The Demise of the Career MT

This is going to sound harsh to some, and some are going to accuse me of being anti-MT. Let me stop you right here – I am hugely PRO-MT. But I am pro-MT as a career, as a profession – not as a hobby.

In fact, I am so pro-MT that I’m going to talk about a subject that many in the MTSO industry won’t agree with.

Very simply – I believe we are contributing to the demise of the Career MT. And in doing so, our organizations have become expensive, inefficient, and unwieldy.

Time and time again in my line of work, I’m asked “why aren’t my MTs more productive?” And time after time I’m surprised to see that editing skills and draft quality play only a small part in their lack of results. Frequently I see that MTs are only editing a few jobs a day – often, incredibly, working less than 10 or even 5 hours a week. Sometimes this is a matter of workflow management and education. Workflows do need to be rearranged such that MTs see enough editing jobs per week in order to become proficient at this new skill.

But many times I’m surprised to hear statements such as “these are independent contractors. I can’t tell them how much to work” or my favorite “we do enforce schedules. MTs who do not meet minimums are made part time” then when asked about schedule or productivity requirements for part-time MTs – I’m told there are none, or they are so low they are laughable.

Even more interesting are some posts I saw recently on an MT forum where MTs complained that supervisors are calling them to ask why they aren’t working their shifts. One MT complained that the reason she took that job was because she wanted to work when she wanted to work. Another commented, if she “wanted to punch a timeclock, I’d get a real job.” WHAT?? A REAL job?

Where is the dedicated professional who takes the job seriously enough to work an assigned schedule reliably? Why has medical transcription come to be looked at, by employers and often times by MTs, as a hobby rather than as an important, demanding profession requiring skill and knowledge?

Someone commented to me recently that MT has become the “Tupperware lady” of this decade. Can that be true?? If so, why?

I suspect the answer is simple – Management and Money.

• If management doesn’t treat the MT as a skilled professional, she won’t behave like one.

• If MTs aren’t paid what their skills are worth – the profession won’t attract the career minded individuals that it once did.

I attended an AHDI webinar the other day, presented by Gary David, PhD. (“MT intelligence: The Value of MTs in HIT Implementations”, June 29, 2010). Dr. David talked about the role of human intelligence in the creation of useful clinical information. He talked about the role of the skilled MT in the future of clinical documentation – about how the MT could play a vital role in validating data entered into an EMR, or in validating the correctness of the results of NLP. I agree 100% that the MT has a vital role to play in the future….

But my concern is, will we continue to attract the MT with the level of skill and knowledge required to perform this vital service into the future if we don’t re-visit our methods of management?

I personally think there are many MTs out there who WANT to be professionals. I suspect that the MTSOs who are known to treat their MTs as professionals – who will pay them accordingly and in return can expect the MTs to be reliable professionals – will have the Career MT beating down the doors to work there.

I truly believe that we can be lean and efficient – and still support the Career-MT.

My next couple of posts will talk about:
1. MT compensation – making the transition from transcription to editing without damaging your MTs’ paychecks.
2. Efficient workflow management
3. The myth that low line rates paid to lesser skilled MTs equals financial gain for the MTSO

I’d love to hear what you have to say!! 🙂

til next time,

11 Responses

  1. Five years ago I was separated from a job I held for nearly 20 years employed as a secretary/transcriptionist. With the advent of EMR I was no longer needed on a full time basis unless I wanted to be a receptionist or doing direct patient care. Over the next five years I have had a few at home transcribing jobs. My longest one, cardiology, recently was put on hold while they transitioned to EMR documentation training and implementation. I was told this was mandated by the gov’t and they were determined to “make it work”. No notice, just an e-mail that my services may no longer be needed. That was the day after Memorial Day. Since then, they have not contacted me. I am assuming their trial period and training transition is working. So, apparently, again, a provider would prefer to document himself rather than spend the time with patients. So I am one of the many who is unemployed and not documented in the gov’t numbers as I cannot collect unemployment. I for one do not think much of the EMR .. I feel my personal information is too easily accessible to those I have no idea may access it and I fear I have no control over it either. Sometimes, the old ways are still the better ways. There is nothing like a human being at the end of the phone line. If offshoring our work does not take it all away, eventually EMR technology and gov’t mandates will. The bottom line, of course, always being money.. Saving in overhead costs means eliminating the transcriptionist.

