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.

Diigo – Software I Use Every Day

Screenshot of Diigo Highliths

Diigo (a “personal knowledge management tool”) is a browser extension[1] that allows one to collect all sorts of information from across the web in a central repository where it can be easily accessed, shared, annotated, searched, and remembered.

Screenshot of Diigo Highliths
This is a screenshot of some of my Diigo highlights.

I don’t know that I aspire to be a polymath, it is more like I hunger to be one. I consume information in copious amounts and synthesize it together to help me understand the world (and share what I learn). But this presents a great challenge – how can I consume massive amounts of information while not losing what I have learned previously?

The answer is augmentation (along with an acceptance of my finite nature). In the past this might have included a physical filing cabinet, for me it consists of Diigo and a few other primarily digital means.

When one saves a site or article to Diigo, Diigo creates a record associated with that specific page. I then add one or more tags to categorize (create a taxonomy) this record among all my other records.

In addition, if the page includes content I consider to be of important, I highlight it and Diigo saves my highlights as well. It also allows me to add notes to the page. Recently I was reading an article about Thomas Oden and something he said connected with something William Barclay had said, so I added a note about the association.

Sometimes the pages can be summarized in a paragraph or two – in which case I attach a description to the page. I also use the description as a place to remind myself why I cared about this page.

Right now I have 25,361 items in my Diigo. An item is a record which is associated with a specific piece of content (usually a web page). Under many of these items are highlights and notes which help me remember the importance of the content.

I personally pay for their Professional level. It is around $60/yr. ($5/mo.), but I consider it well worth it.

There are some features/enhancements I’d like to see Diigo add in the near future, I’ve outlined my ideas below:

  • Archive.org Integration – Right now Diigo can save a copy of a page if requested, which is great, but I’m wondering if it would make sense for Diigo to integrate with The Wayback Machine and cache every saved page.
  • Implement Hierarchical Taxonomies – Right now tags are a flat taxonomy, that is, no tag is a parent or child to another tag.
  • Separate DB of Trash Links – Right now I tag worthless pages as f-value, so if I come across them again in the future I don’t waste time rereading the material. It would be nice if Diigo maintain a per-user database of trash links and had a small visual reminder when we visited a useless site (e.g., a small trash can on the Diigo button).
  • Acquire / Integrate Zlink’s Better Search Chrome Extension – This nifty little extension lacks transparency about how it handles data, where it is stored, and hasn’t been updated since late 2015, but it offers a number of highly useful features. My favorites are:
    • The ability to vote up or down search results, also to delete search results (thus when one searches for the same term again, one sees customized search results).
    • Customization of search pages with navigation to other sites – e.g., makes it very easy to repeat the same search using another search engine with one click.
  • Expand API – The API currently supports only two methods – retrieve bookmarks and add bookmarks. It needs (at a minimum) the additional abilities of editing and deleting bookmarks.
    • I’d also like to have a way to exclude certain tags / sites from the retrieved bookmarks.
  • Ability to Save Chrome Extension Pages – For whatever reason, Diigo doesn’t seem capable of saving extension pages from Google Chrome’s store of extensions.

 

  1. [1]They also offer mobile apps, but I rarely use.

Setting Up A Development Workstation

What Is This?

I wrote this primarily for myself – sometimes I don’t remember everything I do when setting up a workstation for development purposes…it may be of interest to others.

You’ll note that there are several areas missing from this arena – no build automation, task runners, etc. Maybe I’ll get around to adding them once I settle on some…but in the meantime, this still works for me.

[See bottom of this document for a list of revisions to this document]

Everybody Uses…

Version Control

  • Install Git for Windows for version control, ensure that Windows PATH is selected during the install so that you can use git from the command-line without needing to use Git’s special CLI.
  • I’d recommend also getting yourself a GUI to manage Git. Personally, I prefer that the editor I’m working in provide Git integration, but sometimes this isn’t available – in which case Atlassian’s SourceTree seems to do a good job.

