When You Wish Upon A Star

If indeed a picture is worth a thousand words, then I can’t help but wonder if medical transcriptionists have become the poster children for the electronic sweatshop. It doesn’t matter whether you examine ads selling training courses in how to become a medical transcriptionist -- or the display advertising used by large national transcription companies seeking to hire qualified MTs – the images seem oddly disconnected from reality. The clip art used in many of these sales pitches shows trim, perky women wearing business suits or soft white blouses. Whether or not the woman is wearing earphones, she sits in front of her computer smiling inanely -- like a Stepford wife who has just taken another hit of Ecstasy!

This image makes no sense -- especially when the reality of a medical transcriptionist’s lifestyle is so shockingly different. Why don’t these ads show women tearing their hair out as they try to decipher an ESL doctor’s incoherent ramblings? Why don’t these ads show worn and used reference books scattered across a transcriptionist’s desk? Why don’t these ads -- ostensibly marketed to people who want to work at home -- show a cat sitting on top of the monitor and a brat playing in the background? I’ll tell you why. It’s because these ads are about as fanciful as children dressing up and pretending to be adults.

With so many MTs transcribing in home offices while trying to manage a busy household and make sure that their children don’t kill each other, the packaging of the professional medical transcriptionist’s image strikes those trying to make a living from MT as a joke. Despite the glorified images seen in display ads produced by and for the medical records industry, many MTs are fully-figured women working in T-shirts, sweat pants and sneakers. Faced with long hours in front of a keyboard, few transcriptionists are dressing for success. If anything, they are dressing for comfort. Medical transcription is not about wearing high heels and tight girdles (you’ll never see an MT wearing a Madonna-type bustier in the hopes that it will help her transcribe a difficult operative note).

Like Rodney Dangerfield, MTs frequently complain that they “can’t get no respect.” Trust me on this one. It’s not because of how they look. It’s because MTs are usually kept out of sight – invisible data entry people who work from remote locations. And when you are out of sight (and out of mind) it’s easy to fall victim to corporate spreadsheets and bean counters. In the past five years many transcriptionists have had their line counts redefined (resulting in less earned income), their benefits shortened, their productivity challenged, and their intelligence insulted. Some have been harassed by employers and business owners who use guilt-trips as a way of getting MTs to sacrifice their days off and personal time because “there’s a stat that needs to be done.” Others have seen the education they struggled to achieve mocked by people who know absolutely nothing about transcription; people who tell them to transcribe verbatim or “just give the doctor what he wants.”

“Three years ago I joined a national organization because I was tired of office politics and wanted to work from home. But, along with my fellow MTs, we continue to have our benefits stealthily plucked out from under us. Everything (from a cut in pay and a cessation of our longevity bonus to PTO paid at minimum wage and a decrease in 401K benefits) has been snatched away from the home MT. Benefits are now‘adjusted’ every year,” writes Donna Gordon. “Iam saddened and disillusioned by what I see happening to what I once regarded as a highly prestigious and worthy occupation of which I was proud to be a member. I now feel that the MT has been reduced to little more than a cog in the big national machine that is steadily grinding away to fill the deep pockets of CEOs and other corporate VIPs that remain nameless and faceless.”

“If you are an independent contractor, there ain't no such thing as sick days, vacations, or anything like that unless you are lucky enough to have coverage and pay it out of your own pocket,” warns Marsha Macchi, a blind transcriptionist in San Francisco. “When I went to Pilot Dogs to get my fifth guide dog, there was no such thing as coverage while I was gone. I took one heck of a loss – even though I knew that it was just the price of doing business.”

Several postings on MTDesk.com's Hot Zone this spring made it crystal clear that – regardless of the official talking points from AAMT and MTIA – all is not well in MT-Land.

• “Here it is Thursday night and guess what I got from MedQuist? Nothing. Nada. Zilch. Not even a Happy MT week,” groused one transcriptionist. “Nothing last year either. Sure makes a person feel appreciated.”

• “Guess what EDIX is giving for MT week as a show of appreciation? A cheap, tacky, plastic container filled with stale candy. That’s what they give you for 10 years experience!” complained another. “Could they be more insulting? Getting nothing would have been less insulting than that garbage. I threw it in the trash.”

E-mails on the KAMT-list from members upset with AAMT’s hike in membership dues indicate that the natives are restless:

• “After having been a medical transcriptionist for 25+ years and having the reputation I have for turning out quality work, I do not see any reason for being certified, especially as I could find no real benefit to anyone but AAMT,” writes Linda Taylor.

