Case in point: The latest print issue of Advance, in which Peter Preziosi speaks for the Airheads--AKA The "Professional" Organization Formerly Known as AAMT, which should take a cue from Prince and just pick a symbol because their new acronym is just impossible to remember--once again pimps the party line by telling us that the sure-fire way to benefit the field of MT is to bust your hump and get your CMT certification because, golly gee, that alphabet soup and a better wardrobe is what will get you the respect of your employer, your dictators, and your coworkers. Heck, maybe it'd even make your sister-in-law think twice before dropping in for coffee during your shift. But wait--since Peter and his cohorts at MTIA have steered this ship to benefit the speech recognition vendors and AAMT dropped the "American Medical Transcriptionists" from the acronym, they've already declared that they now instead operate as advocates for the medical record and not the transcriptionist. It's all about EMR and SR now, baby. Except MT week is looming and this apparently calls for a flip-flop to claim they're advocating for us after all. So which is it? I guess they're hoping Lenin was right when he said, "A lie told often enough becomes the truth." As an MT, AAMT's claims of advocacy sound hollow indeed. I have a good feeling this is simply a matter of not wanting to give up the potential cash cow that certification offers. They've not succeeded in selling us the idea of the vanity title, though some of our Indian counterparts seem to think it will garner them acceptance. The organization is driven by the idea of selling us on their credential and their BOS, if not a membership. Without everyone on board for individual certification, how will they sell companies on the idea they should also be certified? Nothing else they've done seems to have hit the jackpot. Even that drive a couple years ago to lure in student members has not resulted in many of them staying on as full members, once they discovered how little that membership gets them (i.e. a very expensive lapel pin) and the realities that the organization simply does not want to deal with new ideas. Not that the old way of thinking is getting them too far. These people are the crew of their very own Titanic and as the water rises over all our ankles, they're busy congratulating themselves for jettisoning a few bothersome lifeboats because it gives them room to pack in another game of charades as the orchestra continues to play. To quote Peter: "So if you want to help advocate for your profession, to bring it more visibility and respect, become credentialed. . . The profession could really use your help." Is it just me, or is there a huge disconnect in the concepts of who's advocating for whom and what that really entails? Maybe the medical document isn't the great partner they thought it would be.

As the industry moves increasingly to SR and MTs are told they are now "editors," we find ourselves training the very technology that is replacing us, and at a cut in pay for the privilege. Veteran MTs are not valued when there are sloppily educated greenhorns happy to start at poverty wages. Even the clients are getting used to the idea that crappy transcription is all they'll get--but it's okay because it's cheap! It is fast becoming the norm that MTs with 20-30 years' experience are being hired at the same wages as those newbies and told they must "work their way up the ladder." Only--oops!--they're not talking raises, they mean that you work more difficult accounts with the dictators so awful that SR doesn't work with them, and the main option for increasing your pay is simply to work harder and faster. I know too many who are afraid to leave the nationals because they are at a rate of pay they will never see again and are already struggling to survive, at that. They have simultaneously put the production screws to us whilst redefining our wages with an eye toward 2-4 cpl as soon as they can get away with it. Honestly, is there another field where this kind of thing flies? What did MTs do to deserve an "advocate" like this?

I'm not sure why I'm harping on an organization I truly feel is history. Before I sprout Andy's gigantic eyebrows and launch into another silly rant, will mosey instead to my happy spot: My week has involved a revelation regarding my back misery, in which I suddenly realized the last time my bed didn't make me ache was back before the ex forced me to jettison the beloved waterbed and let him pick out an erroneously named "Beautyrest," which has been akin to camping on asphalt. A little tenacious sleuthing and I sing the praises of Craig's List, wherein I located a very retro full-motion waterbed for a mere $25 and should be floating blissfully by Friday night. The last bad vestige of a worse marriage will soon find a new home with some masochist or desperate cheapskate as I finally relish real lumbar support.

Add in the bonus that my daughter and I finally succeeded in getting far enough into the attic to fix the A/C as the FL summer hits and I am rarin' to get back into school with a clear head and fresh enthusiasm. I've finally received all the textbooks for my next AHIMA module. First impressions are that the computer course will be painfully simplistic and outdated. Since technology advances so fast that any new computer is outdated before you even break it in, I'm not sure how anyone can teach this as more than the basics. It appears that HIPAA is glaringly omitted, at least in the textbook. Hopefully, this class will be a breeze, as I'm still rather bruised from the anatomy & physiology course. Medical terminology looks to be fairly easy, though there's an extra text about pathophysiology that is kind of giving me palpitations because it appears to be an evil cousin to the A&P text. Pharmacology looks to be another fairly straightforward text and involves a lot of things I already deal with, so perhaps three out of four makes for pretty good odds on getting through intact. In light of the increasing grumbling amongst my peers and the knowledge that I need to race to get ahead of our "advocates," am feeling pretty motivated to dive in.

I suspect I'm channeling that lumpy old recliner with the floppy footrest that's been retired to the frat house. After surviving my work week last Thursday and with my A&P course deadline screeching up at full speed, I hit the books hard. Spent over 36 hours solid (yes, I napped a couple hours here and there) reviewing everything--the workbook exercises, then textbook exercises, the online lessons and all those little rabbit trails they link you to, the chapter tests, the word lists, and on and on in circles until I had anatomy coming out of my ears. It was a flashback to my college years, when we'd spend that last finals week pulling all-nighters in the hopes of making up for not paying attention in all those lectures, only with considerably less silliness and no chocolate chip cookie dough (Julie B's mom was the BEST).

The course was HARD--the hardest class I think I've ever taken. Still, for all the information to try to absorb in the chapters, the chapter tests were almost disappointingly sketchy--some only five to ten questions long. Surely, they were representative of what the final would be like, right? Twenty chapters crammed into 60 questions, so they would surely be hitting the highlights. This is a course taken not by med school hopefuls, after all, but geared toward coders, tumor registrars, and whoever else might feel the need to get a clue for their job on the periphery of patient care.

