a reply and a rant!

I suggest if you want to stay in this occupation, just keep looking and be persistent, and concentrate on getting experience in acute care.  Personally I don't think the work is drying up, I think the gist of the problem is there is more than enough work to go around, and not enough experienced people to do it.   The "solution" of voice recognition has not taken all our jobs like they said it would. Offshore transcription has not taken all of our jobs. I don't believe EMR is going to be totally successful either.

Even if they find a good transcriptionist, some of the powers that be are unwilling to pay a decent wage even to well-rounded, seasoned transcriptionists.  I have seen lately on this board several examples of people that subject themselves to nearly unbearable work conditions, extremely long hours, working on little sleep, etc.   I certainly understand keeping up with one's standard of living, but is it really worth it?   We will continue to be treated like doormats as long as we're willing to let others do so.

MT is a profession in trouble. The wages have been getting lower and the workload keeps getting higher, and it's no easier now than it was before.  What young person wants to get into a job like that?  I made the decision to work my way out.  I'm bloody tired of the shrinking wages and the lack of respect from suits and the like who have no freaking idea what this job takes. 

Sorry for the long diatribe but I had to vent my 0.02.

• Is our profession drying up? - Nancy
  • a reply and a rant! - JZ
  • Yes, unless you want to work for (sm) - Peanuts
    • You are right though..you have to search hard to get decent rates...sm - Not drying up
  • The changes are in the medical care area. Doctors want to make - money. Ins. do not want to pay.
    • would you be gracious enough to point out - Snow Bunny
    • Don't forget, doctors are paying out a mint in malpractice insurance. - NM
  • Not drying up...sm - Not that I can see!

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One ARNP on my account is absolutely the most aggravating person!  Obviously she rants all the time because we've gotten memos saying to be extra careful with all her work because she is the "squeaky wheel". You have all these particular things to do to hers for 8 lines, 9 lines, etc. etc., reports taking about 10-15 minutes to be sure everything is done right.. for 8 lines, 9 lines..and so on. .Very frustrating. But then, half of the time, she doesn't even give the name of the patient. So we are to be "extra careful", but she can't even remember to dictate the patient's name!  Very frustrating!  Nobody's perfect. We all get in a hurry, but only THEY can make the mistakes!  Thanks for letting me let off steam..

APPLAUSE!!  APPLAUSE!!!

You are just so right on!!!!  They give us little thought or consideration, but expect us to cover them and "make them look good" for pennies!!!

Ah, my favorite -- a long proselytization that sounds vague but is in fact meaningless. 

It's GOOD you got all of that off of your chest!!

A rant letter to a couple of doctors:

What has happened to the medical profession in this country?  Why is it that doctors forget their Hippocratic Oath?  Why is it they forget the purpose of their career choice?  I've transcribed this week on numerous elderly patients who have been with their doctors for five, ten or even fifteen years, but they have to seek care elsewhere because so many doctors are refusing to accept Medicare.  How would you feel were if it were your own mother or father being refused care with their established physician just because they became classified as "elderly" and qualified for Medicare?  If it weren't for your "connections," your parents would face the same dilemma that other elderly people face.

Why is it that when a patient comes into your office complaining of feeling fatigued and achy that you automatically assume they're depressed and pop out a prescription for them to pop a pill?  Why not LISTEN to what the patient is saying and realize that while some MAY be depressed, others have a legitimate medical problem going on?  Why not do some labs on them to check for anemia, hypothyroidism, etc.?  Oh, I get it -- let them wait two hours to see you after their appointment time and then spend two minutes with them... after all, time is money.  By the way, I guess that kid who came several times a couple of weeks ago complaining of abdominal pain wasn't just trying to get out of school since I saw his obituary in the paper this week.  Even when his mom and dad brought him in a second and third time, you brushed them off.  I hope seeing his obituary hurts your heart at least half as much as it hurt mine.  I can't imagine the pain those parents are enduring right now, but I doubt you've stopped earning money long enough to let it bother you.  And, no, I won't cover your butt if I get a subpoena when his parents sue you for medical negligence.

Why is it that you cringe when I tell you I need to raise my rates when I've not had a rate increase in three years or longer when in the mean time you've raised your rates at least three times a year every year?  Oh - ok - your expenses have gone up?  Do you think they've discounted my electric bill, gasoline, supplies and everything else?

Remember that last check before Christmas that I asked about when you were late paying me?  You know, the one where you said you didn't have the money to pay me until after the 1st of January - although my contract with you explicitly explains payment arrangements?  That was hard to swallow when your wife was standing there while I was waiting to talk to you and making out a check for $8200 to have your home decorated for Christmas?  Yes, it ticked me off that you had the money for that in your budget but not the money to pay me my measly little $702.  It also ticked me off when you took your three-week vacation to France and left me waiting for payment.

