I heard a news report a few weeks ago that last year MDs in general took a 10% pay cut. Someone told me they think that it's the malpractice danger that keeps MTs in business.
From Robin Merica:
The "fear of malpractice" is certainly a good enough reason to utilize the services of MTs. Also, it seems to me that it would take the doctor a lot longer to write notes than to dictate. Most of the doctors I work for spend about 1/2-1 hour dictating all the notes from a particular day. To write as comprehensive a note as they dictated to me, they would spend far more time... time that could be spent seeing other patients. I figure that those "extra patients" that they have time to see because they have chosen to dictate their notes are the ones that are paying for *my* services.
From Bill Bentsen: Gasp! I've never heard of NOT charging for transcription, even if it's cancelled in midstream. Who cares if they really didn't want it transcribed -- if they dictate it, and I transcribe it, then I get paid for it. I don't do this for fun and games, and I don't wear my ears and fingers out without just compensation.
If a doctor wants to cancel the dictation, and he's on a digital system, he can delete the job. If he's on a tape, he can reverse it, then erase it. If he doesn't do this, then he pays -- fair and square. I would never pre-examine a tape or a digital job to make sure it is a "real" job before I transcribe it. If the doctor sends it to me to transcribe, then I transcribe it, and I get paid for it. I had a client call just a couple of days ago to tell me to cancel a letter I'd transcribed. I said I'd be happy to, but I'd have to charge for it anyway. They said they understood, they expected it, and for me to bill for it; however, they just didn't want the letter to be sent out. No problem at all.
From Janie Gilbert: But why would you listen to the end of a report BEFORE transcribing it? That sounds like a waste of time for the most part. I download my work the "primitive" way over the phone lines and onto a microcassette transcriber, and even though I can hear the dictation, I am often either transcribing other reports or away from the speakerphone and cannot hear all the details. I think that's too much to expect. Instead, I would think most hospitals should leave this to the Med Records Dept to PREVENT by informing doctors that if they wish to cancel a dictation that they MUST inform them so that the job can be so noted and deleted from the system. Otherwise, they should have to pay the MT for transcribing it. The same should go for a transcription service. If a client/doctir wishes to delete any dictation, I would think the systems operator for the service should be notified. Otherwise, tough luck for the doctor...he should pay.
From Vicki: I transcribe for a radiology group and there is no way to listen to the end of the dictation...you just type and go...if they bail out in the middle or cancel it at the end there is no way to know until you get there (although some doctors are smart enough to go back to the beginning of the dictation and re-dictate "Cancel this report" or something similar. I charge for what I type...if it's only the name and demographics I let it go, but if I take my time to get through half of an angio or other special procedure, then I charge them for the lines which I typed.
From Bob Willard: I don't know about other MTs out there, but I frequently transcribe reports on my digital system that are aborted (often in mid-sentence) for whatever reason. I always transcribe them, send them on and charge for the lines. At the ignominious, premature end of the dicatation for whatever reason,I type "(DICTATION TERMINATED)" followed by the doctor's signature block. Sending this report on to the doctor for his signature (and also charging for the lines at the same time) reminds the doctor that he has not completed dictating this chart.
It is possible to find the balance between the dictator's input (minutes), transcriptionist's input (keystrokes and minutes transcribing) and the final output (characters), by tracking each of these items per report, noting dictator and report type, in a spreadsheet or database and analyzing the results. Problem dictators cause greater time consumption by the MT, and thus fewer characters per hour. Fairly "weighting" the dictators (giving credit to the MT for more characters per hour than actually produced based on the difficulty factor applied), properly compensates for the extra time it takes to do the tough dictator's work.
There are situations where using the minutes of dictation for MT productivity measurement make sense to me: (1) The word processing equipment does not provide a unit of measurement. (2) The word processing equipment utilized is varied and the methods of measurement are all different with no hope for equating them. (This happens a lot with mergers and acquisitions.) . . . I've been studying MT statistics since 1982, particularly in order to find a way to be fair in transcriptionist compensation or review factors.
. . . From my own experience, transcriptionists can usually control how well and how much they type within the available transcription hours. They cannot always control their non-productive time and that non-productive time is really a separate management issue. Typically in an 8-hour day they lose 10 minutes for set up time and shut down time, 10 to 15 minute breaks, 5 minutes per hour for "health breaks". There seems to be an appropriate average loss of 20% of the time without including other meetings and time losses. This can be more in departments which have non-productive busy work such as charting, inconvenient census access, phone-answering, contant mentoring, etc.
In our office we do not pay any bonus that may have been earned if quality of 98% accuracy has not been reached in that pay period. Accuracy is determined by listening to 3% of each transcriptionist's work per pay period, and a point value system is assigned to errors according to their seriousness.