Holy cow. Big mistake right there. Whilst I was quizzing myself on organ systems and terminology, they were dredging up extremely specific questions about circulations, microscopic functions, and chemical bonds. What the heck? About four questions in and I was flirting with a panic attack because they gave me the wrong test. . . At the very least, they hit me with the gnarliest test in the arsenal. In the end, however, I persevered and made it through with just enough time to click my way back to the beginning and check my answers. Managed to trust my instincts on a couple that I shouldn't have and second guess a couple that I shouldn't have, but in the end, walked away with an A on the sucker. Not a high A--which in the past would've caused me about a week's worth of stomach upset and disappointment in myself--but in this case, it feels like I aced it.

Talk about relief. Bad enough I allowed myself to get sidetracked over the weeks and had to scramble so at the end, but even worse that my trip has been so public. Forget the tuition I'd have to cough up again if I'd failed--I would've had to slink back here to announce my failure. For someone who isn't crazy about the spotlight, this is a silly way to go about my studies.

So the lumpy recliner bit? That's what happened next. My brain wanted to come here and Woohoo! but the stress and lack of sleep made me feel like I'd had the stuffing knocked out of me by a couple of rambunctious toddlers and a semester's worth of frat keggers. I seem to recall getting groceries and surviving almost another week of work, but the brain is still not completely engaged. Spent a couple afternoons trying to find the perfect music video to convey my elation, but Devo's Whip It! has such a stupid video and I kept getting stuck on bagpipes, which I suspect not everyone loves like I do. Mostly, I found myself wandering off nonsensically into things like Shatner does the Beatles, which I couldn't explain away as remotely related to past or future jobs, studies, or healthcare forum in general, but good grief, it's hysterical. . . The gist of all this is that yay, I'm awfully pleased with myself, but lack the strength and discipline to convey it outside my head. I will probably need another week before the edges come back into focus and I'm firing on all cylinders again. With this in mind, I'm sure everyone will forgive me a few nonsensically mixed metaphors and general lack of coherence. Give me another week to clean the Doritos crumbs out of my cushions, replace that missing bolt in my frame (duh--no wonder my back went out!), and time for a good scrubbing and fluffing so I'm more presentable for Parents' Day.

Most silly of all is that it didn't even take me a day to ignore my promise to enjoy the break from studies and thoroughly deflate for a week or two to dive into the next course before I found myself sitting at the computer, looking for the best deals on my next group of textbooks. Any minute, I will probably be able to slobber over three classes' worth of tomes, with an eye toward starting the first class--computers, then medical terminology, then pharmacology. Sounds incredibly easy, given that these are things I've studied before and am immersed in with my job for the last few years.

Wait a minute. . . I thought anatomy & physiology was going to be a walkover, too! I think I'll give myself another week off, just to be safe.

My brain and my back are having an argument about which can give out on me first and after almost a two-week battle, there's still no clear winner.

After three months of study, I'm nearing crunch time on my first CTR course and I suspect the stress has simply gotten to me. Oddly enough, I sailed through school in my younger days effortlessly--rarely cracked a book, rarely bothered with homework (I was usually done before class was even over), and still managed to ace my exams and come out at the end with almost a perfect GPA. Same was true of my MT course--finished ridiculously fast and with few mistakes, though I have to admit at that point I was desperate enough to study like my life depended on it. (Actually, it did--the resulting job enabled me to toss a long, lousy marriage on the funeral pyre.) I recall feeling determined, but not particularly anxious. It didn't hurt that I had the luxury of spending 12 hours a day with my nose in my textbooks.

So what happened? I started this A&P course very excited to be back in school, but quickly took a bad turn. First chapters were great, but then I came up to that first exam. Didn't help that my sister-in-law had a heart attack and various other little family crises piled up at the same time to provide distraction.The material was killer--chemistry and all that good stuff I'd managed to avoid in high school and college--and I was suddenly freaking about a little test. How many questions would it be? How much of this incredibly detailed material would I really have to know? What happened if I really screwed up on it? The more I balked, the worse it felt. Test anxiety was a fairly strange thing to me. Even worse, the clock was ticking--only 15 weeks to complete the course, and if every chapter was this bad, how the heck was I going to hack it?

In the end, of course, I sucked it up, took the test, found it to be almost disappointingly short and easy, and rediscovered my old self and plowed headlong into the rest of the course like a fiend, desperate to make up the lost time. Of course, I also encountered logistical things I'd never had to deal with before because I am now working full time and still have a household to run (I'm sure I could run off on a heckuva tangent about the fallacies fed to us women about how we can "have it all," but I'll spare you all that particular rant for now). Yes, I can throw a case of ramen and institutional-sized bag of frozen vegetables at my teenage daughter and she's set for a week, but I've still got animals to depend on me, crud to vacuum, dishes and laundry to deal with, groceries to restock, and the occasional room to gut and totally redo (still not sure how last bit happened, but it ended up monopolizing my entire two-week vacation I'd so carefully saved up to devote to my studies). I found that I've been useless during the work week and my usual weekend catch-up activities in general still leave precious little time to focus. In the end, I've had to get ridiculous and devote entire weekends to devouring my course, lest I get tripped up at the finish line by running out of time.

So yeah, I'm finally at the point where all I have to do is study the crap out of this thing and pass the final--and yes, I'm finding that anxiety rearing its ugly head again. I have a suspicion that the deadline is going to save me from dwelling too long on the matter because it's bootstrap time. I just need to grit my teeth and "Just do it!" as those folks at Nike keep telling me--hoping that the shoes aren't a necessary ingredient because I prefer to go without. Unfortunately, I think the stress has found a way to assert itself anyway as my sciatica and deadhead vie for attention. I'm currently telling myself that once I pass this final (like that power of positive thinking?), my stress will disappear, my brain will start firing on all cylinders, my back will unclench, and I will have the luxury of a week or two before I head into the next module and start all over again. In the meantime, I think it's time to resurrect my motto and remind myself that failure is not an option.

Here's hoping I survive not only the final, but the next few months without a chiropractor or a wife, though I'm beginning to think the latter might bear some serious consideration.

