A community of 30,000 US Transcriptionist serving Medical Transcription Industry


I seriously don't know how to make this better - Cheesey


Posted: Aug 24, 2011

I've been working with this company for over 90 days. The first 90 days was a paid internship. Paid hourly, minimum wage. I am now a full time employee...paid on production.

 

However, I can not even seem to make minimum wage while on production pay! It is driving me nuts and is very discouraging. I'm not sure where to point the finger.

 

I worked 8 hours, only took one 20 minute break to eat. Over those 8 hours, according to the employers data base, I did around 1200 lines total. This is mostly editing. Only 1 report was actual transcribing. What is so discouraging was that I went at full speed...I felt like I was doing excelllent...report after report done and uploaded, only for me to find that I only did 1200 lines and still did not make minimum wage for the days work.

My payment is currently 0.035 per line for editing and 0.072 per line for transciption. I'm totally new to this field. I have no idea what is good pay or not. I'm just starting out, so I'm not expecting the best of the best pay wise, but I have no idea where this payment falls on the scale of good vs bad.

I don't honestly know how I could possibly improve. It isn't typing...it's mostly editing. I did 22 reports total that day.  One was actual transcription. So it's not about typing speed. Most of my time is spent verifying some garbeled doctor's name or trying to find a medication that sounds like what that doctor just spewed out amidst his yawning and the phone ringing at the same time.

I have no down time. Reports come in 1 after the other just fine. But these doctors either speak so fast that they just mumble everything together or they go so slow that it takes them 2 minutes to spit out a sentence. That slows my production down through no fault of my own. I crank the speed up, but I still have to sit through that silence in case they say something iimportant.

 

I go back and read some of the outlined figures MTs can make, and I'm just doing double takes. I can't even make minimum wage here! Although, company standars say they will up my pay to equal minimum wage for the pay period, but if this keeps up, I will lose my job.

 

I just don't know how to improve! My technique is to listen through the report at the fastest speed I can understand (above regular speed almost always) and go through the report correcting what is obvious and marking what needs to be looked up or verified on the second pass. I don't stop the audio on the first pass unless my eyes get behind on the words. If I don't hear something correctly, I just mark it and continue the audio. Second pass I go through on my own verifying the marks from the first pass...only listening to the doctor when I need to hear what they said again in a certain spot. This goes a lot faster. Third pass is just scrolling up the report to make sure the headings are correct...no rereading the entire report and submit.

 

The ONLY feedback I have gotten was for account specifics that I was not told about....the little things...like accepted abbreviations, etc. That's another frustration in and of itself...the company saying to "remember to do this" even though they never even gave me a sheet for the specifics until a few days later!

 

Ugh, I'm so frustrated right now! It's raelly a kick in the gut when you're working and thinking you're doing awesome, but then see you really just completely sucked. Sorry for the rant, but I thought this would be a decent career. I was so thrilled to get a job right after getting certified. Everything was looking good. I learned a lot through my internship, but now that I'm actually employed, everything is collapsing. How am I supposed to make a living like this? Is this all my fault?

 

Why is the MT so heavy on production pay when so much of what I've been doing at least has nothing to do with my own production? If a doctor takes an hour to tell me something, that is an hour of my time listening to them ramble. That has nothing to do with my own production rate!!!

My suggestions - Happy MT Robin

[ In Reply To ..]
I think part of your problem is the going back through it a second time. I fix things as they come so I don't have to go back through. That definitely will save you some time. You eat up a lot of time going back and re-reading and then finding that point in the audio again. Try to do everything on the first pass through.

The other thing that you might be doing, as I know I do it, is spending too much time trying to figure out blanks. Give it 3 minutes and if you can't get it, then leave a blank. I spend more time than that sometimes because I really like to be able to figure things out, but it definitely has an effect. When it's a dictator issue such as the phone ringing in the background or (my personal favorite from a couple of weeks ago) the dictator's toddler screaming because he's bored and wants to go home and the dictator just shouts over it, then I don't spend much time at all. Things like inconsiderate or sloppy dictating habits can't be allowed to cost me money so I go by the old adage "garbage in, garbage out" and I have no problem leaving blanks for those sorts of issues.

Do a random line count check on some of your documents. Copy them and paste them in Word so you can do a character count and figure out your lines so you can make sure that they are counting your lines correctly.

I also know how many lines I have to do per hour to make the hourly wage I need to survive. I have a little post it on my monitor that has that laid out, i.e., I have to be at x amount of lines by the end of my first hour, x amount by the end of my second hour, etc. It helps to keep me focused.