We have found that 8,000 to 12,000 characters per productive hour is the average range. We start paying an hourly (productive hours only) incentive bonus at 11,500 characters per hour, and have several levels up to 16,500 characters per hour, which is the cap (for health and quality reasons). We have Team A and Team B based on the ability to accomplish difficult transcription. In Team B they earn $0.50/productive hour more than Team A for the same productivity levels because we can count on them to be able to do anything well. We emphasize that incentive is for EXCEPTIONAL productivity and is actually a bonus - not a reflection of the person's total value as an employee. Their base pay is a reflection of that total value, which includes quality, responsibility, ability to work with others, respect for authority, healthy work habits, etc. Incentive pay is simply an extra reward for one aspect that has particular value to the employer. I may be a lot more pleased with a consistent 9,000 cph employee who always shows up, always has great quality, can be counted upon to help others, and has an even temperament, than I am with a 16,000 cph employee who is erratic and obnoxious.
I also agree with you, Ellen, that minutes are actually a measurement of the dictator's effort, not the transcriptionists. Difficulty of the physician's dictation habits can be reflected in weighting factors based on the effect that difficulty has on how long it takes to do that dictator's work compared to the norm.
I constantly find MTs of 10-20 years experience who are still slaving away making $12 an hour. Those are the ones who need to know they can make more from home with good accounts, IF they can afford to provide their own benefits. Get rich quick folks don't last long in this field.
The question for me is do I want to give up some of the freedom from administrative work I now enjoy to increase my MT earnings? It's a tough call. I suppose if I could cherry pick and take on only new clients who allowed me to modem or remote-print work, I'd go for it. I'd also have to give up $0.01/line to lease digital recording time from a local service, since I'm leasing out my phone-in machine to another MT. Or, I would have to stop leasing out the machine and pay for yet another phone line. For now, however, I have slightly less income with greatly reduced administrative headaches, a deal if there ever was one.
Additionally, I put my training to good use in other areas as well. I have a nice little gig at a local college as recording secretary for a committee; that brings in a couple of hundred a month. This weekend I am transcribing tapes from a marketing focus group--something I used to do quite a bit but much less of now. From time to time I type a paper, do up a resume, layout some menus, or other things along that line, all things which bring my annual gross up quite a bit without even trying. I do a little bit of system consulting, building business macros, training, and odd jobs along that line. Altogether, these things add significantly to my income without tying me in to a day-to-day grind.
Given that I make more now (even on a per hour basis versus a per-hour basis versus a per year basis) than I ever have, can work in my bra and panties with my hair in curlers if I want, can work from 10:00 p.m. until 6:00 a.m. if it suits me, have learned something new every time I complete a work session, feel that I am making a positive contribution to my community, even if indirectly, through my work--given all these things, I have greater job satisfaction now than I have ever had in any previous career incarnation.
I guess what I'm trying to say, briefly (hah!), is that your earnings should be looked at in totality, i.e., if you are working at home you have no commuting costs, no wardrobe costs, no lunch-out costs (though I guess you have to subtract the brown bag you essentially still do), no child care costs, minimal association fees, minimal ongoing education fees, minimal headaches, minimal stress, and thankfully no supervisor standing over your shoulder asking when exactly you expect to have your project finished.
My last "real job" was administrative assistant to a group of high-powered capital assets bankers for a major international Chicago-based bank. I guaruntee you that not once since I have been working at home has anyone asked me to momentarily stop working on a 40-page proposal due proofed and printed in two hours to run down to the fourth floor cafeteria and get them a bagel and a cup of mocha java! The loss of this silliness alone is worth whatever income I might have lost had this career move not gone as smoothly as it has. To make my move into full-time home MT, I took on a moonlighting job for just over a year while I got up to speed and contracted enough work. That was a tough year, but one I would gladly repeat to have the freedom and self-direction I now enjoy.
So, when you look at your income, don't just look at the in-flow, also look at the saved out-flowmay be making more than you think you are. Then, look at your quality of life. If you are happier working at home, no supposed increase in income can replace your inner peace. From email@example.com
If you had several subcontractors doing work for hospitals then 40-60 or more would be possible but you'd have the IRS hassles of what's a subcontractor and being responsible for the subcontractors quality of work.
It all depends on where you live, too. Although 40 grand would be nice in a rural area, in NYC it probably wouldn't amount to much. Do the big national services pay a set rate, or do they make regional adjustments? Anyone know?
The only reason my income has been less than $40,000 is because I have chosen not to use day care for now (my youngest is FINALLY in kindergarten this year!), and I only work perhaps 20 hours per week, with several weeks
off each year - all by MY choice. Also, last November I became an editor with the company, so now I have less time to transcribe (I make more $$ transcribing than I do editing), but I'm enjoying editing for now.
