The next thing would be you aren't done until all of that assigned work is done. Want to take a sick day, forget it! The work only gets done if YOU do it and no one is around to motivate you. However, this is also the challenge and the fun. Time yourself, see how long it takes to get through that doctor you absolutely despise, see if you can do it faster next time. Try to get the bad doc out of the way first so that the rest of your day is smooth sailing.

Isolation is next. I am a loner by nature so this really isn't a problem for me. But, if you are thinking of working at home, then stop and think about your personality. If you are a social butterfly and like the interaction, then this may not be the thing for you.

You really have to motivate yourself. That is a major problem working at home. You get calls all the time, friends come over, people don't take your job seriously. You have to set your hours and try very hard to stick to them - if you want to be consistent at making the amount of money you want.

My advice to anyone who has small children and wants to work at home would be to still use a babysitter. I feel so fortunate to have had the time with my children when they were small. Even though I might not have been spending "quality" time with them I was always there (or very close by).

I get a lot of calls from people who have heard that I work at home. They want to work at home so they can be with their kids. I have to tell you, it is not easy but it is the best way to do it. Now both of my kids are in school (ages 7 and 10) and I have thought about going back to work somewhere outside the home. I have come to the conclusion that 1. I cannot make the money working outside that I make now, and 2. I still love the freedom of being on "on my own".

2. Convincing friends and neighbors that although your car is out front all day, you REALLY are working. I don't know if this is as much of a problem today when millions are working at home; when I started working out of the home, no one believed I was actually making money...they thought it was just another volunteer type thing, and they could still drop in for a cuppa. Also in the same vein, I had everyone's keys in case they were expecting a home delivery of furniture or a new washer, etc. So the door bell was always ringing with one delivery man or another asking to be let in to someone's house. That gets old real fast!

3. Handling outdoor distractions. This may not be such a problem for those MTs working in a warm clime, but in the Phila. area when winters are always gray and summers can be just too darn hot to go outside, the distractions of a beautiful spring day or a crispy fall day can be just a bit much for the stay-in worker! I'll get up a half hour earlier if I must (i.e., 4:00 a.m. instead of usual 4:30!) just to guarantee time for an outside break!

4. Isolation. This is much better for me than it used to be with the internet, but still it's there. God help anyone who calls in the middle of my work day - I'll bend their ear just to be able to speak to someone other than my cats! This has to do with my feeling that a human being has to speak x amount of words per week (x = # of words required for extroverts as opposed to introverts). Soooo, the later in the week I have to wait for someone to call and chat, the longer the phone calls become, which is a real negative since my business phone does not have call waiting, and I don't answer the house phone during the day.

From: Marian Leben, Thousand Oaks, CA, marelebone@aol.com: The biggest adjustment for me when starting to work from home was "training" my family to LEAVE ME ALONE!!! I transcribe in an open room without doors, so I need to find time when either the kids are in school or they are tucked away in their rooms for the evening. I had to have long discussions with my husband not to bang around near my desk when I am trying to transcribe - I need to HEAR and LISTEN. I made him put on my headphones and sit and try to decipher some doctors dictation while I banged around and talked in loud voices to the kids...and made the kids do so as well...I think this helped them all to understand what I'm going through. Occasionally they forget and I try to gently remind them, like "Thank you for loading the dishwasher, but please don't turn it on right now or I won't be able to hear my dicatation." Or "Could you possibly mow the lawn some other time, honey?" in sweetest tone I can manage. omeday I will have a room with doors to shut, but I don't know if that would really help. They would probably figure they can now blast the TV or stereo anyway - and this way, they know they need to respect the time when I am transcribing and honor my request for quietness. In return, I try not to transcribe when they are around, so I don't have to inconvenience them too much, either.

The #1 disadvantage for me is not having other trained ears in the room with me. When I worked in hospitals, it was nice to be able to just yell out, "Can somebody listen?" and we all would gather around and try to decipher the garble. Four different MTs might hear four different things, and then there was a discussion about how it would fit in context. You learn a lot in the sweatshop setting, and I think it is valuable to have that experience, but it's like breast feeding...it's good for the baby, but the baby then has to be weaned off the breast and go on to the solid food. That's why I started the Phone Chain Gang - so that other MTs could be called to offer a trained ear. I have called MTs on this list before and played the dictation over the phone to them, and have gotten help figuring it out. Also the online sources for help are very valuable, such as Dr. Davies, the various drug resources online, etc. If anyone would like to be on my Phone Chain Gang list, or would like a copy of it, please feel free to email me, MareLebone@aol.com.

