (back in the early days of telecommuting), that joke has long since lost its humor. While technology has changed the way we work – often for the better – the costs of maintaining and improving that technology have been shouldered by the transcriptionists who actually do the work. This field has witnessed a steady cutback in pay scales, benefits,and professionalism. Some blame AAMT, others look to the pressures of the marketplace for answers.

No matter who gets blamed, the results aren’t pretty. Are you working on a platform where the servers are down? That could lead to lost time for keyboarding (during which a transcriptionist does not earn money). Can’t stick around to make up for lost time? Not only will that make a dent in the earnings you anticipated, if you miss your productivity goals you could get bumped down to a lower pay rate. Of course, if you work for one of the sleazier MTSOs, you could get reclassified by their software as part-time help, thus making you ineligible for benefits. Oops! That was a computer mistake. Looks like you’ll have to start paying for your own benefits until you can meet your production goals. Sorry.

What’s that? You don’t have the kind of cash flow that allows you to cover those Cobra premiums while you try to get your productivity back up to its previous level? Sorry. That’s not management’s problem.

What’s that? You just spent $5,000 on a medical transcription course and you’re not making enough to pay your bills? Life’s tough. You should be glad to have a job in this economy. Did you know that many airline pilots make less than $30,000?

At a certain point, a person entering the work force has to wonder whether a career in medical transcription is really worth pursuing. I’m not talking about the thrill of working with medical terminology or the noble feeling that somewhere, somehow, someone is making a contribution to the medical profession. I’m talking about hard dollars and cents. Many newbies enter the profession with stars in their eyes, not realizing that it takes at least two years of training to become proficient as a transcriptionist and more time after that to train one’s ears and tweak a word expander to maximum efficiency. Some forget to add in the cost of a high speed Internet connection, software upgrades, reference books, and online subscription fees. These people don’t want to be told that they may earn less than minimum wage as entry-level transcriptionists. They want results now. And a big fat paycheck with lots of bennies.

The braver souls, intent on snaring their own clients, try to determine the current line rate (so they can underbid it by one cent) without ever assessing their true costs of labor, equipment, and delivery.

When these people find themselves experiencing severe burnout, they wonder what went wrong. What went wrong is often a case of unrealistic expectations.

Since the dawn of the 21st century, hundreds of thousands of Americans have lost their jobs, their life savings, and seen their stock portfolios shot to hell. Many a dot.commer is now working as a Barista at Starbucks (which, in case you didn’t know, has a damned good reputation as an employer). It could just be that pouring coffee is a more stable job than transcribing medical reports. It might even have a greater future! Certainly, the benefits package and 401K are as good as anything you’ll find at a transcription service which operates like an electronic sweatshop.

Oh, but you want to work at home so you can be with your children. Now I get it.

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