Turmoil in the Medical Transcription World – A Career Path Full of Potholes and Dead Ends

Photo of a Pothole in a Road

In my last post I discussed working from home in general.  In this post I’d like to delve a little more specifically into what it is like to work in the medical transcription field.

Many people are familiar with the term medical transcriptionist.  We are also known as medical language specialists.  I think that is actually a more accurate title, because to do this job well requires so much more than typing.  You have to understand what you are transcribing and have a really good grasp of anatomy and physiology as well as medical terminology, pharmacology and grammar.

The medical transcriptionist listens to and then transcribes recordings of physicians describing their interactions with patients.  These may include clinic visits in cardiology, gastroenterology, neurology, psychology, orthopedics, physical therapy, etc.  You may type emergency room visits or descriptions of surgical procedures.  If you were to work for a local physician, say a neurologist, you would type mainly neurology reports and you would quickly become proficient in neurological terminology.  When working for a transcription service you must be proficient in all the specialties and familiar with all the medical terminology that goes along with them. In addition to that you will have a very large number of physicians you will be typing for, which often presents a challenge as you strive to learn all of their varying accents and idiosyncrasies.

With the advent of new technology the transcription of reports is frequently being replaced with editing of reports.   Computer software translates the physician’s spoken words into text which the transcriptionist then must edit while listening carefully to the dictation.

I personally prefer typing over editing, finding editing too monotonous, but I know people who love to edit.   You can edit more lines per hour than you can transcribe, but don’t get too excited – the companies also pay less per line for editing!  For transcribing dictation the rate may be 8 cents per line but the editing rate will probably be closer to 4 cents per line.  Yes, as a transcriptionist you work for pennies!  These pennies really do add up though and it is possible to make a good income as a transcriptionist or editor, but it takes a lot of skill, determination and self discipline…and often a good dose of luck as well, as I’ll explain  in just a bit.

There are, however, many drawbacks in the field that make it difficult to earn that good income. “Back in the day” it was a lucrative career, a profession.    Today it can be quite difficult to make even a decent wage in this profession.

I am currently sitting here typing this article instead of working at transcribing reports because there is no work available this morning.  I was tired, but got up with the 4:30 a.m. alarm to prepare for my day at work.  Settled in at 5 and ready to begin my workday when the all-too-familiar message appeared on my screen “While your queue is empty, work arrives continuously.  Please contact your QManager.”  Well, 1 hour and 20 minutes later and still that continuously arriving work is nowhere to be found!

I didn’t even bother to contact the QManager this morning…choosing instead to write this article. The days I do contact the QManager I either get a message back saying “keep waiting, work is slowly coming in”…in other words, there is no work, sit tight and eventually there will be some.  The other option is that the QManager will find another account and have me begin work on that.  This can be a frustrating process as new accounts mean reading through pages and pages of instructions about what the client (hospital) expects.

There is so much variation from client to client. For example:

  • Some want their headings in bold, all caps while some want them in bold mixed case while others want all caps, but no bold.
  • Allergies in caps or not, bold or not.
  • Number all lists.  Don’t number lists.  Only number medications.
  • Patient names allowed in the report.  Patient names not allowed in the report.
  • Remember Dr. So and So; he wants to make up his own rules which you need to remember too.

You are expected to study these rules and remember them (or have notes everywhere as reminders!).   This is something that is done for every hospital or clinic you type for.  I currently have 4 hospitals I type for….so 4 sets of rules to keep straight.  You might type 3 reports for 1 hospital, then 2 for a different hospital, back to the first hospital for 1 report, onto a different hospital for 2…so you have to keep all these rules for all these different clients straight. So, sometimes I would rather be out of work and not typing than wading through trying to learn all these new rules for a temporary account.