From: Alec McLure, alec@i-d.com: I've only been working as an MT for a couple of months, working a few hours in the evening after my regular job - (I'm eventually hoping to turn it into a full-time business, but for now am working with a wonderful associate). The only disadvantage I've found is that what was "home time" with my partner (and my cat) has switched to work time - so we don't have as much time together. We know it's just temporary, though - so we deal. There's always weekends. Also, my cat gets really upset when I don't let her sit on my lap while I'm transcribing :-) (Olivia, you're messing up my ergonomics!!! )

From: Robin Merica rmerica@prodigy.com: When friends call, as they invariably do, they don't seem to realize that they're calling me AT WORK. They want to "drop something off" or "drop by". Because I'm pretty isolated (I live alone), I'm eager for some company. Invariably, my callers will give me a time when I can expect them. Then they either won't show or they'll show up hours later. Because I work upstairs with earphones in, I can't hear the door, so when I expect them, I'll take a break... and end up waiting and waiting and waiting.

I've finally had to become a real *bitch* about this, because I've found myself wasting time that I could spend working. It's the single biggest problem that I have with others, in that they don't seem to respect MY time. I realize, however, that they're only taking their cue from me, because I'm not diligent about planning a regular work schedule and sticking to it.

The isolation is true. When I find myself telling the "technical support" person on the other end of the phone about my childhood, I know it's time to get out and around some *people*.

Lately, when people tell me they're envious of my working at home, I've told them that it *is* a terrific work situation. I can't imagine going back to a conventional arrangement of working on-site. But lately, it's gotten to be less "working at home" and more "living at the office". I have got to start setting regular hours and sticking by them.

From: Sue Monson, suemonson@aol.com: Robin - I had the same problem with not being able to hear my doorbell in my office when I had the headset on. I bought one of those wireless doorbells from my local hardware chain and it works great. The sound of the bell is somewhat annoying, but at least I can hear it!

I have a husband, five kids, ages 8-19, two dogs (including a Basset who, based on his activity level, could pass for two dogs all by himself!), a cat, and 400 cows. I am gaining weight from sitting so much so I purchased a treadmill though when I think I will have time to actually use the thing is another puzzler! Any semblance of a social life has virtually disappeared. Because the dairy farm economy is what it is (nil) my transcription business has become our primary source of income. I work under a great deal of stress but, know what? I still LOVE what I do! How many people these days can say that with real honesty? I sometimes think that going to work in an office might separate my personal and my work time better but the very idea of first buying appropriate clothes to wear, the daily commute, the in-office sniping, etc., just would create stress in a different form, as far as I am concerned. Working at home provides such flexibility in scheduling...if I want to work until 3 a.m. I certainly can. If I don't want to get up until 9 a.m....well...I gotta get up by 7:30 but you get my general drift. I can go to school functions, I can go to church functions, I can go to sports events, I can work when I choose as long as I get it done, period.

The Internet, too, has proven to be an amazing source for at-home MTs for outside contact in the event of loneliness, as well as an invaluable source of information!

On Wednesday nights I teach a 12-week, 3-hour/night "Introduction to Medical Transcription" adult education class at our local vocational school and that allows me additional adult conversation and is a source of real pride to me, as well. I make it a point to tell my students not to get into the mind-set, "I am going to work at home or else", because working at home is NOT for everyone. It does require a certain type of discipline that many people don't possess. It does mean going for long periods of time hearing no other adult voice except for the one in the headset. It means talking to the dog or the cat or the guinea pig ("Chuck" shares my office--he actually belongs to my daughter who went into the Air Force but now considers me his surrogate guinea mom) just to hear the sound of your own voice. It also means having to figure out by yourself at 2:30 a.m. what the heck is wrong with the computer or the printer and calling the appropriate 24-hour tech support people and working it through because you have work that must be delivered in the morning.