• “Can any of you erudite MTs give me a reason that I should pay $195 this year to show my support for the organization, when about the only goody I get is the ‘$40' quarterly magazine and the opportunity to buy the BOS at a $10 discount?” asks Valeria D. Truitt.

• “The profession has been demoted rather than promoted; it has little respect from other health professionals who still don't have a clue about what it takes to do this, which may be why wages are still so horrible and often tied to productivity -- all things AAMT was supposed to help but obviously has not,” stresses screen name Bibliomania.

• “I find it interesting that they have the nerve to say they protect your interest, when they have helped train and certify transcriptionists in India. They have done nothing to fight the amount of work going overseas. Many large services say they cannot find experienced transcriptionists. The truth is they can, they just don't want to pay them. We don't need terrorists to take down the US when our own companies are selling us out for cheap offshore labor,” writes Susan Mitchell.

With so much unhappiness rampant throughout the medical transcription community, with our economy headed toward a recession, and with MTs feeling waves of depression, frustration, and anger in the wake of September’s terrorist attacks, I’d like to recommend a book which can inspire each and every MT to pick up the reins and assume more control over her life. While Susan Jane Gilman’s Kiss My Tiara is filled with plenty of good laughs, it also gives anyone who has battled office politics, endured bad supervisors, wrestled with a weight problem, or suffered from low self-esteem a whole new outlook on life. I cannot recommend it highly enough.

In the meantime, I’m going to tell you a story (storytelling is, after all, an age-old device used to calm people and give them hope). Not only is this story based on real life, in many ways it resembles a medical transcriptionist’s version of the Cinderella legend. As most readers know, the Cinderella legend (a/k/a The Glass Slipper) has appeared in various formats in cultures around the world. In recent years, author Gregory Maguire has done a stunning job of re-examining the classic fairy tale in his novel Confessions of an Ugly Stepsister. Music critic Manuela Holterhoff entitled her book about two years in the life of famed mezzo-soprano Cecilia Bartoli Cinderella and Company.

This rags to riches story has been immortalized in opera (Rossini’s La Cenerentola, and Massenet’s Cendrillon) as well as ballet (Prokofiev’s Cinderella). Ever since Walt Disney’s animated cartoon introduced us to the magic of“Bibbity Bobbity Boo,” audiences have flocked to see Jerry Lewis in Cinderfella, Drew Barrymore in Ever After, and numerous other films with titles like If The Shoe Fits. Popular musicals include Rodgers & Hammerstein’s Cinderella (originally starring Julie Andrews and now with pop singer Brandy in the title role), Bock & Harnick’s Passionella, Larry Hart’s rhythm & blues treatment (Sisterella) and Stephen Sondheim’s Into The Woods. So sit back and make yourselves comfortable while I tell you the medical transcription version.

Once upon a time and not so very long ago, I was contacted by a medical transcriptionist who had been referred to me by a member of the KAMT-list. Although curious about working with me, Carla was extremely cautious – almost to the point of being paranoid. Always on the lookout for qualified local talent, I suggested that we meet for an informational session during which we could talk in detail about how my company operates and see if we might want to work together.

Upon her arrival, it became obvious that I was talking to a very attractive, personable, conscientious, and intelligent CMT who, although she was an extremely hard worker, was also a battered medical transcriptionist. The battering had nothing to do with her recent divorce. In the 15 years that she had been working as a transcriptionist her self-esteem had been pummeled to bits by overbearing hospital supervisors and MTSOs who knew how to manipulate Carla’s emotions in order to make her work longer hours and cover for other MTs. Carla’s way of avoiding office politics – and harassing phone calls– was to put on her earphones and keep transcribing (often to the point of exhaustion). Although she had diligently earned her CMT, she did not enjoy socializing with “the girls” at AAMT meetings and preferred to spend her spare time at the gym, running, or playing a musical instrument.

By the time we met, Carla had been threatened with (and survived) so many guilt trips that she was terrified of the future, fearful of retribution, and desperate to make changes in her professional life. Although she had worked for many years as an independent contractor, she still thought like an employee. Feeling powerless against the constant demands placed on her, Carla’s only solution had been to work herself to the bone because (a) she needed the money to pay her mortgage, and (b) she didn’t know how to say no. There was so little sense of self left that there were times when she felt as if she had become a transcribing automaton.

Although Carla was used to working long hours, she didn’t always have a clear idea of how much money she was earning. She never questioned her line counts because her productivity and income seemed far less important than not being yelled at. She was tired of being told that because no one else could understand a difficult doctor’s dictation, she would have to work on his account. Or that because other people had to take care of their children, she’d have to transcribe work that was already late and kept piling up. In far too many ways the drudgery of her professional life resembled the downtrodden existence Cinderella suffered at the hands of her stepmother and ugly stepsisters.

