Unfortunately, I don’t have the original draft I had submitted, which got sent back to me for some editing because the PTB at AAMT didn’t feel I was being positive enough about the future outlook for medical transcription. That draft would have more accurately pinpointed my predictions for the industry and how I felt about the future of medical transcription. With that caveat…

Although many transcriptionists work through the internet, they may be unaware of the scope of technological changes and the jockeying for position currently taking place. Many see a threat from offshore labor, when they should be looking at the technology that resides on their own desktop. The very tools we use to enhance productivity are also available to the computer-literate physician, especially if packaged nicely and marketed aggressively by a far-sighted company. The advertising claims that physicians can replace their transcriptionists are not far-fetched. Some physicians have, in fact, done just that and are perfectly satisfied with the results. The number will increase exponentially over time, in much the same way the technology has advanced. Transcriptionists need to prepare themselves to work within the new model of  business that will be created by the available technology and the changing environment of business brought about by the internet.

I’m pretty sure that last sentence was part of the edit. Notice that I don’t say HOW MTs need to adapt. Quite frankly, if memory serves, I couldn’t think of a way they could that would keep them in this picture. After all, I just predicted that technology would give physicians more tools to facilitate reducing or completely eliminating medical transcription.

At the time the article was written, the AMA reported that 59% of physicians weren’t even using computers. I wasn’t able to find a recent study, which suggests to me that there’s an assumption that medical practices and healthcare facilities are using computers, including mobile devices.

My updated prediction is that this trend will continue and we’ll see an even bigger spike as more computer-literate physicians enter practice. They will not only be less resistant to entering data into the computer directly, they’ll be more proficient at it than their predecessors.

I also predict that as more computer-literate patients enter the system, and as technology advances, we’ll see patients entering their history directly into an EMR, either at the doctor’s office or online. Or, if interoperability issues are resolved, retrieved from a PHR. I predict updates will take place the same way, so you can review the history the physician or facility has for you and enter any updates or changes. As EMRs evolve and improve, the information you give the doctor will be available to any other facilities or offices in the system. There are already systems that share information with providers across the system. As always, the technology will only improve over time. Young adults who have used computers most or all of their life won’t wonder why they’re being asked to type in this information themselves – they’ll wonder why it isn’t available, or why they have to enter the same information multiple times in multiple places. I think there will even come a point when speech-to-text is so accurate that this data entry will take place in the form of speech, combined with touch screen and keyboarding.

A new tool becoming available to the individual transcriptionst and smaller business owners is the application service provider (ASP)… The purpose is to provide an “enterprise” solution for physicians (in plain English – one-stop shopping). By giving physicians access to something everyone knows they utilize, the portals hope to entice them to take advantage of other services and/or goods being sold through the portal. The advantage an ASP can give transcriptionists as a by-product is more equal footing with the large services. Access to both physicians and other transcriptionists becomes a possibility, at a price that is not beyond reach. It will no longer be necessary to take a deep breath, hyperventilage, then sign a five-year lease agreement for $ 60,000 worth of digital dictation equipment that will be obsolete before the lease is up. ASP networking will allow transcriptionists to work with each other to coordinate coverage for peak periods and time off… The ASP model provides state-of-the-art networking and upgrades inclusive with the other services offered.

I’m not sure the ASP model has been of great benefit to the independent MT, working solo or in small groups to provide service to select physicians. I think it has been of benefit to small transcription services looking for growth opportunities. In the past ten years, a model used by some ASPs is to do the marketing and sales, then contract with various independent MTs and small MTSOs to perform the work. In this scenario, the ASP sets the price to the client, not the MT or the MTSO. Like everything else, the ASP market has continued to evolve, with multiple acquisitions, change of ownership, mergers, and some winners and losers. Very few of them partnered with portals; instead, they became transcription platforms, with interfacing on the client end for compatibility with whatever technology the client used. Companies like InterFix made it easier to interface the ASPs with the multiple hospital IT systems and recently, in partnership with AHDI, created the Benchmark KB, a desktop application for transcriptionists that interfaces with various transcription platforms. The value of the Benchmark KB is that it reduces training and learning curve for transcriptionists working for a company that uses more than one platform.

Although currently many physicians remain blissfully ignorant of templates, macros and normals, that will change as doctors become more computer literate and money gets tighter. I predict more transcriptionists will be requested to discount or not charge for templates or normals.

I think I got this one right. What I missed completely was that anyone would not count spaces! I also missed that there would be transcription services (in my experience, predominantly overseas services) that would use this as a selling point, not only discounting the characters contained in templates, macros and normals, but also undercutting prices at the same time, further eroding the rates charged by US-only companies and the earning ability of medical transcriptionists here in the US.

The next level for speech recognition will be speaker-independent recognition. Translated for the technophobe, the technology will be able to understand the dictator who is your worst nightmare, with very little user training.

This prediction was accurate, in fact. Not that no training at all is required, but companies providing server-based (also known as back end) speech recognition do train the speech recognition engine, but they do it using a library of digital dictation files obtained from the system. Physicians are not required to sit and train the engine. Most of them are told they don’t need to change their dictation habits, which is more for the purpose of getting them to adapt to the system than anything else because there certainly would be a benefit to the accuracy of the documents if the physicians were willing to make some changes.