    • The EMR is indeed in some cases doing a disservice to physicians and patients as well. And what many providers don’t realize is that they are not automatically qualified for meaningful use just by virtue of using an EMR. For some interesting discussion about HITECH, see Dr. Vince Kuraitis’ blog

      I haven’t given up hope yet that providers will realize that there is a place for conversationally narrative dictation in the electronic record – and that the MT is a valuable piece of getting that useful information provided by the doctor into that EMR.

      Thanks so much for commenting,

  2. Our measure of worth is still how many lines, not the quality of our lines. We are not measured by how many times we find and prevent errors from entering the record, but by how many lines we produce. We are not measured by how mjany times we correct a left/right discrepancy, understand that mg should be mcg in dosage, or figure out what is meant by “azithromax.” It still comes down to how many lines. By automatically correcting these things, that is now just an expected service, and no longer used as a measure of value. It’s still the quantity, not the quality that is defining us.

    • I agree Crystal – I personally don’t think there is anything wrong with productivity-based pay – assuming the line rates compensate the MT for quality, skill, and knowledge and are not so low that the MT is forced to rush through the document.

      Thanks so much for your comment,

  3. Excellent article!!! Thank you!

    • Lynn, these are great points. I have long hoped that speech recognition editing implementation will help move MTs to being knowledge workers instead of production workers.

      Unfortunately, the typical compensation model, as Crystal points out above, all too often seems to be based on production, not on our knowledge. The worst speech rec implementations seem to cut the MT’s pay in half, from say 6 cents a line to 3 cents, because of the vendor’s statement that their productivity will be doubled. (However, most MTs seem to have a 30 to 50% increase in productivity initially, not 100%!)

      The most successful speech rec implementations do not cut the MTs’ pay but rather pay the MTs during the training period as much (or more) as they were making before speech rec. What motivation is there to learn an entirely new platform if you know it’s going to cut your pay in half? The MTs whose companies treat them right instead of abusing them will be more productive and happy.

      You are 100% right, Lynn. When Management treats MTs as professionals, they will act as such. If they’re treated like dilettantes, then they will show up when they feel like it.

      Thank you–great post! I look forward to hearing more.

      • I couldn’t agree more – I’ll be posting more with some ideas about compensation. Thanks so much for commenting!

  4. I take exception to not being a professional MT. I have always considered MT as a career. I have been involved in med transcription for the past 13 years and my accounts have always been my priority. I am excited about trying to fit into this new coming technology and actually would prefer editing at this point to just transcribing. I am concerned though as a lot of it seems to be point and click and not personalized enough to patients’ needs. Not to mention this point-and-click mentality could just be our demise as we are pointed and clicked right out of our profession.

    I feel the EMR can be a good thing for the patients but only if accurate and complete documentation is the goal and not just the bottom line.

    Thank you very much for making all this news and information available. Diane Y

    • Hi Diane: You are exactly the kind of MT – a dedicated professional – that the industry needs, and should support, and protect.

      I hope no one thinks that I think all MTs fit into the “hobby MT” category.

      To the contrary – I know that being an MT requires knowledge, skill, and expertise and my goal is encourage MTSOs and hospitals to treat them as such so that we continue to attract more people like you to the profession.

      All the best!!

  5. MT has certainly been my career. I loved finding a way to be of service that I loved, was good at, and made a good living.

    My opinion is that money should never be the final motivator, even though it is. Those who put the bottom line ahead of quality service are in for disastrous results. It is a proven fact that cutting costs is not the way to success. Look at BP. The institutions who cut costs rather than provide good service will be short-lived. I’m not sure that doing away with paper records altogether will be sustainable, either.

    It’s kind of sad that someone like me who was dedicated to quality documentation can’t make a living any more and has to move to a different sector. It’s the health care industry’s loss, unfortunately.

    • Hi Kitty: It is indeed the industry’s loss!! Hopefully we can work together to bring attention to this fact and can do something about it before its too late…

      Thanks so much for your response,

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