In Which I Wonder How I Got Here
I don't think anyone who is not a medical transcriptionist has a real appreciation for what the job entails. How many of us have had someone marvel at the ability to work from home and ask for a quick tutorial in how to get started?
"Gee, I've got a computer and a toddler, and I'd love to avoid paying for day care. I could do this, too! You just type what you hear, right?"
Ummm. . . in a word, NO. Although the field has lent itself to outsourcing and telecommuting, that does not put it on a par with an Avon gig. You need to commit yourself to space, a schedule, and be every bit as reliable and professional as if you worked on site. Even doctors-and certainly, hospital administrators-often fail to realize that it's a very important part of patient care, risk management, and even reimbursement. I've heard it said that an acute care MT needs the equivalent fund of knowledge to a third-year medical student. Not only do we need to be self-motivated and self-disciplined, our English skills need to be impeccable, we need to know anatomy, pharmacology, surgical instruments, disease processes, fundamentals of Latin and Greek, computer, keyboarding, and research skills, and possess an ability to understand myriad foreign accents (or just inconceivably poor dictators). We don't even get to specialize. We have to know it all and be prepared to handle everything from trauma to morgue. Whilst transcription is often viewed as something a typing monkey (or now voice recognition) could do and thus, is one of the first things to take a hit in a budget crunch, those of us who do it know better.
I was thrilled to discover the field, which offered a way to utilize my love of language and medicine and seemed to be The Perfect Career to take me all the way to retirement and beyond. I thought I had researched thoroughly and had a good sense of job security, as well. From the beginning, I saw there were people predicting gloom and doom because of everything from the advent of the personal computer to offshoring, but I noted there were many grande dames of MT assuring us that the field wasn't going anywhere. People have been predicting an end to MT for decades and it's still here. Surely, there will always be a need for transcriptionists, right?
A lot has changed in the past five years, though, and I see many of those same people admitting that it may well be time to move on. To my vision, the issue of offshoring has not helped wages, but it's almost a nonissue now that the industry has been overrun with software developers, speech recognition, simplistic EMRs, and more and more clients being sold a bill of goods wherein they believe they are saving money by having a physician playing hunt and peck around a keyboard in the exam room instead of dictating and waiting for the MT to produce a much more useful record of patient care. Even the transcriptionists' supposed representative organization has abandoned the practitioner in favor of the "medical document." Yes, offshoring gave clients a sense that they could save huge quantities of money and that has become the driving factor. It's been said that transcription involves three client needs: Speed, cost, and quality. Of those, it's only possible to have two. Naturally, cost is the one clients seem to feel is most important. All this has conspired to drive down MT wages to a point where it's getting hard to make a living. Wages that seem generous in Bangalore translate to well below poverty level here. Editing speech recognition may sound easier than straight transcription, but in fact it often involves almost as much work-double the production quotas for half the pay or less. With downwardly spiraling wages, I don't see the field attracting qualified MTs as the veterans retire-not when you can make higher wages for so much less work at your nearest McDonald's. No, transcription is increasingly becoming viable only to people with limited options or as a second income, and even independent contractors are beginning to complain that clinic work is disappearing to computerized record-keeping.
In pondering all this, I have come to the sad conclusion that medical transcription as we know it is marching along toward its demise. It's no longer a matter of keeping up with the technological changes, but of turning into a whole 'nuther animal entirely. Transcriptionists are becoming SR editors. Those sometimes-eloquent physician narratives are giving way to point-and-click EMRs. The profession I'd been so thrilled to find and proud to be a part of is starting to feel like it's built on quicksand, and I finally reached the point where I knew I needed to prepare for Plan B.
So what do I do with this head full of medical lingo? I could become a nurse, but I don't exactly have youth on my side there. I'd probably enjoy being an OR technician, but again, am I physically up to long hours on my feet or heavy lifting? I seriously considered phlebotomy or x-ray technician, and ruled out coding because I have a strong feeling it's a bit too "left brain" and requires a mindset completely opposite transcription.
Amid all my mental floundering, I saw it: That fateful letter to Advance by a woman who gleefully related how she took her skills as an MT into a new career as a cancer registrar. I paid heed to that "aha" voice in my head and spent the next couple months using my MT research skills to figure out exactly what this involved, and came to realize my name might be all over this thing.