The question for transcriptionists is: will it matter if recognition accuracy is 100% when grammar, punctuation, syntax and language usage are not (how shall I say this?) – exactly representative of a strong foundation in English? My prediction is that it won’t. I believe as long as the document says what the dictator means it to say in a relatively clear (i.e., defensible) fashion, it will be accepted… While we may wring our hands that the quality of patient care is being compromised, who is actually compromising it – the physician, the transcriptionist, or the software used to create the transcript? Ultimately, the responsibility belongs to the physician. The more we try to take ownership of this responsibility, the more liability we expose ourselves to – a questionable tactic for assuring job security.

Well, I feel my crystal ball was working really well on this one and I probably don’t need to add anything to this.

If you don’t know the difference between DOS and Windows programs, it’s a reasonable conclusion that brushing up on your tech knowledge is necessary. I predict a future where computer literacy will be tested along with English literacy, and not just in the MT profession.

I found the following excerpts in current job listings for medical transcriptionists:

Cerner experience preferred. No satellite.

Meditech Client experience.

Are you reasonably computer literate? (This may be tested.)

Familiarity with transcription platforms (M*Modal, eScription, DocQScribe, and Spantel) a plus.

We are looking for editors who have had experience with the M*Modal platform.

You must have the necessary software (EditScript MT) and equipment (IN-DB9 or IN-USB pedal) in place with Microsoft word and a current electronic medical spell check loaded, ready to work.

Computer that is no older than 3 years. High-speed cable or DSL connection. Air card and satellite will NOT be supported. Internet service with AOL is not supported. RAM (memory) – 512 MB minimum. Hard Drive – 40 GB minimum. External computer speakers with volume control knob and headset plug-in. Good quality headset. USB port foot pedal. CD-ROM drive.

You MUST know how to use a FTP program to download and upload work. … Please DO NOT APPLY if you do not hve the required equipment or know how to use a FTP program.

I think it’s pretty obvious that computer literacy has become an essential part of the job, and we’re way past having to differentiate between DOS and Windows! What’s also become important is having a computer that has up-to-date software and current software. It would be difficult to find a job listing that doesn’t include software and hardware requirements, as well as internet connection requirements.

The article also completely neglected any mention of how technology would impact US medical transcription by facilitating overseas competition. Because digital technology and file transfer was available in 2000, I know overseas competition was a big concern for US MTs at that time. I’m not sure why I left out any mention of it – whether I was asked not to, or whether it was based on my opinion that there’s nothing you could say about overseas medical transcription that you couldn’t also say about onshore medical transcription, or whether I felt it had no place in a discussion that was about technology – I’m not sure. My memory isn’t what it used to be.

My crystal ball says that medical transcription as we know it will continue to deteriorate in both value and pay, and that advances in technology and a burgeoning population of computer literate physicians will contribute to that. We keep hearing that medical transcriptionists need to change their skill set and adapt in order to survive, and I agree with that. However, I see it evolving to an increasingly clerical position, with pay rates comparable to a clerical position. What MTs need to decide is whether or not they want to continue to work in the evolved position, at the evolved pay rates.

Hopefully, I’ll be around in another 10 years to see if the predictions I’m making here will take place.

MT Exchange

MT Exchange

MT Exchange

I’m not going to go into the whole story or link to the original post (because it’s just going to move off the page and be lost forever anyway), but here’s the general idea. The original poster (OP) did some work as an independent contractor for an MTSO in California. The 1099 she received had, for some inexplicable reason, the correct name but the address on it was the MTSO’s address in California. She then asks how she proves she’s not a California resident so she doesn’t have to pay 7% income tax in California.

There are many things wrong with this. First of all, whoever did the 1099s needs to go back to tax school. The address of the person the 1099 is being issued to is what’s supposed to be on the 1099, not the address of the person they did the work for. My advice? Send the MTSO a letter requesting that the 1099 be reissued with the correct address and send a copy of the letter to the California Franchise Tax Board.

Second of all, the withholding being referenced doesn’t go into effect until January 1, 2010, and even then it doesn’t apply in this situation.

Beginning January 1, 2010, the state of California is requiring payers to withhold 7% tax on reportable income for non-resident workers. There are details and notable exceptions of course. Companies and individuals doing work in California needs to download the guidebook (PDF) and read it.

The state of California is, as most of us already know, broke and grasping at straws. It seems the purpose of this particular requirement is to make sure it captures revenue that has been lost due to not being reported. This law will most affect people who come to California from out of state, work for a short period of time, then return home. It targets California non-resident independent contractors specifically.

But here’s the catch: the work must be performed in the state of California. Which lets out remote workers because you aren’t actually located in California. You can work for an MTSO located in California on an account for a hospital in California, but as long as your butt is in a chair in Kansas or anywhere else that isn’t California, you are exempt.

Download the guidebook and read it. I find the horse’s mouth is always the best place to get information. And my husband (a CPA) says you should never take tax advice from anyone but a tax professional. (I’m sure he means this as a warning to me, should I be inclined to give out tax advice on this blog!)

MT Exchange

However, medical transcriptionists everywhere can rejoice, knowing that AHDI now has a manual of ethical best practices available for us healthcare documentation sector workers.

