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M*Modal

MModal makes no sense anymore - Do not understand how can they stay profitable

Posted: Aug 16th, 2016 - 10:01 pm

/seriously long rant.

I'm an MT who loves my job in spite of MModal, I like my account well enough, I pass almost all my audits, but I sometimes struggle to make their line count, and I struggle to make ends meet.  And when you are struggling to make ends meet doing the EXACT same work you once did for decent enough pay to support your family (35-40K), it is hard for your entire focus NOT to be around how much money you are earning and whether or not you can pay your electricity bill.

You do not care about cutesy HR videos.  You do not care about who wins HDS of the month.  You USED to care, even appreciate and enjoy these things.  Now they are annoying; you have a mortgage to pay, maybe you have kids to feed and clothe who used to be fed and clothed much, much better.  Do they think we are a group of high school drop-outs eager to make minimum wage?

Am I the only one who thinks this company makes no sense anymore?  I really don't understand how they stay profitable.  Bottom line, they should pay their US MTs a lot more than they are.  For THEIR own purposes.  Do they not want to stay in business?

Reading earlier posts made me realize how crazy this has gotten!

A decade ago, our line count requirement was 100 lines per hour, which was fairly easily doable for me, and that was straight typing.  We had QA, and we had QC for the weird ADT issues, we had tech support in the US who solved our problems within 15 minutes (as opposed to 2 phone calls to India over 2 hours), no one monitored our keyboard activity, we could send in as many blanks as necessary ("just don't guess" was the policy), and our audit standard was 98% (if I remember correctly), though most of us scored much higher, at least in my group, many of whom I knew because we came over from the same hospital.  Because why?

Because we could take the time we needed to research without anyone saying our keyboard time was off or having to worry that an unreasonably high line count was too low.  We could take the time to proofread every report and slow down enough to listen carefully to what we were hearing and still pay our bills.

We were proud to work here.  We thought it was cool they provided us with a computer.  We even had a magazine, also very cool.  We had incentives!  Incentives to work OT and weekends and nights.  All things considered, the platform wasn't that bad (DocQScribe back then), and small issues could be forgiven, right?  We had some say in our schedules and almost always were granted the time off we requested, and even part-timers received some PTO, if I recall correctly.  Experienced MTs came here and they stayed.  The pay was somewhat lower than industry standard when I first signed on, but I could pay my bills and to me it was a fair enough trade-off for being an employee with insurance and benefits, and I actually loved being held to a high standard and having to be up-to-date on all the latest changes through AAMT.

Here's the thing about transcriptionists:  We're perfectionists.  The really good ones.  We're the grammar Nazi's.  We're the ones who know proper English to the point of being annoying, memorized every single medical term in school, read medical novels for perspective (and fun), and remember almost all of our pathology to this day.  What we are NOT, or WERE not and SHOULD NOT BE, EVER, is minimum wage workers.

There were really only 2 areas that were strictly monitored:  You worked your scheduled hours, and you didn't abandon too many reports.  Does anyone remember this?  And with the first one you still had some wiggle room.  In fact, there was "flex time" for people who wanted not only part-time but to be able to create their own schedules.  As I recall, abandoning reports was the only true cardinal sin that was performance managed.  Making line count and passing audits were also strictly managed, but it was doable enough that it was a nonissue for most of us.

We made between 8 and 10 cents a line for straight typing and could make a decent living at that rate, especially with incentives and over-time.  I wasn't getting rich, but I was getting by (now I am barely making it).  We were all required to work SOME weekend hours, to make it fair for everyone.

You know where this train derailed?  When they rolled out ASR and slashed our pay to 4 to 6 cents per line.

It was a nice thought, that we could make MORE doing ASR at a lower rate because we could go so much faster.  BUT IT WAS A MYTH.

It never happened.  Almost a decade later, and how many of us are making the same amount we made at 8 to 10 cents per line straight typing?  A good MT is an incredibly fast typist, with an impressive arsenal of shortcuts and enough experience to power through reports at lightning speed and with incredible accuracy.

I know I am not alone when I say that I would be happy enough with ASR if they hadn't slashed my pay.  My formerly carpal tunnel ridden wrists love ASR.  But it takes a different kind of concentration to do this well, and it is often a lot harder to stutter your way through an ASR report with corrections on every line - versus straight typing where you are flying through without pausing - all of which translates into LESS PAY.  To say it is fast enough to justify a pay decrease to 4-6 cents per line is to tell a flat-out lie.  Fantasy.  Until ASR is good enough that we need do nothing but read and correct a comma or term every other paragraph, it will NEVER make up for that degree of loss in pay.

