World MTs

4/96, from Mary Morken
I think we need to keep learning about this; it could be new opportunity for us all; it could be something we would need to fight politically. I have learned that 65% of expense of MT companies is salaries; thus saving on labor is a very big factor to consider even for businesses that are not greedy. I showed Bill's list to someone at a company doing this; they said they had an answer to everyone of his objections.

I do know that the large MT companies can only keep making a profit now if they keep growing in size for two reasons, they say: Healthcare industry cutbacks (doctors have decreased salaries 10% in last few years) and competition with more MT companies bidding. Doctors have been dealing with this in their field for years, with the influx of doctors from other countries into the USA, robbing other countries of their finest doctors. We have to think about how much we want government to control these things and how much we want freedom for individuals to choose; there's a price to be paid either direction.

So we need the best thinking we can do or find during this transition, to overcome our fears, to treat each other right in the midst of our differences, to sharpen our ideas together, to figure out how to protect ourselves, to figure out how to protect our interests as MTs, to figure out how to protect our national interests, while at least considering how we are going to treat the Indian MTs and Irish MTs and others who will be on this forum soon enough, and what our vision for the world should be, as well as our vision for America.

Interesting that this trend to overseas transcription is the polar opposite of the trend toward the E&O question. An MT outside the USA would have absolutely no deep pockets; ergo no liability. What a can of worms would be opened there. So as some espouse the liability issue on our own soil with our own well-trained MTs, others are outsourcing to people beyond our laws.

I'd love to "fix" the world if I could; in fact, I was a social worker during race riots of 1966 in Chicago, so I need cold hard reasons to balance my heart. I've learned not to hold on too tight to my tentative conclusions about political strategy issues; must always "stand ready to be corrected!"

We need more counsel on this subject of overseas MT work. I'll keep posting what I can find on MT Daily, send anything you think would be helpful.

Overseas medical transcriptionists almost always have:
1. Poorer access to competant trainers.
2. Political instability.
3. More frequent telecommunication line interruptions.
4. Accents that make it harder for the clients to understand the MT.
5. Poorer understanding of spoken American English.
6. Almost nonexistent knowledge of regional colloquialisms.
7. Less access to sources of new medical terminology.
8. More expensive quality transcription hardware and software.
9. No ability to provide face-to-face personal service.
10. Coordination and communications problems due to time-zone differences. 11. Zero years of experience.

The reduced labor costs advantage is significantly reduced by higher costs in other areas that are necessary to do business overseas. Some of these include:

1. Dramatically higher telecommunications costs.
2. More expensive quality computer hardware and software.
3. Kickbacks to corrupt government officials in the third world.
4. Hugh travel costs for management.
The reduced price to the doctor can only be a fraction of the reduced costs of overseas labor; otherwise there would be no increase in profits to the investors and therefore no reason to risk going overseas.

All that said, many U.S. jobs will still be replaced across time by overseas labor. But, every U.S. MT can help keep their jobs here in the U.S. by working smarter with more personalized service, better training and knowledge, and better technology.

I'm in the process of finding out about salaries for the supervisors, teachers and proofreaders of overseas MTs, but judging from the caliber of those doing it and what I know so far, it is on American standards.

Actually I think our concern for American salaries being affected is the same concern as for those in other countries who lack the opportunities we have, not for ourselves, because these changes will only affect the lower third of the MTs who make $7-10 an hour, I think. What I mean is, we should consider ourselves in the leadership (by virtue of being online and what that probably indicates about our professional abilities), not those likely to be the victims. Thus we can afford to think through these questions from the standpoint of what is good for both the patients of the country and the world, and for MTs. This field of national and world health care is in such a time of accelerated change. New jobs are being created suitable for MTs. For instance, computerized medical records and all the possibilities that brings for companies keeping medical records available for any patient anywhere in the world anytime; web sites and all the medical information flowing...I know one MT we've "lost" or who has graduated on to be an Internet employee putting up web pages (not me!). In fact, I'll wager that the shortage of MTs is going to get greater as we lose people to MT teaching, supervising, consulting, starting businesses, creating software, researching, writing, selling, marketing, editing, web-site creating and maintaining. Maybe we should be asking how can we keep MTs from leaving! No, maybe we have to keep perspective on the large question, and our own unique opportunities and abilities. I think we can do well AND do noble things!

There are so many things MTs can "graduate" to...those of you who are well experienced surely have said no to other things in order to stick to transcribing, I certainly have. My web site has become like a portfolio! When I get inquiries, I explain my role as MT for money and networking facilitator for the adventure. I would be useless as a networker if I was no longer doing MT in the trenches; there's a bond between those of us who "suffer" the endurance test of this work, and we know others don't know what it feels like by the eighth and ninth hour.

If the service employs state-of-the-art compression, an hour's worth of physician dictation can be transported on a T-1 line in 33 seconds, and an hour's worth of physician dictation can be transported on an ISDN line in 7.3 minutes Transcriptionists in third world countries who speak great English make as little as $50 per month.

The Internet is a cheap transport option but can be very, very slow at times. Digitized voice has to be specially encoded and decoded to make it across the Internet (which makes the files bigger) and this slows things down even more.

Unfortunately, like it or not, transcription work headed beyond our borders is going to continue, and it is going to continue to increase in volume. Fortunately, there is plenty that work-at-home US transcriptionists can do to combat this threat:

1. Asking the service you work for, flat out, what their plans are for overseas labor. If they have such plans, start looking around.

2. Use technology (that benefits patient or doctor) not readily available overseas as soon as you can afford it. Examples: Avoid service companies that route either the dictation, transcription or both, through the service company instead of letting the work flow directly between you and the doctor. Transcription companies who do it this way pay double to the phone company (once between them and the doctor and once between them and you). Service companies or independents who go duirectly between doctor and transcriptionist have a lower cost base and faster turnaround time and can therefore compete better. Anyone doing work overseas almost has to route work to a central office before shipping it overseas, so they have to introduce delays and costs associated with a two-step movement of dictation and transcription.

Buy technology that lets you move voice digitally between you and the doctor. Imagine instead of returning a blank for some undecipherable phrase the doctor uttered, you could return the transcript with the undecipherable phrase imbedded in it for the doc to listen to and either rerecord what he said for you or fix it there. Imagine a doctor being able to highlight a section of transcript on screen and dictate a correction that comes back to you as a highlighted wordprocessing file with the doctors voice attached to the highlighted sentences so you can listen to the correction while editing the transcript. These are just some examples of what is coming very soon to systems that move voice digitally between doctor and transcriptionist.

Use ISDN lines to move voice between doctor and transcriptionist. It is extremely expensive to route ISDN overseas. But in the U.S. you can transmit an hour's worth of physician dictation to a transcriptionist in well-under 8 minutes. Here in Bell Atlantic territory, ISDN is $35 per month and 4 cents per minute for measured usage. You will be able to compete in terms of telephone line costs if use use this kind of technology. There are many other technology examples.

3. Take advantage of your local proximity to have personal encounters with your customers whenever possible. Use these opportunities to find out how you can serve them better.

4. Take advantage of medical information sources not readily available overseas.

The world economy is going to level out some no matter what we do. Its our challange not to dig in our heels and say, "Buy American" and hope for the best; but rather, to make sure that we are better educated, better informed, better equipped, more quality conscious, and less burdened with overhead than our foreign competition. Because if we have all of that, cheap labor alone won't take them very far.