And signaling that yes indeed, the practitioner member is once again not as important as the practitioner MTs themselves would like to think, there is no special pricing for practitioner members. Should you decide you can’t live without knowing why there’s a section for AHDI Code of Ethics and another for MTIA Code of Ethics, this baby will cost you a whopping $ 4,000.

Which is, I’m sure, just the start of the confusion.

After stating (very convincingly, I might add) that this is much, much less expensive than you’d pay if you put this together yourself or pay someone to do it for you (can you put a price tag on the AHDI Code of Ethics or the MTIA Code of Ethics? I think not), then setting you back on your heels with the $ 4,000 price tag – they soothe your ruffled feathers by letting you know that everybody except practitioner members can get this for less than $ 1,000.

Damn – I sure hope practitioners don’t actually need this for anything because at a reported average annual income of $ 30,000/year, the cost of this is just over 13% of an MT’s annual pay.

The pricing on this package (and possibly even the package itself) signals that not only is AHDI still floundering when it comes to offering anything of value to this membership group, they also don’t mind spitting in their faces. Because just in case you missed the part where you’re paying more than anyone else, there’s this friendly reminder:

It’s comforting to know that Gold Members of MTIA – which I’m sure includes companies that could actually afford to develop this information inhouse – don’t have to pay a dime. I’m sure this contributes mightily to the credibility of the claims that the relationship between AHDI and MTIA is good for both. I wonder how many Gold level members are on the MTIA Board. Just wonderin’, that’s all.

Isn’t it nice to know that AHDI knows which side its bread is buttered on? I’m looking on their web site and trying to find some indication as to who they think is going to pay the dues to keep the organization afloat if they piss off enough practitioner members, which still constitutes the largest membership group. Maybe AHDI has given up trying to find something of value to offer to the practitioner members.

Since I’m never going to pay $ 4,000 (or, let’s face it, $ 250, $ 750 or $ 950) to actually take a look at this manual of ethics and best practices, I really shouldn’t can’t say much about the package itself. I am, however, going to latch onto the term production location transparency. It’s a whole lot catchier – and easier – than “where is this work being transcribed?” I guess I’m just going to have to wither away with curiousity as to the difference between AHDI’s code of ethics and MTIA’s code of ethics.

MT Exchange

Can anyone tell me if it makes a difference which online program you use? I’ve heard that potential employers look for someone that’s been trained by an AHDI approved program. But when I asked Future MT, a non-approved program, they said that their program was as good as the others on AHDI’s list but you have to pay to get on that list and they simply choose not to, so as to pass that savings on to the student.

I found that an interesting response from FutureMT because it’s wrong on so many levels. Well – I suppose it makes sense if you’re trying to justify to prospective students why you aren’t on that list. I wonder how many people fall for it (probably quite a few). Because if you go read that discussion at MT Chat, you’ll see that Mike DeTuri broke down the cost per student based on XX number of students and it’s pretty negligible. And aside from that, schools don’t pay to get on the list, they pay a fee to apply to be on the list – big difference. A school can pay the fee and submit the required information and if they don’t meet the requirements, they still aren’t approved – and they don’t get a refund of their application fee.

So I moseyed on over to the FutureMT web site to see what their web site says about them. And I discovered something else interesting about FutureMT:

Future MT is not an accredited medical transcription course as a university within the state of incorporation, but rather a nationally recognized online education course using similar guidelines of major Universities.

When it comes to voluntary programs designed to evaluate a school program, FutureMT doesn’t seem willing to waste its money, as it isn’t accredited by the state of Florida, where the company is based, either. Not unlike the transcription sites that all claim “best, fastest, cheapest,” making a claim of nationally recognized online education course is pretty easy. It can’t be verified, certified or accredited – but it sounds good! (Maybe I should change the MT Exchange tag line to nationally recognized online blogger.) There are a number of nationally recognized accreditations for distance learning programs, including the Distance Education & Training Council (DETC), Accrediting Council for Independent Colleges & Schools (ACICS) and Accrediting Commission of Career Schools and Colleges of Technology (ACCSCT). Accreditation by any one of these would at least give proof to the claim of nationally recognized online education.

In fact, this is one of the requirements to become an AHDI-approved school:

The school/program must be accredited or licensed through a governmental body.

So in terms of as good as, strike one for FutureMT.

What I like is the consistent theme: we’re saving money for our students!

Another benefit of Future MT’s course is that we do not have the large overhead needed to run a college, so we are able to pass those savings to our students and offer the same course at a more affordable cost.

I don’t know how prospective students read this, but it makes me wonder whether they have other cost-saving measures that might be cutting corners a tad too close – you know? Like – instructors. Like – curriculum.

Speaking of which…

Another requirement for AHDI approval is that the school must follow the Model Curriculum for Medical Transcription. And it’s really difficult to tell from the FutureMT website exactly where their coursework comes from.

The book Future MT uses is written by the staff of Health Professions Institute, which is the top name in the field, and extremely reputable. In fact, the founder of the American Association of Medical Transcription (AAMT) also founded HPI. Their materials are used widely among the most respected institutions.

