Would I recommend medical transcription as a career today?

My dear sister gave me a heads-up that my nephew's new bride (Heather) was contemplating going into medical transcription, and might call me for my input. I quickly dashed off a response to her that she could print and hand them (I don't have their email addy at their new home just yet) and then as I thought about it, I decided to post my response here. What started to be a few sentences was much longer and apparently, I'm not very happy with my chosen field.....I'd be interested to hear what anyone else has to say. Comments are moderated, but I only keep out obvious spam, so if anyone lands here for the first time - feel free to leave a comment. I am hoping to get some other MTs' viewpoints which give her things to consider.

Here's the gist of my email response with a few edits:

I would be happy to give Heather my impression of the job/business, but I am afraid its not very positive. It is hard, with long hours, difficulty getting paid well, and we are losing business to off-shore (India) operations daily.

It is my hope that my business and my ability to provide jobs for a few MTs, runs out at about the time all the "old guys" (dictators) retire. The new guys seem to be using voice recognition software, and having someone in their office edit, or they are sending it to India to get the work done for pennies, and also having someone in the office edit it....or even using programs that key in their findings into an electronic medical records system. Where I am able to keep business, is in small accounts, with older doctors mostly, or small surgicenters, etc, and being willing to drop everything and do what they need immediately. (I've lost accounts to India and gotten a few of them back when the work came back looking like "Swiss cheese" with all the holes in the dictation....Smaller clients have proved more loyal, so that is my focus rather than hospitals).

Heather has a degree, more than one, in fact. I turned to this business because I did not. I made a good income because I worked way more than 8 hours a day, and way more than 5 days a week. I would not wish this on anyone. Its my dream to semi-retire and go to work for someone else, part time, and when I leave work every day, I'm done! It won't call me from the kitchen or my sewing studio, it won't get me up at 4 a.m., and my check will always be there on time - no waiting two months and arguing with an account to get paid.

She would have to take a medical terminology course, purchase tons of equipment (if she chose to be an independent contractor) and work for very low pay initially. She would discover that the course taught her only a fraction of what she needs to know. She would likely learn on tapes that were relatively perfect, and then start working for dictators who were not. This would for example include dictators who are tired, mumbling, dictating through cold pizza at 2 a.m., dictating while driving on a cell phone, dictating while waiting at a train crossing with the car windows open, dictating while in bed - whispering so as not to wake up the wife, dictating with screaming two year olds in the background, dictating while peeing (yes! been there, done that!), dictating with psychotic patients yelling at them, etc. Then throw in the fact that a large percentage of the above mentioned dictators are also speaking English as a second language.....barely.

Once you take the course, and find someone to let you start (normally a hospital setting or a national service would give the best "in the trenches" training and extremely low pay) you end up making copious lists of new words the transcription course never taught you. Words that just got invented last year. Names of forceps that are not included in the 14 pages (two columns per page) of forceps in a surgery reference book.

I will say, that I no longer use my reference books. Google is my new best reference source. That saves me approximately $39.00 per book, per specialty (gynecology book, ophthalmology book, orthopedic book, pulmonary book, psychiatry book, plastic surgery book, etc). Those books were being updated and getting bigger every few years. I had about 10 specialties I kept up with. No more!

The courses you see ("become a medical transcriptionist and make 30,000 a year at home!") are often rip-offs. In many cases, you get basic anatomy words, a few somewhat-perfect tapes, a certificate that means nothing to any medical records director in any hospital, and you're out hundreds of dollars. In my humble opinion, a course through a local college can be slightly better if it is taught by someone (seasoned!) with actual transcription experience. I believe there is an online course recommended by the AAMT (American Association of Medical Transcriptionists - which recently changed its name to something I don't remember) which is excellent! One of my transcriptionists took a similar course from a company that was affiliated with AAMT 15 years ago, and was very well prepared to start. It cost her a pretty penny and it took her a year to complete it while her son was small. However, even she found out quickly while working for me, that she was learning many new words daily that her course Just. Didn't. Cover. (She remembers crying frequently over her first accounts!)

I have also found that becoming certified in this field is not necessary. It is touted by the association, but it rarely (in my personal experience) makes any difference with an employer or a national transcription service. I have never been asked if I was certified, and I have never asked anyone I contracted if they were certified. (Every job I ever got, I got after testing on the premises. And that was the procedure, per those companies, whether I was certified or not. Likewise, nearly every job I ever gave anyone, rested entirely on their performance on a test dictation I provided them.)

Certification, I have been told (so this is hearsay only) involves being tested in a room with no reference materials, no spell check, no nothing except you and the word processor and the dictation. I don't feel that is a good measure of a person's ability. Its not so much knowing everything, as knowing how to use the tools we have at our fingertips and our knowlege of how to FIND what you need. I had a certified MT working for me once whose work was the "weakest" of my team. So in my humble opinion, an MT can just save the money and save themself the stress of testing for certification.

That having been said, I will say that for me, MT was the right thing to do, for my family, at the time. I never got to nursing school, and this was at least a way to be in the field that interested me. I was able to stay at home with my kids, working out of my home, and was the mom on the block who handed out cookies and band-aids and carpooled and watched everyone up at the neighborhood pool, while other moms worked in a regular office somewhere in Corporate America (this was while I was living in Chicago and Texas). I typed between mommy duties. I have never missed a day of work, because when my little darlin' was vomiting, I was there with her and when she slept, I typed. I have worked every holiday, in those 27 years (normally very early in the morning so that I'm done when the festivities begin). People still get sick and have emergency surgery on Christmas day. (I GET SICK, and four hours later when I can leave the bathroom, I'm propped up typing again!) I worked before flying to San Fran for Michael's dad's funeral, and worked after I flew home that night. I work from mom and dad's in Wyoming when I'm "on vacation". I worked those extra hours, and my income way surpassed that of what I would have made in an "in-house" job. I did the grunt work for years and years, and then bought my own system and started hiring people when I got to CA.