Editor / IDE

IDE stands for Integrated Development Environment. This software offers numerous tools to expedite code development.

Editors on the other hand are much simpler, yet some people prefer them. We’ll look at a few of each of these.

Editors

  • NotePad++ – This is my base editor. The User Interface isn’t amazing, but it works beautifully. Especially awesome when it comes to working with large files.
  • Brackets – An open source project by Adobe, has a number of useful extensions. UI is attractive, I use this one over NotePad++ usually, except for note files (NotePad++ remembers the text you enter even if you don’t save the file) and large files.
  • Visual Studio Code – Another open source option by Microsoft.

IDEs

There are a huge number of options, Wikipedia has a fairly extensive list.

  • JetBrain’s phpStorm – JetBrain makes a number of different IDE’s and unfortunately isn’t the clearest on which IDE one should purchase. phpStorm handles most web-based languages, but lacks a clear emphasis on JavaScript that webStorm has (but which lacks some of the php integration).
    • See Gary Hockin’s Debugging VVV Vagrant Setup with PhpStorm for helpful instructions on integrating one’s VVV setup into PhpStorm for interpreter and xdebug purposes.
      • If you are wondering where your xdebug.so file lives: /usr/lib/php/20151012/xdebug.so
      • And Code Sniffer:
        /usr/local/bin/phpcs
      • And PHPUnit:
        /usr/local/src/composer/vendor/phpunit
      • And Composer:
        /usr/local/src/composer/vendor/
      • And www folders:
        /srv/www/
      • And PHP:
        /usr/bin/php/
  • Microsoft’s Visual Studio – An IDE with a long and venerable history, more recently integrating a number of Xamarin cross-development features into the IDE. The Community Edition is free.
    • WARNING: Depending upon options selected, this installs Hyper-V; if you are running another virtualization technology (Virtual Box) expect to experience BSoD errors. Unfortunately, I know this from personal experience and I am not alone.
    • Supports Visual C++, Visual F#, Python, C#/.NET, Android/iOS.
  • Google’s Android Studio – For the creation of Android apps.

Interacting with Databases

  • You’ll want something that provides a handy way for interacting with databases, in which case I recommend HeidiSQL.
  • If you don’t have a database server currently, you’ll need one. A couple options include MySQL, MariaDB, Microsoft SQL Server, and PostgreSQL.

Virtualization

Image Management

  • You’ll need something to create/edit images with, I recommend paint.net. Despite its connection to a very basic predecessor (Windows Paint), this software can work miracles.
  • JPEGmini – Usually I wouldn’t recommend using lossy means of reducing image data footprint, but JPEGmini manages to offer significant lossy compression without any visible deterioration to the image, unfortunately it only works on jpeg files.
  • FileOptimizer – Offers compression for numerous different file formats in a lossless manner.

File Transfer

  • FileZilla is a good FTP client.
  • However, FTP is a plain-text protocol, so I’d look at using something SSH based like SFTP. In this case I’d recommend WinSCP or built-in functionality in your IDE (phpStorm for example).

Other Tools

  • You’ll also want a copy of ConEmu or another command line interface (CLI). This software is so much better than the default Windows console.
  • A good archive/compression application will make life much easier, and 7-Zip is the perfect application.
  • Hosts File Editor – While it hasn’t been updated since 2011, I find this software extremely handy when I want to make edits to the hosts file. It offers a nice GUI front-end for the hosts file and enables a number of different nifty features not built into the file itself.

Revisions To Document

  • 10/18/16
    • Added location of www pages on Vagrant.
  •  10/16/16
    • Moved VVV under Vagrant.
    • Added link to Louie R.’s article on using Vagrant/VVV.
    • Changed Basics for Developers to Version Control.
    • Added link to VVV Wiki Article about Connecting to MySQL.
    • Added section on database servers.
    • Added link to article on integrating with PhpStorm, location of xdebug.so.
    • Added location of Code Sniffer; PHPUnit, Composer.