As far as I can tell, the coursework (curriculum?) consists of handing you a book that can be purchased straight from Health Professions Institute (HPI) and the SUM Program practice recordings, which can also be obtained directly from HPI.

But wait – there’s more!

You get unlimited live mentoring with experienced MTs! I’m not hearing the word “instructor” or “teacher” there. For all I know, their definition of an experienced MT is someone with 2 weeks’ experience.

Students, at the appropriate time from Future MT instructors will be given access to the transcript keys and compare their work to the keys in a split-screen format, giving them immediate feedback on their errors.

Oh look – NOW we have “instructors.” Let me tell you something about giving students answer keys – they don’t learn much and it renders the rest of the exercise useless once someone has the answers.

But wait – there’s more!

I felt this part was worthy of a screen shot. Please comment if any of this makes sense to you.

Huh?

And in the FAQ titled How Long Will the Course Take to Finish?, I found this gem:

Future MT’s medical transcription training focuses on helping students find work quickly instead of spending more time training.

Yes, we certainly wouldn’t want future MTs to spend too much time training! Let’s focus instead on getting a job!

But wait – there’s more!

There’s an Employment Service!

And it’s part of the Guarantee!

So let me see if I understand… if taking a list of potential employers and bombarding them with resumes for 60 days doesn’t elicit any offers of employment – they’ll help you do it for another 12 months, hoping for a different response? (What are their affiliate transcription companies, anyway? I hope this isn’t just a list of transcription services they scrounged off Google.) Does everyone here understand the definition of insanity?

And every flippin’ page at FutureMT ends with this:

I have to wonder how much value there is to that guaranty when I’m getting bombarded with messages from graduates who can’t get a job. Money back? You can claim it within the first 30 days of enrolling. Of course, by the time you graduate and can’t get a job, the 30 days is long past.

Do I really need to keep going? Unfortunately, there seems to be no limit to the number of people willing to be the fodder for cheap programs that will take their money, turn them loose – and then fill up my mailbox with pleas for help getting that elusive job.Which is why I keep blogging about it – someday, I’d like to believe my yammering made a difference.

I think it’s pretty clear that: (a) not all transcription schools are equal and (b) FutureMT is not as good as a school that is licensed or accredited by a governmental body and approved by AHDI. Let me be clear – I don’t think AHDI approval is the be-all/end-all – but it is a distinction, a step up and frankly, all we’ve got. Given that, I think it’s essential that the medical transcription community supports that program.

But that’s not all…

OK, I have to save the very best for last. This just had my jaw dropping. I went to the LINKS page at FutureMT, expecting to find links to MT resources and information. Instead, I found this:

Is it just me – or is this about the tackiest thing ever for a professional website? The only MT site listed there is one owned by FutureMT. I mean, really – credit score reports and satellite dish links on a professional site?

(Look for my followup article next week on Medical Transcription Schools and the FTC)

Teeny tiny disclaimer: Like everything else at MT Exchange, this is only my opinion. Take it for what it’s worth.

MT Exchange

Is the medical transcription profession doomed?

Just reading the title, I thought maybe AHDI was finally going to take off the rosie-colored glasses they wear in public. During the whole decline of the industry, they’ve insisted that there’s a place for medical transcriptionists in whatever new world health information documentation evolves to. (The other blog post there, Doctors weigh in on the use of scribes, is another worthy of its own separate rant.) So I eagerly went to read the entry, thinking maybe maybe AHDI is going to come out of the closet about the future of medical transcription.

Boy, was I disappointed when I read the blog entry. And surprised not only at the apparent cluelessness at what practitioner MTs (their base membership) go through on a daily basis, but the direction AHDI seems to be willing to take with the tone of this blog entry.

First of all, is it really standard practice for MT recruiters to not respond to those who are applying for jobs? Even if the applicant bombed the test, common courtesy would be to at least thank them for the effort, wouldn’t you think?

Is it really standard practice for the World’s largest professional association representing and advocating for healthcare documentation professionals (MTs, editors, and QA coordinators) (that’s what their Twitter profile says) not to know that yes, indeed, this is standard practice in the industry? That every day, recruiters receive hundreds of applications, solicited and not, and can’t possibly respond to all of them? That MTs take tests all the time – and never hear back a peep from the testing company? That common courtesy isn’t so common? That sometimes recruiters not only don’t know what they’re talking about, but they lie, don’t give direct answers to questions, set up phone calls they blow off, and are even downright rude?

Not that I think that’s a huge factor in what is happening to “doom” the medical transcription industry.

But here’s the part that blew me away:

It’s a tad ironic for someone so concerned about communication skills to criticize someone for not being “atriculate” and having poor “dictation.” And as anyone knows who has participated in online MT forums for any length of time, this scenario is all too common.

Let’s put aside for a moment that anyone who has participated in online MT forums for any length of time should know that the common response to this: I’m not at work so spelling, grammar and punctuation aren’t a priority. (And since I’m putting it aside for a moment, that’s all I’m going to say about it.)

How professional is it for the world’s largest professional association to slam a medical transcriptionist for spelling and grammar errors in an online forum? And a forum that isn’t even theirs?

