Do I think there are too
many transcriptionists? That depends. There has been much publicity
in the last several five years about medical transcription, and
there are ads in many magazines telling readers, "Learn to be a
medical transcriptionist in six months and earn good pay at home."
As a consequence, there are a number of people who have taken courses,
many quite bad and a few quite good. These graduates are trying
to find jobs and some are having rotten luck. Many of these courses
really do not train one to be able to perform on the job.
I used to recommend that
people get into this job but not any more. Our wages are going down,
generally, while the cost of reference materials, software, and
training is going up. As I write this, I am sitting next to my reference
shelf with several hundred dollars of books within arm's reach.
Behind me is another shelf with thousands of dollars' worth of reference
manuals on medicine, science, and computers. I have subscriptions
to or regularly purchase several expensive magazines and journals.
I subscribe to three online services and visit several news groups
on the Internet. I feel the need to do all this just to keep up
with this field, and it is more and more difficult to make money
at this job.
Hospitals have outsourced
to services. The services compete for the contracts, and too often,
the determining factor is price. The service owners then feel they
have to cut both their margin of profit and the reimbursement of
the transcriptionist. There are also mergers going on among services,
and the bigger ones are driving the smaller ones out of business.
Many of the biggest ones are controlled by people who have recently
gotten into the industry and really have no notion of what is required
to produce the medical record.
The hospitals and providers
are well organized and financed. The services are well organized
and finnced. The transcriptionists are unorganized, atomized, individualistic,
and tend to be loners. As you may have noticed from the stories
in the press about financing of hearth care during the past five
or so years, cost shifting is a big deal in the health care industry.
The insurance companies shift the cost to each other and the patient.
The hospitals shift the cost to the insurance or government programs.
Government shifts the cost to the providers. How much of the cost
gets shifted to any particular component of this picture is inversely
proportional to the power the particular component possesses.
have little or no clout because they are unorganized. Because the
medical transcriptionists are so unorganized, they eat the costs.
This cost-shifting to the hapless transcriptionist takes several
forms, including the restructuring of pay rates, erosion and elimination
of health and other benefits, vacation, sick leave, disability insurance,
etc. It also takes other, more subtle forms.
When I worked for the
hospital (at an hourly wage with full medical coverage, life insurance,
and a retirement package), I could spend 45 minutes transcribing
a four-minute dictation by Dr. Mushmouth. When I could not fill
in a blank, I could ask someone else to listen. Sometimes two, three,
or more of us listened. It did not matter. No one said anything
about productivity as long as we got our 1000 lines a day--not difficult
for the experienced transcriptionist. We got regular quality assurance
reviews. We had educational meetings. We were encouraged to belong
to AAMT (American Association for Medical Transcription) and attend
This is no longer the
case. We now get paid between 5 and 10 cents a line, receive no
allowances for reference materials, continuing education, etc. If
we have a difficult dictator, we are faced with the choice of either
taking an extra long time to do it or compromising quality.
It used to be in the hospital's
financial interest to work with the worst dictators to clean up
their act. A few hospital administrators even had the wit to realize
the importance of quality and act on it. But now, it is AGAINST
the financial interest of the hospitals or services to approach
the bad dictators. Doing so costs money and threatens to alienate
the doctor. And one must not forget that the doctor (and not the
patient) is the customer that the hospital is geared to serve. So
the cost gets shifted to the transcriptionists.
These are some of the
reasons I do not recommend this type of work any more, although
I love it and find it challenging and interesting.
The need for transcriptionists
will almost certainly grow. The number of transcriptionists will
not increase fast enough. And the hospitals and large services will
do everything in their power to obviate the market forces that might
raise our compensation. They do this now, which is why our compensation
is going down while the need for our services rises.
The reason the need for
transcriptionists will grow is the advent of the paperless medical
record. By 2002, all hospitals must be on the paperless medical
record. Most doctors will have to be on it too. Handwritten notes
will not be acceptable. That means more dictation by more people--people
like physical therapists, nurses, home health care staff, mobile
transfusion companies, medical social workers, etc. Much of the
current documentation of medical care is scattered and handwritten.
The many doctors who are happy with little scrawls in their office
charts will no longer be able to do business this way, and nurses
and allied health professionals will either have to enter the data
into a computer by typing, using sort of fill-in-the-blank templates,
or voice recognition. Pen and paper will no longer be acceptable
in a very short time.
Who knows how all this
will end? Will quality be sacrificed in the name of economy? Will
the transcriptionist be paid so little that only the least capable
will be able to afford to stay in the field? Will your paperless
record, which will be available 24 hours a day to any physician
in the country who might have to treat you in a life-and-death situation,
have been transcribed by someone not competent to do the job? I
only have the questions, not the answers.