Seriously, though, it's interesting to see that it doesn't matter what level education you're battling. Whether you're a rank beginner taking your first transcription course or going for a major degree, the stresses are the same. Carol points out great advice about picking a reputable school, and I agree fully that online degrees have come into their own, as far as credibility. Of course, there's a huge difference in the number of scam schools at the various levels. Medical transcription is infamous for those hotel seminars that try to convince SAHMs how they can make $60K/year working part-time hours of their choosing (ha!) if they just take this matchbook course. From what I see, the higher the credential, the more a school has to meet standards and accreditation. Many traditional universities have embraced online education and they're just not going to throw away their reputations by slapping up a course worthy of those late-night Sally Struthers commercials. Indeed, they have to meet the professional organizations' requisites before they can even offer a degree, or it's useless.

Coming from MT, I know very well how little accreditation can mean on the other end of the spectrum. The so-called standards simply were watered down repeatedly until they have no meaning. This makes it really hard to figure out where to get your education. The consensus amongst the majority of working MTs, editors, QA folk, and MTSOs is that if you simply pick one of THE two online courses (M-TEC or Andrews), either will pretty much ensure you're not just employable, but sought after. Many of their grads have multiple job offers before they've had a chance to breathe a sigh of relief at the end. In this case, oddly enough, I believe having a certificate from either online school maximizes your employability, at least when you're applying to nationals or other 'net-savvy MTSOs. Even that community college course--though it may meet the same standards (many don't come close)--will not register a blip on the radar when trying to break into the field. Unless that school has a great working relationship with local clients to help with job placement, you may hit a wall very quickly. Unfortunately, the trend is not to local, in-house jobs, but telecommuting, and even a great local school isn't likely to even get you an invitation to test for such a job without experience. Whilst a diploma from those two online courses is often a fast track to a job, any lesser course does not give the benefit of that kind of reputation. Besides actually giving you the best possible foundation to hit the ground running, I believe that reputation is a priceless benefit of choosing either school.

It was quite a surprise when I started looking into CTR. As the requirements for educators is so much more strict, there are considerably fewer options. I was shocked to see so few accredited courses for CTR, but it did narrow down the search quickly. More surprising was hearing that where I get my training isn't going to matter to employers, only the fact that I am or will be certified as a CTR. In rummaging around the job bank, I see that's true. In the ads, they all want CTRs with experience and certification, though they also list internships for new grads needing those hours before they can even take the exam.

It sounds like Carol's travels to her master's degree have similar considerations and stressors as far as the general educational concerns and integrating a career change into the family dynamics. As I find my own nose sore from pressing ever closer to the grindstone, maybe she'll pass some hints on the personal stuff, like how to get teenagers to pitch in and how to actually get dressed out of the closet instead of the laundry basket. *grin*

Ahhh, the internet is a wonderful thing. As a relative newcomer to transcription (i.e. I learned my job on a computer instead of a Selectric and never had to pay my dues in triplicate with carbon paper and Liquid Paper), I can't imagine doing this job without the web. As a book lover, I know there's nothing like a hard copy to validate an obscure term, but have to admit it's been ages since I've cracked that tower of reference materials hovering over my workspace. Having honed my online research skills, it's infinitely faster to simply hop on Google and zip to one of the countless trusted reference sites I've bookmarked. Every time a dictator says, "Oops--go back to where I said this and change it to such and such," I thank my lucky stars it's only a minor annoyance and not a real work-stopping event. You just tack things in as needed and off you go.

The internet pretty much provides all you need in terms of terminology, you can find tons of sample reports, message boards to pick the brains of you peers for that occasional obscure instrument, and now, the web has finally caught up with an MT Style Guide. For those of us who believe our so-called professional organization has devolved past its usefulness, this seems to be the final thing to render it obsolete, once it bulks up a bit and gains recognition.

So what the heck is a wiki? If you're familiar with Wikipedia, you probably understand the basic concept. A wiki is simply an online resource which allows users to add and edit content collectively, regardless of their browser or platform. You don't have to register to use the information, but you do to be a main contributor. Unlike Wikipedia, where just anyone can add information (or disinformation, as the case may be), this wiki is moderated in the sense that only approved users are able to add the main content and are generally very experienced MTs, MTSOs, and/or editors with that extra helping of anal retentiveness to make them perfect for the job. Any user can leave comments on a page, but the main content is entered by volunteer staff. If you're a veteran with a good working knowledge of style, you're free to volunteer for a section and leave your legacy.

It's been pretty much universally accepted that the official AAMT Book of Style is a counterintuitive mess, regardless of all the hype that comes with each new edition. I have to admit there are still few things I can look up in it easily. Nothing is where I expect it should be and it rarely goes into enough detail to answer my specific question. Theoretically, this should've been simplified for those buying the CD version, but noooo. . . the CD isn't searchable unless you knock yourself out making your own .pdf archive. To highlight the mismanagement of the official BOS, the third edition not only does not come with a CD, but they've failed to recognize the current state of technology and have no plans to offer it as an eBook, either. (We work digitally--how unreasonable is it to expect our references to be as accessible as everything else we do?) Not only that, but the new edition is rife with errors. Oops! Those were placeholders from the 2nd edition and they meant to go back and fix them. . . The capper is that having shipped the new book, they've immediately recalled them because there was some brouhaha about the cover and they have to have them redone. Hardly what I'd expect from anyone else who's declared themselves the ultimate professionals. (Yes, I'm still carrying a grudge over their Jan. 2006 edition of Plexus, which was devoted to the concept that AAMT members were professional and the bitter, unaffiliated miscreants loitering around MT message boards were so obviously not to be recognized as their peers. . .) To add insult to injury, we're talking about the "low, low price" of $70 for the privilege of owning this mess. Rather than actually improve the 2nd edition, they've simply repackaged it, leaving cynics like myself to assume it's more about stoking the cash cow than actually creating something worthwhile.