And everything that has gone down since our pay was slashed seems designed to make that unrealistic slash in pay, by some miracle, work.  To make us fast enough to avoid having to pay us make-up pay, to get as much out of us as possible for as little pay as possible.  This is normal nowdays for corporations, as are metrics and the attempt to get as much out of each employee as possible.... what is NOT normal is paying so little for so much.

They want us to be as accurate as nurses and doctors are, which is to say 100% accurate, but in our case no less than 99.6%.  That is not unreasonable in the medical field.  But it is unreasonable for minimum wage.  Nurses and doctors are compensated very well for operating under such a high demand for accuracy.  For decades, so were we.  Most of us were even insured against error, in the off-chance that we made a serious one.

I will not even comment on off-shoring.  That is, sad as it is for Americans, patients above all, here to stay, and it seems they have worked out a method to squeeze some level of accuracy out of that situation (using multiple tiers of QA, it sounds like, but that is not my area) enough to satisfy their clients (I assume), and that is not my concern and I don't pretend to understand it.  Other than not wanting my own records done off-shore, which is a different matter.

But MModal retains a certain number of US MTs as there are hospitals/clinics in the US that refuse, reasonably enough, to have their work offshored, and so they have us.  I am fairly certain they would not have us if they had a choice, but that is not my concern either, and perhaps it is unfair.  Perhaps it is true, as some QAs say, that MModal uses us to demonstrate higher quality standards to their new clients, and then ships the work off to India.  I wonder if MModal realizes how many people now believe this to be true?

Whatever.  They want US to be 99.6% accurate.  And they want to pay us 4-6 cents per line, which for most of us works out quite close to minimum wage, and for many of us is unbelievable in relation to how much hard-earned experience we have amassed over the years, experience that is extremely valuable... that we have all had time enough to see is completely, and completely wrongly, not valued by the powers that be at the MTSOs that currently dominate the industry... at least not in terms of salary.  And how many of us can afford to, or even would want to, after years of learning this profession, disregard salary? 

BUT.... they don't want to pay make-up pay if we fall below minimum wage, so instead of acknowledging the need to raise our pay, they have implemented metrics that require us to make 150 lines per hour, the amount it takes for most of us to make minimum. 

That is not necessarily the amount that many of us can reasonably achieve and still be 99.6% accurate, so they have implemented metrics to try to force this out of us.

Maybe by making sure every moment we are clocked in, we are active on the keyboard?

Nevermind that no one is active on a keyboard when they are researching or proofreading.  Some of us will and are, of course, performance managed on this.

Maybe by monitoring how much time we spend between reports?  Nevermind that we need to get up occasionally and stretch (medical science tell us this, MModal, did you know?), or that we have been told it is better to take a bathroom break between reports than DURING a report.

Maybe by telling us to just go really fast and not to proofread?  But then it turns out, our quality scores drop way low and clients get upset, so now they recommend we proofread again.  Nevermind about the keyboard thing.

And then some MTs are resorting to putting blanks in because they can barely make minimum wage and they don't have time to go back and relisten the way they used to... so maybe MModal needs to put in a blanks metric.  If you go over a certain percentage, your pay will be docked!  That should do it, voila!  Blanks metric is now in place.

Nevermind that most of us are actually putting in blanks because we're stuck with ESLs we can't understand... or we actually can't hear because of poor quality audio... or we're skilled MTs who just have never heard a certain term... or maybe we're new MTs who need some QA help as we go through the initial learning curve.  Nevermind that skilled MTs all agree that it is better to leave a blank than guess!  Nevermind that most medical professionals would probably prefer we do what we have always done, for decades, and leave a blank rather than guess.

Nevermind any of that.  Put in the blanks metric!

And the keyboard metric... that will keep the MTs typing/editing the whole shift, fingers to the keyboard, foot on that pedal.

Nevermind that for quality purposes, MModal also wants us to stop typing and playing the audio long enough to proofread.  Or that they do actually want us to research unfamiliar terms, at which time we won't be typing or listening and the keyboard will be lying there, dormant, racking up the inactive time.  The MTs can work that out, right? (Yes, MModal, we worked around that by learning to tap the arrow keys so we don't get docked when we commit the Sin of Sins... taking our hands off the keyboard and our foot off the pedal to research.  Do you realize how ridiculous that is to a professional MT?)