That afternoon Carla and I spent a lot of time talking about the kind of person she was, what her goals were, the changes she wanted to make in her life, and how she might be able to work with Alert & Oriented. We discussed the relative merits of earning money simply for the sake of a paycheck versus working in an environment where you are treated with respect, people don’t insult your intelligence, you are thanked for your contributions, and you’re entitled -- if not expected -- to have a life.

While covering the differences between an employer/employee relationship and the relationship between a business owner and independent contractor, we reviewed how the issue of “control” affects the definition of a business relationship in the eyes of the IRS. I assured Carla we would not harass her and stressed that, in an entrepreneur/independent contractor relationship we were legally obligated to respect her boundaries. I emphasized that I was not afraid to receive bad news if she had a problem or personal need that was a higher priority than transcribing and stressed that establishing clear and easily understandable channels of communication was the key to a successful working relationship.

That part was the simple stuff. The tougher nut to crack was helping Carla understand that if she had a better work situation, she could lead a happier, healthier life. To help paint a picture of what her future could be like, I tried to depict a lifestyle in which she did not dread hearing the phone ring. In which she no longer transcribed until all hours of the night (only to get up at dawn and start back in at work). A lifestyle in which she was nice to herself, earned enough money for her needs, and didn’t drain her emotional and spiritual reserves to the point where she was always running on empty.

Carla looked at me as if I had described life in another galaxy. But, by mid December, she had gotten up the courage to sever her abusive business relationship and start working with us. Having spent so many years working in WordPerfect 5.1 for DOS, she was eager to see what transcribing in a Windows environment would be like. Much to my delight, her work proved to be excellent. She was computer literate, extremely reliable, and turned over an impressive volume of dictation.

As Carla eased into working with an MT-friendly MTSO she began to experience some fascinating changes in her life. Not only did she enjoy working in a Windows word processor with true WYSIWYG features, but without the constant dread of the phone bringing bad news she was beginning to enjoy her work. Not just enjoy it – Carla was falling in love with transcribing all over again (she had always loved to transcribe but had been so miserable that she had completely forgotten how much she truly loved her work). With a cloud of doom no longer hanging over her daily life, she began to smile more and be open to all kinds of possibilities.

One afternoon, she stopped to look at a neighboring house that had been placed on the market. As Carla toured the property, she recognized the realtor and started chatting with him. They quickly discovered that they had seen each other on numerous occasions but each had been too shy to approach the other. As Carla and Ted laughed about the strange way fate had intervened, they realized they were sparking on each other’s company and agreed to meet for dinner the following week. Not only did Ted turn out to be a fellow vegetarian, “We stayed up all night long just talking and laughing,” Carla told me. “Do you know how long it’s been since I’ve experienced anything like that?”

As Carla became more confident, the flowers of spring weren’t the only things to blossom. So did a new romance. Because the two lovers had experienced difficult divorces in the past, each was wary of the future – waiting for the proverbial other shoe to drop. As you recall, after Cinderella left her glass slipper at the Prince’s ball it was only by searching the kingdom for her matching slipper that Prince Charming was able to find his true love. In Carla’s case, each lover took an old shoe from the closet. One sunny afternoon they walked out onto a nearby bridge and symbolically tossed the “other shoe” into the water far below.

In March, Carla called to inform me that she and Ted were planning a trip to Hawaii and that she wanted to request time off for a vacation. I reminded her that she was not an employee and that it was up to her to tell us when she would be unavailable for work. Pinching herself to make sure that she wasn’t dreaming, Carla agreed to get back to me with full details of her trip. A few months later I received a postcard from a beach resort telling me that everything was going well, that she hadn’t really thought about transcription at all, and that she was enjoying the most relaxed vacation of her life.

A subsequent trip to meet Ted’s family over the Labor Day weekend went smoothly and the happy couple recently celebrated the six-month anniversary of their meeting. Carla has set up a second work station in Ted’s house and often stops transcribing in late afternoon. She tells me that she is happier than she has been in years and often has trouble believing that this has really happened.

Will Carla and Ted live happily ever after? Time alone will tell. My point in telling this story is not to position myself for a new career as a fairy godmother. It is to remind medical transcriptionists who feel “hopeless and helpless” that long hours of transcription need not take place on a dark and stormy night. Fairy tales can come true.

It could happen to you.