Of course, the official BOS is considered the default reference for many, if not most, employers. When a client's account specifications don't address something, this is what you use. Obviously, this online style guide needs to gain recognition before it can supplant the BOS. I'm doing my part to get the word out and I know there are countless grande dames of MT who are enthusiastically contributing. I know there are thousands of working MTs who have divorced themselves from AHDI and will probably be happy to embrace an open source style guide, as well.

As an entertaining sidebar to bolster my disdain for these people who seem to have no clue what they're talking about, I leave you with this: The AHDI I Love My Career contest. Heh. After promoting all the things that have rendered MT a piecemeal sweatshop, I guess they're a little confused about what "career" means. or maybe they're hoping if we'll all just put on our rose-colored glasses and say it enough times, we'll all believe it to be true. You almost have to admire them for their tenacity, no matter how silly reality makes them look.

Seeing as how I've been waiting weeks yet to be approved for entry to the NCRA message board and never did get a reply about my newbie questions submitted to state and national membership heads, I find it especially interesting that the press release once again points out the need to recruit new CTRs:

“We must work together with our allies in the health community to ensure that we continue to recruit and train qualified candidates to enter into the cancer registry field.”

Ahem. That might involve some actual schmoozing with potential candidates, might it not? I guess they're leaving it up to all you CTRs to rope your bestest buddies into the field on an individual basis because I don't see a great push anywhere beyond lip service. Slick newsletters and apparent organization, but the followthrough needs a bit of work. I'm seeing more articles in Advance about registry, but that amounts to little more than dangling a half-eaten carrot if there's no practical information about how to join all those folks who loooove their job. Remember that you're recruiting people who have little or no clue and you need to take them by the hand to make them feel you're really serious about wanting them to consider the field. If there truly is a dire need for new bodies, you really want to be more aggressive about headhunting. I suspect working CTRs are too busy to make a hobby of playing Welcome Wagon for the good of the team.

As for festivities this week, I wonder if they're as universally pathetic as they are for MT week. I come from a world where a coffee mug is considered a major token of "esteem" from an employer and MTs who work on site often relate tales of offerings consisting of office supplies left over from drug reps or snacks quickly devoured by predatory residents--and these are considered fortunate because most MTs don't get any recognition at all.

Lest we feel too sorry for ourselves, however, I feel obliged to point out that I bet few of you were aware we recently missed Doctors Day on March 30. Yep, your favorite physician probably would have loved a token pat on the back because he's also dealing with quotas, bureaucracy, insurance companies, and patients who don't do what they're told. Some of these folks sound so weary as they dictate, I marvel that they do it as well as they do. Of course, it helps to not have to support a family near the poverty level, so we can only muster so much sympathy. (Hm. I wonder if I promote Placebo Journal if Dr. Doug would favor me with a free subscription. Love the gazette, but on an MT's wages I can hardly afford a subscription to the real deal. Regardless, I highly recommend it for many good laughs, if not some fascinating insight into the doctors' side of what we do.)

Heck, I think the problem is that there are just too many Hallmark holidays and no one's bought ad time in the right places to make ours stand out from the crowd--secretaries, auctioneers, customers, librarians, receptionists, third shift workers, golfers, principals, tourists, pirates, and all the others vying for attention in the next couple months. I guess that leaves it up to us to toot our own horns. On that note, I'll give a shout out to the 4,500 cancer registry professionals and CTRs I hope to join. Enjoy your week!

"The whole point of the medical record is to give accurate, readable information about the patient. There are many shortcuts one could take to save time and space, but that would defeat the purpose. I try to keep this little scenario in my mind: What if this record I am typing were read out loud in a court of law. How would it sound? Would the attorney or the jury (or the judge, for that matter) understand the language? I've had numerous calls from court reporters wondering what on earth my doc said as an expert medical witness. It might have been simple and clear to me but to her it might as well have been in Swahili."

As MTs, we're always told that the transcribed medical record is mainly to provide lofty-sounding things like continuity of care and ensuring patient safety but as we all know, we live in a litigious society and the biggest reason of all is more likely to provide that oh-so-important way for a doctor to cover his hiney in the event of a medical catastrophe, should some suit-happy patient drag him into a court of law to explain himself. If this wasn't the case, why don't hospitals in every country employ transcriptionists? The fact is that no one does to the extent we do, and there are a goodly number of countries (we're not talking Third World nations, mind you!) who still find handwritten notes suffice. This is America, the country that's perfected the art of CYA, right? We've got dorky warning labels on everything to ensure corporate America is not held financially responsible for every half-wit who takes their blow dryer into the shower or folds their child up in a travel crib, fer cryin' out loud.

So how the heck do things like speech recognition and those awful point-and-click EMRs actually replace a proper, transcribed record in a legal scenario? SR is designed by software designers, not transcriptionists or even language specialists. I see over and over that MTs forced into new roles as editors of SR output are up in arms because the quality is so poor, they're having to practically re-transcribe them in full because it's less work than fixing the gibberish (at half the pay, mind you), and for too many dictators, SR just plain is never going to be able to learn well enough to churn out a usable document. . . and it surely isn't going to help a jury look favorably on the defendant when tallying up the damages. How are you going to counter a tearful family with vivid memories of what transpired if you can only counter with a computer-generated list, some lab values, maybe an x-ray, and vague recall of a patient treated months or years ago? Face it, if it boils down to "he said, she said," a jury's going to relate to the patient.

Likewise, I've had personal experience with an EMR when taking my mom to the ER with an allergic reaction. Never mind that her face was rapidly swelling, she was asked to answer the same medical history questions at the registration desk, the triage desk, and the exam room. . . pages and pages of questions, the clerk, nurse, and doctor--and I'm talking about people in the same 20 feet of hallway, mind you--all fumbling to navigate through the screens (often starting over at the beginning) before they could even treat her. In the end, what did they have? Basic insurance and billing info, and a little checklist of symptoms she came in with. Even armed with a copy of the printout on subsequent visits, we were obliged to go through the same process from scratch because it was apparently incapable of generating a followup visit with the information already provided. If the poor woman had suffocated in the end, what would their defense be? Proof that these people had ticked a few boxes, but a checklist falls far short of capturing the nuances of patient interaction or the doctor's rationale for how she's treated. In our case, it surely failed to provide timely treatment because it took almost two hours before she even saw a doctor--and when she did, the poor guy was alternately struggling with the touch screen or hitting his head on it because it was suspended from the ceiling like the overhead exam lamp in already-cramped quarters. Our third visit proved to be no quicker, and after sitting for four hours in the waiting room with everyone else suffering the same fate, she finally decided she wasn't going to die and we opted to go find some over-the-counter Benadryl without benefit of a medical degree. Pffft. Even if I wasn't an MT, it wouldn't have left a good impression.

