Getting Started

Getting Started by Cynthia Lewis / Finding Vacation Backup / Back to Free Stuff

5/96, from Larry Wilson, in response to a question about starting an MT business from scratch:
If you have no experience at transcription, then you are probably in for a lot of trouble. This field is very knowledge intensive and it takes about two years of full-time in-house practice before you get really good. That's considering you already are a crackerjack typist (100+) and know word processing. Most transcriptionists who work at home work by the line or by the character and so speed and volume are the keys. But the ones that really make the money have a lot (I mean A LOT) of experience and don't have to look up the zillion medical terms, drugs and surgical instruments the doctors dictate. So during the learning curve you don't make zilch if you are on a line-rate.

True, once you get good and keep at it you can make as much as $50, but I've been in this business for 20 years and I type 120+ wpm. If you are new at this field then don't plan to make any money until your learning curve is over. If you're in business for yourself, you'll have to get your own accounts or work for an agency and they only want EXPERIENCED MTs. So, my advice, sight unseen, is DON'T GET RIPPED OFF. No home kit can give you what it really takes to make the money and that is skill and experience.

On the other hand, all you need is a good wordprocessor, Wordperfect is most popular and some home dictation equipment like Dictaphone and there is lots of work out there for you. The Dictaphones run from $500 to $700. The rest is your skill. The best thing for you to do is try first to see how hard medical transcription is. Go take a test for an agency or try out at a hospital just for the fun of it. It's a great field, it pays great, but it's very difficult in the beginning.

From there, I worked at large clinics and finally a large hospital, getting great experience. After my daughter was about two years old, I knew I had to find a way to work at home, so I started freelance transcription. It has been 11 years now and it has been great.

One word of advice to new MTs: Be sure to get a good computer. Even though it may be more expensive, computers become outdated in approximately six months and you will be glad you went top of the line. I recently upgraded from a 386 to a 486 and I wish I had the 586. Typing 65 wpm is fine, especially if you are accurate. That is what counts more than speed. Get lots of memory on the computer, then you'll be able to handle all the whistles and bells like the dictionaries, though I must admit I still use my books.

Eventually I made a trip to Majors where I immediately discovered an entirely new world. No one I worked with had any awareness at all of what else was out there, not even the owner herself, but she did have a lot of knowledge. So that's when I started consistently acquiring books for my own library, which shed considerably more light on many subjects.

At the time, none of our clients were hospitals, all were private practices. It was therefore fairly easy for the MT assigned to that specific client to focus on that one specialty, use her Sloane Medical Word Book, occasionally leaving blanks when something was unclear. The editor (owner at first, then myself when she sold the business to someone else) filled in the blanks and sent feedback to the MT. If all else failed, the office personnel simply faxed the page with the blank to the doctor's office for completion or verification, then made the correction before printing & delivering the work.

I now see that this was a fairly "small-time" service. Each MT had the same doctor(s) to transcribe regularly, and each became a specialist for her particular assigned accounts. I feel the setting provided no motivation for anyone to reach out for more knowledge. Once she had her particular doctor(s) down pat, she was home free -- at least until the account changed services for pricing reasons, and then she would have to scramble to learn another one all over again. That was the system in place there.

I was unique among our group because I hungered for greater knowledge and the ability to transcribe anything that might come along, as well as a desire to share with others as I learned coupled with an ability to "teach." That became my personal goal from the very beginning. The others were happy to just do what they were doing, they were comfortable, and didn't feel the need to pursue anything else unless they were forced to. I also focused on fine-tuning and using more advanced macros with built-in pauses, etc., became an amateur programmer of sorts, shared with others, etc. I even ended up teaching formal classes at our office on advanced features of WP51. They all just typed the same keystrokes over and over again, without thinking about how they could improve production and thus income. I began to use merges and field codes for my formats which allowed me to advance more quickly through each format without having to type or even macro headings, or retrieve pre-formatted docs where I had to stop and cursor down, over or wherever to get to the next pretyped spot to type the next thing -- whatever I could think of to speed up the process, particularly if it was repetitive. I just hated having to leave the keyboard, or spending time getting to the next spot. I was very conscious of speed and wasted keystrokes. It now occurs to me that I was, in a very elementary sort of way, attempting to "reinvent the wheel" which I didn't even know existed -- shortcut abbreviation systems.

After six months subcontracting, I switched gears and started to market myself independently with an entire package (brochure, business card, cover letter, introductory offer, etc.) I only received two immediate responses, both for periodic work only, a report here and there. I'm confident the work will come some day (perhaps when their MT quits six months down the road, etc.), but if you're waiting to pay any bills, that's another matter!