Who'd a thunk so many years ago that that old Remington Rand manual typewriter my grandpa bought me for Christmas when I was in the 9th grade "all young ladies should learn to type so they will always have something to fall back on") would lead to such wonderful things for me?! I am still in awe of my good fortune!

Anyhow that is probably more than anyone wanted to know but being an at-home MT is one of the things in my life I am most proud of, that I taught myself, that I have learned where to look for things I don't know, that I got it going, doggone it, all with my own two little housewifey/mommy hands! My kids are proud, my husband is impressed and I feel pretty great about it, too, so there!

From: Debbie Hahn, VA: debbicmt@visuallink.com: After six years of working at home for a national service, in December I started doing a little "per diem" work on the side for the local hospital in the Medical Records Department (AT the hospital), because work at the service was a bit slow at the time, and I was also curious about how it would feel to be out in the "workplace" again.

I was a "per diem" employee for the hospital -- set my own time to come and go, work as many or few hours as I wanted, whatever days I wanted. It was all up to me -- great flexibility compared to the full-time MTs with their set schedules. I agreed to try to come in for 6-8 hours each Thursday and Friday, and maybe a few hours another day of the week. Well, it was okay the first two days I went in. The pay and incentive program at the hospital is quite a good one for this area, and I was able to make about 2/3 per hour what I could make transcribing at home for the nat'l service, which is extremely good pay for this area. They use Wordperfect 5.1 and Dictaphone voice processors, same thing I used at home; they even had PRD+, although with their setup you were limited to a certain number of abbrevations and I had to bring my own abbreviation file from home on a floppy disk since each transcriptionist had her own computer set up with her own abbreviation file. The work stations were very ergonomic -- great keyboard setup (actually I was able to bring my own ergonomic keyboard from home and use it) and good chairs. The dictation was very clear, and 99% of the doctors were American with no accents at all. The other MTs I worked with and the supervisor were very nice and friendly and greatly appreciative for any time I could work since their dictation was behind. They even have fairly up-to-date reference materials, though I did bring in two of my own books. And the hospital is only 2 miles from my house.

Sounds great, doesn't it? Well, after the first couple times of going in, I was ready to go back to staying at home, transcribing my mainly foreign horribly accented dictators for the nat'l service. And it wasn't because I was only making 2/3 what I could make at home -- that was really a minor consideration. I realized that after 6 years of working at home, I had begun to take my working situation for granted. To work at the hospital, I had to go out and buy clothes (no jeans/sweats allowed); I "wasted" half an hour getting ready to go to work; "wasted" another 10 minutes driving to work, another 10 minutes driving in circles looking for a parking place in the designated "employee areas" and then walking a LONG way from car to hospital. I was basically tied to the work station, of course, for the entire working period. The temperature in Medical Records was kept at least 10 degrees warmer than at my house, and the humidity level must have been 0% - when I went home in the evening I felt like my body was completely dried out. Then there was my family -- I had this very strange feeling about not being at my house all day, keeping an eye on things and being available for my kids (although they are both in school). My 6-year-old daughter was so concerned over the fact that I wasn't going to be at the house all day (even though she was at school) that she had several serious discussions about the situation with me and then insisted on having a photograph of me that she could carry around with her!!

I agree 100% with the other posts about some of the pros and cons of working at home -- they have all applied to me, too, especially the ones about people not thinking you have a "job", and having children at home while you're working. But the only "advantage" I found by working at the hospital was the feeling that when you "punched out" and came home, your job was really over and you were "free". That was a nice feeling -- working at home seems like a 24-hour, 7-day week job sometimes. BUT with a little more self-discipline and more structured working arrangements I think I can get close to that feeling without going out to work!

Fortunately, work has picked up again for the service, and Friday was my last "regular" day at the hospital. They insisted on keeping me on their per diem list, and begged me to come in anytime I had some "free time" to help them out, but I will have to be pretty desperate to do that! I talked to a couple of the MTs there and told them my feelings on working at the hospital versus working at home ("why in the WORLD don't you quit this place and go to work for a service???......"). A few of them need the hospital benefits, which is certainly a legitimate reason, but aside from that I can't think of any others! If I ever had any questions or doubts about working at home versus outside, they were set to rest very quickly! I'm a permanent "homeworker" from now on!

