Important information regarding MTSOs for those of us in the Medical Transcription profession in 201

This is a wake-up call to anyone currently in the Medical Transcription profession and to anyone who is thinking about going to school to become a Medical Transcriptionist.  If you do not at least read this and consider it, you will have no one but yourself to blame when in 2011 you are in a worse situation than you are in today.  Do you have your head in the sand, or are you making wise choices regarding your profession?  Read the following and you can then make an informed conclusion. 

Medical Transcription seems to be the most uninformed, in-denial, and change-resistant profession on the planet.  And, unfortunately, it appears, in my humble opinion, to be mostly perpetuated by the people currently or even formerly who work in the Medical Transcription profession as “pajamas”, more so than their employers, the dreaded “suits.”  Almost daily there are posts about “no work,” “my platform stinks,” “no one returns my Emails,” “the pay they offered was an insult,” “we have no voice,” “we must unionize,” etc, etc, etc.  These may all be legitimate complaints, but at the same time, these same people become defensive and almost combative if anyone dares to offer an opinion or post factual information regarding what the future of Medical Transcription has to offer.  Any facts given for informative purposes are met with:  “That will never happen,” “that does not affect me,” “that is wrong, because I have never heard of that” etc, etc. 

How informed are you?  Are you up on all the changes coming to the Medical Transcription profession in the next few years or are you in denial?  If you are planning to continue in the Medical Transcription profession for the next 15 or 20 years, you owe it to yourself to read this entire post.  You need to be well informed should you lose your present job and need to search for another one.  If you are recently graduated or fairly new to the field, you need to ask your employer the hard questions to protect your economic future.  If you are an Independent Contractors you need to find out what your clients know about the upcoming HITECH Act and if they are implementing the required changes.  After the HITECH Act goes into effect in February of 2010, any HIPAA violations can go all the way down to the Medical Transcriptionist or VR Editor, and YOU can be fined or fired if a breach occurs.  Have your employer/clients informed you of how they plan to implement the changes mandated by the HITECH Act? 

First, a quiz to see how Medical Transcription profession savvy you are.  Answer the questions as you honestly believe they are today, and then go back and answer them again after you have read the entire post.  See if your opinions of the profession have changed. 

It would be great if you posted your answers for others to read, so that others will be more willing to answer the questions also, or post your comments if you garner any new insight into the future.   

QUESTIONS: 

1.     How many Medical Transcriptionists or Medical Transcription-related jobs (in-house, at-home, Independent Contractors, off-shore) (Medical Transcriptionist, Medical Language Specialist, Voice Recognition Editor, Quality Assurance, etc) will there be in 2020 (ten years from now)?

According to the U.S. Bureau of Labor Statistics, Occupational Employment Statistics, as of May of 2008, there were 86,200 people who identify themselves as Medical Transcriptionists (this does not include people who identify themselves as self-employed).  Knowing that number is woefully inaccurate, for the sake of ease of statistics, lets say there are over twice as many if we include Independent Contractors and people who identify themselves by another name (VR Editor, etc), and make it 200,000 people working in Medical Transcription-related positions in 2010. 

     a.     What percentage of that 200,000 will still be working as Medical Transcriptionists in 2020?   

2.     What percentage will be doing ONLY Straight Transcription?

3.     What percentage will be doing ONLY Voice Recognition? 

4.     Of all Employers currently hiring Medical Transcriptionists/Medical Language Specialists/VR Editors – or whatever we are being called now --- from large multi-country (those that off-shore) corporations such as MedQuist, Transcend, Spheris, etc; to large USA Only corporations such as Webmedx, Keystrokes, SoftScript, etc; to medium companies with less than 200 total employees; to small one-or-two-person owned companies that only hire Independent Contractors; to the individual Medical Transcriptionist who hires one or two other IC Transcriptionists to help with overflow --- 

     a.     What percentage of the total MTSOs/employers in existence in 2010, will still be around in 2020? 

     b.     What percentage of MTSOs/employers will have merged or have been bought out between 2010 and 2020? 

     c.     What percentage will have closed their doors permanently?

5.      Will the majority of Medical Transcriptionists (or whatever their title will be in 2020) be employed at-home or at-site in 2020?

THINGS TO CONSIDER: 

Please do not try to “shoot the messenger.”  I have read and heard from numerous sources that the following information is considered to be accurate by the professionals who track this type of information.  Much of the information below is taken directly from Government sites. These are not my opinions, but the opinions of various professionals who supposedly have no bias, and you can disagree with THEM all you want, but please leave out personal attacks on anyone who has a different opinion from yours.

Professionals predict that Medical Transcription will be a fading profession in the next 10 to 20 years, due to the changes already in the works, in addition to the mandates of the HITECH Act which goes into effect in February of 2010. 