I can recall feeling outrage that someone in bad enough shape to even go to the ER would be forced to sit with a clipboard and fill out an info sheet before being seen. Well, forget that--they've found a way to waste many more precious hours. Maybe the real goal is to clear the freeloaders out of the overcrowded waiting rooms. Anyone incapable of walking away in disgust is obviously sick enough to merit treatment.

Though MTs love to commiserate on the silly or horrendous dictation errors we encounter, the truth is that many dictators are actually pretty adept communicators. My favorite account of all time treated me to a huge number of Brit-educated dictators, whose reports were often downright poetic. When a doctor's narrative includes niceties and chit chat about personal interests, their admiration for a patient's supportive family, or a kindly reprimand to get out of the house, find some romance or hobby, and start enjoying life, you get the feeling they really care about their patients. All that is lost with checklists and canned transcription.

Forget the MTs displaced in this rush to embrace the latest technology for technology's sake. As a patient, I have to say that I deserve my physician's full attention, not the top of her head as she hunts and pecks on her laptop or Blackberry. (Is it really cheaper to have a physician transcribing her own reports, anyway?) I've had doctors make mistakes, occasionally with tragic results. If we've connected as human beings, I also found it very easy to shrug it off as their best effort in the circumstances. I suspect if the same kind of thing happened today, though, and I found my records dehumanized and distilled to a soulless checklist, I'd be feeling much less forgiving.

Obviously, the die is cast and all this is probably moot, but It'll be interesting to see how this plays out. Now they've all been sold the bill of goods on "cheap" technology, I don't foresee clients suddenly willing to pay more again for real transcription. I do think they're in for a rude awakening once the real costs reveal themselves, and in my admittedly humble opinion, I think the CYA department is going to turn out to be one of the biggest whoopsies. One thing's for sure, though--whether as a patient or as an MT, I'm not at all happy with what Big Business is doing to the quality of my healthcare.

When we learn to do transcription, one of the key things we need to learn is the various abbreviations and acronyms for things. Sometimes, they have more than one possible expansion (like CVA can mean both cerebrovascular accident and costovertebral angle) and in certain parts of a report (i.e. the diagnoses), you generally need to expand those. You also get the lovely Latin abbreviations in medications (sadly changing because someone decided if everyone can't write them by hand clearly, no one should be allowed to type them, either--heaven forbid someone might confuse q. h.s. for. . . I can't even imagine what!) as well as the obscure shorthand for instructions on a patient's chart, like NPO (nil per os or nothing by mouth). It all makes for a pretty easy language to learn in the end and you can see how it helps streamline things--and even save on overworked fingers and transcription costs for when you have to type out all those long words like esophagogastroduodenoscopy over and over.

So. . . it seemed only fair to assume that since I already know so many of these, I'd be that much ahead of the game, right? Several chapters into my Anatomy & Physiology course, I've seen enough to make me question that. I assumed there would be consistency, that all of us medical people were speaking the same language, but apparently not. Or maybe I'm once again suffering from the Crappy School MT education I whined about last time. . . Well, except that I'm now encountering clinical abbreviations I've never had to transcribe. Curiouser and curiouser with every chapter.

How many MTs recognize BRP as bathroom privileges? NR as no response? Never saw ung before to specify ointment, and never once encountered EAHF (eczema, asthma, and hay fever) as an acronym. Obviously, there are many bits of shorthand an MT never sees--wouldn't need to see because we're not usually documenting every trivial activity in a patient's day (although some residents make us think we are). In general, although some of these seem silly to me, I'm finding it fascinating to be that much closer to the hands-on patient care side of things.

Afraid I can't even muster a good rant this week. I always said I wished I could be a professional student, and I'm just enjoying the heck out of my course and savoring every bit of it. It's kind of a dangerous trek to those of us who easily fall prey to following bunny trails because every chapter, we're fed dozens of URLs to supplementary websites for more information and practice. I made a bookmarks folder for my CTR stuff and it's already stuffed with more links than my Apple folder (clue: That's a lot of URLs!) After dreading that first test (not sure why because I've never seized up on one before), I've found that they're not as hard or detailed as I expected. Not sure if that means I'm trying to absorb too much or if they bring out the big guns for the final. It is a HUGE amount of information to absorb in only 15 weeks, though. I think what really makes my colon clench is the thought that I've got many more courses to complete and how much I need to be able to recall once I reach the end. Trying not to dwell on the what-ifs, lest I dredge up that old dream from high school, where I'm suddenly plopped in the middle of finals week and can't even remember my schedule.

Next time (apparently): Yes, I have issues!

As a tantalizing clue as to my decrepitude, I have vague recollections of life before color TV. For some reason, my family was slow to embrace new technology (which probably explains my geeky obsession with Everything New) and I spent a good deal of my formative years viewing the world in black and white. I remember particularly the night we crossed the street to watch The Wizard of Oz on our friends' new color set in glorious Technicolor. OMG--it was like when I first got glasses and saw how blurry and ill-defined my world had been. Oz really was amazing, those shoes were really red, the witch was a sickening green, and the monkeys were much more scary than ever before. (In contrast, black and white was perfect for the tornado scene--as an Iowa girl, I didn't need to see that in color to be terrified.) It might as well have been in 3D, it was such an amazing revelation.

So what's that have to do with anything? Well, that requires a little back story.