I do understand - its all about the money.  Of course, that is why I work.  But, if I ever get to the point that I'm so cold-hearted or money-oriented that I cannot try and give the best of my abilities in my transcription for every patient I type on, I have common sense enough to know its time to get out of my profession.  Yes, to you I'm just a "typist", but how many times have you picked up the phone and called me asking, "Do you remember the names of the tests that I need to order for Lyme disease?" Or, what about when you can't dictate a proper letter and you say, "This is what I want to say - can you fix it for me?"  What about those times when I've flagged a lab result and said, "This patient would be dead with a potassium of 988."  Regardless, I remain just a "typist" in your mind.

In spite of all your faults, I do my best for you.  I give you accurate work every day of every week because I know one typo (on the transcription work you don't review) with a drug dosage could mean the difference between life and death of your patients.  But in the end, does it really matter to you? 

Hey, everyone.  We have all been so worried about VR and India taking our jobs that I think we may have let something slip by that is so very much more dangerous. 

My uncle had to have a procedure at the local VA last week, which was an education in and of itself, but what was perhaps most interesting was that I was able to watch his doctor work with the VistA EMR system.  For those of you who are not aware, VistA is the EMR system the VA uses.  It was created by them for use throughout the VA system, and basically it is a click and choose transcription system, minus the transcriptionist.  It uses templates and normals, and if the doctor needs to add more specific information, they simply type it in.  As I sat there with my uncle and watched his doctor type a few words, click some boxes, ask some questions, and do a completed preop report in the time it would have taken him to dictate the darned thing, I was astonished.  It is a very slick system, very impressive to see up close and personal.  From the perspective of patient care, it is wonderful.  The doctor pulls up the report with a few clicks, the patient signs off on it with a little electronic signature pad, and a nurse approves the whole thing with a code.  Very slick. 

So why should this scare us?  Here is the kicker.  The VA/Government/Medicare system is giving this program away.  That is right, GIVING it away to any doctor who wants it.  The problem is that it is extremely difficult to install and set up for proper use, and hard to learn to use initially.  It is also hideously expensive, both for the equipment used to run it on and the installation, though for a large practice probably no more cost prohibitive than paying a team of transcriptionists (2-3) for a year.  Okay, now add to this equation that Medicare is encouraging doctors to learn and use this system, and the date 2014 has been thrown out there as a target.  Skeptics say that 2014 is not reasonable but I am not convinced.  Here is why.  I think we can all admit that the transcription workplace is most definitely not what it once was.  Part of the reason is that it is getting harder and harder to find decent, qualified transcriptionists.  I know there are many, many hard-working transcriptionists out there who know what they are doing and take pride in their work.  I also know that there are many folks out there who like to call themselves transcriptionists, people who think the job is nothing more than typing and see no need to further their educations and stay on top of things once they have obtained a job.  This is not a problem that is confined to our profession; many other areas of employment are suffering the same malady.  However, most other areas are able to weed out the bad seeds, if you will, before their business has been harmed and find the hard-working people they need after searching at length, but medical transcription is not one of these areas.  Because of the nature of the beast, the seriousness and responsibility of the job, if a Transcriptionist messes up people have the potential to die.  With wages decreasing over time and companies becoming more desperate to hire anyone who can type, experienced transcriptionists are moving away from the job, not being able to support themselves on the lousy wages companies are paying.  The dwindling experienced work force is being replaced by a new generation of transcriptionists whose only experience with doctors' offices is when they visit their own primary care physician.  They are educated online, and while there are some schools out there truly committed to producing qualified workers, most are fly-by-night operations.  This is why, in part, doctors are trying to find other avenues of getting the reports they need.  Two of the VR perks that are pushed by companies are cost reduction and accuracy.  The companies that are promoting VR are using our inaccuracies and poor performance to tout their new baby, and they are succeeding.  Because they still pay us a minimal pittance to edit the VR after it is dictated, the doctors never see the product beforehand and therefore are under the impression that we are, in fact, inept, and that VR is a much better system than using humans. 

Now, imagine this if you will.  Transcriptionists are already on the hot seat and so, when the government starts promoting its EMR VistA system, it appeals to doctors.  Not only does it eliminate the need for transcriptionists, it costs about the same overall as they are already paying in wages/fees.  It gives the doctor complete control over the reports they produce, and they have immediate gratification because in the time it takes them to dictate the report, it is finished and in front of them.  The impression one gets from reading all the articles and forum posts pertaining to transcription these days is that doctors are becoming frustrated with the services they are being provided, and are ripe for being swayed into something else that is more productive.  This is the perfect time for doctors to begin transitioning to EMR, and the proliferation of companies out there who have developed EMR systems is testimony to that fact. 

