To Form A More Perfect Union

In the past two years many medical transcriptionists have been impacted by corporate mergers that closely follow patterns witnessed in the aviation, software and banking industries.

• Backed by lots of venture capital, a relatively new company named Rodeer acquired a large number of small to medium-sized transcription services in order to achieve the kind of critical mass which would allow it to compete in the marketplace.

• Several of the nation’s largest transcription services (Transcriptions, Ltd., MRC Group, Signal Transcription Network, Inc., and Digital Dictation, Inc.) were swallowed up by Medquist, Inc. -- a publicly-traded corporation which is now being touted as a good buy for investors.

• With each round of corporate acquisitions, many older MTs were either laid off or forced to take a pay cut which resulted from a post-merger redefinition of their line count.

• As certain national transcription companies have grown larger and achieved more dominance in the marketplace, the quality of their service to clients has often dropped.

Simultaneously, recent advances in computer technology -- combined with the growing power of the Internet -- have had a stunning effect upon the medical transcription industry.

• Transcription services with access to sufficient venture capital have been able to implement new technology which has allowed them to grow their companies in previously unimaginable ways.

• Satellite technology has drawn offshore firms in countries like India, Pakistan and Bangladesh into the bidding frenzy for American hospital and clinic accounts.

• Once perceived as a local or national service, medical transcription is now being affected by global economic forces.

• Voice recognition technology (which will probably be incorporated into a future Windows-based operating system) has made inroads into certain areas of medical transcription.

• Lured by the promise of easy money, more and more people are trying to become medical transcriptionists in the hope of owning their own home-based business.

Throughout this period, veteran MTs watch and wonder if they can still compete in the marketplace, if they can survive another round of mergers and acquisitions, or if they are stuck in a profession which offers them no future. Given the rapid and radical changes taking place within the industry, it should come as no surprise that the natives are restless.

A recurring symptom of such restlessness is the call for medical transcriptionists to unionize. Because the question of whether medical transcriptionists should form a union pushes a lot of red hot buttons, perhaps it is time to examine some of the issues at stake.

Many hospital administrators originally decided to outsource transcription as a way to save on capital investments (digital dictation systems, computer workstations, software upgrades) and/or labor costs (skyrocketing employee healthcare benefits packages). While nurses, janitors, cafeteria staff and many other hospital employees may belong to a variety of service unions, office workers and medical transcriptionists frequently do not.

The most important ground rule to remember when one contemplates calls for unionization is that, just as there are good medical transcriptionists and bad medical transcriptionists, there are good employers and there are bad employers. Some employers were -- and may still be -- medical transcriptionists. Others may be under the influence of MBAs fresh out of business school who have no experience in transcribing but nevertheless maintain a ruthless eye toward the bottom line.

Much like the concept of beauty, the bottom line is very much subject to the eye of the beholder. For someone who has worked as a professional medical transcriptionist, the bottom line incorporates such factors as quality assurance, reliability, high standards of professionalism and a desire to take genuine pride in the quality of service delivered to clients. For a corporate bean counter, the bottom line may only reflect costs of doing business and dividends to shareholders. Dividends to shareholders can be increased through a conscious effort to streamline the work process with new technology. Or by standardizing the work product while tempting management with incentives to produce greater profits by reducing labor costs.

Ah, yes. Labor costs. Those horribly opinionated drones who do all the work. The folks Leona Helmsley once called “The little people.”

There are medical transcription firms of all sizes that respect their MTs (whether they are employees or independent contractors) and pay them well for the services they perform. The labor pool in such situations is usually extremely loyal and satisfied. However, in other (frequently larger) companies, one often finds high levels of anger and dissatisfaction accompanied by a substantial turnover in personnel.

Asking whether a group of employees should unionize is similar to asking whether or not a driver should take a sobriety test from the highway patrolman who stopped his vehicle. If the driver is sober, there should be no problem. The popular assumption, however, is that the sobriety test analogy only applies to employers. What about employees and/or independent contractors? If people produce and are rewarded for their work, there should be no problem.

But what if they fail to meet deadlines, produce lousy work and sabotage a business owner’s profit margins? Is a business owner obliged to keep working with them? Not if they are independent contractors.

That’s where we get into a sticky wicket. As the business world has shifted from hiring full-time workers who receive a wealth of employee benefits to using contract workers with particular job skills, many medical transcriptionists have found themselves caught in a pricing bind. Anyone who works as an independent contractor is essentially running his own business, must be responsible for the costs of doing business, and accept the risk of losing clients. While medical transcriptionists seek to increase their earnings by opening up home-based businesses, the pressures of the marketplace keep driving the cost of services lower and lower.

Lacking any kind of organized labor movement to fight for higher wages -- as opposed to increased earnings -- many medical transcriptionists now find themselves stuck in an electronic sweatshop where technology works on the side of the employer. The electronic sweatshop benefits from the fact that, thanks to digital dictation technology, most MTs are now able to telecommute and work from their home offices. As a result, they have little contact with one another.

Not only does this make it hard for a medical transcription service’s transcriptionists to band together, the transcriptionist who is rebellious or troublesome can soon find himself without any work. The “virtual offices” which now dot the medical transcription landscape also ensure that management can remain a remote target, with individual transcriptionists having little idea of who is really running the show. And little room to threaten an employer.

Some MTs cling to the fantasy that the American Association For Medical Transcription will fight to get them higher wages. That has not happened, nor do I expect it ever will. With the growth of the Internet, MTs are no longer as dependent on AAMT for networking opportunities. Nor are they hampered by AAMT’s strict local/state/national structure and rules of communication.

MTs must never forget that, just like the American Medical Association, AAMT is a professional association. Unlike a strong union (where paying one’s dues is mandatory), membership in both the AMA and AAMT is voluntary. If you don’t like the organization’s policies, no one is forcing you to pay dues to become a member. Nor is there any penalty -- or threatened loss of income -- for not belonging to the organization.

In recent years, AAMT’s membership has dipped below the 10,000 mark while industry figures claim that as many as 250,000 Americans may be working as medical transcriptionists. If only 4% of the people purported to be working as medical transcriptionists belong to AAMT, then employers have good reason to question AAMT’s industry clout.

Despite the wildest hopes of some medical transcriptionists, AAMT’s mission statement may not include creating a union for medical transcriptionists. And without any structure currently in place from an existing professional organization, who is going to shoulder the costs of creating such a union, finding people to enlist in the union, and collecting dues from them?

Union dues could be a real stumbling block for medical transcriptionists who claim they are not earning enough money. But without dues, a union can’t pay its costs of doing business. And without the ability to stay in business and service its membership, there cannot be a powerful union.

My guess is that no knight in shining armor will champion an army of home-based workers who insist on maintaining their autonomy. And that, while the unionization of medical transcriptionists sounds like a delicious panacea to some, bringing the concept to fruition is much more costly and difficult than most people imagine.