AAMT/AHDI has never seemed to understand that nonmembers are still potential members and that’s demonstrated again in this blog post. It’s probably not a good idea to alienate your prospective membership base if you expect to recruit and grow – unless, of course, AHDI is happy with the number of members it currently has. However, by claiming to be the world’s largest professional association representing and advocating for healthcare documentation professionals (MT’s, editors and QA coordinators) it’s painting the MT world with a very large brush. I guess it wouldn’t sound so great to be the world’s largest professional association representing and advocating for a very small percentage of healthcare documentation specialists – but it would be a more accurate representation.

It’s one thing for a blogger with no affiliations to blow off steam about whatever they want. Heck, I do it all the time! But I don’t represent the professional association. Matter of fact, I don’t represent anybody but me. Call me old-fashioned, but the official blog of the professional association should be – well, professional! And in my opinion, being professional means you don’t slam MTs posting in forums for their spelling and grammar, even if they are anonymous.

AHDI had an opportunity to focus on something that’s wrong in the industry and actually advocate for the practioner MT – and they blew it by losing focus and attacking the messenger.

So if we’re looking at factors that doom the medical transcription profession, I have to say – AHDI, look at the mote in your own eye.

MT Exchange

In a prior post, Internet Marketers and Medical Transcription, I noted how medical transcription is an attractive target for internet marketers. What I didn't talk about was flogs.

In the medical transcription world, a flog might look like this:

Hi, my name is Jill. A couple years ago, I was desperate for work I could do at home to make some extra money for our family. A friend of mine told me about medical transcription, so I checked it out and found out it's a great work-at-home career for people like me. I went to XYZ Transcription School and got my certification. When I graduated, I found a job right away and now I'm making extra money while my children are in school. I don't have to pay for daycare, either – by the time they come home from school, my work is done and my house is clean! If you want to work at home, you should sign up today to go to XYZ Transcription School and become a medical transcriptionist, just like I did!

What makes this a flog?

What would make this a flog is if the person who owns the site and posts the entries isn't named Jill, didn't go to XYZ Transcription School (or any other transcription school) and/or isn't working as a transcriptionist – and never has. The site exists solely for the purpose of attracting people who are searching for medical transcription careers, work-at-home careers, etc., convincing these people that medical transcription is a wonderful career and that XYZ Transcription School will do a fabulous job of preparing them for this career – then referring them to XYZ.

Why would they do that?

Because XYZ Transcription School will pay them $ $ $ . This is known as an affiliate arrangement, where you have the advertiser (the MT school) and the publisher (the web site). Depending on the program, they will get paid for a lead (an e-mail address, which is why many of these have a "free" giveaway that requires signing up for a mailing list), a phone call to the school and/or a sale. Most of them pay based on a sale and the amount can be substantial. For example, FutureMT pays $ 160 when an affiliate site sends them someone and a sale is generated.

Don't get me wrong – I'm all for generating revenue. And there's nothing illegal or immoral about affiliates or affiliate ads.

However, not only are flogs immoral (in my opinion) – they are also illegal. And they always have been.

Pity the poor FTC, having to police the internet.

Example of a suspected flog

I came across this site that just practically sat up and announced  "I am probably a flog" to me. Somehow, I really doubt that "Kate Delaney" is really someone who went through the program and now works as an MT. If you send her e-mail and ask her questions about FutureMT, getting a job as a new graduate, is she hiring, who does she work for, how does she like it – you aren't likely to get an answer. Even though her contact page gives an e-mail address and tells you to contact her if you have questions about a medical transcription career, an e-mail I sent 2 weeks ago from a gmail.com mail account still hasn't been answered. Maybe she's busy transcribing.

Or – maybe she's busy doing other stuff because she isn't actually Kate Delaney. Look who owns the domain name: Beth Stefani of Lariat Group. (I'm going to start the timer after I post this and see how long it takes Beth Stefani to make this registration private.)

Now, it's POSSIBLE that "Kate" hired Lariat Group to buy her domain name and manage it for her because teaching businesses how to manage blogs and be profitable is one of the services offered by Lariat Group.  I would hope that if a company like Lariat Group is advising "Kate," they would certainly make sure she complies with the FTC requirements for bloggers and endorsements. But it appears to me that Ms. Stefani gains her expertise for consulting through "hands-on experience running her own network of sites," so I suspect there is no Kate Delaney and that this is actually a site in said "network of sites."

Again let me reiterate – I have absolutely no problem with people putting up websites and trying to make money. Hell – I do that. But in my opinion, what Beth Stefani is doing at this site is immoral. And I guess the FTC agrees with me, because it's also illegal.

FTC Regulations for Bloggers

False advertising has always been illegal, anywhere. The FTC has recently updated its guidelines because flogs have been a real problem on the internet. For one thing, they're lucrative. Imagine if "Kate" can get 10 people a month to sign up with FutureMT – she made $ 1,600. Heck, most legitimate transcriptionists I know would be happy to create a REAL blog for that kind of money!

There's just one catch and that's the FTC's guides concerning the use of endorsements and testimonials in advertising.

When the advertisement represents that the endorser uses the endorsed product, the endorser must have been a bona fide user of it at the time the endorsement was given. Additionally, the advertiser may continue to run the advertisement only so long as it has good reason to believe that the endorser remains a bona fide user of the product.

