Medical Transcription: How Did We Become a Commodity?
My quote for today comes from Virginia Satir, who said, “We must not allow other people’s limited perceptions to define us.”
You’ve heard it over and over again–medical transcription is “commoditized.” Because medical transcriptionists are such wordsmiths, I looked up the word “commodity” in the dictionary. Here’s what I found:
1. an article of trade or commerce, esp. a product as distinguished from a service.
2. something of use, advantage, or value.
3. Stock Exchange . any unprocessed or partially processed good, as grain, fruits, and vegetables, or precious metals.
4. Obsolete . a quantity of goods.
Take a close look at that. What we do isn’t really a “product,” but it IS a service. I guess we could fit in definition #2, as something of value, and yet, when you hear this word used in relation to our industry, it’s not talking about value. It is used in a manner that says “we’re just not worth as much as we used to be worth.”
For those of you who are somewhat new to this profession, here’s a little history lesson. There was a time when medical transcription was better paid than it is now. It was a valued service and an important role in healthcare documentation. When I first started in transcription, there was no such thing as production-based pay, nor frankly did we have incentive pay plans. We were paid a fair hourly rate or salary for a good day’s work. Interestingly, those were also the days when, at my first job in a hospital, a “great” day meant we had done 20 reports for the day. If you really think about that and consider an average report being about 40 lines, it meant we did about 800 lines per day. Now mind you, we did those lines on a typewriter, with correction tape and carbon copies! 
And yes, I know there are a lot of you who have never, ever worked on a typewriter!
Then came incentive pay plans, which were touted as a way to “earn more money” and “reward the fast producers.” Management sold the idea to the MTs as a way to “reward” them for what they did. In reality, perhaps it was a win/win situation. Management had to hire fewer people, and the MTs made a little more money.
Then came production-based pay. How did that happen? I’m a firm believer it happened because we demanded it. Medical transcriptionists saw they could make more with an incentive plan and so it didn’t take too much to figure out that perhaps one could do ever better with straight production-based pay. So, we asked for it, and we got it. There’s no question that those rates have changed over the years, and many report that their line rates have dropped.
Worse than changing the pay structure, I am a real believer that changing the compensation method in our industry changed the mindset about what we do. The value was now on how fast one could type, how many lines you could put out in a day, and not necessarily on the knowledge we have in our brains. And I think that was the beginning of a downhill slide.
Don’t misunderstand me. I still believe you can make good money doing medical transcription. I think there is a lot of technology that can be used to increase your line counts. And I think that using those technologies are a must to success. Still, it becomes all about how much you can produce. One of my mentors in my early days in the profession asked a group of MTs once how many had been called “a high producer” in the past. Several hands went up. I don’t think I will ever forget her response: “You know, that’s what they say about dairy cows too.” Ugh!
And yet, employers say “transcription is a commodity.” Even our professional association says out loud we have become commoditized. And what happens when that is voiced out loud? It devalues our profession and it devalues us as professionals. It’s time we stop allowing that to happen.
It is true that we have a crisis in health care. It’s also true that customers are constantly wanting to pay less and less for services. And what happens? They get that because someone says yes. Our industry operates out of fear. What if the customer goes somewhere else? What if we lose business? What happens when employers say they are reducing the pay for their employees? It happens because the employees say yes. Just suppose for one minute that every MT would stand up and say no, I am not working for less money because I am more valuable than what you are offering. What would happen then? I can hear some of you saying “well, I’d be out of a job.” And yes, in this economy, that’s scary. I am not suggesting that anyone run out and quit their job. I AM suggesting that it’s time that we stop being the victim and start standing up for ourselves. It’s time that we stop letting other people define us because they really don’t have that right.
Guess what? I am not a commodity, and I hope you aren’t either! Today my challenge to you is to be bold, be proud of who you are, and do not let someone else’s limited perception define you! I look forward to your comments!
Related posts:
- Medical Transcription: Where do You Make Your Investments?
- Medical Transcription: Alternative Career Paths
- Navigating the Fog
- Medical Transcription Success: What is your Best Tip?
