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

Something we could do individually, locally, but would have a massive impact... - sm

Posted: Oct 17, 2012

Instead of trying to form a union or dealing with these MTSOs or trying to get the government to listen, let's just go straight to the clients with modest offer letters to work IC directly for the hospital. When I say modest, I mean an MT with over 10 years of heavy acute care experience would offer a flat 8 cpl as an IC for all work performed. Yes, yes, this is still low, but think about how it compares to transcribing random clients and running out of work all for a whopping 3-4 cpl. Also, this way, we could submit requests for cpl increases, which isn't available with MTSOs.

I'm in no way suggesting that MTs send out offers all over the country, or to the clients their currently typing for via the MTSO. I'm suggesting targeting your local hospitals and clinics selectively. Sending out random resumes doesn't help our credibility. We have to present ourselves as professionals. Clients want to feel special, and if we want their business back, we're going to have to accommodate them better than the MTSOs. For example, getting certified (the Indian MTs are CMTs, so to be competitive, we have to be CMTs), offering a set schedule, providing our own equipment/software, providing extra coverage upon request (including holidays, nights, weekends), offering to train new MTs if requested to do so, etc.... basically, above and beyond what the MTSOs are offering.

We could do this individually, so no worries about job loss or whether others are participating; and if enough of us do it, it could make a really big difference.

This is what the MTSOs did to us. They went behind our backs directly to the clients and made them an offer they couldn't refuse. We must do the same if we want our jobs back.

How do you plan to pay for - business sense

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all the administrative costs of doing the transcription? The MTSOs in many, maybe most, cases pay for the transcription equipment, maintain the equipment, provide IT support to the MTs, and pay for all the other costs involved in operating and maintaining a business. The hospitals aren't going to want to foot that bill, which is why they outsourced their transcription in the first place.

One MT cannot cover all the dictation produced by a hospital, and a bunch of individual MTs would have to coordinate their activities to get it done. Wow, you've created your own MTSO, with all the expenses and headaches involved in running one.

I'm sure I will be accused of being a "suit" or an MTSO shill since it's easier to attack the messenger than to accept the message. I'm just an MT, but I also know what it takes to run a business and what it would take to complete all the dictation a hospital produces and manage the transcription and equipment.

No hospital is going to hire a bunch of random MTs to replace an MTSO that is handling all aspects involved in getting the transcription done. Just not gonna happen. So, good luck with that.

How did you get from individual MT to MTSO? - sm

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No implication or suggestion or offer to start an MTSO was even remotely implied in my post. Read it again.

she is saying your plan morphs into same as MTSO. - lacks business common sense in a way. SM

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Please taken no offense.

MTSOs all lack a huge chunk of business sense. - Kindve evens out the playing field. ;)

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well then - are we blind leading blind? - anon

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Somewhere along the line we - MTs AND MTSOs - need to start listening to each other as far as brain pickin' and turn the ball the client who, I feel, pull our puppet strings just as much as anyone.

Do you know ALL MTSOs? - Nick

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Any time you quantify by using ALL, you have spoiled your equation. You need to take a course in basic logic before you spout off.

I did understand your plan - business sense

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I was making a point of my own, which seems to have sailed overy your head. I was simply pointing out that the only way your plan would have a chance of working would be to organize and coordinate the activities of the many random MTs who would be miraculously hired by grateful hospitals to replace the evil MTSOs. The organization that resulted would be a de facto MTSO. You can't replace an organized, functioning business with a bunch of amateurs. And before you get all huffy and claim umpteen years of experience as an MT, I'm not talking about MT experience. I'm talking about business experience, which is something your plan lacks.

In any event, no hospital is going to hire a bunch of IC MTs with no plan or ability to provide the back-end infrastructure and IT support that they are currently getting from MTSOs. If you think they're going to buy their own dictation/transcription systems and then hire people to maintain them, you're living in a dream world. Any hospital official making a recommendation to commit to that kind of outlay and ongoing expense would be committing professional suicide. Hospitals use MTSOs because they are cheaper than keeping the process in-house.

Some hospitals already ARE hiring ICs. Not all of - them are tickled pink with their MTSO. nm

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XYZ

Who said anything about buying and maintaining their own dictation systems?? (sm) - Annie

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All the client needs is a digital recorder. They have the staff and computer to upload the sound files to a secure FTP. The OP said nothing about clients buying the MT equipment and a digital recorder is a drop in the bucket compared to an EMS system and much easier to use with less down time.