One of the big downsides of being a transcriptionist is that we are only paid for those lines produced which means the time you spend studying those client expectations, time spent reading emails from your supervisor, time spent researching medication doses or unfamiliar terms or the name of the taco joint in St. Louis, Missouri the doctor mentions that the patient works at….all the time you spend doing any of these things you are not compensated for. The time spent waiting to see if any work comes into your queue isn’t compensated for, either (I know of one company that will pay you for up to 15 minutes of out of work time per day; not very helpful if you are out of work for 2, 3 or 4 hours!).

How many other professions are there where you are expected to report to work on time and not get paid if when you get there they have no work available for you to do?  This policy seems like a real injustice to me, but it is the norm in the medical transcription field.

Some companies require that you stay near your computer and “keep checking back” throughout our shift for work.  Some employers offer “flex time.” If you come to work and there is none available you can request flex time.   This is helpful in a way as you can then go do something else for a while and work again later in the day when there is work available again.

But what if your schedule isn’t flexible?  I’m currently caring for my elderly mother who needs my full attention during the day…I get up early in the morning to work, before she is up.  If there is no work I don’t have the ability to come back 3 or 4 hours later to see if there is some available.  The result?  No pay for the hours lost.  This can make budgeting difficult and this lack of having a consistent dependable income is one of the biggest problems that I see for the medical transcriptionist.

There is another practice in the medical transcription field which I really don’t understand or like, because it means two transcriptionists with equal skills can be earning very different income based on the accounts they are doing and the rules of those accounts.

Let me explain.  We are paid by lines…so for example for every 65-character line we might be paid 8 cents for typing or 4 cents for editing.  I recently had been working at one company where my accounts were all straight typing, which I loved!  I had one account which had many macros (pre-typed text you can copy and paste into the report; this only takes seconds, but you get credit for all those lines just as if you had typed them) and it also had text often plugged right into the report, so before you typed anything at all you might already have 30 or 40 lines to your credit.  Other accounts never did this, so my line counts were always much lower when I worked on those accounts.

There are also varying rules for each account regarding how many blanks you can leave.   The transcription companies put a lot of weight on how many blanks you leave and it counts against you if you send in too many reports with blanks.  The problem comes when one account might allow you to have 3 blanks in a report and not send it in for corrections while another account allows no blanks.  So it’s harder for the medical transcriptionist on the account with zero blanks to keep her submission rate low than it is for the transcriptionist on the other account, but there are no allowances for this (at least not at any companies I’ve worked for).  Since this is often tied to the amount of money you make it really can be more of a situation where luck of the draw (which account you are on) determines your paycheck more than how good a transcriptionist you are or how hard you are working.

One company I know of will reduce your line rate to a mere 7 cents per line for straight transcription if you send more than 5% of your reports to QC for corrections.  Many times these submissions are not the transcriptionist’s fault.  I have had to send in reports when there was no dictation, the attending physician’s name was not dictated, or some other similar situation which couldn’t be avoided…these reports counted against the QC submission rate and can result in a significant decrease in pay.  All rewards for 100% accuracy and high line counts disappear if the QC submission rate is deemed too high.   We are always told not to guess, to flag anything we are unsure of – but if we do it just one too many times we can pay for it, literally.

I actually had this happen to me (I went from 11 cents a line to 7 cents a line) because I was 0.1% over the quota for that pay period…and I know that I had 2 reports during that time that were no dictations; it was almost certainly one of those reports that caused me to exceed the limit and lose several hundred dollars in pay that pay period.

I am writing this article not to discourage anyone from becoming a medical transcriptionist, because there are some positives things about this career, but there are also many downsides and I hope this article helps you go into it with your eyes wide open.  The charge for tuition to learn transcription is significant and learning this trade also requires substantial investment of time.

I went into this profession expecting to make very good wages and be appreciated for producing quality work.  Neither has happened, in nearly 12 years as a transcriptionist.  One of these days I will go back to school and finish my degree and get a better job.  But for now, I type on.