The Medical Transcription profession had its highest number of employees in 2001.  Since then, the number of MTs had decreased by approximately 10% each year, and is expected to continue that trend of decreasing by at least 10% per year in the future. 

Reasons for change:

1.     More and more hospitals/clinics are moving towards front-end voice recognition and EHR.  By 2020, the professionals predict that less than 10% of dictations will need to be straight typed in all types of settings or specialties --- hospital, clinic, single-physician office, etc. 

2.     As front-end voice recognition improves, there will be no need for back-end voice recognition Editors.  We are already seeing this.  Although we think there will never be voice recognition good enough to decipher ESL dictators, in reality, they are the easiest to convert to front-end dictation.  The reason is that most (not all, of course) ESL dictators try to enunciate and phonetically pronounce words exactly the same way every single time (whether they are understandable to us or not).  That is precisely what VR systems are programmed to decipher.  The ESL dictator may butcher “oophorectomy,” but they butcher it the same way every single time.  So, eventually, the VR system knows when it hears “o’frec-o’mee,” the dictator means “oophorectomy.”  Eventually, the VR system will go from back-end to front-end – thus no need for the Medical Transcriptionist/VR Editor.   It is ironic that as the Medical Transcriptionist becomes a better VR Editor and we finally raise our wages back to where they were when we all did straight transcription, it will only be short-lived, because eventually the back-end VR technology will become good enough to eliminate the need for it and go to front-end VR, eliminating the Medical Transcriptionist/VR Editor completely.  No matter how good we became as VR Editors, we may never again make the same wages we were making even five years ago.  The Medical Transcriptionist pay peak has come and gone.  

3.     Although the Medical Transcription profession over the next 10 years may find that there are more Medical Transcriptionists then there are jobs available, there will possibly be one segment of the profession that will increase.  These people will be called something like “in-house Medical Text Editor.”  These people will, basically, look over what the physician has inputted into the EHR and, in the same way that the VR Editor listens to dictation and corrects errors, the Medical Text Editor will read over what the physician has entered and flag anything that may be in error.  In large clinics and hospitals, these people will probably be very specialized.  One person may work exclusively for a hospital department or clinic specialty.  They will, supposedly, become so familiar and expert in the language and pharmacology of the physicians they work for, they can simply read the report and know if an incorrect drug or procedure was inputted by the physician.  They would also look for he/she, right/left, etc types of inaccuracies made by the physician.  So, if the Internal Medicine physician sees a patient with foot pain, and the physician clicks on Psychiatrist from the drop-down menu as the next referral to, the Medical Text Editor should be versed enough to change it to Podiatrist.  Because the knowledge and skills required for this type of position are more akin to nurses or physician assistants, hopefully the pay for these Medical Text Editors will be more in line with these professionals or most certainly paid by the hour or salaried.  Medical Transcriptionist pay by “cents per line” could be a thing of the past in 10 or 20 years. 

4.     The U.S. Congress has mandated through The American Recovery and Reinvestment Act of 2009 (ARRA) “to improve the nation’s health care through health information technology (HIT) by promoting the meaningful use of electronic health records (EHR) via incentives.   The reasoning for this is that it will be easier for a physician to do almost real-time transfer of information from one physician to another with this type of technology, thus eliminating duplication of services or tests.  Their scenario:  Patient goes to see Internal Medicine physician and has lab tests and chest x-ray done.  Internal Medicine physician determines that the patient should be seen by a Pulmonologist, and sends the patient to another floor in the clinic to see that physician.  While the patient is waiting in the lab for tests to be done, the Internal Medicine physician finishes his EHR report.  After the patient finishes in the lab, while the patient is waiting in the Pulmonology Department to see the Pulmonologist, the Internal Medicine physician’s report, the lab reports, and the x-ray report are all being uploaded to the patient’s EHR file.  By the time the patient sees the Pulmonologist, that physician has read the Internal Medicine physician’s report and knows what tests have been completed. 

“The HIT provisions of the Recovery Act are found primarily in Title XIII, Division A, Health Information Technology, and in Title IV of Division B, Medicare and Medicaid Health Information Technology.  These titles together are cited as the Health Information Technology for Economic and Clinical Health Act or the HITECH Act.   The Recovery Act establishes financial incentives beginning in January 2011 for eligible professionals (EPs) who are meaningful EHR users.  Beginning in 2015, payment adjustments will be imposed on EPs who are not meaningful EHR users.  The Medicare fee schedule amount for professional services provided by an EP who was not a meaningful EHR user for the year would be reduced by 1 percent in 2015, by 2 percent in 2016, by 3 percent for 2017 and by between 3 to 5 percent in subsequent years.”   This means that small clinics or single-doctor offices will not be able to afford to stay in business if they do not convert to EHR by 2018.  These physicians will close their offices and retire or move to larger clinics/hospitals.  As a result, small MTSOs and Independent Contractors who work for these small clinics or single-doctor offices will lose these clients. 