It can take some time to build up speed and accuracy on VR. I have heard some people say it takes 6 months or longer and I believe it. I've been on VR since about the middle of June and I'm just now really getting up to speed and some days definitely are better than others.

Most importantly, don't let yourself get too discouraged. You made it this far, you just have to hang on a little longer and you will get the hang of it.

Garbage in, garbage out - CAMT

[ In Reply To ..]
Sorry, that made me laugh. If I had a nickel for every time I have told myself that with one particular dictator, well, I wouldn't be an MT. Thanks for making my day.

some thoughts - destinyisntfree

[ In Reply To ..]
I feel for you. Let me ask a few questions here. Is this your first MT job? If it is, really, then don't beat yourself up because it takes time to get up to speed and used to things.

What platform are you working on? The suggestions I can give vary by platform.

The other poster is right, though. A lot of your problem is the amount of time you are spending in each report. It is definitely much faster to edit and proof as you go to go back through a second and third time, trust me.

I was once told that the best way to go is to shoot for a 10% improvement, so say if you are doing 1200 lines comfortably, tomorrow, shoot for 1320, and when you are comfortable with that, go up by 10%, et cetera.

Another thought, is, do you spend a lot of time filling blanks? If so, set a timer...3-5 minutes should be the max, because after that you probably are not gong to find it anyway.

I use timers. I work for a certain amount of time and then take a break. Breaks are actually critical. You really should be taking at least a short break every 2 hours. Get up from your desk and move a little, get the blood circulating, and it will help your concentration.

Have you asked your supervisor for any tips to improve your production? Most companies will be willing to help if they can, at least the good ones.

Thanks - Cheesey

[ In Reply To ..]
Thanks for the responses. I am definitely getting discouraged and frustrated. I was excited that I actually got a job given all the negativity I read here and was ready to begin a new chapter in my life. But with the money I'm making now...I'll never be able to leave! I know...I'm thinking too far ahead...but you can't help it when you're seeing such horrible numbers on your own part.

Yes, this is my first job as an MT. I was just certified in April and snagged the paid internship 2 weeks after that. It was quite a stroke of luck!

The company I work for uses DocQscribe. With editing, I don't need to find the points in audio on my own. I simply click on the report in the area I need to listen to again and hit ctrl_M and the audio sets itself to that point in time in the report.

I honestly did not think I spent that much time on trying to fill in blanks. It's just the sheer number of blanks that is bugging me. Some I know is just due to me being a newbie and not being completely familiar with a lot of terms. Others are just when they mumble something reminiscent of a word I sear I know but can't quite connect the dots with.

I do find myself pressuring myself to not take breaks. Time is money...no time for breaks. I need to change that mindset though.

So, you are requesting to correct as I go then, right? One pass...if I don't hear something right, correct it right then and there instead of passing it by for another pass?

The reason I've been doing the second pass is because of something I did not see coming. The company took me off of QA the day I was employed. If I have less than 3 blanks, they are sent directly to the client. More than 3, I can pend to QA.

This is where I'm torn. I'm a newb...so my confidence in sending my personal work in which my eyes were the only thing to see it directly to the client...well, that's pressure!

Also, I was wondering....what exactly do they mean when it is "sent directly to the client"?

Does that mean it goes into file and is only looked at when needed? Is there another person that does look at it at the hospital when it arrives?

That's one thing I don't like about this company....every thing just feels disorganized. It's hard to ask questions because I don't know who is who. It's a bigger company. I don't know who to ask what. When I do ask someone something...I usually get a reply of "I don't know. Let me ask so and so."

Some input - Happy MT Robin

[ In Reply To ..]

So, you are requesting to correct as I go then, right? One pass...if I don't hear something right, correct it right then and there instead of passing it by for another pass?

Yes, exactly.  You might need to go slower for a while, but I think you'll make up for it in the long run.   About the only time I go back and listen to the audio again is if I have a blank and then somewhere else in the document they say something similar or say the same term, which happens a lot.  Then I'll go back and see if that was what they said the first time. 


A lot of what you're dealing with is just being new.  I know my first year was I was dreadfully slow and a lot of that was because I was working on my own with no one else right next to me for guidance and/or support.  The company wasn't the greatest, but they were the only ones to hire a new person.  I just knew i had to stick it out until I could put them down for a year and then find something better, which I did.  You will, too.


I am surprised that they took you off QA that fast, but if they did so, then you're doing pretty well.  When they say "send directly to the client" it means exactly that.  It goes directly to the doctor's "in-box" or whatever system they have set up so the dictator can electronically sign it .  It shouldn't go directly into the file, because the documents must be signed in some way by the dictator - their malpractice insurance requires that.  They may not actually look at it and just sign off on it - in fact I think that's what most of them do - but it's their name on the bottom of it verifying/confirming the information.