Part of the reason I harp on the necessity to choose a great transcription course is because I hope to help people to avoid my own mistakes. I took a course that claims to be wonderful without researching enough to know the real score. Upon entering the work force, I felt inadequate to the task and it probably took me the first year or two to feel at least on a par with graduates of M-TEC and Andrews. Even once I was able to transcribe without researching to double check every fourth word, I remained insecure about my abilities. Heck, even now I still operate under a certain mantle of paranoia. I learned very quickly that you don't know what you don't know until you know it and unless you learn from someone who definitely "knows it" themselves, how good is your education, really? If I hadn't been suckered in by that assertion that "cheaper can be just as good--you just have to want it and work that much harder. . ." my self confidence would be thanking me now. Paying double on tuition would have been a bargain as far as readiness for the job and maximizing my earning potential.

Fast forward to now, as I am enrolled in my first AHIMA course, Anatomy & Physiology, and I'm having flashbacks to that Oz revelation so many years ago. Yes, my MT course included a unit on anatomy--and I mastered it quickly--but I see once again how lacking that basis is. We learned little more than mere names for body parts, a bit on planes, and. . . not much else, really. Only six chapters into my course, I'm already seeing the world in a much richer, three-dimensional fashion and I'm gobsmacked. Yeah, I whined at first about having to steep myself in basic chemistry and biology, but I see now why that was important. Now that I'm into actual anatomy, my world is zooming into much clearer focus. More and more, I'm seeing benefits even in my current job of transcription. Whereas before I understood the terms that went together and their general meaning, now I feel much more in tune with what I'm dealing with. I've always enjoyed the major specialties--cardiology, gastroenterology, oncology, pulmonology, urology, orthopedics--and when they'd speak of malignancies, I'm seeing clearer distinctions between things like "adenoma," "carcinoma," "sarcoma," "adenocarcinoma," all the way up to "glioblastoma." Before, I knew only that anything -oma was a tumor and usually carried bad mojo with it. Now, I'm starting to hear these terms and flash back to my textbook illustrations and tables and see that patient much more tangibly in my mind's eye and even have a clue as to their prognosis.

It's been a real revelation, I tell you. Now, I can't speak to the specifics the aforementioned courses get into as far as anatomy and physiology, though I do believe they use The Language of Medicine (a really excellent book--of course, also not included in my official training). At this point, I can't imagine even training to be an MT without getting into this much detail. Obviously, in training specifically to become a tumor registrar, it's mandatory.

Getting my first real glimpses of Medicine in glorious Technicolor, I am reeling in the wondrousness of it all. It bolsters my "you don't know what you don't know" motto, of course, but I'm starting to feel like my world is coming into focus more each day. As long as I keep those danged flying monkeys on the periphery, I'm great.

Well, whaddya know. . . I may have missed my calling here. I've been so focused on what makes a good or bad MT course and trying to move upward and onward into CTR that I totally neglected other possibilities. Those of us who've been around any length of time at all know that the world (and particularly, the internet) is full of bogus courses that will promise to train you as transcriptionist in 12 easy lessons and have you making $60K a year in no time. If a $3000 course with a stellar track record will get you there in 9-12 months, why not pay half the money and just apply a more concerted DIY effort? Heck, why not hit eBay, where you can drop anywhere from $1 to $500 and really save some money?

The same is probably true of coding and other HIM courses, of course. There are countless "matchbook" schools (so called because that's where they're apt to advertise--matchbook covers, magazine inserts, even postcards in that diaper bag of goodies the baby formula company gets your OB to hand out on your first prenatal visit) just hoping you'll be enticed by their hype. Of course, this isn't confined to the pink collar ghetto of work-at-home-mommies. You can train to become all kinds of cools things, from locksmith to crime scene investigator, paralegal to IT specialist, dog groomer to court stenographer. . .

. . . and now, even doctor! Yes, in a mere two years and ten months, you too can finally hear your mother introduce you as, "My son, the doctor." No pesky Bachelor's degree or MCATs to pass for admission. No quotas, no age limit. Heck, you don't even have to worry about dragging your hiney out of bed to your first class because the campus is apparently virtual, cleverly concealed in this PO annex in a California strip mall. (To be fair, the campus photos elsewhere emphasize the lovely public beach across the street as the apparent student union.) Now, I've been told that a good acute care transcriptionist has a fund of knowledge on a par with a third-year medical student and being quite full of myself and eager to believe this, I find myself wondering if I couldn't just breeze through this school with such a background. I see they take PayPal, after all. *big grin* I don't think it's too alarming that their faculty only has four instructors, do you? Maybe the rest of them are at those "Caribbean locations" where you do your clinical rotations. Cool--a medical degree AND a great vacation!

All kidding aside, I don't know whether this makes me happy to see it's not just SAHMs being taken advantage of or really depressed because the internet has really outdone itself. Do they honestly have more than the one student who fell for this? Are there really hospitals who would happily accept a new resident with such a pedigree? More importantly, how many of us are going to pay a little more attention to those diplomas on our MD's wall, hoping we see almost anything but this particular alma mater? I bet PT Barnum is laughing himself silly about now.

For myself, I think I'm content to aim just slightly lower and revel in the knowledge that I seem to have chosen a field with considerably fewer loopholes on the educational end. Even though I'm still floundering around the starting line, I've been really bolstered by the feedback from fellow MTs that I'm on to something here.

I've been watching the various online forums with a new eye since embarking on my journey to a new career and I think it's done nothing but bolster my jaded view of the MT world.

In the Advance forums, Lisa Algeo asks for feedback on bad transcription or coding schools--which has almost entirely consisted of discussion of coding courses. I suspect if she had broken this down into two topics, the transcription discussion would have few, if any, replies at this time, aside from the usual promotion of AAMT's school approval process--a process which, in my humble opinion, started with the best of intentions and quickly deteriorated into a tainted money-making gimmick, thanks to lowered standards and apparent sweetheart deals. If nothing else, it lumps schools that barely meet the requirements on a par with schools that have set the standards for MT training (i.e. Andrews and M-TEC), both of which produce graduates who not only find jobs quickly upon graduation, but are able to pick and choose. In contrast, other graduates are either shuttled through internships because they're not ready to dive straight into the workplace or find their diploma doesn't get their foot in the door to even test for jobs. (Yes, I know they've changed their name and are no longer about "American" or "medical transcription" anymore, but the fact remains that "AAMT" is what we associate with them, no matter how many times they change their acronym.)