Next point: Would you pay the same to have a house built on top of a rocky mountain with no paved road access as you would on a flat surface off a highway? NO! Then it makes no sense not to be selective with clients. I would always offer to do a few dictations for free so they could see my quality (and vise versa), then I'd quote a price. I loved an ICs comment yesterday about charging .35 cents a line for dictation via cell phone.

LOL. You think they want to pay staff to upload and download? sm - anon

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Again, obviously posted by somebody dreaming instead of facing reality or not interacting with physicians and office managers. Do you think that hospitals have time and funds to upload and download voice files? Think again! What about stats? Do you think a physician is going to run to the computer to upload a stat when he is caring for critial patients in the hospital? LOL. Think realistically... Even physician OFFICES will not deal with that. How do I know? I have obtained several accounts with the physicians not even giving their MTs notice because I have call-in dictation. They want to pick up the phone, dictate, and get the report back ASAP without issues or time involved. Think thast doctor is going to stop and upload his preop HP before surgery that he just dictated? Please....

Another thing.... Think it is easy for just any MTto walk into a clinic or hospital and obtain an account without their name out there and known? I think not. Even with a solid good reputation, I had to cold call to several thousand offices to land 1 account. I have since landed a lot more, but not without work, sweat, and being known to the physicans and surgery centers, all after working 12 years for them.

Another thing. Go cold calling and speak with these physicians. They seem to want the sun, moon, and everything else for 6 cpl. Luckily, I specialize in transcription requiring a lot of critical skills to require higher pay, not to mention experience with the right physicians to back it up.

pipe down, that is how it is done in the clinics. She probably is - not considering hospital work.. mt3

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ever think of that?

Even most clinics do not want to deal with this... - anon

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And she specifically mentioned hospitalomplications I work for 96 physicians, and none of them wants to upload voice files. Period. Not to mention, the audio on voice files from a recorder is extremely subpar to dictation systems. Also figure in the FTP folders needed to do this and costs involved.

I do not think the majority of transcriptionists who are working for companies realize the costs involved in obtaining and keeping accounts or the costs of doing business. Just to hire 1 transcriptionist and train is extremely expensive. Then add the costs of editing behind her.

every clinic I did had someone in the office do it. Took no time really. - course they did not WANT to but did.SM

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Only talking clinics here. Hospitals cannot use hand-helds.

and this is how I get accounts---they do not want to play with recorders - anon

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I have numerous clients who are paying me from what they say 2-4 cpl more than they were paying their last transcriptionist and drop them with no notice because I offer call-in, which I use a landline and INSIST they do too, and I am a happy camper transcribing extremely clear voice files.... Sounds like they are right next to me.eft They love just picking up the phone and not worrying about carrying a recorder or their staff uploading/downloading. You do your thing, and I will do mine. :) There is still no way a co op can exist transcribing at 8 cpl. I gross well over $7000 per month, and after expenses, let us just say there is not much left. I work solely to pay for good medical care and my dignity. Pride that I work instead of collecting off the government dole. Unfortunately, pride does not buy anything extra really. I would be out of business at 8 cpl and lose money on reports I subcontract out for overflow at this rate. Also, you should not be underbidding, which just drives everybody's prices down, defeating the purpose. When a physician tells me he gets his transcription at 8 cpl or lower, I tell them, good, stay with that service or MT. The ones familiar with my work or clients always come up in price.

Physician offices use software, too. - RC

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Just wanted to say, I'm still an IC transcriptionist, and my offices use software to upload/download.

They get their work back right away, and they seem to be happy.

That was my post, and I am extremely selective with clients - anon

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No, a dictation system is a lot cheaper. I have 96 physicians plus "guests," so multiply that by $600 per recorder, and no the facilities/clients do not pay for systems, we the transcriptionists do. Also, figure in the poor sound quality of a recorder and where they take it, and you would definitely appreciate a call-in system.

I have rules for my clients and include the use of a landline only on my service contracts.ight If they want to use my services, they follow the rules. Otherwise, they can go elsewhere, as I do not need the grief...

The most intelligent post I have read - anon

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Unless it is an extremely small hospital, but even they realize this now. My friend just lost her account to Medquist or whatever they are called now.