Of course, those ads in the magazines are deceptive - nobody can start out making that kind of money. But I believe it certainly is a realistic, attainable figure for those who have a few years' experience, have quick fingers and a good ear, are getting paid by the character or line, taking full advantage of shorthand programs and other computer aids, and are in the right kind of position (most likely working for a large service) not having to waste a lot of time with organizational details and setting up headers, etc. Before I began working with this service, I had spent the previous 10 years working for a group of cardiologists and managed to get up to a whopping $10/hur at the end of the 10 years. The local hospital pays its MTs around $8/hour. Nobody can get rich that way!
Also I have been approached by young adults thinking of doing MT at home (haven't we all) and the question inevitably comes up -- well how much can you really make? Then I'm sort of stumped, because, as Mary points out in her FAQ page, it begins at a fairly low rate, then increases as your experience increases. But it's hard to explain that that upper limit is controlled by many things, like how fast you really can tanscribe physically, what accounts your doing, what your pay/line is, how many hours you put into it, etc. I find as I get older, my little hands and brain can only stand this for so many hours.
I also have found that abbreviation programs help me somewhat but I do not experience tremendous leaps in productivity. I do find I keep my nose out of the books (which I LOVE), but I haven't tripled my output or anything like that. Is there anyone out there like me?
Again, I just wanted everyone to know that I'm not thinking -- hey, I want all that money, too -- I just wonder, why aren't I that fast?
Whenever I feel like I'm just plodding along, I try to think of new ideas to speed things up and make them more efficient and productive. Sometimes I can't think of anything more and it's just time to keep plodding. I don't like the feeling of a ceiling, even though I know we can't go faster than the doctors or accuracy allow, but I don't know anyone who is keeping up with the doctors all the time yet, so there is room to improve.
When I first became an MT, I remember the feeling that the fast typists wanted to hide their secrets of speed as their own trade secrets. Online communication has done a lot to break down that attitude, but I sure do want the brainstorming and sharing of better ways to do things encouraging and not oppressive. Speed is a very individual matter...I've wondered if it would show up as "associated with" nerve conduction velocities.
So, with the right accounts, right service, etc., it can be done. HOWEVER, I shudder when I think back to 10 years ago when I worked 12-14 hours a day, six or seven days a week and at the end of the year I made 8800. Sickening. Even now, when I was managing, I see people who are working full-time production and are making in the high teens to low 20s. That, I think, is really more the norm. With services getting away with "robbery pay" (don't want to call it "slave wages, cause at least some slaves were given room and board), we, as a profession will never advance to where the "average" transcriptionist makes 30,000+ a year. I wish "newbies" would look at these ads they see in magazines -- you know, take a six month course and make 30,000 a year, as exactly what they are -- A BUSINESS VENTURE. The person selling the course could care less how much you make once your through, or even if you finish. They make money by selling.
Anyway, as I said, it is possible to not be a service owner and still make decent wages.
Of course it depends on client base, productivity tools and personal productivity, discipline and commitment - but it certainly isn't beyond reason - as I'm sure many MTs on this board can attest to. By the way - this is only my second year at MT-ing -- it is certainly attainable.
P.S. Perhaps some seminars on really how to save time per hour should be set up. I've found that it's not how fast you type but how much time you waste during the hour, even from poor transcription skills. It's that extra 20 minutes you save that adds up to put you from the $20 range to $30-hour range.
Transcriptionists know the true story when it comes time to pay those taxes! So it is very possible when you're a workaholic and you get a good rate. Some accounts pay as much as 18 cents a line. If you can type 500 lines an hour which you can do with some accounts with PRD or other keyboard macro problems, theoretically.... that's $90 an hour! It adds up.
I consider a full-time rate for an experienced transcriptionist to be $1000 a week for a 40-hour week -- standard. That's my rate as a SUB-CONTRACTOR; that means the actual account is paying more. Things are getting competitive and the prices are going down, but the money is definitely possible. It's no joke, IT'S A DREAM! In fact, the money was so good for me at one time I got addicted and had to force myself to take some time off because every waking hour was more potential money. If you know how to work the system, the money is there.
Business expenses are also a major concern. Some MTs may be covered under their spouse's health insurance policy; others may have to purchase expensive individual health coverage. Aside from MTs working for national services, there seems to be a significant difference from coast to coast and from small towns to large cities between employees, subcontractors, and independent contractors.
Networking with local MTs will probably give a more accurate view of where one stands, and they can set their goals from there. This is not at all to say that a national comparison, such as the one provided here, is of no benefit. As medical language specialists, we need to set our goals high, strive for the recognition and salary we deserve, and tune in with national as well as local trends. Personally, this sci.med.transcription newsgroup has done more to promote the cause of our career than any national trade organization! Let's keep asking questions and grow together!