From: Ann Ferra, aferra@aol.com: I have worked at home for the past ten years so my children don't know anything different. One thing that they do know is that I am always here - when they get up in the morning, when they leave for school, when they get home from school and when they go to bed.

My husband lost his job a year and a half ago and we figured it would be more profitable for him to stay home and help here while I ran the transcription business. What a turn around - now he gets the kids off to school, takes care of the little ones still at home, does the shopping, plans meals and delivers work every day to my accounts. He also does other mundane housework including laundry, cleaning, etc. He might not do it how I would, but my mother gave me some good advice a long time ago "Don't complain -- he might stop". This works for us. Before he lost his job, I basically did everything though because he worked long hours. He did deliver all of my work then so that was a big help. It comes down to this -- if I don't work - I don't make any money. Also, one of my fantasies is while I am transcribing money shoots out of my computer as I make it! What an incentive.

I'm wondering if others have experienced something I experienced. When I first came home 5 yrs ago, I was panicked the first few days of being totally on my own, alone with a brand new computer and first experience with modem. But I was relieved, so relieved, to get away from the stress of office conflicts and politics and meetings and having a boss!

As I recovered from those two things, in the new aloneness I went through a few weeks where I found myself reviewing and reliving my whole life history in detail, day after day, feeling the pain of past difficulties all over again, as well as the comfort of good memories as I involuntarily mused.... It was not a quick process like some report from traumatic experiences. I wondered if this was what people experienced in solitary confinement...counting the days on the calendar became more important too! And counting lines!

Well, when I discovered online networking with MTs a few months later, I felt like I was tapping on the walls for sure, and I still do! I have found it soothing to face a window as I work and I really enjoy working alone, but I am convinced that I would have burned out a few years ago if it hadn't been for online MTs.

Just think of the many hospital MTs that will be coming home to work in the next few years as hospitals find it such a cost savings and MTs find they can make better money and live better that way...I think those of us online already can make the difference for their isolation.

From: Judy Hinickle, judyhi@execpc.com: At one point in my life when I began working from home (1982-1988), my husband STOPPED shopping, taking care of 5 children, cooking, or any of the other things required while I was previously gone at work, because now I was there (at home) to do them... Now THERE'S a sweatshop!

I guess the biggest change for them has been, instead of me sitting down and watching TV at night with them or cooking all day or keeping dishes and laundry completely caught up and all floors spotless, etc., we have all had to let our standards down a bit. Meals are pretty much a thrown together affair now, the kids are helping by doing their own laundry (starting at age 12--and I still do my 16 y/o son's ironing since I would really rather he didn't burn the joint down!!!). They also help (the word "help" is used very loosely here) periodically (and always after a very loud song and dance on my part---grrrr) by dusting, vacuuming, and picking up in general.

They cannot seem to understand, sometimes, why I am not doing all this stuff myself anymore...after all, I *am* home all day, aren't I???? They forget that I really am WORKING. Oh, I occasionally lose my screws and start having screaming fits (boy, does it kill me to admit this) about the lack of consideration expressed by one in particular or all in general and wonder, yet again, out loud--very loud--why didn't we just raise goats like we had originally planned! Then one of the five will look at me like I've lost my mind (sure did--a very long time ago--19-1/2 years ago, to be exact, the day the first one was born!) and my sunshiny 16 y/o son will amble over and throw an arm around my shoulder (have 16 y/o's always been so tall?) and say, "How ya doin', ma? What do ya want me to do?" and I melt and remember exactly why we had them, and why I am working at home...we didn't have our kids to let someone else raise them...we made the sacrifices we needed to so that I could be at home, working or not, to raise my own.

