Maze

As much as things change in the medical transcription industry, one thing seems to remain the same. Discussions, and confusion, over the definition of a “line” of transcription. For those of you who are relatively new to the industry, perhaps a bit of history will help.

There was a time when most MTs worked in-house in a hospital or doctor’s office and were paid hourly. Then the move came to work from home. At the same time, as we grew as an industry, production pay became a part of our world. Medical transcription is quite measurable, and in the beginning, there were many ways that was done. Sometimes it was a gross line (anything on a line is a line), sometimes it was total characters divided by a number to calculate a line (and that ranged anywhere from 45 to 80), and sometimes computer “byte” counts were used. Sometimes MTs were even paid by the page of transcription, or the minute of dictation. It was quite confusing, and there was no real way to do an accurate comparison, for customers or for the MT.

In the early 1990s, three organizations (what is now AHDI, MTIA, and AHIMA) came together to try to come up with some common definitions of things. Those discussions were quite fascinating as it became hard for the group to even agree on what a “minute” of dictation was. This meeting actually resulted in a document with a list of definitions for things like a line, character, and minute of dictation. AAMT (now AHDI) was the first organization to publish this, and so the definition of a line in the document became known as “The AAMT Line.” It was never intended to be a “standard” as none of the organizations involved are standards development organizations. What is WAS intended to do is provide some common understanding of the metrics in our industry. By around 1997, AAMT was hearing from the membership that this definition was causing problems for them. MTs who had previously been paid on a gross line were now being told that they had to be paid on a 65-character line because “AAMT says that’s what we have to do,” but there was no change in the compensation rates offered. The resultant decrease in pay was, of course, not something anyone was pleased about. The reality is there never was any such thing as an “AAMT line,” that’s just what the industry used. Even with that definition, its use was manipulated. Do those 65 characters include spaces? What about formatting codes? What about things like bolds and underlines? Even though the definition addressed those things, each user manipulated it to fit their needs. That’s not uncommon when you have a “definition” list and when you are in an industry with no real defined true standards. In 1998, the year I was AAMT President, the association formally removed its support for the document of definitions due to the misuse in the industry. And yet still today you will hear people reference “The AAMT line.”

A few years ago, MTIA brought forth the idea of the VBC as the answer to our industry issues. The VBC, or verifiable black character, simply meant that you only count those characters you can see, which means spaces were not counted. Once again, this certainly caused some uproar in the industry. The idea of a VBC is that you can measure it more accurately, there is no question about spaces and such. To their credit, the organization did issue a statement that this meant the old methods of billing and compensation would have to be addressed to account for the differences. And yet, even with this, I have already seen manipulations.

The real question for medical transcriptionists must be, in my opinion, how is your line defined? What is included in that line and is it verifiable for the MT? I do not believe anyone should work in a situation where it is unclear how they are compensated. Yet, today, I still meet MTs who aren’t really sure how their compensation is calculated. Who is responsible for that?

I have to say that I believe the only way we are truly empowered is by taking control ourselves. In job interviews, I believe that’s a two-way process, and each person has a choice to make. The employer or client is choosing the MT, and the MT is choosing the employer or client. The method for billing or compensation should be absolutely clear and transparent. Find out if spaces are counted. Ask about headers and footers. And what about things like bolds and underlines? Are they counted, and if so, does that mean each bolded character counts as two characters? Can you verify those counts on whatever system you are using?

I urge you to be sure that you have all of the information so you can make an informed decision. It’s easy to say “this place pays xxx cents per line and this one pays 2 cents more, so I will take position B.” Yet, if you don’t have a real understanding of the definitions that are used, you cannot make an informed comparison and decision. Don’t let that happen to you!

Now to the age-old question. What if a company doesn’t pay for spaces? I’ve heard some MTs say they simply won’t work for that company. In the end, that’s a personal choice. I’ve heard some MTs say if spaces aren’t paid for, then let’s notgivethemspacesanymore. In the end, of course, we can’t do that because ultimately it is the patient we serve. For me, frankly, it never mattered. I don’t care if you pay for spaces or not. What I DO care about is understand how things are calculated so that I can take that into consideration in asking for an appropriate rate of compensation. If I know that spaces take up 20-30% of a document and I’m not going to be paid for spaces, then I will expect that my line rate will be 20-30% higher than normal to account for that. It’s really that simple, and it is all about transparency.How about you? I will look forward to this discussion and your input!