What does "bona fide use" of an education mean? It means "Kate" not only must have actually done what her "blog" says she did (attended the FutureMT program and graduated), but she must also be working as a medical transcriptionist in order to endorse the product, which is an education that allegedly prepared her to be a medical transcriptionist. Even if "Kate" actually did attend FutureMT, she cannot endorse the product until she is working as an MT. And when she is no longer employed as an MT, she is no longer "using" the product of a medical transcription education.

One of the other requirements the FTC has clarified is that a blogger must disclose material connections with an advertiser, and that disclosure can't be hidden somewhere in the small print – it has to be easily apparent. Even if "Kate Delaney" is a real person who actually graduated from FutureMT and is working as a medical transcriptionist, there is no disclosure anywhere on the site.

When an advertisement is clearly an advertisement – such as a banner ad or Google block (who can possibly mistake those for anything but an ad??), no disclosure is required. Endorsements and testimonials are where people really seem to get into trouble. This is nothing new – the same rules apply for print ads and endorsements, infomercials, television and every other kind of media. For some reason, bloggers thought the rules didn't apply to internet advertising!

Can the advertiser be held responsible for what its affiliates do?

Let's look what the FTC says in their guide:

In order to limit its potential liability, the advertiser should ensure that the advertising service provides guidance and training to its bloggers concerning the need to ensure that statements they make are truthful and substantiated. The advertiser should also monitor bloggers who are being paid to promote its products and take steps necessary to halt the continued publication of deceptive representations when they are discovered.

That looks like a yes to me!

Last but not least – why do I care?

As noted in my last blog post, people who want to join the work-at-home workforce seem to be like cannon fodder – or lemmings. These flog sites are run primarily by people who make their living off affiliate sales and who know how to get to the top of the search engines so they'll be found. They don't care if someone scrapes and saves and spends their last dime to pay the tuition, then scrapes and lives hand-to-mouth during the entire time they complete the course, or that they are depending on the money they will make once they complete it and start their career. All they care about is getting more people to their site because it's a numbers game – more targeted traffic translates to more sales. And that's really what they care about – the sale. You won't find them promoting the best schools – you'll only find them promoting the schools that offer the highest dollar amount to their affiliates. By the time the prospective MT finds it's next to impossible to get that dream job, the affiliate has been paid – and isn't answering e-mails. They also don't care what this does to the industry and how it drags all of us down. First, it was "matchbook schools" we fought – now, it's internet marketers looking for the big-dollar affiliate payouts. I've made a good living from medical transcription all these years. No, I don't recommend it for anyone because of changes in the industry since I started – but I also acknowledge there are people who don't have as many options as I do, who really do need a job that's portable or that they can do at home, for a variety of reasons and not all of them having to do with having children. For those people, medical transcription may still be the best option. I just hate to see them given information based solely upon how much money the person disseminating the information will get if they can make the sale. Even if we believe in "let the buyer beware," the FTC has undertaken these guidelines to protect consumers. And for as long as I give even a small damn for the medical transcription industry, I will continue to try and not only call these people out when I find them, I will also try to outrank them in the search engines so that prospective medical transcriptionists come to sites where they are talking to real medical transcriptionists, not fake ones trying to make a sale.

Now for the disclaimer!

I am not 100% positive that the above-referenced site is a flog, I only suspect it is a flog. Heck, it may be legitimate. I will publicly retract my allegations if Kate Delaney will contact me with proof of her identity, a certificate of graduation from FutureMT and verification of current employment as a medical transcriptionist. As with everything else at MT Exchange, this is just my opinion based upon the facts availableto me at the time of publication.

MT Exchange

So here’s officially what I think.

On the surface, this appears to be a good job for a medical transcriptionist. I see several obstacles, however, to viewing this as the saving grace of a dying career.

Scribe candidates are college graduates, many of whom are multilingual and “highly motivated,” Pierog said. Typically, the person she is looking for to join her staff is “someone who has an intense interest in medicine and is looking to go on to something else,” quite often medical school.

“It’s not hard to find scribes,” she said. “The program has a 300-person waiting list.”

The majority of the current medical transcription workforce isn’t composed of college graduates. If a college degree becomes a requirement or a preference for scribing jobs – and based on this statement by ScribeAmerica, it looks to be heading in that direction – the majority of MTs would not be candidates for these jobs.

That’s not to say it should be ruled out as an option. It’s quite possible that, given the skill set medical transcriptionists possess and how it applies to the scribing position, the preference or requirement for a college degree would be waived. The articles says that about 30% of its hires are people with secretarial backgrounds.  It’s certainly worth a shot for any MT who is interested in doing this kind of work in order to transition out of medical transcription.

Speaking of the skill set, I read this paragraph and wondered how much of the skill set is actually the same:

Esquibel said there is “a very strong correlation” between eventual success as a scribe and a candidate’s prior successful work experience in service-sector jobs, particularly as a waiter or a waitress. “There are a lot of the same patterns,” she said, in keeping multiple food and drink orders straight in a restaurant and keeping tasks and records straight in a busy ER.

Transcriptionists sit in a (preferably) quiet room and do one thing – they transcribe. One could argue that working at home requires multitasking, but it simply isn’t conducive to productivity in transcription. There aren’t many things you can do while transcribing, and be productive/accurate.

