Question Period
| Welcome to the VLC's MT Question Period where our instructors and staff express their opinion on a medical transcription related topic. This is a chance for students, aspiring MTs, and even grads to get insight into this medical-support field through the eyes of experts. |
Debbie Nolan, CMT: What are the benefits of being certified?
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Have you ever wondered how to become a CMT? Times have certainly changed since I became one. There was no experience requirement; anyone who had just graduated from MT school could take the test. Back in the "olden days" of 1997, the test was taken in two parts. The first was done electronically on a touch-screen computer. It was all multiple choice, true and false, etc. You weren't informed of your score; only of a "pass" or "fail".
Then, there was a certain amount of time you had to wait to do the "practical" part of the test. That was the hard part for me, because I worked out of my home office and had to find a place of business to take my test. AAMT would not allow you to take it at home, and I also had to find a proctor. I lucked out because my former MT instructor was also an instructor at a business college, so I was able to use their facilities; however, I had to bring my own computer (with WordPerfect 5.1-does that show you how long ago it was?) and my own standard-sized transcriber/foot pedal combo. Your proctor had already been mailed the heavily guarded, armored, secret package of one tape that you had to transcribe in full. You were allowed, however, to have as many reference books as you could carry to that part of the test and, believe me, I brought a box load! After the test, you had to go home and wait a few agonizing weeks before you received word if you had passed or failed. If you failed, you had to wait a certain amount of time before you could take it again, and there were NO discounts for retakes. Well, times haven't changed all that much, I guess. There are still no discounts for retakes, and it's a whopping $275 for the whole test if you are a non-AAMT member. Now, you can take the entire two-part test at once, done at a special testing center. There aren't any reference books or materials allowed in the testing facility. A proctor is supplied for you, as well as a computer, and you take the first part of the test, then the second part. You find out the same day whether you passed or failed, and you get your score. Plus, you are advised about areas for improvement. |
The biggest change is that two years of acute-care experience, or "equivalent," are required to take the test. There is a Candidate Guide on www.aamt.org, which will give you a better idea of what that experience entails. You will be tested on the "basic 4" acute care reports, which consist of operative notes, discharge summaries, history and physicals, and consultation reports. They say a "small" amount of the test comes from clinic notes, procedures, etc. On the Candidate Guide, there is a small self-test you can use that shows sample questions. They also give links and good references to study before your test.
So, the burning question is: Is it worth it to become a CMT? Did I find fame and fortune? Well, yes, no, and somewhat. In the beginning of my career, I did believe that being a CMT in this industry was the only way to advance my career. Early on, I found that it didn't really matter as far as pay went, but over the last few years it has made a difference. It did open some other doors for me. It is very difficult to move on to QA as an editor or proofreader without being a CMT. Most large MTSOs (Medical Transcription Service Organizations) now do pay a line rate differential based on CMT status. Also, most employers will reimburse you for your continuing education/tuition when it is time to renew your CMT certification. It is almost essential to have your certification in order to advance to any type of supervisory position. Still, the main reason I obtained my certification was purely for my own benefit. I proved to myself that I could go the extra mile, and I know that CMT status makes an MT a true professional in the eye of employers and peers. Just remember when you are considering your first job after school, keep an eye toward the experience you will need to fulfill the requirement of two years of acute-care experience; this can either be in a hospital setting or working at home for a service that does these types of reports. Working for a doctor's office and doing clinic notes will not prepare you to sit for the exams. In summary, if you are willing to do what it takes, going for your CMT certification is definitely worth doing! |
Amy Rudd: How do grads find jobs when most employers want two-year's experience?
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Most MT companies require at least two years of experience; however, many are willing to test individuals who have recently completed a medical transcription course. We have a list of over 50 companies who have hired our students upon graduation.
It is important to receive as much transcription practice as possible. Our Expert Certificate course includes three levels of transcription, level three being the most difficult. We have had MT companies comment on how well our students have done on their entry tests. In fact some graduates have done better than MTs with 2+ years of experience. It is also very important to have an excellent resume and cover letter. With the use of the Internet and the ability to work from home, many companies do not give personal interviews. You are, therefore, hired depending upon your entry test score and resume. Often, your cover letter and resume are your 'first impression' offered to a company. |
As students of the Virtual Learning Center, all resumes must be submitted to Beverley Henderson for review before your certificate can be issued. Bev worked for many years as a MT department supervisor and knows what an employer is looking for in a resume and cover letter.