Now, my little corporation bills a fair amount a year and I gross less than half of that because I pay a large chunk of that to my transcribers who are independent contractors to my corporation.

I type a little less now, because I'm also proofing other people's work. When proofing, I make an extremely good hourly wage (if you look at it from that angle). I have one account for which I rarely type anything but the occasional correction. That is easier income for me, as an editor. Its a nice break in between the accounts I actually transcribe myself. But I'm afraid to take on a lot of accounts like that, because in the event of several transcriptionists being unable to work one day, I simply could not make up the difference. I also am afraid of losing the rapport with the individual clients and my ability to truly give them the attention they want.

But MT (as any career) can be a pain. I argue with accounts to get them to provide patient information for the work that they want to come back to them with that information included (medical record numbers, properly spelled names, etc). I juggle their changes in days dictating with my staff's days available. I argue with accounts over waiting 60 days to pay me. They want their work in 24 hours (or less! my radiology account gets 4 hour turnaround). Well hey, I want my check in 20-30 days. Go figure.

(I've had to learn my way through small claims court when a psychotic doctor didn't want to pay at all. I won!)

I get phone calls from accounts at 7 AM that want to know where a report is, and find out the dear doctor dictated it in a stupor at midnight the night before. (I of course was unconscious at 9 pm asleep at midnight!) And I have daily adventures in coming up with enough staff to get the work done. On any given day, one of my seven "peoples" (whom I love dearly and are all good people) might have an emergency, a vomiting child, an elderly parent in the ER, a teenager issue, an urgent parent-teacher conference, a flooding washer, a wrecked car, a power failure, a computer failure, an equipment failure, an internet failure, or a pet that needs to have medical attention. When this happens, if one of my "peoples" cannot pick up the slack, the ultimate responsibility is mine.

Still, its all I know how to do. And I do a good job of it, with the help of good "peoples." We get business without advertising, by "Word of mouth on the Golf Course" or "Word of mouth in the Operating Room" or "Word at the Networking Breakfasts" from satisfied and enthusiastic clients.

And until I can get Mr. B to decide its "Time" to semi-retire, I will keep doing it. (Even after that "Time" arrives, I foresee continuing to do this in an abbreviated form, from a different location!) It pays the bills. His present job is only part time (about 30 hours weekly) and along with income, provides us with medical benefits, and contributions to our 401K and other retirement accounts. It works for us! I value the benefits very highly, with my diabetes!! He works very hard around here after he gets home every day while I keep typing. I have not seriously grocery shopped or explored the shelves at my "walmarts" more than once a month in a long time. I hand him a list and the stuff appears in the kitchen. He pays the bills and manages our affairs, handles my payroll, handles my gazillion pages corporate income tax return, and typically cooks for himself, does his own laundry and deals with our emergencies.....I keep typing. I cannot tell you how helpful that is!

For the last 27 years, this has been good for me and bad for me. I have not had a holiday come around in 27 years that I was not toooo tired to enjoy celebrating. But my kids have been well fed, clothed, educated, and I have been HERE for them, all day, every day. Sometimes their perception is a little different. I heard a lot of "You're always working!" and still do! But I have reams of pictures upstairs waiting to be scrap booked that point to my ability to get to games, get to school presentations and plays, be a Brownie Cookie Mom (and Dad!), be a Room Mom and throw Christmas parties (back when we could call it that!), manage sleepover parties, create costumes, bake for bake sales for various causes, etc, over the years. Some of that would have been a lot harder if I had worked in the Land of Suits, Pantyhose and Long Commutes. We've paid off a home, achieved an excellent credit rating, and we've saved a small chunk of change for retirement.

It has been a good job for me. And I've met and worked with some absolutely fantastic medical transcriptionists. My current team is amazing! I have a group of real "do-ers" who are WILLING and share my work ethic. They make my job much easier and more pleasant! The comaraderie is certainly helpful and most of my "peoples" truly try to step up to the plate when one of us has one of those pesky emergencies - I have been very blessed!!

But I still wouldn't recommend MT to anyone. At least without giving them an earful of information that they will only hear from those of us who deal with it daily. A good source for her to read would be MTStars.com.

All of this being said, if she is still interested, I could get a course name recommended by AAMT that is the good foundation, and obviously, if she did wish to do this and completed the course, I would LOVE to be able to provide her some work. I will be at this job for several more years....so at least if she decided to go this route, she would know she would have some opportunities to start with. Getting started is very very hard.....it seems like every job opening I see calls for 2-5 years experience ..... But I'd be thrilled to help with that. If she still wants more information, let me know....I can send the course name, and also some idea of the equipment she will need so she can consider price versus earning potential.

She may wish to consider learning to be an MT but then functioning as an Editor. And medical billing is also possibly something she would want to consider.

Well, gotta get back to work!
Love,
Joy

I think she got more of an answer than she bargained for!! The above opinions are just that: OPINIONS. They are mine; they may not be yours. I would love to hear other MTs' opinions about this career choice. Thoughts, anyone?