My take on today's MTs and MTSO (long) - Been there/done that...

I see so many posts going in so many directions on these threads.  It made me think about how very hard the whole MT thing is in today's world.  I thought I would make a few points for those just starting or those just staying...

Many posts say - you must know AHDI Book of Style.  True, for some companies and some accounts.  Not true for some companies and some accounts.

Many say QA has been helpful; hurtful; unfair; unreasonable; confusing; contradictory.  Truth is; QA is whatever the company and account call for.  There is no "right" or "wrong" way - it is whatever is called for on any given day, any given account.

Many say the line count is going down.  This is true; for various reasons.  Mostly because the competition is greater because of off-shore MTs.  The MTSO feel they have to bid low in order to keep the work state-side & they have to pass the loss on to the MT to stay in business.  The individual doctors and small MTSO take their cue from the larger MTSO and hospitals.  It just goes down, down, down - and it will until there is a shortage of MTs; which will drive the line count back up - supply and demand is the name of the game.

VBC - Visible black character.  This is the up and coming new way to bill and pay transcription.  It is counting the black characters on a page - no spaces.  It gives the MTSO the "edge" when bidding - they say they will bill VBC only, which makes their customer happy.  Then they tell the MT they will pay a higher line rate or use less than the standard 65 characters to constitute a line.  Problem with this is - experience has taught us that this will be a temporary concession.  Soon, the "standard" will be VBC and the higher line rate or less characters will fade away and we will have a still lower line count.

Employee/IC:  This is a tough one for all.  The MTSO needs to meet TAT to stay in contract and can't do that unless they can control the schedules - need employees.  However, employees require enough work to meet the requirements of full time employees - something that can't be controlled most of the time.  They also need benefits - something that is expensive unless the employee is making a profit for the MTSO.  On the other hand, IC status does not help meet TAT although it is cheaper as far as benefits.  For the MT, employee status means their schedule is controlled but they are not usually given enough work to make the line requirements.  IC status gets them in tax trouble and usually targets them for less work if there is rationing. 

Backup accounts:  If MTSO gives an MT a backup account, this is what happens.  Employee #1 is on account A daytime.  Employee B is on account B evenings.  #1 runs out of work at 10 a.m. on account A, switches to account B for 5 hours.  Employee #2 starts at 3 p.m. and the work dries up at 6 p.m. -   Think of the headaches when this is multiplied by a few hundred MTs scratching for work.  It is a no-win situation all the way around.  People get incensed over primary accounts, secondary accounts, tertiary accounts, promises made and not kept - on and on.  We all know the headaches for the MT - no work on A, B, C - because the people who have it as the secondary or tertiary accounts had no work and switched to your account.  A new account opens - MTSO wants to knock their socks off with our efficiency - so they overhire, take down the backlog, wow the customer - and then no work or tiny amounts for all - or worse, lots for some, none for others. 

This business has evolved into a nightmare on so many levels when it comes to MTSO.  I came home on a pilot program for a hospital many years ago.  It was great.  One block built on another block - one problem solved for a customer made another problem for off-site MTs and MTSO.  We kept going, changing little by little, until we got where we are today.  MTSO trying to keep head above water, stay competitive, meet TAT, pay expensive perks, avoid penalties, keep up with the tax laws for 50 states, provide work to MTs, avoid lawsuits.  The MTs are where they have always been - trying to make a living.  However, we have also evolved.  We expect things today that we didn't expect 20 years ago.  We want the perks of employment and the perks of being at home.  We want 10 cpl for a 65 CL with spaces, we want insurance and all the other perks, we want a guarantee of work when wanted but don't want to be given a line requirement, we want vacation/holidays/PTO but we don't want to help catch up the backlog that has to be done unless more MTs are hired for the account.  If we have a bad day with the kids or Susie has a school play, we are furious if someone questions what we are doing or says "no" we cannot go to Susie's school.

We are where we are because we have all wanted the whole pie.  The MTSO wants to be able to take the cruise or build the big house like the other MTSO - make the necessary cuts.  You hear how it started at the "kitchen table" but it certainly didn't stay anywhere close to that.  They have forgotten.  It is now about figures, bottom lines, and how to retire in 10 years.  The MTs have forgotten how happy they were to be at home where they could throw more water in the stew on the way back from the bathroom or listen to music in the background, control the thermostat, wear sweats, drink at their desk. 

It is a snowball rolling downhill.  I see it starting to happen - MTs advising younger or newer MTs to stay on site - don't go home.  Some have found they are making minimum wage at home.  I see the chasm between the MTSOs and MTs growing wider every year - in every company.  The newer companies stay connected for a little while, but soon find they cannot do both - be a buddy and be a competitor in today's MT industry.  Eat or die.

This is long.  I apologize.  I just was sitting here thinking about the entire industry.  I am leaving the MTSO companies and going to work for a clinic for the above reasons - as an employee.  I love MTSOs and have worked for quite a few of them as MT, QA, management.  I see the problems from all sides.  There are are villians or heros - it is what it is.  My heart mostly goes out to the thousands of MTs who followed the dream.  These are super intelligent people who have fought to figure it out, learned anatomy, physiology, typing styles, different specialities, computer skills, and finally got to the point they considered themselves a medical transcriptionist - only to discover it is hard to find a job, hard to make a living, hard not to be made to feel like trash by QA and/or management.  They are all asking "why", "what has happened?"  This is my take on some of the rhyme and reason.  I would be interested in comments - do you agree or disagree.  How could anything be changed.  Is there any hope.  Will you stay, go, work in house?  What will you do in the future?