- Medical Transcription: E is for Embracing Change
Tagged with: Goals • medical transcription • medical transcription goals • values
Filed under: Goals
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Thank you for this post. I totally agree with you. I’m very proud of what I do and love the job. Although I do love the job, I don’t really like the pay that much, especially when it comes to doing an edited report by speech recognition. The company I work for slashes that pay rate to half of what I do for a fully transcribed report. If there’s a way to stand up for ourselves and not be a comodity, I’d love to know what I need to do.
By the way, I have typed on a typewriter but not while being an MT.
If medical transcription were a commodity, we might be more akin to definition #3, partially processed goods. One would think our work would be subject to the laws of supply and demand; the more it were in demand, the more the market would pay. Instead, less skilled workers have been enlisted, service levels have been compromised, quality has suffered, and compensation rates have decreased. Rather than pay more for the desired commodity of high-quality medical records, “Good enough to get paid” has become the standard for many facilities. Don’t fool yourself into believing what we do is primarmily about patient care. It is primarily about getting paid. And the amount of production these days is even taking a back seat to turnaround time (TAT). So if you are able to keep your accounts in TAT with good enough reports that they get paid, they will forego grammar, spelling, and the other little things that make a report readable. Problem with letting any one of these things go is that the reports grow more and more sloppy, minor errors perpetuate, and eventually major errors creep in.
I remember getting my first “self-correcting” IBM Selectric typewriter. It was a revolution. Of course you still had to do the carbons by hand. We were paid hourly with incentive bonus for high production, but you could make a living on your hourly wage. We were able to take this manual process a step further and develop “check box” templates to cut down on dictation time. Eventually our first word processor (a Wang) arrived and our “check box” list made it easy to automate. The evolution in voice recognition has missed this step of using known correct phrases. Some of us would still often rather delete the drafts and replace them with known good text. The technology can be helpful, but is certainly not as advertised.
The incentive pay bonus was an opportunity for some us to work fewer hours. If we could produce quickly, we could make a living and have a life too. At least in my company that is no longer the case. We need to keep a minimum production standard PLUS work 40 hours in order to be eligible for benefits. My production in lines per hour has taken a nosedive, and am having symptoms of repetitive stress. This seems to be counter-productive, but perhaps it is another strategy to weed out the weak. I can still make a decent living, but am having to work harder and longer to do so.
Even with all the frustrations, we as keepers of the medical record need to treat every report as if it were being done for a loved one. Be accurate, be clear, be precise, be grammatically correct. As medical records are brought more in the spotlight (am wishing here), hopefully our efforts will pay off with recognition of our brains, not just our production numbers.
I too worked on the typewriters. But from about the early 1980s we had some form of electronic typewriters which then morphed into full blown word processing. It soon became required to produce so many lines, because if they were paying you by the hour and you just sat and talked all day and only typed one report, they are paying you for doing nothing.
as far as not making any money now, well the hospitals wanted to save money, thus the outsourcing to the new medical transcription companies. Mostly run by men who have never transcribed. I believe I’ve gone down this road before. But it’s true. The transcription companies are out to make money – the biggies — Transcend, Medquist, are making in the many millions. You can bet that the big money makers in those companies are NOT the transcriptionists. It’s top level management. The transcriptions are similar to factor workers: cranking out the work, making the owners rich. I’m all for capitalism, but not like this. The MTs NEVER get raises, NEVER. The company keep getting new clients and keeps making more money, but they are not about to pay MTs what they are worth. And if they hire newbies, well they don’t object to the low wages.
The only way to make any money is to become self-employed or independent contractor with clinics/hospital – where you can type as much as you want, you are paid more than at a service, you have no set hours and no quota. You don’t produce you don’t get paid, but that’s true in ANY service industry whether it be farming, beauty shop, restaurant, or even a doctor’s office. No patients, no money. No customers/no income. Sorry if this sounds negative, but it’s the truth. Anybody who has been in this business at least 30 to 35 years knows it is true.
Gwen, The drawback is you end up paying through the nose for health insurance … to the point where your profit is gobbled up. I’m not particularly interested in doing marketing, or accounting, or collections. I AM interested in producing a quality medical record. MTSOs could do better by marketing advantages of quality to their clients, but they aren’t evil … they are just doing what their clients have asked. Crank it out fast.
I feel the whole scenario is demoralizing, and perhaps that is why there is so much apathy amongst MTs.