Do doctors look at the EMR as a potential end to the careers of tens of thousands of workers in the United States?  No, probably not.  They only look at how this is going to affect them, their practice and their patients.  Congress is supporting and pushing this initiative, as are certain presidential candidates.  The concept of losing this many workers to EMR is apparently not something they are concerned about.  Implementing this sort of system will make them look good, and the importance of image to politicians is a given. 

While there can be no doubt that outsourcing has hurt medical transcription, as has VR, I strongly believe that our biggest threat is coming from our own government.  I think the EMR system is, within the next 5-10 years, going to put 80% of transcriptionists out of business.  There will be holdouts, and I am sure not all types of reports will be producible from this system, but if a doctor is given a choice between paying for a transcriptionist to possibly do a report correctly and perhaps get that report back within 24 hours if all goes as it should, and using that same time they would be dictating to produce the report themselves, with very little actual work on their parts, which will they choose? 

Consider the source, laugh, and enjoy your home and your family. You don't have to defend yourself to anybody.

While it is true that change is the only constant, change should not be accepted uncritically.  *New and improved* is often neither.  While *if it ain't broke, don't fix it* can be taken to extremes such that it inhibits any kind of innovation, change merely for the sake of change doesn't result in improvement either.

Students anywhere, not just those who are financially poor, are often eager to learn when they start a new course of study.  Perhaps the difference you see between third world countries and the US is that transcription pays relatively well in third world countries when you consider their economies (not ours).  It's not a palace, but it's not a shack in the country either.  They believe they are on their way up and may eventually push for higher wages as they want to continue to better themselves and their families.  It's an immigrant's mindset without actually having to go anywhere.  In the US, on the other hand, middle class, and even financial poor, students are in for a shock when they find that they may only be making $20,000 to $25,000 a year and can't afford the average 1 bedroom apartment in their area, much less a house.  If they know any *old* transcriptionists, they may find that wages have been, and are continuing, to fall.  For them, this is not a step up nor will it allow them to do better than their parents, and the bloom comes off the rose pretty quickly.

How much feedback you get depends largely on where you work, not how many years you have in.  It's a function of how much your employer values quality.  How feedback is accepted also has a lot to do with how it is given.  Constructive mentoring that is actually helpful and collaborative is vastly different from the adversarial merely playing *gotcha*, and the response to each will be similarly vastly different.

As for the Book of Style, some clients want it and some don't.  Long-time transcriptionists aren't the only ones who say *but we've always done it this way.*  Long-time dictators have been known to get in a rut, too.

Good long-term transcriptionists have already learned to be adaptable.  Is anybody still transcribing on a non-correcting Selectric and using Dictaphone belts?  Is anybody still using WordStar?  We are already teachable.  Medical care in all sorts of specialties available today little resembles what was originally learned 10, 20 or 30 years ago.  We know how to use resources whether it's books, books on disc or the Internet and are grateful for the increased resources.  Gone are the days of only having a Webster's, a Dorland's and a PDR.  We must continue these good habits.  School is never out!

What needs to happen is for this current exacerbation of the newbie vs oldie fued to die down.  Both bring strengths to the table, as well as weaknesses, and both could learn from the other.  It was easier when we worked in the same place, but if we want to strengthen transcription as a career, we have to do it together.  Fragmenting ourselves into newbies, oldies, mommy trackers, career people, us, them, simply allows employers to play to our fears and play us off against each other.  Transcription as a career cannot survive this way.    

  They whine about everything they're sent.   I think we should all boycott QA for a week, send them nothing, and put them out of a job.

As a former schoolteacher.... We would not have done "snowman poop" in class.  No way, no how.  I think it's a little on the tacky side but still relatively harmless, so that isn't why I wouldn't do it. 

Too many parents with no life and too much time on their hands would complain.  Teachers have to walk on eggshells to avoid giving parents any tiny thing to freak out about.  The kids? They're great.  Parents?  Man, do we need some chlorine in the gene pool.  If they aren't expecting teachers to do free tutoring after school (Why would you expect that? Do we give away free MT for doctors? No! ) or to hold conferences after 6:00 PM so they don't have to leave early from work (Hello, teachers have families, too! They're YOUR kids, YOU take off work early rather than expecting a teacher to stay past 5:00, okay?) they're "forgetting" to send lunch money for weeks at a time or refusing to take any responsibility for their child's behavior and blaming it on a million different reasons other than that they just don't take the time to work on the problem.   