5.  Once the HITECH Act regarding HIPAA comes into play, Independent Contractors or small MTSOs who do not have the proper encryption will have to either upgrade (which could be costly) or close/sell their businesses.   It is predicted that any company who does not use some type of encrypted proprietary platform will not meet the HITECH standards.  That means those who currently use only MS Word and file transfer with FTP will have to upgrade their encryption.  “For many of these organizations, particularly those smaller providers and vendors, the concept of encryption and the associated NIST standards are likely to be foreign. These standards are complex and costly, and will involve a great deal of IT management time as well as training of users in order to meet even the spirit of the guidance. Nevertheless, taking steps now to begin implementing the proper encryption components to one’s operations should prove to be a wise investment when a laptop, for example, is lost or stolen.”

“The guidance identifies two methods for rendering PHI unusable, unreadable or indecipherable to unauthorized individuals, encryption and destruction. In particular, the guidance for securing PHI focuses on three main areas, including PHI at rest, PHI in motion and the destruction of PHI.  Electronic PHI has been encrypted as specified in the HIPAA Security Rule by ‘the use of an algorithmic process to transform data into a form in which there is a low probability of assigning meaning without the use of a confidential process or key’ and such confidential process or key that might enable decryption has not been breached.  Because of the increasing capabilities of computers, encryption key lengths must increase over time in order to keep data secure. Therefore, it is likely that encryption standards will continue to be revised as technology develops and will require periodic updating by covered entities and business associates in order to remain exempt from the HITECH Act’s notification obligations.”   Clear as mud, right!       Most small MTSOs and one-person Independent Contractors will have to hire someone just to read the requirements to them, let alone explain how to implement them all.   

The cost to small MTSOs or one-person Independent Contractors may be financially prohibitive.  Specifically, one or two person Independent Contractors may find they will not be able to recoup the cost of encryption upgrades and will instead opt to leave the Medical Transcription profession.   

6.     We all know the Health Care Reform currently going through Congress will be expensive.  There are already threats by various specialty physicians and clinics stating they will close their doors because reimbursements under the new Health Care Reform will not be sufficient to keep their doors open.  Although no one will admit this to be a fact, there is also the chance that the Government will try to get more money by nitpicking the HITECH Act.  Since MTSOs and even Medical Transcriptionists will be subject to fines due to breach of HIPAA, many will become overcautious.  Independent Contractors will fear being charged with a HIPAA violation and fined because their laptop was not secure enough.  MTSOs will fear being fined because one of its Medical Transcriptionists viewed an unauthorized report.  The MTSO will be fined and the Medical Transcriptionist will be fired if a breach is found. 

7.     By the way, for anyone who works for an MTSO whose platform has the capability to review prior reports for a patient or a group of reports by a particular physician in order to verify a diagnosis or drug, or to make up standard operative reports for future use in your InstaText or SpeedType expander, did you know that the MTSO will be required to instill “spyware” that will record everyone who looks at a prior report and how many times it is accessed?  Medical Transcriptionists will find themselves having to explain to management “Why did you look at the report dictated by Dr. Jones for patient Sue Smith?”  If you do not have a legitimate answer, they can fire you immediately as a HIPAA violation. 

8.     It is rumored, but not verified, that any at-home Medical Transcriptionist will be required to use the computer “Exclusively for activities associated with employment.”  This means if you are an Independent Contractor and you have only one computer that you use for work and also for personal Emails, etc, the hospital/clinic may require you to sign a statement certifying that only work activities under new stricter encryption standards are being done on that one computer.  Also, they may require a separate “office” that is locked and no one (no kids, spouses, etc) can enter that room.  I have no idea how they will be able to enforce this, but if there is a way, the Government will come up with it because they need the money.  The Government will do whatever it needs to in order to find you in breach and be able to fine you in order to obtain money for their Health Care Reform.  So do not be so quick to dismiss this as something that could never happen.  As technology improves, anything is possible. 

9.     The professionals who track employment in the future are predicting that at-home Medical Transcriptionists will become rarer and in-house employment will be making a comeback due to the stricter, more complicated encryption requirements. 

10.     At this point in time, no one knows how the HITECH Act and EHR will affect off-shore transcriptionists.  It is very possible, according to the professionals who track this type of information, that no further dictation will be sent off-shore.  Because of this, there may be a slight spike in Medical Transcriptionist activity in the U.S.A. as the work comes back to the U.S.A. and away from other countries, but that will be short-lived and may not even be noticed.  As smaller MTSOs and Independent Contractors close shop, those Medical Transcriptionists will be absorbed by the large MTSOs who are bringing back their off-shore work.  So, the Medical Transcriptionist working day-to-day for the large MTSO will not see an increase in their workload, just an increase in the number of new employees, for a short period of time.  Over time, any Medical Transcriptionist that leaves their job will not be replaced, front-end technology will eliminate the need for VR Editors and Quality Assurance personnel, and EHR systems will continue to decrease the amount of dictation sent to MTSOs.   As a result, the Medical Transcription profession will change forever. 