I'm now working part-time at a very professional clinic here in Scottsdale, and it's easier for me to see why working outside the home first is what many people recommend. It's not for everyone, I know, but for me it has worked out very well. It's such an incredible learning experience, and definitely takes away the pressures and lack of immediate money that often accompany a starting business. For example, my clinic covers just about every specialty you can imagine; working at home I only did family practice and some occasional dermatology work. Unless you work for a multispecialty clinic, your depth of knowledge may be more limited to the areas in which you land your business. My whole attitude towards MT has changed since I started working at the clinic. Everything there is very professional and uniform, a real learning experience.

As for facts about starting up an MT business, The Independent Medical Transcriptionist, 2nd Edition, by Donna Avila-Weil and Mary Glaccum (1994) is excellent. It's over 400 pages long and full of good information for independents. Jennifer Martin's MT Monthly newsletter also is very helpful. You can get info about that on the MT Daily home page as well. The MT Monthly also puts out a small publication on starting up an MT business. Call some of the larger MT services in your area and see what they are paying their subcontractors and what their hiring requirements are. There can be quite a variance in how they charge their customers or pay their subcontractors. Some pay by the line (and what constitutes that line? a full line, a word, etc.?) page or byte. You may need to do some calculating to figure out which service pays the best.

As for subcontracting pay, I was paid 8 cents per 75-character-equivalent line, and also had to print out my work. This was a high cents/line rate for my area, but the printing and high line character count brought it down to more like 6.5-7.0 cents per line, in my opinion. Going subcontractor rates here in Phoenix run about 6-7 cents per line, and some even want you to completely service the account, short of billing! Independents get about 10-12 cents a line here; some may make more, but I haven't heard anything specific. I think it's pretty competitive here, so that keeps our line rates down.

Throughout the program, although jobs were not guaranteed, we were led to believe that "employers were dying to hire us" and the pay would be really good. Up until my class, everyone who completed the program did successfully find a job. So when I finished, I really thought there would be no problem. Well it wasn't until eight stressful weeks later that a hospital 35 miles away hired me.

After finishing my on-the-job training, I knew I was not ready to work out of my home. I did not know any doctors and did not have a clue how to even go about getting accounts. I was too green for national transcription services, and I wanted experienced people around me to help me when I ran across bad dictators (of which there are many) and difficult accents.

Most of my job leads were not through the paper but through word of mouth. Everyone I talked to was either not hiring or wanted 2+ years experience (some even 3-5+ years). There were no entry-level jobs anywhere; either they did not want to put in the time to train or did not have the time to train. You just had to hope that the employers were unable to find an experienced MT and in desperation would give you a shot.

Another issue was the pay scale. I was led to believe it would be higher than it was. Starting pay ranges from $8-$11 for the "newbie" and if you get on with a service, they pays 5-6 cents a line (at least in my area). Of course, when starting out you are still in that learning curve and not very productive so a line rate probably won't pay the bills. I know it would not pay mine.

I feel very fortunate that I got a starting position with a hospital. I get to work in a very supportive environment where everyone helps everyone else. I know it is not like that everywhere.

I love my job. I am so happy and relieved to get my foot in the door. The possibilities appear limitless once you have experience. There are plenty of jobs available for the experienced MTs. As a single person, I look forward to someday working for a service at home, being able to travel and take my job with me, maybe even doing MT work in Saudi Arabia someday. I would also like to help other "newbies" starting out.

My only complaint about the program I went through was it did not have a class on starting your own home business. A lot of people enter this field to work out of their home, and learning the essentials for starting your own business is essential. Thank God for this MT Daily page and newsgroup where you can find helpful people and information to start that business.

My advice for starting out would be to do some research and find a good MT program, find out the job potentials in your area, be prepared to learn a whole lot, be ready to pay your dues as a "newbie", and have a really good chair since you will be sitting on your seat a lot!

I had previous experience as a medical office receptionist and knew how to "touch-type" but had NEVER transcribed in any way, shape or form. They were desperate and were willing to train me (it was a transcriptionist/ receptionist position). From there, about seven years later, I worked in a hospital medical records department part-time. Though I didn't have hospital experience, once again they were desperate and were willing to take me on. I learned a lot with the help of other transcriptionists. Though you may not have lots of medical transcriptionist experience yet, other positive work traits or experiences you may have can help you get started.

I am now hoping to get started again with my career as a medical transcriptionist. I realize I still have alot to learn and it is really difficult to find a service willing to train you and take the necessary time to proof read your work. I am not going to give up. I will keep training and hope to find a willing teacher. Transcription is so interesting to me and I am determined to succeed. Again, thank you so much for your interest in my situation. It helps just to know I am not alone.

Of course, I may change my tune about all of this as I near the end of my severance package. I started the course with the idea that I would do MT part-time, then when I was done I would work at it part-time while keeping my full-time job. I really could not afford to take a pay cut because in 3-1/2 years my husband and I have been married, he has lost two jobs due to a reduction in force, and the fact that the only programming language he has vast experience in is disappearing from the face of the earth. So he decided to start his own business as an indexer. The good news is that it is just starting to take off (he just completed his fifth book), but the bad news is that it is not enough to support us yet. Add to that the fact of the previous financial difficulties we have been going through, and perhaps you can see that this was probably the worst of all possible times for this to happen. So I am stuck trying to find another supervisory job, in another office, with another daily commute, and more office politics. And at the worst possible time of year. Bah, humbug!