One thing I cannot stress enough: do not test with a company until you have completed your course. If you do not do well on their test, many companies will not allow you to re-test for up to six months, and most request a copy of your certificate before they will even consider hiring you. Our students have done well, and many find employment within weeks of graduating. I wish you all success. |
Sheila Cryer, MT: How does an MT start up an independent company?
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As a medical transcriptionist, there may come a point in your career when you decide that you want to run your own business. There are many different aspects to consider and we will touch each in a small way below.
First and foremost: experience. As the owner of a small MT company, it is generally expected that you are a transcriptionist as well. Therefore, you must have the ability to transcribe for all types of physicians, including ESL doctors. When you, "as the company," are guaranteeing a client 98% accuracy work, then it falls finally on your shoulders to make sure you fulfill that commitment. I think the best recommendation for developing this is to get at least seven to eight years under your belt before attempting to start your own company. Many people think that money is a big issue when starting any company. However, in the MT world, there is not a big start-up cost. Personally, I provide all of the equipment/software needed for my clients who use digital recorders, and each runs approximately $75.00 per set up. However, I still have some physicians that refuse to give up the old microcassette recorders. Although these are not ideal, there is a way around this. You can re-record the tapes to digital files and send them on to your transcriptionist to be typed. The software to do this is extremely reasonable (around $50.00). There are also call-in services that can be loaded directly onto your computer, and a physician can dictate straight into your computer via the phone. Again, this is at a cost of around $75.00-$100.00. However, we still cannot forget the cost of maintaining a good reference library. Books are expensive, but always remember to watch for used books. Some MTs update their books every year, some every few years. To give an example: My last Dorland's Medical Dictionary was purchased in 1997. As long as you use the Internet and read, you can keep up-to-date without having to update your books yearly. There is one exception to this: I highly recommend drug books be updated annually. There are just too many new drugs coming out to keep up with all of them. If you end up needing to get a loan for equipment, etc, there is the Small Business Association that may be able to help. There are also loans for minority groups, which includes women. The big cost factor you do have to consider is how long you can wait between checks. These are your clients and although you will set your own billing procedures and pay dates for the MTs to whom you subcontract, that does not mean that your clients are going to pay you on time. Therefore, while you, as the company, are waiting to be paid, your MTs still expect to receive |
their checks. So, you must be financially stable enough to cover a couple of pay periods while waiting for your money to come in.
As a MTSO (medical transcription service owner), you can make money in the MT business. It takes building a good clientele, which takes time. There is no easy way to determine how much you can make because every client is different and dictates differently, which impacts the line count. You must get the account and then see how much they dictate on average. For example: Doctor A - dictates daily but is short and to the point - Average/month: $160.00
Doctor B - dictates daily but sees more patients than doc A-
Average/month: $600.00
Doctor C - dictates whenever he pleases - not steady
Average/month: $200.00
Doctor D - dictates 1-2 days per month but is very long winded
Average/month: $300.00
Total monthly income: $1260.00 Then, we must not forget that taxes have to come out of this as well. To do this amount of dictation, the average MT must spend approximately 80 hours per month to finish this amount of work. Of course, some will be able to complete it in less time, and others may take longer. On a more personal note, I have technically had my business since 1994. Until a few years ago I was satisfied with the one or two clients that I had. This was mainly because I have always worked for someone else as well. However, when my husband was laid off a couple of years ago, I chose to become more aggressive in trying to get new clients. This has actually worked to our advantage. He now sees how tough it really is to work from home (no, your family will probably never completely grasp that concept), but he has learned to do it. He transcribes work, does sales, and maintains my books, plus many other things as well. It would not be a business without him. My best advice, if you decide to go this route: Be ready for some tough times. In the long run, it will be worth it. For those times in between when you might want to throw your hands and give up, always remember to take a deep breath and keep on typing. |
Debbie Nolan, CMT: What is the most difficult learning curve in the course of becoming an MT?
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A medical transcription student faces a number of challenges on a daily basis, from unfamiliar terminology to foreign accents, to dictators trying to speak with a mouth full of food while driving in their cars, and even while attending sporting events. The comment I hear most often is "What is he trying to say??" Many MT students have heard of "developing an ear" for transcription. I have also heard this referred to as "peripheral listening" or "looking at the big picture." This can be one of the most difficult parts of the learning curve for MTs. What this means is that an MT should not focus on just the word or phrase, but read through the report, listen to the context, and think through and come up with possible alternatives.
