RE:Heartland Woes

A group of professors is taking a hard look at the medical transcription industry.

By Lynn Jusinski

His knowledge of the industry a few years ago? Admittedly, zero. Coming from, as he described it, a position of ignorance about the medical transcription industry, Gary David, PhD, associate professor of sociology at Bentley College, Waltham, MA, hit the road and headed to Reno, NV, last year, where he took in the Association for Healthcare Documentation Integrity (AHDI) Conference. After realizing no formal academic research had ever been done on the medical transcription industry, Dr. David and two Bentley colleagues, Donald Chand, PhD, professor of information and process management, and Angela Garcia, PhD, associate professor of sociology, set out to do an in-depth study of the industry.

The first part of the study was an online survey taken by 3,800 MTs, and the results of the survey were compiled, analyzed and presented as the study's preliminary findings. The full study is still in its infancy; the preliminary results from the survey represent only one part of the teams multifaceted approach. Dr. David has become embedded in the industry, serving on task forces and committees with AHDI and the Medical Transcription Industry Association (MTIA), and he's now a staple at the annual conferences.

ADVANCE spoke to Dr. David, as well as to experts in the industry. We aimed to look at specific aspects of the study's preliminary results and gauge its reception. The opinions are mixed when it comes to three major issues in the medical transcription industry: quality, the work force shortage and the ever-present salary issue.

Questions on Quality

The survey posed several questions related to the quality of documentation done by MTs. Nearly half of MTs reported that they see how flagged errors are resolved only rarely or never. Also, the survey showed that 59 percent of MTs transcribe for multiple physicians at multiple hospitals and/or clinics. Dr. David's view is that if an MT isn't told how a flagging issue was resolved, he or she may not know how to resolve a similar issue in the future, which can affect quality. Likewise, Dr. David noted, if an MT is transcribing for many accounts, he or she might not be able to develop an ear for physicians.

According to David Plummer, founder and CEO, Probity Medical Transcription, Harrisburg, PA, quality review is useless unless that information is shared quickly with the MTs. He also agreed that transcriptionists should have primary accounts to work on, and then when that runs out, have pre-determined secondary and tertiary accounts. Today, many MTs are transcribing the dictations of multiple physicians from multiple hospitals and/or clinics, Plummer said, and that's just the way the business model works for most medical transcription service organizations (MTSOs), he explained. Quality, turnaround times (TATs) and productivity suffer in this design; however, when you have a transcription system where the pools do not contain sophisticated logic and has transcriptionists flit from one account to another, these are expected outcomes, in Plummer's opinion. What has happened is that the architecture of some of the newer platforms has not been built with [MT familiarity] in mind, and it creates these massive pools with multiple hospitals and tens of thousands of physicians, and that's just not good for quality or the MT, Plummer explained.

Chris Hopkins, chief operating officer, Landmark Transcription, St. Davids, PA, looked at the survey results from another angle. He noted that approximately 50 percent of his work force consists of independent contractors, which may indicate that those MTs are working for multiple companies, which would explain why they are transcribing for many different accounts. Hopkins also said that just because an MT is transcribing for multiple accounts doesn't mean that quality work isn't being produced. Landmark maintains a system where MTs are assigned certain accounts, and MTs do transcribe for multiple physicians. By working on certain accounts, however, MTs can keep track of the different client specifications, something that Hopkins said may be difficult in a pooling system as mentioned above. [MTs] can't build up any kind of speed or fluency on an account when they're doing 10 different accounts, Hopkins said.

Bonnie Crow, director of U.S. operations at MxSecure, Scottsdale, AZ, agreed that in an MTSO setting, MTs are most likely transcribing for multiple accounts. These MTs are often experienced and highly skilled, Crow said, and therefore they produce high quality documents. With the flagging issue, Crow said that software used at MxSecure provides feedback to MTs, and she believes most platforms will allow this (Probity and Landmark have software that lets MTs see how a flagging was resolved, as well). Crow also noted that MTs should go through a quality auditing process on a consistent basis. I strongly feel the Quality Assurance monitoring process today is the best it has ever been, Crow said.

That's due in part to the technology that can allow MTs to follow documents through the quality assurance (QA) process. Kathy Eberle, who works in QA and is the operations supervisor for Landmark Transcription, explained that as soon as a document leaves QA's hands, MTs can immediately see the changes that were made. Some platforms make this difficult, however, and MTs and QA personnel may have to work harder to ensure that errors are explained. It is extra work to give them the feedback that they need, but in the end, it always pays off for QA because the MTs always become better for it, Eberle said.

