ok this is really a rant and it's long - tiredoftheBS

THE DEMISE OF THE MEDICAL TRANSCRIPTIONIST

I started to call this "The Demise of the Medical Transcription Industry," but that would have been inaccurate.  The industry itself is thriving.  Actually, transcription companies in all probability show the highest profit margin of any healthcare-related industry in the United States.  In fact, I would swear to it. 

I have done some research and I came across several interesting articles.  This paragraph is an excerpt from an article about HCA Holdings.  Their profit margin for the last quarter of 2011 was $1.9 billion.  It is a staggering amount, but not really so much when you break it down. 

"HCA Holdings, Inc., through its subsidiaries, provides health care services in the United States. The company owns, manages, or operates hospitals, freestanding surgery centers, diagnostic and imaging centers, radiation and oncology therapy centers, rehabilitation and physical therapy centers, and various other facilities. Its general acute care hospitals provide medical and surgical services, including inpatient care, intensive care, cardiac care, diagnostic services, and emergency services, as well as outpatient services comprising outpatient surgery, laboratory, radiology, respiratory therapy, cardiology, and physical therapy; and psychiatric hospitals offer therapeutic programs, such as child, adolescent, and adult psychiatric care, as well as adult and adolescent alcohol and drug abuse treatment and counseling. As of December 31, 2011, it operated 163 hospitals, including 157 general acute care hospitals with 40,988 licensed beds, 5 psychiatric hospitals with 506 licensed beds, and 1 rehabilitation hospital, as well as 108 freestanding surgery centers in 20 states and England. HCA Holdings, Inc. was founded in 1968 and is headquartered in Nashville, Tennessee."

So the generation of $1.9 billion in profit is split between 227 different facilities.  Obviously, the large hospitals would be taking in a lot more than the small outpatient surgery centers, but still, for the sake of the numbers, it is split 227 ways.  That calculates to $8.37 million per facility.  Quite a paltry amount once you read the next excerpt.  Transcend Services is a transcription company, although this information was in an article about their 2009 profits, and it is a bit of a moot point now because they have recently sold out to Nuance.  I will get to Nuance later, but for now, let's just look at this one single transcription company's profits.

"Transcend Services Inc.’s net income was up 3 percent in the first quarter, following charges related to a bid to acquire a competitor.

The Atlanta-based provider of medical transcription services (NASDAQ: TRCR) had net income of $1.63 million and earnings of 15 a share, compared with net income of $1.58 million and earnings of 18 cents a share in the first quarter of 2009.

Revenue for the first quarter of 2010 increased 49 percent to $22.2 million."

Now you could argue with me on this one, because $8.37 million is quite a bit more than $1.58 million.  However, you must take several things into account before I will call it a good argument.  Let's just say the $8.37 million is for an average-sized, 300-bed hospital.  Obviously, a 650-bed hospital would make more, while a small outpatient surgery center would make much less, so I just picked a number in the middle.  At one time, I worked for a 650-bed hospital.  It was an 8-story building with a separate (attached by a crosswalk) emergency room.  There had to be a minimum of 5000 employees when you consider everyone from ancillary services including lab work, x-ray technicians, and all the way down to maintenance, housekeeping, cafeteria, and so on and so on.  It is a 7-day, 24-hour operation, and except for things like surgery, unless emergency surgery, most hospitals do not run on an 8-hour day.  Considering the cost of paying employees 24 hours a day plus the cost of electricity, etc., it is a very high number, so to make $8 million, probably at least four times that amount must be taken in.  This is a guess for me because I am not a math person, but let's just put that in as an estimate. 

So let's go back to the amount that Transcend Services brought in in one quarter.  That is the $1.63 million in the first quarter of 2010.  If the average hospital needed to make $8 million in one quarter to make a profit and pay all of its employees' salaries, benefits, and overhead for the hospital, there is no way their profit margin could have been equal to Transcend's $1.63 million profit.  So where did all of this money go?  Let's just say it was NOT put into Transcend's employees' salaries, benefits, or overhead.  It went into the hands of the company owners while they were continuing to hire more transcriptionists for less money than an average transcriptionist was paid over 10 years ago.  I have not personally worked for this company, but since they are all the same, I know where the money did not go. 

I think this advertisement will illustrate it much more clearly than anything I could say.  I just Googled "medical transcription companies for sale in Tennessee," and this is what came up.

Medical Transcription Company - $300,000 Profit
Location: United States -> Tennessee
Industry: Health and Medical > Other Health and Medical

Business Summary

Well established medical transcription company with long-term established client base. State-of-the-art software technology. Owners to stay involved in a commission-based sales capacity after the sale.

Financials

Asking Price Range:  $500K - $1.0M
Gross Revenues:   $1,200,000
Cash Flow:   $300,000
Cash Flow Type:  EBITDA
Seller Financing:  Yes

About The Business

Year Established:  1999
Number of Employees:  10 - 19
Relocatable:  Not Disclosed
Franchise:  Not Disclosed
Current Real Estate:  Leased

Here are the key points.  I do not really have to mention the asking price or gross revenues or cash flow, do I?  The point I want you to concentrate on is the "number of employees."  It says 10-19.  WHAT?  Very funny.  That is NOT the number of transcriptionists they have working for them.  That is the number of employees they have working in their ACTUAL OFFICE.  These include the CEO, CFO, COO, HR Coordinator, Payroll Director, computer techs, and the staff who answer the phones to help a client in need.  That is how much overhead they have to pay which is just enough to cover the skeleton staff they have in their actual office.  The transcriptionists pay for their own computers, internet service, library of reference books (I prefer Stedman's), desks, printers, and literally anything else necessary to have a "home office."  They are not free.