There is a dearth of information for potential students, as far as making an informed decision on their education and more often than not, we learn after the fact that we've chosen poorly. Not even taking into consideration the matchbook schools that are solely in it to rake in tuition bucks, and given the purported level playing field claimed by AAMT, students often choose a course based on faulty logic: Why pay $3000 for a course when I can get the "same" training for half that? Well, the sad fact is that by the time you struggle through that cheaper course that comes with no instructors, few reference materials, and often inaccurate or outdated instruction, you're going to end up paying much more to supplement with those same reference materials for the job, remedial transcription materials, and still no guarantee that you know what you're doing. There's an old adage about how a lawyer representing himself has a fool for a client and I think that applies to education even more. You can have the identical textbooks the good courses use, but without a qualified instructor, you can't teach yourself what you don't already know. Even if you could, how much longer would it take you than if you'd just gone with the right school to begin with? Even more important, how much is it worth to you to be ready to make the most money possible as quickly as possible on the job? No, even great training isn't going to make you an expert, but it is going to ensure you don't waste the first six months on the job learning stuff you should have known already. MT wages are low enough these days and if you're struggling to churn out 300 lines a day because you have to research everything, you're not going to last long as an MT.

It seems like most of the transcription questions I see posted are heart-wrenching tales of education gone wrong, people who've found they've invested precious savings and months of effort, only to find things are not as rosy as depicted in those glossy ads for cheerful mommies making $60K a year whilst their well-behaved toddlers perch on their laps. Almost worse are the tales of folks who have chosen well and love the job, but are now facing plummeting wages and speech recognition woes. Contrary to what the vendors are telling clients, SR is not that wonderful money-saver because it's so efficient. It's cheaper largely because instead of paying an MT to transcribe lousy dictations, they're calling MTs editors now and cutting their wages in half or less and requiring double the production, even though they're often finding they're still really doing basic transcription because the SR output is so bad, in essence working twice as hard for half the money. As speech recognition and EMR take over, I'm afraid we're all doomed to transitioning out of straight transcription. It does not matter that canned text and point-and-click records do not make for a cohesive medical record, it's the bottom line that's being sold.

True to form, proponents of AAMT are still claiming a rosy picture for MT, even if our jobs transform into something totally different. In The MT Parachute, we were recently told to expand our skill set, go back to school, get our CMT, and I guess learn to love speech recognition. I'm afraid I found the interpretation of a "parachute" less than logical, as it wasn't actually advocating parachuting to anything viable, just the same AAMT party line.

So yeah, I'm having a "bad MT day." I still love my job, actually, but I see these things barreling down the pike and it has me nervous. This is what prompted my foray toward CTR, after all. I think part of what appeals to me is that the organizational setup for groups like AHIMA and NCRA seems to be done in a much more professional manner than I've been accustomed to as an MT. Of course, I'm a newbie to this side of the fence and not privy to the grapevine yet, but so far, I have a much better feeling about things like school accreditation and member advocacy.

Now, if I could just fast forward to the end of my course so I see more of the picture. After whining last time about a lack of time, I spent my weekend cramming my head full of cell structure, mitosis, osmosis, and all kinds of good things--only to find that I was supposed to jump ahead 15 chapters. Good news seems to be that I can still learn. Bad news is that I apparently have issues with following directions. Gotta love mistakes--no better way to cement a concept in my head than to mortify myself with a doozy. At least learning is something you can never overdo. Now, next time someone asks me to diagram a cell, I'll be ready! In the short term, interestingly enough, I'm already finding that studying anatomy and physiology really has enhanced my understanding of my current job--something I didn't really anticipate, but a great bonus!

That's how many hours a day I figure I need in order to deal with everything on my plate at the moment. I suspect the problem is exacerbated when you work a graveyard shift. It seems like I'm forever working, sleeping, working, sleeping, working, sleepy, or just allowing myself a couple hours in the evening to veg in front of the TV with an easy dinner. Come the weekend, I still need to get groceries into the house and pick away at household projects. I tend to hang out with one or both kids most of Saturday. I live in a perpetual handyman special, which seems to have something falling apart regularly - new garage door, new floor in the laundry room, refinishing the bathtub, or agonizing over how I'm going to replace the siding. I also have bird cages to clean, dog to groom, cat box to empty, and for some reason, I thought it would be a good idea to start making my own dog food (a twice-monthly ritual). This doesn't even factor in the regular household routine, which already involves dressing straight out of the dryer too often so I can bypass the intermediate step of actually putting the clothes where they belong. . . To make things worse, I get to deal with all of this on my own.

So when do I fit in time to go back to school? What was I thinking? I'm hoping this is a matter of time expanding to meet my needs. After all, working moms burn the candle at both ends all the time, right? Fortunately, my kids were in high school when I started working, so I was spared the most difficult choices to balance work and family (to say nothing of watching half my paycheck go toward child care). Before the divorce, I had the luxury of taking a course and doing nothing but for at least 12 hours a day - and I did. I finished my MT course ridiculously fast, and with near-perfect grades. I grasped the material well enough that I was able to toss the marriage on the funeral pyre and support myself almost immediately. Now that I'm working toward transitioning to cancer registry, and having the benefit of the intervening immersion in the medical field, it should be almost as easy, right?

Ugh. I'm not finding it to be so, unfortunately. Besides burnout from working through every holiday in the last year, I figured it was time to take some of my stockpiled vacation days and play catch-up on my coursework. True to form, I then discovered a critical disaster in the making and have spent the last week ripping apart my Florida room and putting it back together. This has meant single-handedly ripping out cabinets and flooring and about 26 hours of sanding and painting. If I can figure out this “easy” laminate flooring, I may actually finish with some vacation remaining. *moan*

I think it hasn't helped that my first course is a bit hard to get excited about. At first, I thought Anatomy & Physiology would be a snap. I know this stuff already, right? Yep. . . except the first few chapters are about the least compelling part of it - chemistry. Do I really need to know how to figure the atomic weight of something? Do covalent bonds actually figure into the job of a CTR? I want bones, dangit! I want muscles! I want to be quizzed on where organs are and what they do. I want to know how a diseased one affects the next one down the line. I want to make use of this stack of anatomy coloring books I've amassed. To make things worse, AHIMA's course includes countless links to relevant websites, which I find myself poring over. (I am a serious web junkie.)