Dictation systems are more expensive than most realize, a good one costing up to $10,000 for a 4-port system, which has to be replaced every 2 years or sooner. Then, add phone lines, service contract, etc....

yep. lets not forget mainframing between facilities and - is that not supposed to happen nationwide now? NM

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`

MTSO/MT works for management, not drs. Manag. pays bills. - They want easy and cheap. nm

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x

most physicians in my local area have already gone... - anon

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with the point and click EMR systems and do not "need" transcriptionists any longer at all. Why would they give that up and have to pay an MT, even if it is less than the current MTSO???

It would not be cheaper than the current MTSO - business sense

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The MTSO covers a lot more than the simple transformation of the spoken word. There is the transcription platform to supply and maintain, the administrative costs of scheduling transcriptionists to make sure the work is done and returned on time, IT support, and the myriad of other activities associated with getting the work done and turned into medical records. A few IC MTs are not going to be able to provide the services an MTSO provides.

Platforms can be downloaded for free for the MT (sm) - Annie

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A secure FTP can be used for about $35 tax deductable dollars a month.

What I envision, and have posted about before is to talk about a co-op where we can exchange services such as overflow and IT services. Perhaps having one private Web site that would include a blog, jobs, classified, tech support, word board, etc.

I certainly don't have all the answers, but that is where we need to brainstorm. I don't see we very experienced MTs sticking with what we have to put up with from MTSOs and making half the wages we used to. There has to be something else for those of us who wish to stay in the business but make a legitimate wage.

Well, it takes a lot more... sm - anon

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Than you think besides the obvious equipment needs/IT. Experienced MTs? I just hired one with 30 years of experience. It took over 2 hours to edit a report from the most clearly spoken English orth imaginable. I sent her a 2-minute report several hours ago, again English-speaking on a landline. Where is the report? Patient is now having a procedure done... doctor is emailing me. Who is going to edit the work? I have gone through over 1,000 experienced transcriptionists, and not one can follow even 3 easy instructions or has less than 12 major errors. FTP: You need a separate folder for each dictator to upload, and then another folder for the transcriptionist.... very expensive.. And at your proposed 8 cpl? Who is going to pay to obtain the clients? Have you thought of this: If a transcriptionist pays all the expenses of obtaining a client and account setup (this can be extremely expensive for a hospital or surgery center or even certain clients), is she only getting 8 cpl and the others getting 8 cpl too without putting out the expense or time? Is that fair?

I wish I knew the name of your company - you have been here before I think

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Do you post your jobs on the Job Seeker's board and if so how can I find them?

No, I no longer posts jobs but... sm - anon

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Yes, I recently hired somebody, which is why I am a bit cranky today... Gosh, I have such extremely easy accounts and doctors that I just do not get it.

how about you send me a job - and I do it for free

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and if you don't like it you don't have to send me anymore.

Contact me Friday/Saturday OK? - anon

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I am seriously behind because I hired somebody else, took time out to send templates/info, and she disappeared... on my busiest day.

I have back injections Friday and might be sore but if not Friday, then Saturday. Are you familiar with templates? Lots of free lines but critical thinking skills needed for some accounts, very easy. Doctors all speak clear English on a landline. Great clients!

have you tried to contact this new hire at all? - anon

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maybe she is sick or something. Maybe her computer is down. call her. email her, see what is up. was there a time limit on the work you sent her? did she know what the time constraints were? It seems to me, for your "busiest day" that you have spent an awful lot of time on this site commenting on things, as well. You can't be that busy then, in my opinion, but that's just me. Communication is key. If you don't tell the new hire exactly what you expect of her, maybe she does not know that you wanted the work done right away. JMO.

Yeap..... - anon

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I finally got a hold of her. Yes, she knew what was expected of her, but that does not mean she will actually do it.

I do get to take a few minutes while eating and a break here and there.

If you are transcribing reports for surgeons for patients going into surgery, it is kind of obvious they are needed right away, but I did inform her of TAT for all 9 facilities just in case. If you just got hired for a new job and specify you want to work earlier hours, would you not check your computer prior to 5 p.m. when you state you do not wish to work past 4 p.m.?

beware....is all I can say. - nonymou

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you will be sorry!

It sounds like there truly is a shortage of MTs - Leaving MT

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Based on what you are experiencing, it sounds like there is a shortage of qualified MTs or at least responsible MTs. What a headache. Makes me kind of embarrassed to be an MT.