As to the company disorganization, what you might do is the next time you get a response of "I don't know, I have to ask so and so" is make a note of that name and then send your request for information to them as well.  You need to follow up as well.  If you don't have a response by the next day, e mail them back with a copy to so and so if you can get the address and be really persistent.


If/when you do send blanks to QA, do they send you feed back and let you know what those blanks are?  If they do not, you need to bug the you-know-what out of them until they do.   That's a big hot button for me and I actually asked to be moved to another team because of that kind of issue.  When you do get feedback on your blanks, write them down.  I have little notebooks that I keep by my keyboard and I write everything down that comes back.  I go back through them periodically and review them, but the sheer act of writing it down helps ginormously in terms of imprinting it on my brain.  Feedback from QA is a training tool, IMO.  I've never been at odds with my QA people like some have, but I've always been very lucky and have had really good QA people to work with.  I look at them as another training tool/teacher and when you take that kind of approach with them, they're usually really good about helping you do your job better.


Try this tomorrow - Instead of doing your normal 2 passes, change it up and try to correct everything on your first pass.  Then go back and proof read it to make sure that you got everything.  This will slow you down initially, but I think it will give you more confidence that you really are doing a good job and you'll start to get better and faster.


It's frustrating, I know.  I've had to completely retrain my brain and eyes and how I read.  I used to be a "skimmer" and when I read a novel I would sort of fly over stuff and not read every single word.  Now I'm having to read every single word and it really took me a while to get in that habit.  I would get my stuff back from QA and think "how in the world did I miss THAT?"  It does take time and it can be frustrating, but once you relax and realize that you really can do this, the lightbulb will come on over your head and everything will click.


Good luck.

Thanks, beat me to it! s/m - destinyisntfree
[ In Reply To ..]
Thanks Happy MT Robin, I didn't get a chance to check back until just now, but work is slow tonight, so I am taking a minute to check on posts.

I will add that breaks are critical for me. The longer I go without a break, the slower I get, and I have been at this for 10 years, so that can be very frustrating. While I agree that time is money, a 15 minute break, you may find, will improve your production enough to make up for the time you took off.

I struggle with unmedicated ADHD, so focus and concentration sometimes are a problem for me. This is what I do. I set a 30 minute timer, and work for 30 minutes solid, not leaving my reports unless I have to look something up. After 30 minutes, I will take a 5 minute break to check my email and line count so far. I get hung up on my line count and how much work is in the queue, so that is like a reward for me. Then, after 5 minutes (and I set a timer for the break, too), I do it again. After 4 of those runs, I make myself get up from the computer for 15 minutes. Get a drink, check the laundry, feed the dog, make sure the baby is still breathing in her crib (she has apnea), or hasn't gotten her legs stuck (she has fat legs, so this is a regular occurrence) between the slats of the crib. Then, after 15 minutes or so, I sit back down and do it again. After another 4, I take a half an hour or so..eat something high in protein, stretch my legs, and do it again. Sometimes I will actually do sit-ups or something to get the blood circulating and the adrenaline going a little.

As recently as a few months ago, I struggled with my production. Yep, even a seasoned MT can struggle, so do not feel bad, please. We all have to do what we need to do to get through, and we need to support each other, I think.

Regarding DocQScribe, I do have a few tips for that somewhere, but I will have to hunt for them, as I haven't worked on that platform in several years. However, if that is the platform you are working on, you might also could post on the Medquist board asking for tips on improving production on the platform, as they own the software.
Thank you so much! - Cheesey
[ In Reply To ..]
Thank you so much! And thanks again for explaining the whole process. I wish they would go into more detail on that end in school or within the internship. It gives your work more purpose when you know where it goes when you send it. I mean, you have a general idea...but when you really start to question it, then you realize how little you know.

I will try the 1 pass method. Honestly, I don't see how I could get much slower or at least make any less money to actually matter.

Unfortunately, the company I work for does off shore. But honestly, I just wanted an opportunity to learn. So, I took the internship. They offered me a job, so I just took it. It's experience I need. My resume is rather bleak, so I need something.

Like I said, I didn't expect to be making good money my first year. Thought around minimum wage would be the norm. Just wasn't expecting it to be this bad.

I do get QA feedback for most reports. Not all, but most. I am happy with that, and I really like that. I learn so much better from my mistakes.

The amount of work is just fine. The quality sucks though and so many ESL! After a few ESL's, I do take a break....and try to refrain from ripping my hair out.

