Thursday, September 20, 2007

Why Is It So Hard To Find Good MTs?

Ask any medical transcription service owner (MTSO) or transcription departmentmanager to list the top five challenges faced by their profession and I’ll bet you that one of the top three is finding good professional medical transcriptionists.

  • Not medical transcription wannabes who saw an ad promising quick money.

  • Not someone who watches soap operas and thinks she knows a lot about medicine.

  • Not some doctor’s relative who can type 30 words per minute but is not computer literate.

  • Not someone who can’t spell or correct a doctor’s grammar.

I’m talking about good professional medical transcriptionists.

Where are they hiding? Why don’t they want to come work for us?

The truth is that different personalities are drawn to different workstyles. Just as some medical students have strong personal reasons for choosing certain specialties, medical transcriptionists now choose between working in-house for an hourly wage or transcribing on a production basis. At first, one might not think that such a choice would make much difference in the way transcribing talent gets distributed. But as more and more people have started working at home, a very clear pattern of behavior has emerged. People who are paid to transcribe on an hourly basis spend more time socializing on the job. People who are working against the clock are motivated to work harder because “the meter is running. “Although you may never have thought about this, the method by which a transcriptionist is paid can determine who is transcribing your work and thus have a severe impact on the quality of transcription you receive.

Back in the 1970s and 1980s, many medical transcriptionists worked in hospitals and clinics where they were paid an hourly wage for their labor. Once they established a comfortable pace, they pretty much kept to that level of production. If the work load began to back up, they didn’t type faster. Nor did they necessarily volunteer to work overtime. They knew what they had to do in order to collect a weekly paycheck and did not aim much higher.

The fact that these transcriptionists could beassured of a weekly paycheck (and anticipate the approximate amount of that check) meant that they could take the luxury of devoting some extra time to looking up words, rewriting the dictation of a doctor who could not speak coherently, and reworking certain documents until they were satisfied that their work matched some personal and/or professional standard. Knowing that they were union or tenured personnel allowed them to enjoy a certain degree of job security, rely on a comfortable benefits package, and be sure that they would be paid for the hours punched on their time cards -- no matter how hard they did or did not work. They could also spend as much time as they desired socializing on the job.

However, as hospitals started farming out more dictation to transcription agencies, the really good transcriptionists learned that by transcribing a hefty volume of dictation on a production basis they could make substantially more money than they did working for an hourly wage. With that incentive in mind, some were stimulated to work harder and set new goals for themselves.

As computers became more affordable, a noticeable trend began to emerge. Transcriptionists with stronger skills, more discipline, and a greater desire to determine their own work style began investing in home offices. Many of these“new-age entrepreneurs” realized that by adapting the latest technology to their needs and developing a client base, they could stop working for another transcription agency. The brave ones started their own businesses, nurtured them, and watched them grow. Their belief in the strength of their skills allowed them to take dramatic risks and earn sizable rewards. They quickly learned the truth behind the old adage that “You have to spend money in order to make money.”

Because their success depended on staying on top of the latest technology, these people did not stint when it came to upgrading software, buying reference books, and acquiring any tools of the trade that could help their businesses to grow. Minus any financial incentive or purchasing power, the people being paid on an hourly basis remained dependent on their department heads, waiting for them to acquire new reference books. Because many of these people were not computer literate, and had no incentive to learn newer word-processing programs, they continued to work on software that was quickly becoming obsolete.

At the same time this was happening, hospital administrators were frantically crunching numbers in an attempt to cut back on spiraling healthcare costs. With the advent of managed care, two hard truths quickly became evident:

  • Important savings could be achieved if hospitals could reduce the number of fully-benefitted employees by outsourcing services like janitorial work and medical transcription.

  • Floor space which produced income was more valuable than floor space which did not.