It does go both ways with small MTSOs, though. I worked for one for my first MT job and it was a nightmare, mainly in terms of her assigning work in a timely manner and then honoring the 24-hour TAT that was required. In her contract, she stated that we would get our work assignments in the evenings and have 24 hours to get them back to her, but I would be sitting there waiting for the assignments to plan my day out the next day, and it would be sometime midmorning the next day before we would get the work. She still wanted it back by close of business that day, though. I left and now work in a big MT pool, which has its own problems, but at least I don't have to wait on someone to assign work. If there is work in the queue, then great. If not, I can leave and check back later. I cannot imagine working for a small MTSO that has demanding TATs but having to wait on assignments to trickle in. I can't sit at the computer with no work and wait. I have to be able to leave and come back. The typing pool is great for that. Paid hourly -different story.

There is no shortage of MTs! They would come back if offered - a LIVING WAGE.

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!

yes, agree sm - anon

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But... I assign work as soon as it comes and and state exactly what to expect up front, and I also give them the names of service owners I am friends who have work available for additional work as well as email the service owners myself. I am simply besides myself, need urgent medical care, so..

I have a lot of clients who gave up doing EMR; however... - anon

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Love the convenience of templates, etc. The problem is I cannot find transcriptionsist who can use critical thinking skills to transcribe these reports, despite the fact how lucruative this is, as in free lines.... Besides my own clients, I receive a lot of calls weekly from physicians who now realize time is money for them....

I get a lot of calls from physicians... - just me

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Not wanting to do EMR themselves anymore. They have figured it out that they can be making money seeing patients, etc., instead of documenting this or are now getting injured. In fact, 2 of my largest accounts WERE EMR and now use me. Too time-consuming for them.

I work directly for the physicians on 99% of accounts - anon

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No, a low percentage work for office managers, and we all answer to the physicians themselves. If that doctor wants "the" instead of "a," as an IC will will definitely hear about it. They also want client-ready work, so for those of you who think punctuation and grammar, etc., is not important, think again. My clients require 99.999% accurancy, including "a" and "the."

Underbidding is not the solution. We want to RAISE our wages - anon

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Obviously, you are not experienced in having your own clients to suggest such a low price. Have you thought about the costs of call-in dictation, editing, hiring/training/QA, advertising, website hosting, FTP folders (2 for each, dictator and transcriptionist), software/platform expenses, accounting, overhead expenses, fax/printer/ink, etc.? I think not. I am losing money paying my transcriptionists 8 cpl, as I have to edit behind them significantly, pay dictation system costs, numerous landlines, etc., as well as constantly update reference material, have at least 2 of everything, and a very powerful computer, taxes, health insurance, the list goes on. You would also be UNDERBIDDING everybody else, and the only way you could provide transcription at that cost is to pay 4 cpl, which is what everybody is griping about. I have my own accounts and have owned my own business for the last 12 years, since prior to graduating from my transcription course, the second one, as the first was worthless. For acute care especially, you have to have reference material for every field not to mention addressing sound quality, which is expensive. I know. I do not allow VOIP or cell phones and pay through the nose for landlines. Oh, and platforms! They cost several cpl also.

If I cannot make it on 10 cpl and am turning down clients due to this (as I lose money on what I do not type by myself), how do you propose to make it on 8 cpl? And underbidding? We all know what that leads to.

Unfortunately, this is just another example of some transcriptionist working for a national that is unaware of reality.

Gosh, this has already been done... Called IC - just me

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I have had my own clients since the beginning of time.

I can assure you it costs more than 8 cpl. I spent $80,000 training my main transcriptionist and a lot more than that following. Oh, did I mention the costs of equipment? Dictation systems? Advertisement? Insurance?....

When you have your own clients, there is no set schedule. You work 24/7 until the work is done. Period. Call-in. Well, they think you are open 24/7. QA: You better have that work 100% perfect, which means QA'ing 100% to voice by yourself. Do you think that transcriptionist working for you cares about the quality? Think again. She does not stop to think if you lose the account, she loses her job. BYW, they job hop every few days, so the money you spent or it cost you by not working to hire/train/send templates and info is now gone, as might your client be depending on how fast you can type and how long. Overhead: I would like to know where you can get free equipment and QA, as not even I can afford to work for 8 cpl. Time and money spent obtaining clients: Please start looking and advertising and then post how much time and money this cost you.