Now I can get to the point of all of this.  I have a link to an article that I got this information from.  I did not send the link because most people will not open a link from a blind e-mail, but would be happy to provide it to you.  While all of the transcription company owners are making a fortune, this is what has happened to the transcriptionists' salaries.  These were the only 4 jobs in the comparison.

Position                1998                           2009                                        % Change
HIM Director       39394                           67500                             71.35%
Coder                 27609                            42500                          53.94%                       Cancer Registrar   29357                         42500                              44.77%
MT                    26556                         27500                                3.55%

HOW DID THIS HAPPEN?

The transcriptionist became devalued as a result of many things, one in particular being those stupid study-at-home courses to "become a medical transcriptionist, work at home, make $40,000 a year."  I do not see a $40,000 salary listed above, but I can tell you there was a time that I made that and much more.  It was in between the 1998 and 2009 listed above.  We do a hard job.  We have to know all of the medical terminology for every specialty.  We have to listen to dictators who do not speak English and try to figure what medical English word could the dictator possibly be trying to say.  We do not get an hourly pay.  We work by how much we produce, and we must maintain a 98% quality score on any random audit done on our work at all times OR THEY WILL CUT OUR PAY.  Sometimes there is no work during our shift, through no fault of our own, and we have to make up the hours during our off time.  If we fall short, THEY WILL TAKE AWAY OUR INSURANCE.  I am required to punch into a time clock and then sign onto our transcription software.  The software is now so sophisticated that IT KNOWS if I am typing!  I must be typing at all times that I am punched in with a 10% allowable variance.  This means that in an 8‑hour day, there are 480 minutes, and I am allowed to be not typing for 48 minutes of the 480 minutes.  This means I must type 54 minutes of every hour.  I am no longer a transcriptionist.  I am Chinese Slave Labor.

So once again, HOW DID THIS HAPPEN?

WELCOME TO INDIA!

One day, someone came up with the bright idea that we should send OUR medical records to be transcribed by people in another country, such as India!  Then, as if the owners were not rich enough, they could pay EVEN LESS money out!  Oh what a happy day this must have been!  Maybe I can move to India and get my job back! 

When this began, they began to cut our pay.  The transcription companies all looked at what each other was paying, and suddenly this became the "standard rate."  There was no increase for experience.  Everyone is paid the same, and if you do not think that is fair, they will give you some trite statement like "you should make more than someone with less experience because you should be faster."  I have been doing this for over 20 years and I only have one speed, and it is fast, but I still only have the one set of hands and one keyboard.  Make me an octopus and I will give you more work.

Over the last 5 years, I lost my house to foreclosure, filed bankruptcy, moved to a 2-bedroom apartment (so I could have an office), moved to a cheaper 2-bedroom apartment, and now live in a 1-bedroom apartment.  Why do I still do this job?  Because I am almost 50 years old and have applied for every medical job ON EARTH, but apparently no one is in need of a washed-up transcriptionist.  In addition, I watch a website called MTstars.  On this website, you will find people complaining they cannot even make minimum wage.  The companies they work for have to pay them the difference between what they made and minimum wage, then they fire them because they could not make minimum wage, when 9 times out of 10, it is the company's fault for overhiring.  I have two problems with this.  One is that there is NO ONE who is transcribing medical records should be only making money for the owners of the company.  The second is that I DID NOT GET INTO THIS CAREER TO MAKE MINIMUM WAGE.  I did not give 20+ years of my life learning everything medically that I could so that I could make MINIMUM WAGE.  I can get a job in housekeeping at a hospital downtown and make more than that.  It is completely ridiculous.

Now here is my real problem.  I realize this is in part a result of NAFTA.  I know that everything I pick up in the store says Made In China.  I also know that if I call a credit card company, etc., chances are my call will not be answered in America.

I HAVE A PROBLEM WITH MY PERSONAL INFORMATION, INCLUDING MY FULL NAME, DATE OF BIRTH, ADDRESS, SOCIAL SECURITY NUMBER, AND ALL OF MY MEDICAL HISTORY BEING IN THE HANDS OF SOMEONE IN ANOTHER COUNTRY. 

In the United States, to be employed in any job associated with healthcare, we must all abide by the laws of HIPAA.  Citizens of other countries are not bound by American laws.  We made the laws for our PROTECTION, and if my personal information including all of the above is being sent to another country, I am not protected.

I consider this to be a gross breach of Homeland Security.  I will give you a scenario.  Imagine there is a person transcribing medical records in India.  Imagine it is a Discharge Summary and the patient happened to have died.  Imagine the person transcribing this report has contacts with terrorists.  Imagine he makes a phone call and gives a terrorist organization the deceased person's name, address, date of birth, and social security number.  Imagine they have a fake passport with all of the deceased person's information on it and they are on a plane to America before the deceased person's obituary is printed. 

Like I said, this is not about products being made in other countries.  I cannot stop that.  What I would like to do is get our medical information back in this country where it can be secure or at least there are laws to protect it. 

Oh yeah, and then maybe I could trade in my 14-year-old car for something like maybe 10 years old???