Two degrees in education and a gift for teaching, but never again.  I'm an MT for the rest of my working years.  

a little um, ya know, excessive.  But ya know, some of us, uh aren't quick thinkers like um, ya know, you.    Just havin' a little fun.

I worked with an older lady who got sick of hearing all the ums, sniffles, coughs, crunching from a certain dictator. She was one to tell it like it is no matter who you thought you were, co-worker, supervisor, doctor, administrator.  She had been at the hospital for nearly 30 years and was nearing retirement.  I loved her!  So she typed a report of his verbatim and I mean VERBATIM.  With every grunt, snort, and nonsensical word he made.  She, then of course transcribed it correctly.  She sent in the verbatim report just to show him and his staff what he sounded like.  Long story short, he didn't have a sense of humor at all and he couldn't take a very large boulder of a hint.  He called our supervisor ranted to her about this transcription and said that our department had better not be disprespectful to him like that again.  He never changed his dictating style either.

Anyway, there's my story.  I always have one. 

Let me FIRST say that I do not usually rant, I am not a ranter, if something bugs me I take a deep breath, look at the offending item in the grand scheme of my life and realize that most of the time it isn't that big a deal.  However, these condescending trailer park references that I run into are a bunch of crap!

How can you make a derogetory referrence regarding people who live in trailers?  If it had something to do with race or sex you have been flamed by the whole board.  I am sick and tired of generalizations directed basically towards me!  I live in a trailer in a trailer park and I MOST CERTAINLY am not a skank.  I have heard it all, white trash, trailer trash, skank, etc. when people talk about parks.  My town even named it a "Manufactured House Community" and hid it where you can't see it!  I am here because I can afford it here.  The average price for a house in my town in Maine is $250,000 ++.  While we do just fine, I cannot afford that on my MT salary (been MT for 6 years) even though my husband works his butt off at 3 jobs.  Oh sure, we could probably get a loan for a $300,000 house but I refuse to get in over my head in debt just to convince people like YOU I am in your league!  I also LIKE it here.  My neighbors are the best I have had.  All of our homes (trailers) are well maintained, the lawns are spotless, and there is not a single car up on blocks that I can see anywhere!!  Don't even bother to tell me that is not the norm for parks because there are 300+ trailers in this park and they are all just as well taken care of! 

Another thing that irritates me is the word "skank".  I have never understood why women have to tear each other down using trashy descriptions like that.  Of course I am sure there are those out there who DESERVE the title but most of the time women seem to judge based on the look of the offending party. 

You may think your comment was tiny and I am blowing it out of proportion, but I am not!  It is comments like that that makes people like my neighbors ashamed to even tell people where they live. 

I have said my piece and I await the flaming.  When you drive through my park (yah right) and see me standing on the nice, green lawn in front of my pretty trailer with my 7-year-old in the yard, my toddler on my hip, looking very pregnant in my cutoffs and tank tops, you can THINK "skank" all you want.  I KNOW that I am a strong, educated, well-employed woman with a nice little family who refuses to put all our happiness and our hard-earned savings on the line to prove that I am EQUAL to people like you! 

and really sad too....

Thats what i said..we don't know.  So therefore, she needs to be aware that she should definitely do the research PRIOR to just leaving the job.  If she hasn't then a new job is not going to do her any good other than show that she changes jobs often, which does not look good on a resume.  As far as trusting QA...not ALL companies hire crappy QA.  We again do not know.  The QA COULD be right and COULD be very good at his/her job.  You simply don't know, but telling her to move on before you even know the facts is just silly.

When I got the email telling me I passed my test, I had tears rolling down my face. My 10-year-old daughter said, "Mama what is wrong?!"  I said, "I passed the test!"  She said, "Why are you crying?  You're happy aren't you?"  The combination of the stress of testing and finding out that I actually do have what it takes, hit me all at once.

I've been home for a year now after doing inhouse for over 15 years, and it is the best decision I have ever made.  I love it.  The flexibility is great for my kids, not to mention that I'm saving a small fortune on gasoline!

I get your message loud and clear about looking things up.  I have dozens of dogeared reference books and I am the queen of Google.  I took a medical terminology class to help with areas I wasn't too experienced with and the instructor's main focus was, "Don't guess. Look it up!" 

because I needed a laugh too! 

My microwave is broken again, so I had to order out for pizza.

I first called my sister and asked her what to do.  I asked her how to use the big huge white appliance thingy with all of the dials on it that sits next to my refrigerator and has cute little covers over those "coily things" on the top.  I told her that the dials and numbers are way to confusing.

Her reply to me was, "Oh my gawd, you cook?"

Glad I made you guys laugh or chuckle.  With this job, we all need it.