Reality MT

A shocking percentage of business startups fail within one year of their launch. An even larger percentage last no longer than five years. The medical transcription industry is hardly immune to such statistics. Some MTSO failures have been single-transcriptionist operations; others have been more complex. Some have involved small, struggling regional MTSOs that were acquired by larger, well-funded corporations; others have involved people who bought into an entrepreneurial dream only to discover that they couldn’t deliver the goods and/or the market did not welcome their services.

Some MTSO failures have involved poorly-conceived, flash-in-the-pan business ventures while others have involved embarrassing corporate meltdowns that (much like the Enron debacle) were preceded by a substantial amount of hubris. In April of 1999, while attending MTIA’s 10th anniversary conference in Las Vegas, a crowd of MTSOs was informed by a representative from Lernout & Hauspie that his company was going to revolutionize the medical transcription industry and put a lot of its old farts out of business. In the next three years, L&H made some major accounting blunders and ended up selling its transcription division to Medquist as part of a bankruptcy auction. One can’t help but wonder: Where is the mighty L&H now?

My company is one of those small transcription services that takes good care of its clients, provides a high level of accuracy with good turnaround times, and has chosen not to bite off more than it can chew. Like the proverbially slow and steady tortoise, we’ve outlasted quite a few hares who had all the answers, lots of venture capital, and plenty of flash -- but who crashed and burned in their rush to glory. Unlike Gloria Gaynor, our anthem has not been “I Will Survive.” Nor are we crooning Stephen Sondheim’s “I’m Still Here.”

I am, however, proud to report that this month Alert & Oriented Medical Transcription marks its 10th anniversary. In honoring that milestone, I’ve been taking a curious look at what it means to be a survivor in this business. Keep in mind that the decade during which Alert & Oriented has been in business closely parallels the Windows and Internet revolutions. In the course of those ten years, we’ve witnessed a rush of greedy entrepreneurs (with no previous experience in medical transcription) as well as new technologies that have turned this profession on its ear. We have watched California move from a recession through the dot.com boom/bomb and ridden the wild roller coaster of power blackouts and a sagging economy sucker punched by the events of 9/11.

And still we’ve survived.

Survival has taken on a particularly strange meaning in light of the reality TV phenomenon. Last year, I participated in a Harvey Milk Institute workshop for gay men in their fifties who were trying to cope with issues of aging. As we discussed what it meant to (a) survive 20 years of burying friends who had died of AIDS, (b) survive being downsized from jobs, (c) survive seeing our job skills lose respect, and (d) feel as if we have become irrelevant in a culture obsessed with serving youth, someone asked what we can tell the generations who are following in our footsteps. Without hesitating, I suggested that younger generations need to know that we are the real survivors – not the buffed dudes and tanned babes they watch on Survivor, Boot Camp, and Temptation Island. Staying in business is not as sexy as it sounds. There are routines that must be fulfilled, fires to be put out, and problems to be solved. Managing a medical transcription service brings some jaw-grinding, white knuckle moments along with occasional feelings of exhilaration, triumph and personal fulfillment.

MTSOs are confronted with many frustrating challenges which prove that the customer is not always right. It’s especially hard to explain this to doctors who are used to being treated like gods. If there is one phenomenon that Tom and I encountered in our first ten years that truly shocked us, it was the high level of technophobia among physicians and the ways in which their technophobia would manifest itself in their behavior. On numerous occasions, we would listen to physicians insist that our files could not be found on their computer in any way possible. Yet, when push came to shove, the truth was that these physicians did not know how to use the search feature contained in both the Windows operating system and their word processors and were not about to admit it. Especially not in front of their staff!

After I directed a surgeon who was a client to Amazon.com he was shocked and dismayed that I wouldn’t walk him through each step of ordering a book. Another physician (who barely knew how to turn on her computer), went into hysterics when underlining appeared under most of the medical terminology in her reports as she tried to view documents in MS-Word. Despite my explanation that those words were underlined because they were not programmed into MS-Word’s basic spell checker, she spent the next five minutes screaming “This won’t work. This is taking up too much of my valuable time.”

The doctor nerds were usually fairly aggressive surgeons who stood in a class by themselves. I recall one egomaniacal plastic surgeon who, because he was too cheap to purchase an upgrade for his billing program, spent three days trying to convert WordPerfect files to ASCII text files. (This same surgeon called me two weeks before Christmas to inquire if I had any fat friends who wanted to schedule a liposuction for the holidays). And then there were the Macintosh-platform surgeons who, when they couldn’t open the files we had sent them, insisted that there must be something wrong because the fault certainly couldn’t be theirs! (As it turned out, they were so used to clicking on desktop icons that they had ignored our instructions to open files through MS-Word so that their word processor’s import engine could make the proper conversion between file formats).

