Friday, September 28, 2007

Who Would I Work For?

Anyone who studies gambling learns a quick lesson: The odds are on the side of the house. So if you’re wise, you find a way to become the house. Things are pretty much the same in medical transcription. If you want to earn more money and have greater control over your work process, you start your own service and take the responsibility for making things happen the way you want them to happen.

Alas, not everyone is in a position to make that move. The majority of medical transcriptionists are women. Some are single mothers and, as the sole wage earners in their household, are doing everything they can to keep their heads above water. Others may be raising children with the luxury of a second income in the family. Others may simply be single (male or female).

Whatever the domestic situation, not everyone is cut out to run a business. Some MTs are at their best simply transcribing. That’s what they do. They do it well, they do it efficiently, and they enjoy doing it. Unless, of course, people are trying to make their professional lives miserable (a wealth of dysfunctional behavior can be found in the field of medicine).

With the industry facing a critical shortage of qualified medical transcriptionists – and the Internet making it easier for MTs to check out a wide variety of job opportunities – it has truly become a seller’s market for talented medical transcriptionists. With one qualifier: Technology is what is driving change. Thanks to technology, MTs no longer have to go where the work is. Instead, the work can come to them. Although medical transcription cannot be done without the human resources necessary to do the job properly, too many entrepreneurs, MBAs and venture capitalists have been seduced into thinking that the professional MT has become a vestigial part of the process.

Having gone through various stages of working as a medical transcriptionist (hospital employee, independent contractor, and owner of a medical transcription service), I think it would be wise to examine the financial, professional, ethical and practical ingredients of an employment package which are going to make a seasoned medical transcriptionist want to work for any employer.


With competition from offshore transcription firms increasing the pressure to lower the cost of transcription, it’s difficult to find qualified MTs who are willing to work for peanuts. Why should they? No matter what formula or unit of measurement is used to determine earnings, experienced transcriptionists have been doing this kind of work long enough to know when they’re getting screwed. Thanks to the Internet, it is now much easier to shop around for transcription services that might place more value on their skills and experience. In an age where corporate loyalty has become a joke (sometimes the corporation is no longer in existence by the end of the year), there is no reason for experienced MTs to take any job unless it is worth their while.

Corporate culture:

Is this company run by people who have experience transcribing and will understand the professional and ethical values of a medical transcriptionist? Or is it being run by a bunch of cowboys and jocks with MBAs who want to pay transcriptionists as little as possible? Does this company believe in protecting the confidentiality of a patient’s medical records? Or is it sending work overseas to offshore transcription firms in an effort to make a quick buck? Will I feel I can be proud of the work I do for this company? Or will I be ashamed to admit that I work for this company?

Employee versus independent contractor status:

MTs who choose to work as independent contractors take on certain responsibilities for which they get certain tax breaks. Unfortunately, some MTSOs want all the advantages of treating an MT like an employee but don’t want to pay the taxes that come with having so much control over someone’s work situation. If being a “statutory employee” means I must sacrifice all the benefits of being an independent contractor in return for a big fat nothing, why would I want to work for your company?


Do your documents follow a standard format? If not, how many different formats must I work with? How often am I going to be asked to switch from one format to another? How many different accounts am I going to be working on?


Will I have to perform all work for your company on a separate computer? If so, will you furnish the computer at no cost to me? If not, how much is my investment? How much of that investment can I salvage if we part company?

Leaving blanks:

Does the management of your firm understand why medical transcriptionists leave blanks? Or are they trying to deliver “cosmetically appealing” documents to their clients – regardless of the risk of compromising patient care?

Lost Time=Lost Money:

I’m willing to work on a production basis assuming that a steady flow of work is available. But what about when the work dries up? What kind of compensation can I expect if your servers are down and I can’t receive any work?


Will I receive a manual which clearly outlines procedures and responsibilities? Has this manual also been written in HTML format so that I can access it from my desktop? When was the last time this material was updated by someone who really knew what was going on?

Medical Benefits:

More than line rate or salary, one of the most crucial issues for information workers is medical benefits. Some transcriptionists have hopped from job to job without being able to maintain coverage; others have a spouse whose employee benefits cover the entire family. But for those who are single – or single parents – medical benefits can make or break an employment offer. Sometimes the benefits package offered by an employer isn’t as sweet as it sounds. My prediction for the future is that information workers will shoulder the costs of their own health plans as they take on work from more than one source. In the end, “bennies” will no longer be the golden handcuffs that can keep employees in place.

Prompt payment:

Will my check arrive on time? That’s not as funny as it sounds. If you – or one of your partners – is an alcoholic (or snorting cocaine), I can’t afford to let it affect my ability to pay my bills. I don’t want to hear lame excuses about a client being late with payment or be forced to listen to any long, sad tales of woe about the problems you’re having with cash flow. If you expect me to work tight deadlines and deliver for you, then I expect you to deliver a check to me. On time. Every time.

Quality assurance:

Medical transcription is very difficult work which requires lots of judgment calls (always remember that the quality of an MT’s transcription is directly related to the quality of any doctor’s dictation). If I have to leave blanks because some bozo can’t -- or won’t -- speak clearly, I need to be assured that my professional expertise will be respected. If I am not hearing things correctly, I don’t want to be reprimanded like a child. And if the folks doing quality control are prone to retaliatory strikes against MTs because of personality conflicts, unhappiness with their own failed careers (or perhaps some particularly evil bouts of premenstrual syndrome), I want to be told about this situation before I sign on to work for your company.

Respecting boundaries:

We’ve all heard horror stories about MTSOs who call transcriptionists at 6:00 a.m. and scream “Get out of bed and start typing -- there’s too much dictation on the system.” I still remember the transcription manager who told me I was not allowed to leave my own home without her permission. Medical transcription is a profession, not a religious cult. If I say that I’m unavailable between certain hours, don’t call me. If I say that I’m going on vacation for several days, don’t call me. Never forget that lack of planning on your part does not constitute an emergency on mine.


How much training is required to understand your software and get up to speed on it? Will off-the-shelf applications like word expanders, drug indexes, and medical dictionaries work with your software? Do you furnish those to your transcriptionists?

Technical support:

With more and more proprietary software systems in use, a common complaint is that “the software is great – when the servers are working.” If I have to rely on your software, are you going to have tech support people available during all of the hours that I’m scheduled to work? Because if you want me to work evenings, graveyards or weekends, I need to know that there’s someone I can call when things go wrong.

Toxic work environment:

I’ve got enough drama in my life without unnecessary egomaniacal tantrums and unprofessional nuclear meltdowns getting in the way of my work. If your managerial staff is prone to screaming at each other, having fights in the hallways, or laying the blame for management’s stupidity on the transcriptionists who work hard to earn the administrative staff their salaries, then I don’t want to work for you. Is that clear?

When confronted with voice recognition technology and constant pressure to decrease the earnings of medical transcriptionists in order to pay for expensive technology, there is a lot to be said for MTs having a solid sense of self worth -- and knowing that every job offer they receive will not necessarily be their last. Any experienced medical transcriptionist worth his/her salt has put a lot of effort into developing the skills and vocabulary necessary to do this kind of work.

In a thriving economy, the smartest employers will treat their transcribing talent well because happy workers are more productive workers. Stupid, selfish and uncaring employers will quickly learn that unhappy workers can vote with their feet and warn others about their experiences in an unhappy work environment.

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