The other interesting thing that I learned from the hospital was that although they don't currently farm out their overflow work to ICs they are strongly leaning in that direction now, and it is primarily because they can't get enough qualified people to work in-house as permanent employees. Before I decided to start my course, I had read numerous articles that seemed to indicate that the demand for MTs was growing much faster than the supply and this seems to demonstrate that very well. And you know what happens to price when demand exceeds supply. Good news for MTs! So, despite all of my bad news, there seems to be a lot of good mixed in there.

I did take a special test in medical terminology that the school offered and got a nice certificate for excellence in medical terminology. That didn't hurt my resume at all.

It is realistic to think you can start from home if you make certain provisions. First, you need to provide for the care of your children for the times you are working. If you let them interrupt you all through your work time, you won't get anything done, and you will probably have hard feelings toward the kids. So doing the work when the kids are sleeping or when they are in school works best.

As for studying and rocking the baby, enjoy it while it lasts. They grow up fast, and the second one will not be as easy as the first because you'll still have the first one to deal with. Once the kids are crawling and walking and climbing, etc., you will need to be ready to give them more of your attention each day and then provide for their care so you can give good attention to your work.

You also need to have a lock on your office door so little kids and cats can't mess with your computer. They can cause big problems for your equipment if you let them get at it. When I started working at home, the kids were out of the house, so that problem was solved for me.

I have wondered how the correspondence schools could take the place of a teacher at your side with ears that can listen along with you. I found that it is helpful to have a teacher and classmates in the room with you while you are doing the lessons.

I also found that working at a hospital for the first few years was great! We could ask someone else to listen if we encountered really difficult dictation. Another thing to consider when deciding about what kind of course to take is to know yourself and give an honest answer about how well disciplined you are. If you tend to procrastinate, then you'd better take a class at a school where you go at certain times, do the lessons by certains or flunk. If you take one of the "go at your own pace" courses and you tend to put things off, then you may never really finish the course. To study at home and to work at home, you have to have the discipline.

Also, some people are more social than others. They love being with people, even if only a few people. They would go bonkers staying alone at home studying or working. So, all in all, it's good to hear from people who have succeeded at the different kinds of courses and work situations. Good luck to all of you who are just starting out!

In response to your last question, the point of switching to independent is going to be different for everyone. It largely depends on how much income you absolutely, positively have to make. As you make progress with your speed and production, start thinking in terms of "lines" and "lines per hour". If you know how many lines you can transcribe in an 8-hour shift, multiply this number by the going line rate in your area and divide by 8. This is your full hourly potential (at that specific time) as an independent -for the hours you work-, and that's important. You usually will make less per day (unless you work longer hours) as an independent, all else being equal, because of the interruptions and other non-income-producing tasks that are necessary during your work day to run your business. On the other hand, as an independent you can frequently use utility programs to enhance your production, which is not always possible in an employment setting. Ultimately, with good speed skills, enough experience that you don't have to spend most of your time in a reference book, and good software to help you out, working in an independent setting can be not only more serene, but more financially rewarding as well. I made the change when I was able to consistently produce 1600 lines/day working in an acute care transcription department, but it was a gradual change. I built up my outside clientele while still working at the hospital, and after I quit the hospital, supplemented my own accounts by contracting from a transcription service, until I had enough of my own to drop the subcontracting. Some people don't want the hassle of running their own service, and like to continue subcontracting. It's a very flexible situation.

In <458oab$1l7q@usenetw1.news.prodigy.com> CEJD60A@prodigy.com (Maggie Becker) writes: I am subcontracting at the moment, but am looking ahead and planning for my first account(s). Is there a general opinion regarding which specialty is a good one to start out with? Are there any I should steer away from until I get more experience? I currently subcontract in family practice and dermatology.

I am very, very interested in psychiatry and psychology; studied psychology in college. Is it possible to get pscyhology business? How much work do the psychology and psychiatry fields generate? Are they just as difficult as other specialties?

Maggie,
My first MT work was in cardiology, and to date I still think this was one of the easiest. However, now about 75% of my work is in psychiatry and not only is it interesting, but once you catch on to their unique lingo, it's pretty automatic, too. However, I would avoid pshchologists. They dictate test results and evaluations and while the former are usually cut and dried, the latter can drive you nuts with their length - you just can't make as much with six to eight page reports as with shorter ones. Also, in my experience the psychologists are generally very manipulative and demanding. One I worked for would edit out paragraphs and insert new ones in long hand and expect me to redo the reports at no cost. Then she wanted me to take them to the post office and priority mail them, again at no charge. I had another psychologist who expected me to create all his letterhead paper and envelopes, and Fed Ex them to him, free of charge, of course.