I mean, as MModal execs, we want the MTs to be well-trained, to research and proofread (not all of them do, but the ones who do, we want them to continue) and we want them to be able to work quickly like well-trained MTs can do.  But we don't want to pay more than 4-6 cents per line, right?  Even though well-trained MTs had been earning more like 14-16 cents per line.  We want to make them more cost effective, more like the Indians! 

We obviously just need tougher metrics and more monitoring.  So we'll pay managers to generate all these metrics reports, and then we'll pay our supervisors (as little as possible) to muddle through all the reports and make sure everyone is meeting all these (conflicting) metrics, and we'll pay them to put the errant MTs on performance management, and then we'll pay to hire and train new MTs when these experienced MTs get fired over not meeting our (conflicting) metrics, or fed up and quit....

And OMG, after all this emphasis on productivity and speed, we are now (who saw this coming?!) having issues with quality, so we need to bring in and pay an outside auditing team and we'll have them do frequent audits.  That should bring these MTs in line! (It's not about working conditions, right?  It's about motivation!!  Metrics!!)  And then we'll pay the supervisors to performance manage the MTs who have are having trouble meeting the quality standards.  What do you mean they are only having trouble because they have too many ESLs? the blanks percentage is making them prone to guessing? the audio quality is bad on many of these accounts that we are demanding they work so fast on? we are losing our experienced MTs and hiring newer, inexperienced MTs and not even giving them a chance to learn from QA because of our blanks metrics?

Because all of this makes perfect sense from a financial perspective, right?

It is good for the company!

Ridiculous to even consider paying the US MTs a US living wage!  Nuance doesn't do that, right?  The Indians aren't making that much, right?  We can make this work, paying them pennies!

What do you mean MTs are professionals?  That training matters?  Didn't someone just tell us that newbies are better?  No bad habits to unlearn, right?  What do you mean experience = speed and skill in MT work?  that it's different?  We don't believe it!  We can hire monkeys to do this job with the right metrics in place!!  Right?

What we can't understand is why so many MTs are leaving, why the quality scores are going down, why the clients are unhappy.  Maybe we need more metrics.

Who can we pay to force the MTs to produce more and higher quality work?  What works in India?  What works for Nuance?  (what do you mean India is different and Nuance has the same issues?)

Who said pay the US MTs more?  That we were wrong, that we mis-led them when we said they could earn equal or more on ASR?  Did we really say that?  How ridiculous.  Of course, we knew all along we were saving the company a ton of money slashing their pay when we implemented ASR.  We could save the CLIENTS money by slashing the MT pay!  All we had to do was get the MTs to perform.  To do 150 lines per hour so we don't have to pay make-up pay and to consistently score higher and higher on their audits to keep the hospitals happy.

It's just that the MTs are struggling to meet that line count, and they are struggling to meet that audit score with all the metrics we had to put in place in order to get them to do what we wanted under the conditions we have them working under.  We're sure it can't be that we are losing all our experienced MTs because we are paying so little!  Or that our metrics are unreasonable or the working conditions are intolerable for professionals.  We're sure it can't be that experience matters and we were right 10 years ago when we paid them a living wage as if MT were an actual profession!

Now what?

I don't know, MModal.  How about someone up there.... is there anyone up there who is able to be reasonable? scraps the dishonesty that is costing you a ton of money, pay the US MTs a living wage, and watch how things get better?

Will anyone there EVER understand, again, as you seemed to a decade ago, that MT IS a profession, that experience does matter, that the more experience, the more speed and the higher the accuracy?  That years of experience, that holding your MTs to a standard very near 100% accuracy, always has, and should again, mean paying them accordingly, and according to US standards?

I am ranting and will sign off now.

I just don't understand how this company doesn't see that paying their US MTs more will result in the need for less metrics, which will result in the need for less monitoring, which will also result in less turnover and the ability to retain more skilled MTs, that in this industry skill equals speed and quality, that higher pay will address that issue, too.

I don't pretend to know what is working in India or the Philippines, and I don't care.  But in the US, that is the solution, plain and simple.

Thanks to anyone who listened to all that.

/rant over.



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