If you choose this profession I wish you well.  I hope you are one of the fortunate ones who can find a company that rewards your efforts and skill appropriately.

So You Want to Work From Home….

Photo of Margaret Mackey with Kittens Typing

kittens at workYou’ve heard the ads, perhaps dreamed of working from home. You envision yourself positioned in your own little office in the spare bedroom or a cozy corner of the kitchen, working away while the children play quietly nearby, the dog sleeps by your feet and the money just keeps dropping into your bank account as you faithfully apply your skills.
As a seasoned medical transcriptionist with nearly 11 years’ experience, I’d like to take this opportunity to share with you some of the ups and down of working from home.  There are many reasons people choose to work from home and certainly there are a lot of benefits from doing so.  For me, my venture into this lifestyle started when my marriage fell apart and I was suddenly the sole provider for myself and the 3 of my 7 children still at home. I had been a stay-at-home mom for over 22 years and the thought of diving headfirst into the regular workforce was terrifying. I think it was a real saving grace for me and for my kids that during this time of great upheaval in our family I was able to still be the at-home-all-the-time mom while being able to work and provide for us. Being able to avoid the need for before and after school care and the predicament of knowing you really need to be in the office when your 6-year-old is running a fever significantly lessened the load for all of us. Snow days weren’t a problem, because I was home. Teacher conference days, Christmas break, summers….all were handled with so much more ease because I didn’t have to feel quite so pulled in both directions. I know a lot of women seem able to juggle working outside the home and family and do it really well…but I will always be grateful I had this opportunity to remain in my home full time.

So, for me having the chance to work from home really was a lifesaver and a blessing and I do encourage mothers (especially mothers with young children) who need to work to consider working from home. But, there are also special challenges and drawbacks and I’d like to present some of those here, because I think knowing what you’re up against can strengthen you to face the challenges and still achieve your goal of working from home.

obed at workThat picture of the kids playing quietly and the dog by your feet? Yes, it happens sometimes…maybe once or twice a year?! Seriously, one of the biggest challenges to working from home is that because you are home everyone assumes that means you’re available…the kids, the neighbors, the dog, the cat. There have been so many times I’ve been on a roll typing away when one of the animals would get sick, or the dog would bark to go out. Then there were the times I would spot something outside my window…yep, the goats had broken out of their fence again and were running down the road or worse yet, heading for the neighbor’s garden! So keyboard tossed aside and a dash out the door to do a little mid-morning goat wrangling, or clean up after the dog, or answer the phone and talk for a few minutes with a lonely grown daughter in another state. I found the best way for me to handle distractions like these was to work either early in the morning (really early, i.e. 4 a.m.) or late at night, after kids were in bed and life had quieted down. Some companies will allow you to choose your own schedule and are pretty flexible while others are very rigid. If you can choose to work when there are fewer distractions that’s great. If not I think establishing firm boundaries right from the beginning is a key. Set up your answering machine stating that you are working and will return phone calls when you are finished. We have a code in our family that if we are calling home and really need someone to pick up the phone we call 3 times in a row. That is the signal that somebody needs to answer the phone right away! So you can either use caller ID or a code or another idea of your own so you are accessible in emergencies, but really try to guard yourself from phone interruptions.

Teach the kids right from the beginning that you are not to be interrupted while working unless it is urgent…and be clear on what is urgent. The younger your children the harder this will be. Of course when the goats escape…there’s nothing to do but catch them!