So yeah, I'm sputtering around the starting line, frustrated and impatient with myself. I think once I'm done with the first three chapters, it will be much smoother sailing. In the last six months or so, I've started a self-improvement kick and have been faithfully journaling my food intake and sticking with an exercise routine, so I've proven I can accommodate a new routine and stick with it. One less hour a day in bed and I should be able to fit in the necessary time with the books to get this done. It's not like I have to do it for the rest of my life, after all. . . and in the end, I'm looking at not just a new career, but on the opposite side of the clock! I have a sneaking suspicion that's where they're keeping all those extra hours my days seem short on.

Have you ever bought something that you need to assemble, then found the instruction booklet was some weirdly skimpy diagram that didn't look anything like the parts before you--and the instructions were all in a foreign language? That's how I felt when I tried to find out what cancer registry was and how to get into it. Based on a couple comments here and there I was intrigued, but even my Google skills weren't proving to be of much use. So where to begin? I'll tell you what I did, and perhaps save you some time.

First hit, of course, was the National Cancer Registrars Association (NCRA). Upon hitting the "education" tab at the top, I was taken to a page with a dizzying amount of information--most of which pertained to mentorships, ongoing education, workshops, and things that didn't really seem to pertain to me. Aha--there was one little link in the midst of that to take you to a page to find certified tumor registrar (CTR) courses. I figured this would make it easy, just find a school nearby and figure out how to enroll, right?

Oops. Not quite so simple. In looking at all the traditional (i.e. on-campus) options, it's not like there's something available around the corner--unless you live in one of the five places that offer a course. Well, fine--I'm better-suited to online learning anyway. I work a graveyard shift and don't mesh well with a 9 to 5 world. There are probably tons more courses offered online anyway, right?

Wrong. Counting both degree and certificate programs, there are only about 7 offerings online, as well. Stranger yet, it looked like there were more offerings through vo-tech schools than actual colleges. I spent days poring over their websites, playing with their classroom interface demos, and crunching the numbers. If you're lucky enough to live in a place that has a course offered, the cost is actually really reasonable (as low as about $600 for the course at your local vo-tech, or free in some states if you're a high school student). Enroll from out of state, however, and you lose that resident tuition and are talking about $2,000 more. Argh. I've been trying to figure out where to move for years and actually pondered if it was worth that difference to go back to IA (family beckons, winter weather does not) or venture into parts unknown (I've actually considered NC, being the traditional retreat for Floridians escaping the heat and tourists). Well, that's silly. It seemed that the AHIMA course was the most affordable, and AHIMA is a logical choice for healthcare education and has a good reputation, right?

Otherwise, I saw a link to SEER and a self-study course. You mean I could study and just take the test myself? I downloaded all the PDFs and it only fueled my belief I could do this job. I went through about a dozen exercises in abstracting and got more excited. Once I got over my transcriptionist's mindset where everything seems important and started getting a handle on what a registrar is really focused on, it all made so much sense. Still, having been burned on the no-instructor school of medical transcription, I knew full well that a simple self-study course would not suffice. I wanted a real instructor to answer my questions if I got stuck, not just a student forum where the blind lead the blind. I wanted structure. I wanted to be forced to immerse myself in every detail so that in the end I would never question whether I knew what I was doing, whether there were gaps in my education, and never have to wonder if that certificate at the end that would truly mean something to potential employers. I could see that some kind of internship would be necessary before testing for the actual credential, but beyond that, I still felt in the dark.

I decided at this point to contact the NCRA to enquire about what membership actually would offer me. I obviously need a mentor and yes, that's one of the benefits they list--but there was still a lot of grey area. I found no forums to ask existing CTRs for course recommendations or other clues as to how to proceed. It didn't seem that I could join NCRA at any level (national or state) until I was actually a student, so that was a dead end. I scoured Usenet for newsgroups pertaining to CTR and found nothing. I found only one message board for CTR and that also seemed to be private and for existing registrars. What's a newbie to do? Sadly, I messaged both the NCRA and the FL chapter and neither membership contact deigned to grace me with a reply. There seems to be a grave disconnect there, perhaps not understanding how crucial the Internet is to their viability. Everywhere I look, I see how the world is "desperate for CTRs," but no one seems to have a firm grasp on how to entice new recruits and get them trained!

That's when I stumbled upon Linda Wilhoute's blog here at Advance and subsequently, the forums. I asked for an opinion on courses and general encouragement, and received a couple of excellent replies that assured me as long as I chose an accredited course, completed an internship, and obtained my CTR credential, that's all employers would care about. This was contrary to my experience as an MT, wherein graduates of M-TEC and Andrews medical transcription courses are looked upon so favorably that they can pretty much pick and choose their jobs because the courses have such a great track record for turning out grads who can jump right into the deep end in the production-based world of MT. In contrast, cancer registry seems to either be too new for matchbook schools to find a toehold or else the restrictions are simply too well-planned in advance for them to even be an issue. Hooray--more evidence I've chosen a great field to get into and a feeling that any course accredited by NCRA would probably be a good choice. 

That solidified the decision for me. I went 'round and 'round the AHIMA site and decided to take the plunge. It seemed a bonus to me that I could pay for each module as I went, rather than having to cough up full tuition and books at once. Credit card in hand, I headed to the prerequisite courses and signed up for the first: Anatomy and Physiology. Hey--I love this stuff and use it all the time as an MT, so it should be a breeze, right? Heh. Well, that's a whole 'nuther story. Suffice to say I'm happy to be a co-ed once again, even though I'm still a little apprehensive about whether I've assembled my kit entirely per the instructions.

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.