Put this under your hats, but there has been a study performed in Ohio regarding the cost effectiveness of outsourcing transcription versus bringing American MTs onboard to handle all of it. Oh, happy day!! The concensus is ..... sit up and read this twice ...... it is more lucrative to hire more people who are skilled and pay them a nice hourly rate with benefits than to outsource some or all of the work. Hang in there. What goes around, comes around. It's about time that the true cost effectiveness of inferior work be scrutinized. There are managers and QA's and editors and customer service people up the "ying-yang" who may have to worry a bit because I truly feel that doctors across the county (many of whom have invested in outsourcing medical transcription) are beginning to realize that it definitely is a skill/profession that needs to stay here in The States. Woooohooo!