I hope this will make anyone currently looking for a new employer or pondering whether or not to accept a job from a small MTSO; or who is thinking about taking a Medical Transcriptionist course or go back to school, to ask themselves the following questions and ask yourself if you can afford to stay in this profession: 

1.  Do I want to be looking for a new profession in 10 or 20 years?

2.  Do I really want to quit my job and try to become an Independent Contractor?

3.  Will the Independent Contractor job I have now still be around in three, four, five years?

4.  Will I have to buy a new computer to keep my job? 

5.  Will the company I currently work for still be around in three, four, five years?

 The following is my opinion only.  No need for any MTSOs to get all bent out of joint.     

My advice:  If you have a job, even if you hate it, stay put – at least until the HITECH Act has been implemented and all the changes are in effect; and also until after we see what happens with Health Care Reform.  If you are about to accept a job, either as an employee or as an Independent Contractor, the first question you should ask is what they have done to comply with the HITECH Act.  If they do not know what you are talking about, that might be a warning sign for you to seriously consider whether to take that job and take your chances of still having it in six months, or whether to look somewhere else, where the “suits” have already implemented the changes required and are on top of what is going on in the Medical Transcription profession. 

I have no dog in the race.  I am retired, so I am not trying to discourage anyone from entering the profession or from accepting a different job offer.  I read the board and see how unhappy many Medical Transcriptionists are currently.  All I want to do is make sure everyone who is in or will be in the Medical Transcription profession enters it with eyes wide open and fully informed of what the future has to offer. 

No one else is looking out for you.  MTSOs do not want you to be well informed because they will continue to hire as feverishly as they can to make sure they make as much money as they can before they have to cut back because it becomes too expensive or too complicated to continue.  They will not inform you that you job may be in jeopardy until they lay you off.  Employees have the potential for Unemployment Compensation Benefits, but Independent Contractors do not.  MTSOs will let you go and never look back. 

There have also been many complaints about schools and at-home on-line courses that supposedly train someone to become a Medical Transcriptionist in a few months.  People pay good money and then are just let go to find work as best they can.  These “schools” only want your tuition money.  They do not care about you.  I believe anyone thinking about paying money to become a Medical Transcriptionist deserves to know all the facts before making such a commitment. 

To those of you who do not believe you will be affected or that nothing will change for the next 50 years, well I have been a Medical Transcriptionist for 35 years.  We have come a long way from typing on an electric typewriter on sticky paper, all the way to at-home work on computers.  We all laughed when they were talking about Voice Recognition – “It will never happen.  Nothing will be able to understand Dr. So and So.”  Even 10 years ago, no one thought our wages would be cut in half.  Those of us who have been around 20 or more years thought we would consistently make more and more money every year, and after 15 years, we would be doing so well, we would all retire or at least only work part-time.  Well, times change and the next ten years may have the most changes of all.  Please do not get caught off guard.  Now is the time to carefully consider what you want to be doing in ten years. 

I know Recruiters hanging around are going to try to convince you that the above is all hogwash because they want you to apply for their jobs.  The MTSOs all want to make as much money as they can before all the changes go into effect.  Remember, if things change and you lose your job, they will not be out anything.  You will be the one without any income.  We are all intelligent people and can make our own decisions.  Do not let negativity influence you.  Think carefully about what makes more sense.  I have to reason to try to frighten you.  MTSOs have financial interests in getting you to remain uninformed lemmings.  You can continue to search for better positions, just do so well informed and in control of your own destiny. 

Bottom line, I have posted this because the Medical Transcription profession was good to me for many years and I hate seeing it become a third-world job, where more and more people are disheartened and unhappy in their careers.  Choose wisely.  Consider all the facts and be well-informed when you have your interview.  Ask hard questions.  There are MTSOs out there who are on-the-ball and you will be fine, but there are others that are already planning to bail out, but will not tell you.  Just be savvy and cautious.  Discuss this with your friends and fellow Medical Transcriptionists.  It certainly cannot hurt for you to be prepared for the possibilities of the future.  We can all just go along as if nothing will happen.  Unfortunately, with the high unemployment rate and continuing recession, now is not the time to be in denial.  You need to consider the “worst case scenario” in order to make the best decisions for yourself and your family. 

I wish you all happiness and prosperity in your chosen profession.  I hope each and every one of you are in jobs or find jobs that will bring you all that you aspire to. 

That is my New Year's Wish for all Medical Transcriptionists.

Happy NEW YEAR.  May you live long and prosper.  LOL