goats4Working from home can be pretty lonely. I’ve spent decades at home…first as a full time stay-at-home mother and then as a working-from-home mother. While there is no workplace drama, there is also no workplace conversation or adult companionship. So, you have to find that on your own. Scheduling in coffee with friends or other activities that feed your soul can help to revitalize you and keep you sane, sometimes literally!
Some of the other positives include being able to keep handle on running the home with a little more ease than a mom who has to be gone from her home all day…you really can get 4 loads of laundry done and be there to turn off the oven when the brownies are done baking. And I believe scheduling a break so you can be there to greet the kids when they arrive home from school is a priceless gift you can give them, and yourself. I also scheduled a break when my kids were getting ready for school in the morning. One of my fondest memories is that every morning one of my teenage daughters would come into the kitchen while I was packing up lunches and say “Hey mom, listen to this song” and she would play me a new-found favorite song on her iPod. Just a little thing, but I was there for it and now that her high school days are over I’m glad I didn’t miss it. So, those are what I’ve found to be some of the basic ups and downs, positives and negatives of working from home. If it’s something you have been thinking about I’d definitely encourage you to do it!

Please feel free to post questions regarding working from home in the comments section below; help me determine what other topics I should cover in this series!

In my next post I will discuss working from home specifically as it relates to being a medical transcriptionist…the good, the bad, and the ugly…stay tuned!

If you are interested in becoming a medical transcriptionist I highly recommend CareerStep.  It’s the school I graduated from and it’s graduates are highly sought after by transcription companies.  They also offer the following programs:  Medical coding and billing, medical office management, medical administrative assistant with EHR, pharmacy technician, health information technician, computer technician, executive assistant, medical billing, and veterinary assistant.  Visit them today at http://www.referral.careerstep.com/ref12112.

Soylent 2.0: A Better Meal Replacement?

A Little Background

I enjoy eating sometimes but oftentimes it is more of a chore. Unfortunately, eating is a necessity if I want to be healthy, energetic, productive.

Soylent 2.0 being poured into a glass.
Photo of Soylent 2.0 from official Soylent site.

I’ve written about Soylent, a meal replacement drink, in the past here and here. I’ve tried other meal replacement drinks like RAW Meal and Shakeology (also here and there, and up there and down here).

I’ve written about and regularly consume Ensure, I don’t care that I’m not the target audience.

When Soylent started out (and when I first began consuming it) it was a powder which one mixed with water and then added some bottled oils to. It only took two or three minutes to make a days worth and I thought it tasted decent – much less grainy than either RAW Meal or Shakeology – but much more grainy than Ensure.

I Try 2.0

Recently Soylent announced and then began shipping Soylent 2.0 – which comes bottled similar to Ensure. Now there is no prep time, just take a bottle out of the fridge. I purchased my first twelve pack and have consumed them all. I’ve now upped my order to 24 monthly, which will cover almost one meal a day. I expect, if I continue to like it, I will up my order to perhaps 48 bottles/mo., which would make almost two a day.

While I didn’t have a problem with the old Soylent’s taste, the new Soylent is significantly better. It tastes and has the texture of almond milk.

At first I thought I would need to mix something with it to drink it with great consistency and I tried some chocolate syrup as well as some V8 juice – the latter worked rather well. But as I have continued to drink it I find my taste buds developing more and more of a liking for it and I don’t see myself needing to mix anything else into it.

Why Else I Like Soylent

Besides Soylent providing me an alternative to meals there are a number of other techie reasons I like them.

First, their recipe is open source and this has resulted in a cottage industry producing similar products. I’m a huge fan of open source.

Second, they provide release notes with each version as well as providing detailed blog posts about why they do what they do and when problems arise. I am especially fond of the latter.

Third, they are constantly iterating on Soylent. 2.0 is great, but I’m sure 2.1 will be better!

But Dave…

“But Dave, this can’t be as good for you as eating real, organic food for meals.”

You are absolutely correct – thing is, I don’t eat real, organic food for meals. Soylent is a healthier alternative to a lot of the standard American diet / standard Dave diet. So, while not perfection, it is a step in the right direction…

And I won’t stop eating real food altogether. In fact, I may eat healthier the rest of the time b/c I am drinking Soylent. I always feel so time constricted – so much more I want to accomplish in a day than I can – if I feel a little less time constricted I may be more willing to invest in a meal (no promises, but hey, it’s possible!).