Now, I know that can't be the situation in all cases, so please don't start in hollering at me. I KNOW I have been incredibly fortunate in being able to find things to do at home and, boy, do I REALLY KNOW (dairy farming income SUCKS; please forgive my bluntness) what it is to dread answering the phone because you don't know what to tell the bill collectors on the other end. I drive a 7-year-old car that needs its second transmission in seven months (well, I don't drive it right now but I would if it ran!) and we had just replaced the engine a month before we replaced the transmission the first time. Now I drive a Barbie pink 1988 Ford Festiva that my 18 y/o daughter bought herself before she went into the Air Force...letting my daughter go into the AF was the only way we could "afford" to give her a college education. My 19 y/o daughter works full time as a hairdresser and is putting herself through college, too, with the long-term goal of becoming a teacher. My 16 y/o and 12 y/o boys each do a man's work in our dairy barn for little to no pay. These kids have learned the work ethic from the examples set by their dad and me...because we have "been there". I know without doubt that my family is all the richer, maybe not (no--definitely not!) in dollars but richer in that irreplaceable time we have spent together while they are young (I mean, is that hokey or what?). Sure, we still have the same little spats..."no, I can't drop what I'm doing and take you to so and so's house right now, no, I can't run out and buy you that $90 pair of sneakers this week, no, there aren't any clean towels, no, dinner isn't ready yet, no, I didn't make dessert, etc.", but it is worth it all if they know they can count on me to "be there" when they come home. It is one of my strongest gut feelings that "the problem with kids today" is that, because of our country's economic state, where even two paychecks don't pay the bills anymore, moms can't be there when the kids come home from school...there is no safe place, no moral grounding, in so many kids' lives today. And on that note, my little sermon is ended...Amen

Big adjustments? Nah, nothing that a little consideration and common courtesy won't take care of. And having--and displaying--a sense of humor can help lighten the load considerably!

From: Cynthia Lewis, cynroses@aol.com: The only downside I've found to working at home is that my housekeeping standards have somehow risen to the level of making me craaaazy. I NEVER spent this much time on "house stuff" when I worked outside -- and I can't claim to be the tidiest person by nature in the world, either. I have a housekeeper come in weekly (sometimes twice if I can talk her into it) -- but I still spend too much time and energy getting things "perfect" before I can settle in to work. My office is somewhat removed from the living area (having been a sun room until I commandeered it...) so I don't even SEE the mess while working.... but just knowing it's there.... I don't remember doing as many errands before, either. Where does this stuff come from? However -- these are the only sources of stress in my entire life -- so up with them I gladly put.

From: Ruth Japhet: I've spent six years trying to GET isolation syndrome. Why would I want to relieve it?

From: Kay: Great idea or order UPS.....and I tried that for awhile. But after he saw me in my "work clothes" (flannel pj's or sweats that don't match) with no make-up and hair all over the place a few times, he started just leaving the packages behind my storm DOOR! I'd hear the dogs barking, throw my earphones down, run as fast as I could (in my little furry house slippers) to the door - and there he'd be, running down my driveway lickety-split and jumping in his truck (which he had left running). Anyone ever seen a UPS truck go from 0 - 50 mph in ten seconds flat?? I have.......

There are so many little things that can help break that lonely cycle we all tend to fall into now and again. The main thing to remember is that WE hold the power in our own hands to change the way things are at the moment, be that getting up for a cup of tea and a peek out the window, tuning into a radio/TV talk show for a fresh perspective (and the realization that lots of peoples' problems are sooo much worse than my own!) and some thought provocation, keeping a good book in the bathroom (my own special place for privacy--it's the only room in the house with a lock on the door! Gosh, from the time my oldest (19-1/2) was born until three years ago when my youngest (now 8) went to school I don't think I had been alone in the bathroom for almost 15 years!!! Now it's the Basset hound who sits outside the door and whines--sigh.

Anyhow, I guess the main thing to remember is that we are never really alone. Heck, just sign on and find an online friend if it comes right down to it and you really need an outside "voice"!

This past week I had a neighbor knock on my door twice during the day, once to inquire if my phone lines were okay (several neighbors were without service) and once to tell me that my heat pump was frosting up and may need to be fixed (which it was, to the tune of $450, I might add!) I had to call and thank him for being so neighborly and assure him that I don't wear pajamas ALL DAY LONG, he just happened to catch me in them twice in one week.