Shortage or No Shortage?

Besides quality issues, another point brought to light by the MT study's preliminary results is the aging work force and, potentially, a looming work force shortage. There's no denying that the work force is on the older side—77 percent of respondents are older than 40. There is, however, room to debate whether or not there's an immediate crisis when it comes to a work force shortage. Dr. David commented that because there are no solid numbers on the actual number of MTs working, there's no way to determine if there is definitely a shortage.

Plummer disagreed with the conclusion that there's a work force shortage right now. He pointed out that Probity uses all domestic labor, and noted that all of the accounts he'd like to secure are either being transcribed in-house or by other MTSOs. When an account is landed, the MTs on that account typically join Probity, and the need for more workers is quickly met. Plummer called the work force shortage overplayed.

Eberle referred to the shortage as simply a shortage of qualified MTs, rather than of all MTs. She's noticing that many good MTs are leaving not just their positions, but the industry, and they're going back to school to start different careers. With quality MTs, we're truly lacking at the moment, Eberle added.

Hopkins echoed that, to a certain degree. He admitted it was hard to say whether or not the industry was facing a work force shortage, and said he doesn't see that happening at his MTSO, where his needs differ from some of the bigger transcription companies. At my level, where we are, we don't see a tremendous shortage of transcriptionists, Hopkins said.

He added that if he has an opening, he advertises it and that day, he'll wind up with 40 résumés in his inbox. I can usually fill a very specific position within a day, Hopkins said.

Crow, however, is worried about finding qualified MTs to support the growth of the industry. There aren't enough younger MTs to replace the retiring MTs within the next 10 years, she pointed out, and she strongly believes that there is a work force shortage. She added that new education programs are being put in place to produce good MTs, and many MTSOs are offering mentoring programs. Her company started a mentoring program 2 months ago for new MTs to help them garner experience in the field. This seems to be easing the labor shortage, according to Crow. We are very excited with the decrease in attrition numbers we are seeing already!

Salary Woes

While there may be debate over whether there's a work force shortage right now, one certainty in the MT industry is that wages aren't heading upward. In the survey, MTs reported varied personal incomes, with the majority, 72 percent, bringing home $10,000 to $50,000 annually. Another survey question asked about the number of wage earners in MTs' households, and 33 percent said that there is only one wage earner in the household--the MT.

Dr. David called the industry one of the only places where the laws of supply and demand don't work. There may be fewer transcriptionists and there's a greater demand for transcription services. [That] should mean that [MTs] get paid more, but their pay doesn't increase—if anything it goes down or stagnates—and so part of it is linked to how there's just no perceived value in what it is they do, he explained.

The industry as a whole needs to recognize that MTs spend a lot of time and money learning their craft, and if wages continue to drop or stagnate, potential MTs are going to look elsewhere—to other industries—for jobs, Hopkins pointed out. We want to see a viable pool of labor here in the United States, he said. If people can get better benefits and better wages at McDonald's, why wouldn't they go there? It's too hard to learn this business. It takes years of work to be fluent and professional.

Dr. David observed that there was a sense of unrest in the industry about salary issues. There's a number of things impacting [MTs], causing their wages to go down or be less robust in terms of going up, so it's definitely an issue that we've heard about, Dr. David said.

What's Next?

Overall, despite differing opinions on the results of the survey, everyone agreed that it could be a valuable tool in the industry. Crow said she hopes the study can lead to medical transcription being recognized as a degreed profession with mandated certification. I think once this is in place, the profession will be viewed by the younger people as a desirable health care position, Crow said.

Hopkins hopes the study highlights the fact that offshoring labor is doing what he called a disservice to the industry. I think if people focus on providing a livable wage to the transcriptionists with a reasonable package of benefits and a decent schedule, the labor pool will become deeper and broader because more people will start to come into the industry, he explained.

Plummer hopes to see more transcription programs set up at colleges to help school more domestic MTs. He also hopes the study helps companies adhere to better quality, because that could help the entire industry. Overall, he found the preliminary results to be valuable, and he noted that the industry is ever-changing. It's a dynamic study, too, because it's like painting the Golden Gate Bridge—by the time you get done, it's time to do it again, Plummer said.

Lynn Jusinski is an associate Editor with ADVANCE.