Brenda, I think one thing we need to do is stop allowing anyone to refer to medical transcription as a commodity. Technology like SRT does exist, in some way, so that money can be saved in health care. At the same time, it shouldn’t make anyone earn LESS money. There is something to be said for being able to master the technology to make it work as well as having the critical thinking skills to be able to make sense out of some of what those speech engines put out. Sometimes I think instead of standing up for ourselves when we hear those negative words, we stay quiet and play the victim. I think it’s time we stop playing the victim and take control back.
Crystal, I’m with you in your wishing. Still, that only happens if MTs decide to step up to the plate and speak out for themselves. Eleanor Roosevelt once said “no one can make you feel inferior without your permission” and I hope to adopt that stand!
Crystal, I 100% agree with what you have said. Speed NOT accuracy has taken REIGN in the field of medical transcription. But that is not my way and it does not best serve our employers or the patients. As for me, I will continue to put accuracy ahead of speed. I worked in-house in a local hospital as lead MT for 10 years and was APPRECIATED by all doctors because of my accuracy and concern for their reports to be accurate. They called me the “MT police.” At that time I was paid hourly and the only reason I left is because God gave me a son 21 years ago who has Down Syndrome and he is graduating high school and needs a life. Being an MT at home allows me to provide him with transportation so he can go to a community college and work in the community.
I LOVE medical transcription and after 14 years, I remain COMMITTED to excellent reports. I hate the pay and feel it is unfair as being a medical transcriptionist is certainly NO COMMODITY. It is hours of careful and intent listening, research and continuous expanding of the intellect to make room for all the new state of the art medical terminology, not to mention the ever changing and constant production of new medications and high tech procedures. But I love the challenge and as I mature in age I feel that this career keeps my mind constantly alert. If I hear a new drug while watching television, I immediately add it to my list as sooner or later one of the doctors will use it.
Gwen, I think every experience is different. Transcription companies are absolutely in business to make money, otherwise they wouldn’t do it. I spent many years being self-employed with my own business (oh wait, I am doing that now, just not transcribing!):) Being self-employed does mean you give up some things that you have as an employee and it means you pay more in taxes. Every person has to decide what’s best for them with that one.
And perhaps it’s the “Pollyanna” in me, but I would still like to believe that somewhere there ARE employers who care about their people and do their best to take care of them. Again, it’s about finding what works for YOU. If those situations didn’t work for the MTs, then they would work elsewhere.
In the end, it’s about finding where you feel the best about what you do. It’s clear you’ve done that and hooray! That IS a part of what this is about, standing up for yourself and doing what’s right for you.
Becky, what great points. One thing that I do think is that the move to transcription services has broken down the relationship between the MT and the physician, which we did have when we were in the hospitals. Accuracy always has to be our focus, no matter what. It IS what we do. Last, hooray for you for doing for your son. That is also what it’s all about and being able to be at home does give us options for our families that we didn’t have before.
Lisa, I agree that being thought of as a commodity is demoralizing. But is that really the cause of apathy? Or is it that it’s easier to be a victim than to stand up for ourselves? I remember years ago when MTs were fighting for recognition in the healthcare industry. The passion was palpable and it was an awesome thing to be involved in. Those were the days of being called “typists” and being stuck in a basement office with no windows. No one really knew who we were or what we did. Yet, the MTs stood up for themselves, found their voice, and became involved in creating a future. Sometimes I fear we take the easy way out and in doing so, let others decide our future of us.
Crystal, I’m fortunate though in that my husband is retired civil service and we have the same insurance we had when he was working and will have it for life. It IS a pain in the neck to pay my own taxes, yes, but believe me with what I’ve seen and been through working for services, it is well worth it.
In Maine, when you say someone is paid “based on production,” it is also called piecework – and the majority of those folks who get paid this way are in Maine’s seasonal industries. People pick crab meat and lobster meat out of the shells and people make wreaths for Christmas. These employees get paid for how much they produce. Of course, their work does not put much demand on the brain – just physical things like dexterity and speed, and, God love’em, endurance for all that repetitive motion. (Many of them get carpal tunnel just like we do.)