However, one of the biggest obstacles I see in medical transcriptionists transitioning to scribing is the fact that it is an in-office job. Traditionally, the allure of medical transcription has been that it is a job that can be performed from home, on a fairly flexible schedule. It’s ideal for people who:

• are caretakers for children and/or adults
• have health problems that preclude working in an office but can be accommodated in the home office environment
• live in rural areas where there aren’t a lot of job opportunities
• move around frequently and need “portable” jobs (i.e., military spouses)

All of these advantages go away with the scribing position. It absolutely requires that the scribe go to where the physician practices medicine. In my opinion, that’s going to eliminate many current MTs who might otherwise be interested in this as a career.

Even supposing that the issues of caring for children and/or other adults are removed, I know a lot of MTs who say the ability to work at home has provided them with the only available option to make money, given their rural location and lack of local job opportunities.

Then there’s the pay rate…

Although there are plenty of jobs in healthcare and the job outlook in healthcare continues to be good, there’s not a lot of money in healthcare

Starting pay for a rookie scribe is about $ 10 an hour, she said, while chief scribes make $ 14 to $ 16 an hour.

OK, first of all – it’s better than no job at all, right? Second of all, I know MTs who make about that. The big HOWEVER is – they’re making that while working at home, not having to go into a hospital (where most of these jobs are based).

Those are the obstacles I see to current medical transcriptionists transitioning to the scribing career. The other obstacles require me to take out my crystal ball and making some predictions about the future.

Prediction #1: Technology always gets better. That’s not a crystal ball prediction, it’s a fact. Therefore, it stands to reason that EMR software will continue to improve in functionality. Hardware will continue to improve. The two put together will be more intuitive and easy to use. (Consider Apple’s iPad a major game changer – the healthcare technology forums are going crazy over what it will mean for mobile healthcare and EMRs.) As software and hardware improve, it will be easier and easier for doctors to use the technology without assistance.

Prediction #2: I think the demand for scribes will decrease as older doctors retire and are replaced more and more by doctors who can’t remember what life without a computer is like. Keep in mind that the youngest doctors already in practice probably remember not having a PC at home, but likely had one by the time they were in their teen years, depending on their family circumstances. Medical students currently close to graduation are very likely to do their internships and fellowships at hospitals that already have EMR technology. The “computer generation” of doctors will be comfortable with technology, likely more so than with dictating.

Prediction #3: Whether or not hospital  and clinics are going to want to add the expense of scribes will depend on how much they see billings drop as a result of doctors trying to deal with the documentation on their own, and how much value the scribes add and whether that all balances out. It appears to me from the article and the ScribeAmerica website that they’re specializing in ERs and in EMR transition. Is there longevity in a service that’s offered on such a limited basis; and, in the case of EHR transition, for a finite period of time – will healthcare providers be willing to continue the expense of a scribe post-EHR transition?

Medical transcriptionist to scribe

I think for MTs looking to transition to a different career, the decision to become a scribe depends on a number of things. First and foremost would be whether you are able or willing to work in an office, and whether you live in an area where this kind of job is available (or other jobs that are just as good or better).

Second, do you want to transition to a career that doesn’t pay much better (or any better) than MT and may be just as short-lived? If you believe my predictions are fairly accurate, then you’re looking at a career life that’s approximately equal to MT. It might be worthwhile if no additional expense for schooling is necessary.

Since the article states they have difficulty finding people who will stay or can do the job, I have to wonder if the same inverse supply-and-demand that has resulted in stagnant pay in medical transcription is going to take place in scribing as well. The pay rate doesn’t seem to be in alignment with the statement that good people are difficult to find and keep. Maybe there’s a lesson there that ScribeAmerica needs to learn, or maybe its due to the financial constraints of healthcare being in play again, I’m not sure.

While I just don’t see this as being a promising transition career in the long term, I think whether or not it’s a better option than MT will depend largely on the individual circumstances of the MT.

MT Exchange

KathyNicholls: AHDI proposes governance changes. What are your thoughts? http://bit.ly/dB8eeT

Now, I had nearly made a vow to leave AHDI alone. I’m not a member and haven’t been now for several years (not counting one year of corporate membership). I’d say I don’t care what they do, but by golly I run a forum for medical transcriptionists and they get discussed – so I decided to go see what Kathy was talking about.

This whole thing reminds me of a MTIA annual meeting a couple years ago, where I wanted to register in time to get the early bird discount – but there was no speaker schedule posted. Upon my inquiry (to AHDI, who is in charge of MTIA’s business), I was told one was not available yet. I then asked if the early bird discount would be pushed back so that it was available for a period of time AFTER the speaker schedule was available. I was told no, it would not. Therefore, in order to get the early bird discount, I had to buy a pig in a poke. Well, first it boggles my mind that any professional organization wouldn’t have a speaker schedule set by the time they started advertising their annual meeting; and second, that anyone would be expected to register for a meeting when they had no idea what educational sessions would be offered. Why offer an early bird discount at all, under the circumstances?