Anyway, while trying to study this home MT course AND homeschool my kids (I quit my outside job to do both of these things for one year) - I thought I would go nuts. I had lots of trouble concentrating on my course while trying to proctor a 6th grader and a sullen 2nd grader and keep my household intact. Fortunately, I have a supportive husband who would jump in and help out when all my hair was ripped from its roots.

My point is, something has to give!!! Either your sanity will give, your marriage, your kids, or the quality of the work you do. I think that was probably Bob's point as well. Yes? If you are prepared to live in hell, and you like it in hell, then homeschool your kids and try to be a home-based MT.

From Velon, MTSAH.4@ix.netcom.com: Working at Home: I love it! I am able to have a career and be with my children and husband. I am able to make my own hours, work in pajamas, and have loads of fun during my breaks!

I have found that because I work at home, my hours are early (4:30 a.m. to 12:30 p.m). This is so that I have the rest of the day for my family. I have found it be alot easier. Yea, some mornings it is tough to get up, but I just think about how lucky I am to be able to work at home and be with my family, get my coffee, talk to the husband and get up! I also know that if I do not get up, I will be trying to make up my time during the rest of the day and that takes away from my family. Also, if I do not work my time, my paycheck will show the results.

To beat the blahs of being by yourself and working at home, I have found that being active in outside activities really helps. Also, during my breaks, I either see what my children need, do the stepper, go swimming, take a short walk outside, and make a quick phone call (try not to do this so often). Exercising is really a great stress reducer during my day of pounding away at the keyboard.

I also have an endless number of word books, the internet and my mentor (who makes her self available to me) if I ever get stuck on any words. Also, because I work for a service that has people who fill in my blanks when all else has failed, I feel really confident in working at home.

You know, in the beginning I was really scarred about working at home. Now, I would not have it any other way. Yea, some people try to say that it is harder working at home and you need tons of experience, but by having the internet, tons of reference books and a mentor (or someone who offers listening help) it is not hard. I also use a production program (Smartype) that has really helped me and the Medical Phrase Index. It has taken me about six months to really start utilizing the internet and getting word help from that too. I absolutely LOVE working from home!

From Becky, bshelby70@aol.com: I am a hospital employee working at home, also using Lanier equipment. It is the best of both worlds. We use our own computers, pay for our own phone lines. At the time this was being discussed, I was to be the "guinea pig" for this project and I really didn't care about arguing over who paid for the computer...I just wanted to go home.

My main reason for being glad about this: This is MY computer and nobody can control my use of it, as in the moonlighting I do. I could write all day about working at home as a hospital employee. I'm thrilled with it. We're all at home now except for one MT, who really likes working in the office. I kept my old computer, added some memory chips, and it works fine.

WARNING: The hospital data processing department sent a list out with recommendations as to what computer to purchase. One friend of mine spent about $3000 on a Compaq with WIN 95, CD-ROM, purchasing EXACTLY what the hospital told her to purchase. MedWord and WIN95 are not compatible. Karen now has a PC which is only good for her work with the hsopital - no CD-ROM, no WIN95, no games, no printer, no NUTHIN. They had to gut the thing so it would work.

We call the hospital computer system via modem, so we are actually typing on their system, and not our own. The network is very, very slow compared to the in-house computers, but at least you can look outside at your own yard during the lag time.

Even without the overtime, I have almost doubled my income. Because I am familar with the Softmed system (Chart Script), I usually spend about two days a month in the office, but who cares! We have 10 transcriptionists and we have each other's phone numbers, so if we're stuck on a word or just feel isolated, we call each other and help each other in that way....it helps. This is the best of two worlds, benefits of working for a fairly large hospital, and getting to stay at home. Hope you get to go home also.

From Sherhoff, sherhoff@aol.com: Some time ago our hospital decided to start a home-based program. The transcriptionists provided their own PC but the hospital had the software installed. We use a modem to send work back. Since then, a couple of people have had their PCs crash, etiology unknown. The company that provided the software says the problem was in the PCs. There have been a lot of disgruntled employees now fearing a crash. Now the hospital is considering buying PCs for home-based employees. Employees pay for phone line. As far as salary, we are still on the payroll just like we would be at the hospital, benefits stay the same. This works out very well.