I am, as you said, a “high producer,” but typing speed alone does not a high producer make, nor does a consistent account or familiar dictators. I believe the brain comes into play more than anything – to constantly be analyzing, memorizing, learning (including learning from mistakes!) – that’s the brain’s job. That is the part our business that sometime the higher-ups don’t “get.”
Also, I do work on site in a hospital, and, although there are always decisions there I don’t agree with, I believe we are viewed less as a commodity because we have a physical presence at the hospital. Most of the hospital employees do not even realize we get paid by production; to them, we are just fellow employees. I would be willing to bet at-home MTs are more likely to be “out of sight, out of mind,” resulting in more of a “I don’t really know you, but what can you produce?” effect. I have often considered pressing the hospital to let me work from home, but I worry about that exact situation. I like to be in their face, LOL!
I agree with pretty much what most of you have said, but I want to throw in my 2 cents on something. I work from home as an independent contractor. If my husband didn’t have a good job with good insurance, I’d have to find a different job and quit being able to work from home. MT jobs are few and far between in our area, so I’d have to do something else–and I’d probably end up as a waitress or bartender again and work really cruddy hours. As an IC MT, I have a lot of benefits that go along with having a home office and avoiding that rat race of having to do my hair, make up, have a work wardrobe, drive to and from every day (with all the added cost of more-frequent maintenance, keeping the gas tank full, etc.), etc. I don’t have kids, so I’m not saving anything on childcare (though a lot of at-home MTs do).
Anyway, I’m kind of straying from the point I wanted to make. I take pride in the job I do–I push myself to get done as much as I can, but I do not sacrifice quality for quantity. The lady whose company I contract with knows this, and because she has the faith in me that she has she transferred me from an account where I was being paid 0.065 CPL to one that pays 0.09 CPL! She also knows that I’m available in a crunch, that if she asked me if I could help out on the “old account” because they were in a bind–perhaps too many people being off on the same day or whatever–that I would jump in and help out, even though on that day I would be losing money because of what that account paid. (I wouldn’t want to make a steady habit of it, but she knows she could count on me in a pinch, even though it’s never happened!)
I also used to work in the Transcription Department of a local hospital. When the workload in our department was cut back drastically due to (1) an ambulatory surgery center being opened that could perform outpatient surgeries for patients who were not Medicaid/Medicare and (2) our ED switching to about 90% of their reports being lines filled in on a form that was then scanned into our hospital’s records system, the hospital cut back our department by 6 positions (including not only Transcription but also in all of the Medical Records area). The hospital has 2 unions that cover everyone with the exception of the management (not sure about the docs). Layoffs were made by UNION seniority (which was based on date of employment BY THE HOSPITAL, not by seniority within the Transcription Department), and since another lady who came into the Transcription Department 8 months after I did but who had worked in the hospital 2 months longer than I had, I got chopped. But I will say that when I worked at the hospital, I developed quite a reputation as a transcriptionist, especially with the ED. Those doctors loved me, and I truly enjoyed doing their transcription!
Anyway, I think that as an individual we aren’t going to be able to change the world….but in our little corner of it, we can continue to do our best and develop the best relationship possible with whoever we are getting our paychecks from whether you are an IC like me and have a signed contract with a transcription company or whether you work on-site in some capacity. Unless you’re in a position to change the world, and who is(?), all you can do is your best and hope that you are individually recognized and appreciated for it.
Sherry, you make some great points! And you’ve clearly found a place where you are appreciated. I think it’s important for the newcomers to our profession to know that there ARE good places where your skills are respected. I also agree that we have to change our corner of the world!
Carol, it IS about the brain in our jobs! I think you also make a good point about it being a bit different when you are in-house as the actual physicians really see MTs now and then and seem to connect differently.
Don’t get me started. This is one of my soapbox opportunities. Why must we lobby on Capitol Hill – why can we not affect change ourselves within our profession? Why can’t transcription services bring about an hourly rate? How is it that these services continue to propagate this type of compensation. If we “demanded it (production-based pay)” back then, why can we not “demand it (hourly wages) now?” I am a little confused on this issue and somehow find it hard to encourage others to enter this profession knowing that base pay for them may even be below minimum wage as newbies? Fortunately, I do not HAVE to work (I love medical transcription). But what about others who think they will be able to support a family…