For example, did the dictator say "Heart: A regular rate and rhythm," or "Heart: Irregular rate and rhythm"? Or, in the case of a neck exam, you may not be able to tell if the dictator said "cervical lymphadenopathy" or "no cervical lymphadenopathy." In the first example, if you listen to the rest of the context, you might find that the patient has an arrhythmia of some sort, which could help determine what is being said. However, if |
you are still unsure, the best and safest way to proceed in both of these examples would be to leave a blank and flag the report for the dictator.
Some of the ways to develop the "ear" for transcription include to leave a blank and finish the report to see if the word or phrase is dictated again more clearly the second time; take off your headphones and play the dictation through speakers (or vice versa) to see if it is more clearly discernible; and take a break from transcription for a few moments before returning to the document. Also, think carefully about what body system is being discussed. The patient has a plantar wart; did the dictator say "perineal" or "peroneal"? Developing the "ear" for medical transcription takes both persistence and patience, and a lot of practice. Even though you may become frustrated, remember that our priority as transcriptionists is to ensure a quality document that will not compromise patient safety or care. Never be afraid to leave a blank if you are at all unsure, and never guess at anything that is unclear. The "ear" will come with time. |
Arlaine Walsh, CMT, MSN.: What is the most pressing issue facing MTs today?
| For many (practicing) MTs the most pressing issue today is offshoring of work. Obviously, there is a great deal of anxiety, not to mention anger, surrounding this issue. There are other issues that seem to be reflected in this conundrum as well, and MTs and MTSOs are busy trying to cope with the threat of a shortage of qualified transcriptionists and offshoring. Here in the US, offshoring poses problems beyond the loss of jobs. Federal laws that govern the security of medical records can't be enforced when the information is sent outside the United States. We have all heard the story of the Pakistani woman who was a third party contractor handling UC San Francisco's transcription who threatened to expose private health information on the internet if her contractor did not pay her for transcription services rendered. Her contractor lives and has business in the United States. As well, quality of work returned from overseas employees often leaves much to be desired given |
English is a second language. The fear is that many transcription end-users are much less concerned about the quality of the work coming back to hospitals and clinics and more concerned about controlling costs, while everyone is so very mindful of the costs that are escalating in every area of medical spending.
The issues rage here in the United States and many say that if less work or no work was to be offshored, then MTs here would not be losing their jobs and new MTs would have more chance of finding a job, the wage situation would improve to boot. Though I personally feel the die has been cast in terms of cost controls, and paying less and expecting more, the situation might be helped greatly by having MTs understand that getting adequate credentials will give them a better chance at finding suitable employment, and will prepare them to do business with scrupulous employers who will not create such a situation. |
Beverley Henderson, MT, HRT: What do you see as the most significant changes in the medical transcription business during the past 20 years?
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The most significant change in the MT industry over the past 20 years is the change in dictating technology.
Twenty years ago, hospital dictating systems consisted of a central system with minimal tracking capabilities and regular- size cassettes. The cassettes gradually improved and evolved to microcassettes with some analog features, but they were still just cassettes. Fifteen years ago, the optic disk central dictating system was introduced. It was fully digitalized with great sound quality, doctor ID, patient ID, time, dates, etc., all capable of being monitored with this system. Work types could be directed into a priority order on a first-in first-out basis. Since this system audited each dictation by work type, dictator, and minutes of dictation, health record statistics were able to be measured with great accuracy. Dictators no longer could use the excuse that "dictation had been lost," as they sometimes did when using cassettes, since the optic disk system had the management capabilities to check a user's every access by time, date, patient ID and user ID. No entry for the patient ID - no report dictated! |
Since the first optic disk system, sound has been improved even more and there has been improved ease of operation by the MT. Each new model has an improved memory bank, back-up, etc., and is able to keep voice files on disk for a longer period of time.
An optic disk system can be shared among hospital departments (i.e. Pathology, Radiology and Health Records usually share a system, with HR owning the majority of the disk space. Larger units are now shared among healthcare facilities. The system may be located at one facility but doctors from several hospitals can dictate from any location; all dictation goes to a central system. (I understand this can cost a bundle.) Other features tracked by the optic disk are MTs' productivity; a manager can run an audit on an MT at any time. For instance, on an afternoon shift with no supervision, any gap in the work flow could be detected - bad news for some MTs. It would be with these methods that large MT companies calculate an MT's productivity rate. Statistics gathered by this system can calculate the minutes of dictation/minutes of transcription ratio for each MT. |