I will look into local jobs too. My mother said she works with someone who has an aunt that is a medical transcriptionist. She said she'd ask what company she works for....she really made it sound like that job was too good to be true...as in she worked whenever she wanted throughout the day, paid on salary, made great money, didn't have to work holidays...etc. Eh, we'll see.

Again, thanks for all the helpful feedback! This line of work really is 2 faced. I kept reading how it was a growing industry...projected to grow...so many job opportunities...not enough MTs to fill the slots.....and then I see these forums where it seems the opposite is true.

Cheesey, to make $21/hour, you need to - edit 600 lph. Very hard to

[ In Reply To ..]
accomplish as a newbie on an account because that's 10 lines per minute. ONLY 10 lines per minute scanned; surely you can do that?

BUT: Look up 3 mangled physician names in an hour, (30 seconds, 2 minutes, and 3-1/2 minutes) check specs twice to make sure you're doing it correctly (1-1/2 minutes), write 2 notes to QA for stuff you can't figure out including double scanning to make sure the info really isn't there and hitting the wrong keys once), relistening at several points again and again (5 minutes), searching old reports twice for unfamiliar terms and googling twice(9 minutes). You get the idea.

That's roughly 20 minutes x 10, equaling 200+ lines lost to newbie crud. No wonder you need to be rich to start a new job on production pay. Not all hours are that bad, but a lot are even worse when you're new. Subtract 200 lines for spending 20 minutes trying to figure out how to work an important new macro, and another 200 for stopping to stick a bunch of repetitive corrections in your expander for a lowsy-SR dictator with 7 more reports waiting.

When you're new, NO reports flow along the way you need to get that 600 lph. With each interruption that becomes uncommon, though, (like those income-destroying names) your production will leap. Especially if you take to heart the other advice. Always try to move forward as much as possible and go back as little as possible. Happy editing, Pragmatist :)

It is not you, it is this field in general-- See inside - dfasdfsaf

[ In Reply To ..]
Most good, easy transcription is sent overseas or done by voice recognition or templated by physicians in any number of software programs that bypass a transcriptionist.

Your best bet is to find a company locally where you know the people or be an IC for a company. Some IC positions still have relatively good physicians you can make a line count on, but have to have benefits provided by a spouse or buy, which are expensive.

As far as MT companies, there are literally almost no good companies. Over the 1990s national and international MT companies developed and spent their time and money on tech and off-shoring and voice recognition, and reducing MT wages to ridiculously low levels. Of course your line rate is low. But that is what off-shoring (sending medical transcription overseas) and emphasis on large national and international companies with investors has done.

If you read further on this board, you will see that everyone has the same complaints- very, very poor dictators and sound quality, getting new dictators all the time, or no work avail because companies overhire and send work overseas and to voice rec.

I have 30 years' experience and the last time I was off-shored/outsourced to voice rec, I had a very hard time finding a job. With 30 years' experience. I will pray for you, but as it stands, with even experience and lots of it, MTs are not making even minimum wage because of the factors above. And the MT companies know it, don't think they don't. Or, they give you so little work that you do not even have 2 hours' worth in an 8-hour shift and have to work around the clock to get any jobs.

I can only say to post your resume, say where you live, and see if an IC company near you has anything and is willing to work with you and help you make at least some more and have better dictators, that you can work on and get used to. That is the way it used to be.

I am hoping something works out. If you can do anything else or retrain, think about that. Most MTs are not recommending anyone they know go into this field. It used to be a nice field but has been ruined by companies buying up other companies and shipping overseas and to voice rec. I sincerely hope you can get another idea. Also, some hospitals still have employees and let them work at home after a while. Look at your local medical facilities. Most post jobs on-line. Good luck. God Bless.

I have to respectfully disagree with some of your points s/m - destinyisntfree

[ In Reply To ..]
Yes, the industry has changed drastically, but it is still possible to make a decent living. I work for a company that does not offshore, and never will. They pay decently, and I have a primary account that has a VERY low ESL percentage. Yes, a lot of my work is VR, but I am able to get a pretty good line per hour average on the voice recognition that does equal a decent living wage, well over 20 an hour. It is all a matter of perspective and what you are willing to do for it. I had gone without work for nearly six months trying to find this job, and while we struggled during that time, I was glad I waited and didn't take my first offer from a national who offshores heavily.

And let's not forget - Anon

[ In Reply To ..]
In addition to outsourcing, our current government is really forcing the change as far as new mandates regarding Medicaid/Care reimbursements - providers must digitize or forfeit premium reimbursements, etc., so of course VR/EMR will continue to increase and force out positions. It's kinda tragic, the destruction of an industry. I'm happy for the MTs who are doing well and happy, and I hope I find something good when I need to look again, but IMHO, we really are kinda bein' screwed. I am working an hourly right now, which is nice, but even that will be gone soon - death by Dragon, lol.

