Setting Reasonable Goals

Mae West used to sing “A guy what takes his time, I’ll go for any time. I like a man who arrives in slow..........” With the Internet affording 24-hour access seven days a week (and voice recognition claiming to instantly transform speech into text), MTs are constantly confronted with unrealistic expectations from management and clients. After years of having watched instant replays of crucial moments at televised sports events, some doctors want to have every report delivered stat. AAMT’s Pat Forbis remembers hearing about one physician who told a medical transcriptionist that he wanted a 30-minute tape “done and back here in 10 minutes.”

Unfortunately, most people have no idea of the real time required to perform medical transcription. Why not? Because most people have never attempted to do it. An average-level MT anticipates a ratio of three minutes to transcribe one minute of dictation. With super-tweaked computers and word expansion software, the best transcriptionists might require 1-1/4 minutes to transcribe one minute of dictation from a top-quality dictator.

Medical transcription is all about process, not product. And the obstacles faced by MTs (scratchy sound, poor dictation, missing data) have an exponential rather than mathematical impact on productivity. In a world ruled by numbers and spreadsheets, bottom liners measure results with little awareness of the process necessary to achieve the end result. If you don’t believe me, ask some of the MBAs who are now managing transcription services if they have had any professional experience as medical transcriptionists. Most have not -- a tragic workplace reality which is reflected in their attitude toward the people who do the real work.

Have you ever served guests a wine that had not aged properly? Or a pudding-like desert that had not had enough time to congeal? If so, you may not have budgeted enough time to produce the desired effect.

In today’s electronic sweatshop, time has become a most precious increment. And yet, when it comes to productivity, the element of time is most sorely misunderstood. Speed doesn’t just kill on America’s highways -- it kills when MTs are forced to sacrifice accuracy, quality control and professionalism in order to meet productivity quotas.

The true success rate of professional medical transcriptionists is best illustrated by Aesop’s fable about the hare and the tortoise. The slow and steady MTs (people who might be characterized as “pluggers”) usually win the race because they know what they’re doing and understand how to budget enough time so they can pace themselves to survive the long haul.

Why do so many hares fall by the wayside? Suppose we examine the types of people who enter the field of medical transcription with unrealistic goals. Many are looking for ways to work at home. Many are hoping to make a quick buck. Many are attracted by ads which claim that an individual can stay home and earn at least $30,000 a year typing for doctors “with no previous experience.” Alas, such ads are only selling a curriculum.

• They do not guarantee that someone who aspires to be an MT can do the work.

• They do not guarantee that someone who lacks basic skills can get hired to do the work.

• They do not guarantee that someone who cannot tune his ears (to decipher language being misspoken in a variety of accents) will be able to “hear” what doctors are really saying.

• They do not guarantee that someone who completes an MT course will have strong enough entrepreneurial skills to run a business.

• They do not guarantee that 40 hours worth of work will be waiting for their graduates each week.

• Last, but certainly not least: They do not guarantee that a client’s check will
  arrive on time.

Why not? Because there are no guarantees. And yet, many people are drawn to this profession with unreasonable expectations that they will launch a thriving business of their own and earn a great deal of money in their first year. They don’t want to hear that 90% of new businesses fail in their first year. Nor do these people want to be told that they may be supremely unqualified to do the work.

So what happens when reality hits?

• Some people don’t calculate the real costs of doing business.

• Some people work for peanuts until they discover that they can’t earn enough money.

• Some people are shocked to discover that they don’t like the work as much as they thought they would.

• Some people lack the discipline to keep transcribing day after day, report after report.

• Some can’t handle interruptions from family and friends (which undermine productivity and thus reduce earnings).

• Some people can’t manage deadlines.

• And, despite the best of intentions, some people have no talent.

Nevertheless, like the hare in Aesop’s fable, many MT “wannabes” start off like gangbusters -- insisting that they can do the work simply because they’ve researched this career and “know” that it’s right for them. Their lust for success and greed to succeed leave them in a state of total denial. When reality hits, many burn out and seek another form of work. Why? Because, despite what they’ve read in display ads scattered throughout the healthcare industry, it takes time to become a good medical transcriptionist. And in this industry, time means experience, maturity and craft.

Back when I taught master classes to young American opera singers on how to survive an interview with the media, I stressed that an interview was very much like a seduction scene: No matter how well endowed you are, if you get everything you want in the first five minutes, you may not be the world’s greatest lover simply because there’s a big difference between the mechanics of performing the sexual act and the process of making love.

So let’s get real. If we want good talent, we have to pay for it and “treat it nice.” If we expect to receive quality work from professional MTs, then we have to be willing to pay veteran transcriptionists enough money so that they don’t become disillusioned and look for work somewhere else.

Similarly, if we expect people to evolve into good medical transcriptionists, then we have to make sure they understand that completing a correspondence course is not enough. Aspiring MTs need time and experience to tune their ears, develop a rhythm, and become professional medical language specialists. While medical transcription may not be an art form, it most definitely requires a sizeable amount of talent and craft.

Managers who lack transcription experience (and therefore don’t understand how much time is required to do the job properly), are always looking for ways to cut costs and increase profits. For many, the answer is to make transcriptionists work harder to earn less money in less time.

When the great Wagnerian soprano, Birgit Nilsson, was once asked why the managers of so many opera companies continued to pay her exorbitant fees (which, at the time, were reputed to be the highest in the opera world), her reply was short and simple: “When the birds are happy, they sing.”

Birgit was nobody’s fool. So here’s a tip for some of our industry’s more misguided transcription managers: The next time you’re desperately scrutinizing statistics and trying to figure out where you can squeeze more profits from, stand up and look away from your spreadsheet. Try to concentrate your attention on the people who do the work that earns you your salary. For one brief, shining moment of clarity, try to remember that you are looking at real people and not mere statistics. Then take a close, hard look at the turnover in your MT personnel and ask yourself these questions:

• What is our retention rate?

• How much time is spent recruiting and training people who stay a short while and then leave?

• What is the hidden cost of each MT’s departure?

• Why aren’t these people willing to continue to work for us?

• Could there be something unrealistic about my goals and expectations as a manager?