MTWorld Medical Transcription

World MT, 1996 Discussion

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6/25/99, from Dr. Naureen Mirza, MBBS, Lahore, Pakistan

I am a 32-year-old doctor who graduated from Fatima Jinnah Medical College, this being one of two all-female colleges in Pakistan. Currently I am working as an MT for a company in Lahore, Pakistan. My husband is a chartered certified accountant; we got married in 1991 after he returned to Lahore from London after 26 years. He is now a country representative for the UK-based Association of Chartered Certified Accountants (rather like your CPA).

I was born in Lahore, the cultural capital of Pakistan, and have grown up in this city and completed my education here. Lahore is a historical and a very beautiful city with a great Mughal heritage. We have many wonderful historical buildings at par with the Taj Mahal, also built by the same Mughals who ruled from Lahore.

I had a great childhood. I am the eldest of three sisters. The youngest is now married and expecting to migrate to Canada. My parents were kind and loving. My mother used to help us in our studies. In our free time we liked playing badminton, cricket, playing cards and many other indoor games, some games we invented ourselves. Also enjoyed listening to music, watching movies and childhood favorite TV programs like Star Trek, CHIPS, Planet of the Apes, etc.

After my house job (residency), I got my first job with a charitable blood transfusion center helping children with inherited blood disorders like thalassemia and haemophilia for three years. It was a good experience and I got so much love from my patients and their parents. I left that job in 1997 and stayed at home where I began surfing the net.

Currently I work as an MT for a company where I am transcribing ER reports, discharge summaries, consultation reports and operative reports sent by American hospitals. My medical education is a great help in this job. Some people say that I am doing a secretarial job after studying so hard but I don't think that way. I like my work and want to continue this in the future. I would like to become independent and work from home. I know this is not an easy target but I have hopes that some day I will be able to do so. I know it is going to take time, patience and experience.

You may be hearing a lot about relationships between India and Pakistan in the news lately. As far as MTs in South Asia are concerned, I don't think our political and religious differences will interfere with helping each other online. I never ever think that somebody is Indian or Christian before answering questions on the message board, and I think others also think the same way. It's the same as not asking a patient's religion before giving them treatment.

Just recently I got a letter from an Indian MT who wanted to ask about the MT business in Pakistan. I wrote him back and got answers to my questions back too. We do want to resolve tension between the two countries. That's why the Indian Prime Minister visited Pakistan a few months back and our foreign minister has recently visited India, which is a good sign. I think the new Indian and Pakistani generation want to resolve our differences, mainly over Kashmir occupancy, a hot topic now a days. I hope both countries start living in peace. The easiest solution is a fair referendum in Kashmir supervised by The United Nations.

I always like to know other people and their cultures. My husband and I love traveling and luckily we have had a chance to travel to many countries. Whenever I browse the MT site and see the message board, I always see messages which give me an impression that American MTs do not like foreign MTs. They must have their own reasons. Most of them think that foreign MTs are going to take over their jobs. There is no need to be afraid of competition from foreign MTs. At present the medical transcription business is only popular in America and Canada. I think more jobs will be created in this field for both local Americans as well as foreigners. You never know, local hospitals in European and Asian countries may start providing such jobs to their local MTs.

2/97, from Mary:
This issue of American dictation being done in other countries sure is a hot issue, and I think there are people on both sides of the issue on this forum and among MTs at large. Hope we can continue to learn together, but perhaps it is going to require action as well, since this forum is in the global marketplace and we share trade information here.

I am for free trade because I see it as inevitable, and I think total isolation is worse (leads to war). I think we have to ride it out like whitewater on a river, watching out for our interests and competing fairly, with political limits (there are enemies). All of us posting helpful information on this forum are aiding free trade, and MT Daily is available around the world. American MT equipment, books and journals are also being sold overseas. It may be many years before the doctors in other countries stop handwriting meager records and begin to dictate, and hire MTs, if ever. Hope we can keep discussing this here and learning.

3/7/98, from Ted Branin:
I have an A.B. from Rutgers University in German and Russian and I have taught German for five years. You mentioned MTs in India as a possible threat to your profession and on your message board others have expressed some concern. I do not feel that one should worry. In my experience with learning a foreign language and speaking it I find that only educated native speakers of a language who have never left their culture for an extended period can render consistently competent prose in that language. With only very few exceptions such as Joseph Conrad, are great authors and poets great in any language other than their native one. To be a good MT I would think that one must have a good ear, because the ear is the final guide on all good prose. How can someone in a foreign culture develop a competent ear for current American pronounciation and usage? Additionally, I feel that it is the reponsibility of the foreigner living here to speak with proper pronounciation. I can speak German with some fluency and with nearly perfect pronounciation which means that I have some experience in this area.
1/97, from Mary:
Open letter to RAJA's note on
RAJA, I would like to take your note seriously and dialogue, but I fear your note is an anonymous, address-less, hit-and-run note. Please come back and talk with us. These discussions that you object to are not going to stop by your decree.