Today, it is hard to imagine a small business surviving without computers. Yet, as our business grew, we encountered numerous physicians whose stinginess and childish behavior boggled our minds. There was the Russian physician who whined “I’m just a poor neurologist. My husband won’t let me upgrade from a 286!” And the greedy physician who furiously kept trying to grow his practice but could not understand why we wouldn’t transcribe twice as many reports for the same amount of money.

There were doctors who asked us to provide technical support on a variety of software programs because they thought that, by doing so, they could avoid paying the software manufacturer for use of its customer support help lines. And the doctor who was notoriously hungry for good publicity in the community, but who also knew how to run up a huge bill just before filing for bankruptcy protection.

What I found most amazing were the doctors who didn’t hesitate to buy a top-of-the line computer on which their children could play video games and do their homework, but who would not budge when it came to making a routine investment in upgrading the hardware and software used by their office staff. Not that their office staff was sufficiently computer literate to know what they were doing. I still remember one administrative person who called to ask “Like, hey. What’s my password?” She wasn’t very happy when I answered “I don’t know. That’s why it’s your password.”

Did we meet eccentrics and flakes? How about the recently widowed urologist who, after our business presentation, confessed that he was just lonely and really needed someone to go clothes shopping for him now that his wife was gone. Or the absent minded physician whose wife showed me where their children’s pet rabbit had pissed all over her husband’s medical degree certificate. Let’s not forget the former chairman of a hospital’s Medical Records Committee (and former beefcake centerfold) whose home has been used for porno film shoots and who confided that his recent evening at the ballet had become a truly fabulous event after someone slipped him some magic mushrooms.

As expected, we encountered a fair amount of haughtiness in certain medical practices. There were numerous cases where we were told that doctors and administrative staff were simply too busy or too important to have to open files! There were also physicians who expected us to give them free computers just because they were doctors. And the hour-long sales presentation we did for a plastic surgery clinic whose practice manager -- after asking numerous hard-hitting questions-- confessed that her physicians only generated a total of five letters a month.

Two meetings stand out as my all-time favorites. One involved a ditsy practice manager who insisted that my business partner fly in from Tennessee on a moment’s notice to attend a meeting about whether or not she should change the margins on her reports (he did not). The other was a meeting with two Internet entrepreneurs who were interested in acquiring us for the portal they were planning to market to physicians. Essentially, they wanted to be able to use our receivables as proof of a revenue stream so that they could go for a second round of venture capital on their merry little path toward an IPO. When questioned, at least they were honest enough to admit that they knew absolutely nothing about medical transcription.

Occasionally, we get the kind of compliment which makes us realize thatwe’ve been doing a good job. After the death of an ex-lover and soulmate, one of our clients found a typed autobiography in the decedent’s safety deposit box. The deceased man had been a fairly famous fashion model and photographer who spoke English as a third language (after Swedish and Italian) and did not believe in changing typewriter ribbons. Our client requested my help in converting the barely legible text into a word-processed document that could be sent to publicists and publishers. “Money is no object. But please help me,” he begged, as tears welled in his eyes. “I don’t know who else to turn to who does this kind of work. Victor knew you and I know he would have loved for you to be involved in this project.”

Another client recently sent me an e-mail in which he stated that “...I would be willing to pay considerably more for your service, which is excellent. I would also marry you, but unfortunately, as you know, I'm about as straight as they come and happily married to my wife of 21 -- soon to be 22 years -- so I don't think that would be a workable deal. Please help. As I'm sure you realize, my transcription service and dictation is one of the most important parts of my practice. I value your knowledge and assistance in this effort.”

In the past ten years our business has grown in ways we could never have imagined. We’ve seen our industry undergo dramatic changes sparked by new technologies and incredible opportunities. Tom and I have been extremely lucky to have the help of some excellent transcriptionists, computer consultants, mentors, and friends. But if one thing has guided us through these ten tempestuous years, it has been a goal we articulated when we first started our business. As we discussed our business plan, we both agreed that we wanted to use medical transcription as a way to earn a living and still be creative. We wanted our freedom to travel and to be our own bosses. We wanted medical transcription to support us rather than tyrannize us.

Our goal, simply stated, was to make sure that we did not follow in the footsteps of all those who had reluctantly become slaves to medical transcription. So far, we have survived ten years of constant change and triumphed during a decade filled with trials and tribulations. Our new challenge is to see what the next ten years have in store for us!