And let's not forget - anon - Nick

[ In Reply To ..]
No kinda about it. And without even so much as a kiss.

The problem isn't you, it's the pay. My co. pays .035 - for editing, too. I worked my - sm

[ In Reply To ..]
rear off one day, and did around 1180 lines. When I tallied it up, for an 8+ hour day, I had grossed less than $42. That come out to around $5.25/hour. After taxes, it came out to about $3.21/hour, give or take a cent or two.

Funny, I thought 1st-time-ever employees could make more per hour at McDonald's! And yet they want WHAT? MT experience? No newbies? 99-100% accuracy? Able to type ALL specialties, and multiple different hospitals, hundreds of doctors, proficiently?

It's total bull pucky. We're being scr=wed, people.

You guys, the BIG question you need answered is, what are - others doing your job making?

[ In Reply To ..]
That is the only way to evaluate your own production. If top people are topping $50K in a 40-hour week and a nice percentage ranging between $35-50K, you're in a good place and just need to focus on getting faster. If their fastest people are making $35-40, with the largest group happy if they can make $30, run!

Note, I didn't mention people who are not (yet) skilled competent MT/MEs since their income or lack of it would, hopefully, be irrelevant to someone intending to support herself in this industry.

Also, $0.035 could be a quite decent rate if the work was fast enough. The only numbers that are reliable and clearly enough understood to base decisions on are the ones on your paychecks and, again, those of people doing the same work you are. Everything else, spaces or no spaces, characters per line, even line rates are just technical details. If I'm bringing in $50K (which I no longer am as I took one of the many hits flying these days but am working on fixing), I don't care if the official line rate is $0.02 or $0.20.

Very well put. n/m - destinyisntfree

[ In Reply To ..]
x

Exactly - defakadkl;

[ In Reply To ..]
Exactly. And people posting that they work hard, etc. Don't they think we all do?


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You CAN Make Big Bucks With VR!! NOT
Apr 18, 2010

Poster below crows about how much money they make with VR.  What are these big bucks, you struggling VR people ask?  Poster states they clear $1000 a pay period--A whole $24,000 a year!  THOSE ARE THE BIG BUCKS??????  Sad, truly, truly sad.  ...


Make Sense??
May 06, 2010

Hypertension ocular losses.  is that right?? does it make sense?? ...


Do More Make Less, Yessiree!!!!
May 15, 2010

Okay fellow MT'ers.  Gestapo measures are in place nationwide as I see it.  Just informed by MTSO that since the new platform is going to be so wonderful, that I will be able to double or triple my production, (Right!!!) hence I will be getting 2 cents a line less for speech.  Okay, as an  IC , I pay all all own expenses, SS, equipment, internet, (HIPAA room), utilities, electronic and book references, education, wrists, fingers, feet and toes, so take another ...


Things That Make Me Go Hmm
May 19, 2010

Have ya ever wondered, WHY is it that we get "audited" when we are having really, really bad work days? Why does the "computer randomly chose" (ha!) the most difficult, awful report to review?   My latest audit was on a dictator I had NEVER EVER DONE before, on a brand spanking new account, was 1098 minutes and ASR and ESL!  I got an 84%.  (Hey! as far as I'm concerned that should have been an A+++!!  Least I gave them something that looked like a report.) I a ...


Unable To Make Out!
Jun 27, 2010

The doc is saying " This PI (hear as PI, not sure what it is)  is a 9-year-old white male who is in good health and ( I hear it is cola, after the and, could it be colon?) earlier this am when he presented quick complaints with headache, fever, chills _____ ( hear as provia)for next to his nausea and vomiting ____ ( hear as " times wound). Looks like I cannot get on in this field much longer, if I hear to doctors transcribing this way. Please help! ...


Does This Make Sense
Jul 15, 2010

His psychotic symptoms have always been [s/l a vague and oddness] ...


What Do You Do To Make Yourself Comfortable
Jul 30, 2010

I get soo uncomfortable sitting for at least 8 hours every day.  My right arm and hand just ache/sore constantly, and my fingers, especially on my right hand, are really getting painful.  I sit with my keyboard on my lap (on a pillow), sit with a pillow underneath and behind me.  My heel even hurts from using the foot pedal.  I'm wondering if a left hand keyboard would work for me, or an ergonomic.  I've used an ergonomic before (it broke) and didn't recal ...