So now we have AHDI proposing another change in governance. Whether or not it’s a good change for the organization isn’t the point – I don’t know and I don’t really care. But, according to what I’m reading on Kathy’s blog, AHDI doesn’t even know the financial impact of what they’re proposing, yet it’s supposed to be taken to vote at the annual meeting the first week of August. Am I the only one who wonders why the rush?

Some of the comments at Kathy’s blog indicated that maybe members haven’t been very informed about this proposal. I consider Kathy – a former president on the national board of AAMT and a former HOD delegate and president of the HOD – to be pretty plugged in. If she doesn’t know about it, it doesn’t say much for how well information about this proposed change is being passed along to membership.

It appears the Town Hall meetings were first announced back in February – but the first Town Hall meeting wasn’t until the end of May, just 9 weeks prior to the ACE meeting and a vote on whether or not to implement this plan. Again, I’m reminded of the MTIA meeting – shouldn’t there actually BE a plan prior to announcing the plan? And what happened in the intervening months between mid-February, when this was first announced, and the end of May? According to comments made at the MT Tools Online blog, delegates were not allowed to disseminate information about these changes until a few weeks ago. Another comment was that the concept seems to change with every Town Hall meeting. There are, of course, the rah-rah posts – one commenter indicates she has been attending the BGG webinars “for several months” – which would be hard to do unless her definition of “several months” is what most of us would call a couple of months.

What I found most interesting were the comments by Miriam Wilmoth, a long-time member who has been very involved in the association for years.

Yes, there have been opportunities to ask questions – and to have some of them answered – but the “feel” of these meetings has all been one of an informational meeting and they have each projected that the BGG is a done deal, despite the fact that the House has yet to vote to move forward with it. Not once, when concerns have been raised, has anyone in leadership responded with the acknowledgement that yes, you have raised a valid concern and this is a problem with the new plan, or that anything needs to be taken back to the drawing board and re-thought. There is simply the continual message that this is the only salvation for our association and it must be done right now or we lose everything.

This doesn’t surprise me because this is de rigeur communication of the association to its members. I’ve said it before and I’ll repeat it: AHDI doesn’t actually hold discussions with members, they talk at them. The AHDI board has been very mother knows best with members, especially in the last couple of years. While I understand the need for the BOD to present a united front to membership and to keep its doubts and disagreements private, the united front seems unable to acknowledge the concerns of members or make members feel as though their input is valued, appreciated – or will even be considered. The end result is the feeling by membership that it’s being bludgeoned and the purpose of the Town Hall meetings isn’t actually to solicit input in order to formulate a plan – it’s window dressing for a decision that’s already been made and that will be rammed through because mother knows best.The fact that most of the people who serve in leadership at AHDI work very hard and are very passionate about what they’re doing is beside the point (the road to hell being paved with good intentions, and all).

Barb Marques, who is the current President-Elect to the AHDI BOD, says in her comment:

A couple of points I would make is that (1)perhaps all individual members have not heard first hand about the proposal, even though Townhalls have been open to any member. (2)I suspect the grassroot members will be hearing much more about this now that the component and state/regional association leadership, and the HOD, has been given several looks at the plan, several times now, and I hope ready to speak to their members on he subject with an assurance of understanding. Meetings with specific regional leadership (and anyone else they care to invite) will be held this and next week. The FAQs are available on the website for anyone to access.

I see no FAQ associated with that BGG. WHICH DOESN’T SURPRISE ME! After all, this is the same group of folks who start selling admission for a meeting with no agenda and asks people to vote on a plan that appears to still be in the planning stages. Link, please?

Of course the Town Halls were open to all members – but were all members adequately informed of them? Or are even members past the point of caring how AHDI reinvents its governance?

Keep in mind that the meeting where this vote is to take place is August 4-7, so all this discussion that’s going to take place is during the remaining two weeks before the vote. How many changes can be made after input from members in that short time?

If AHDI really feels it’s on the brink and needs salvation, and if it really wanted input from its members, it would have a frank discussion about the status of the association and present several alternatives, rather than offering up one “solution” to the problem for a vote in a few weeks’ time, especially when the proposed idea seems to be half-baked at this point. If the association is in such dire straits, surely it would be better served by a concrete plan and financial statement. The phrase out of the frying pan and into the fire comes to mind here, as does “a stitch in time saves nine.”

I’m going to go back to the proposal that got me into so much trouble with AAMT/AHDI several years ago and suggest that it’s past time for medical transcription to roll back into medical records. The case for this is even stronger now than it was the first time I brought it up. The evolving role of medical transcription in the medical records documentation process is bringing it more and more into the health information management sphere of influence. The people who really make the decisions about what happens in medical records – and in medical transcription – are in AHIMA, not AHDI. Let’s forget about MTIA for now – it’s a self-serving alliance of transcription service owners. The only comment of value about MTIA members I can make is to note that many of the C-level executives are most likely also members of AHIMA because they know the value of that organization to their business. At this point, AHDI seems to be spending a lot of time and energy struggling to make itself relevant, and reorganizing itself just to stay afloat. When it comes to legislation, it duplicates many of the efforts of AHIMA – only with less money and less effect. Doesn’t it make sense then to just roll it all into one organization? As a therapist I know once said: Sometimes a good divorce is better than a bad marriage. AHDI has, in my opinion, been a bad marriage for some time.

MT Exchange