As digital dictation technology improved, more and more hospital administrators found it easier to farm out medical transcription in order to save on the cost of employee benefits. Thus, when the moment arrived for a hospital administrator to choose between upgrading dictation and/or word processing equipment, or farming the work out, it was often more cost effective to cut capital expenditures and accept bids from contractors who would handle the hospital’s transcribing chores. This, of course, led to cut-throat competition for large accounts and, as the price per unit dropped, transcriptionists had to take advantage of any shortcuts they could use to boost productivity.

The electronic sweatshop in which many medical transcriptionists now find themselves working is beginning to resemble the famous candy factory sequence from I Love Lucy. Remember that episode when Lucy and Ethel started dipping chocolates on an assembly line? As the conveyor belt started moving faster and faster, Lucy was forced to take more desperately farcical measures to keep pace with production. Just as she was about to keel over from a combination of nausea, stress and exhaustion, the supervisor yelled “Okay, let’s speed it up!”

An alarming industry trend has been to maximize profits by cutting the rate paid to medical transcriptionists. The results of applying this “MBA cowboy” attitude to professional talent would be laughable were the situation not so tragic. A subcontractor who now works for my company told me of the ingenuousness with which a representative of one former employer told transcriptionists all about the millions of dollars the company had spent on new technology, the great profits the company was enjoying and then said “By the way, we’re redefining the line count. It really won’t make much difference if you can just type at least one more report per hour. I mean, you’ll probably make as much as you did under the previous system.”

As she recounted this story, this veteran transcriptionist angrily asked “How stupid do they think we are? Do they think we can’t even count?”

One of the saddest ironies of the business world is how many companies are always so busy chasing after new business that they ignore their oldest, most loyal customers (who know the value of their business and could easily refer new accounts to them).

  • Think about all the “improvements” and lame-brained management ideas that have been foisted upon transcription departments by people with no transcribing experience.

  • Think about all the changes which began in the purchasing department without anyone ever consulting the transcriptionists to learn what they really needed?

  • Think of all the money being pouredinto new technologies that don’t always fulfill their promise.

  • Think of all the money invested in satellite technology to ship dictation overseas (where the confidentiality of a patient’s medical record could easily be sacrificed in pursuit of profits).

  • Think of all the money HMOs have returned to management in bonuses and dividends while denying patients the standards of care they deserve.

  • Think of all the money that’s been spent investigating and reporting on President Clinton’s sex life.

Then ask yourself what might have happened if just a tiny percentage of that money had been used for training and supporting professional medical transcriptionists? If some of that money had been used to pay MTs a decent wage so that they thought their work had value? If some of that money had been spent to make MTs feel sufficiently appreciated for their professionalism that they didn’t have to look elsewhere for work?

Like librarians, medical transcriptionists have very strong reference skills. They have amazing levels of mental acuity. Their work requires an uncanny ability to interpret garbled speech, analyze medical situations in search of a diagnosis, spot contradictions in a doctor’s dictation, and synthesize the results into a coherent statement that many licensed physicians cannot produce. These people are not fools. Nor do they like being treated like fools. So why not stop and ask yourself: What are the rewards of doing medical transcription for a pittance? What are they trying to prove? That they know more than the doctor? That they don’t deserve to be paid for professional work?

The bottom line is that if you devalue the talent, you devalue the results. When my partner and I found a wonderful new subcontractor, we didn’t hesitate to take her to dinner in a nice restaurant. We considered the evening an investment of time in a business relationship and money well spent. As we talked, it became more and more apparent that -- in all her years as a professional medical transcriptionist-- this was the first time someone had told her that the quality of her work was good and that her diligence was appreciated. Despite her value as a skilled medical transcriptionist, not one of her previous employers had thought to treat her as a human being.

Because of the time and effort we were willing to invest in treating this transcriptionist well, this woman is now earning nearly twice the rate she received from large national services. Look around the industry and this should help you understand one of the key reasons it has become so hard to find, hire and retain top-quality professional medical transcriptionists: Most employers set their transcriptionists up for failure instead of setting them up to succeed!

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