Approaching local hospitals - Anonymous

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My local hospital outsources. The clinic where I work just laid off the entire MT department and sent the work to a company that offshores. There is no one for me to approach on a local level. I'm afraid that is the norm for almost everyone these days, all the on site MT jobs have disappeared, and they are not going to bring the work back and give it to us.

Definitely worth discussing! (sm) - Annie

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I like the idea of a nonprofit organization formed by experienced MTs who have had a lot of IC experienced. The purpose would be to support MTs in their endeavor once again be independent and return to a living wage. Administrative costs could be financed with annual membership dues. The benefits of membership would include an online forum, as previously described, where MTs could form specialty groups to handle larger accounts, access to back up MTs for overflow, vacation coverage, etc. Cross training between two MTs would be an additional benefit, as well as an IT forum.

I have worked as an IC for over 20 years and this has included sending digital files via secure FTP server. The dictation was via quality digital recorders and I had no problem with sound quality.

A lot of good information has been provided in this thread by one IC I'll call "96" with 96 clients. 96, your system seems to work well for you, but the cost of call in dictation systems with numerous landlines, with maintenance of the equipment I would not even attempt. One would have to have the capital to finance this, and I don't think it is as cost effective as digital transfer, although I may be wrong. That is why I am here, to learn and share. If we can do it in a respectful manner, we can accomplish a lot more.

If anyone would be interested in joining a Facebook group to brainstorm and share ideas, please "like" this message and if there is enough interest, I'll start one.

Annie, the biggest issue to address is the QA-sm - anon

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Years ago, transcriptionists would be responsible for their own reports. Unfortunately, over the years, Mtshave now relied on QA to fix their reports. I speak from experience. I have the EASIEST English-speaking dictators on the easiest accounts, so you would think this would be no problem, especially when most of it is templated right there. Think again. Right versus left, wrong side, wrong procedure, dictation and transcription not even coming close.... You would be amazed at what has come across my desk, or in today's case, WHAT IS NOT ON MY DESK, a 2-minute report, a consult doubling as a preoperative HP assigned 7 hours ago. OK, procedure is now over, client is furious... Also, digital recorders can add up a lot more expensive than a dictation system and a lot easier to manage as well as sound better. I know all of my clients and see them not only as a service provider but a patient. Most do not like recorders at all. I am lucky that a lot of clients have fallen into my lap, word of mouth, as I have had to cold call as well, which is extremely expensive for the results you get. I am the one with 96 physicians and have been turning down accounts and large clinics for the last few years due to QA issues when I hire.

96, I've been there with subs... - Annie

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I had what I considered extremely good dictators who dictated extremely fast. I was surprised at the feedback from subs who "couldn't understand a thing he says". Part of the problem was the MDs becoming so spoiled as I'd had their accounts over a decade and knew what they meant to say. A person several states away who doesn't know the local doctors, locations, facilities, etc. is doing to have to devote a lot of time to research. I finally gave up on subs for this reason, although many were very good MTs. It just took me too long to have to proof and edit all the work so I preferred to drop accounts rather than sub to keep my hours under 16 per day.

Part of this problem could be eliminated with doctors knowingly dictating for a new person. Most of mine have been very cooperative, slowing down a little for the autopilot standard PEs, etc. That doesn't happen with MTSOs as it seems everybody is new and the docs don't even know they aren't in their state.

I'm very suprised your docs do not like recorders. Mine hated the idea of EMR because they could no longer dictate while driving, walking around, checking labs, etc. I think doctors would still prefer recorders than a stationary mic or headset. I didn't have a problems with quality recorders, except when one doc liked to place the recorder on top of an oscillating blood spinner while he wandered the room dictating.

I'm familiar with the problems ICs face, as I did it for over 20 years, but the situation today working for MTSOs is worse than working long hours as an IC with half of what you do admin and unpaid. I think the solution is a group (nonprofit), membership due supported, that is run BY MTS FOR MTS rather than a group of management people with the capital to buy all the software, equipment and IT services to collect half our salaries. I may be completely wrong, but I think it is worth a try to save our jobs and income.

Dictators - anon

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My dictators are not allowed to dictate as above. They call it the bat phone... A landline specifically used for dictation in the quietest area possible for dictating and nothing else. To my horror a while back, they installed VOIP, but as my service contract states a landline, they put it back in for me. So sweet! Just like in the good old days when they had C-phone stations.

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