It is not a matter of setting the record straight; it is a matter of all of us already being in the soup and having to learn to navigate the unpredictable twists and turns of the inevitable global market where tariffs won't work for long and civilized competition is the only good alternative, given the Internet and our involvement in the global flow of cyberspace right here. We have personal, family, professional and national interests at stake as well as global ones, and those loyalties make it complicated so we need to talk and learn, to sort it all out in a new frontier where trial-and-error is the only way to learn some things.

You have a credibility problem. Who are you? Your note contradicts my information. I hear rumors of Healthscribe not yet making profits, having a hard time finding willing American MTs to proofread, electricity and water problems in India computer boomtown, and AAMT's "neutrality" on offshore outsourcing. I hope you will post again with your real name and address.

10/96, from Mary, interview with Sharad Patel:

Question: What is your opinion about dictation from American physicians being done overseas?

Personally, I do not have an opinion one way or the other. I am one of those who buys American and supports American-made products. That does not mean I denegrate those who buy globally available products. In fact, we are in a global market and must accept that as a fact of life. This medium we are using is a great example of the marketplace, and the widespread use of it will definitely mean easier access to the global marketplace. So long as the quality of the product is good, who cares where is is made?

Question: Are you an American?

I am a US Citizen, born and raised on the exotic island of Zanzibar (most only know of this place from songs - and those who wish not to date themselves will acknowledge a movie with the name in its title). I was processed in India for 3 years (middle school), refined in UK for 4 years (high school), and packaged in the US - 26 years and going!

Question: What is your advice to MTs in view of the growing international market?

There is much ignorance of the emerging, almost developed, global economy. If the MTs abroad were to make the same salaries as US MTs, would there be so much discussion? After all, our clients, the healthcare facilites, don't know the difference - they are paying as if the work was done here!

WMy company will soon (read 60 days) be able to provide Internet dialog with MTs abroad. We have just commissioned a dedicated line. By no means am I saying " shut up and compete" - on the contrary - I say "accept the way it is and go forth..." We waste too much energy figuring out the what-ifs out there. Every US transcriptionist I know who has visited sites in India come away enlightened and educated. We must transcend the ugly American syndrome. It is we who wish to lower the cost of healthcare in this nation - and this is one area that will be hit.

The MTs should be looking at voice recognition. For those who think it is far away - think again. I saw a demo from EDS which was on a show floor. It recognized continuous speech! - no training. It is still commercially expensive - but we thought that about computers on every desk maybe a decade ago.

As far as MT trade goes, the largest companies are desperately looking for sources overseas. Most of them don't even know their work is going overseas. It is the transcription provider that is going abroad! And they are saving money big time!

Question: Are these companies bidding less than American companies?

It can be - and is not. But then, the Transcription Providers are positioning so they can. How much money is saved by healthcare facilities depends on their ability to negotiate. I can attest that folks doing business off-shore, particularly the area discussed in this forum, can make enviable profits selling at 8c per line. A line - while most in the indusrty are still quibbling about this - is 65 printable characters (a space is a printable character).

No businessperson would walk in and undecut a market - especially this one. While most overseas folks can sell profitably at US costs, they sell just under the US selling price. Any other pricing would be giving away the "fat" and invite the fury of the commerce department. It would be labeled as "dumping" - a convenient protectionist term.

I have seen RFP's from two major US facilities specifically requesting quotes from abroad, and at substantially lower prices. If greed prevails, they will get the lower price; it is economical to deal in voulmes with 1 customer rather than several making up the same volume.

From Mary:
I got an e-mail note today from a doctor in Madras providing medical transcription services, thinking I might be interested. This gave me two ideas:
1. I wrote him asking if he does transcription for hospitals and doctors in India too.
2. I thought (just for a minute) that I might send my work to India on a subcontracting basis, but my contract doesn't allow it.

If only we could control progress and make it good for everyone the same, but then there would have been no doctors...

From Alisha,
It has long been my belief that we are turning into a WORLD of people, not just this COUNTRY versus that one. In Lakota, the words are Mitakuye Oyasin (pronounced mih-TAHK-wee-ah-sihn), meaning we are all related. I have thought over the sending work out of the country for years, since this has been an issue economically and politically. If we are good at our jobs, why do we fear having someone else take them away? And if our jobs are no longer available as we have always done them, mightn't there be better jobs for even better pay and even easier on our hands, wrists, arms, necks, backs, etc? I guess I've always been a cockeyed optimist.
From Mitzi Ponce:
I value your optimism and your opinion, but believe transcription is not so much a good as it is a service. IMO, tariffs unfairly support domestic goods produced by inefficient methods over the same goods produced by more efficient methods in foreign countries *where all other factors remain constant.* I encourage tariffs when it can be shown that the efficient production of the goods in a foreign country is at the expense of humane working conditions and compensation. However, pricing for transcription services is not based so much on production costs as on the cost of living of the transcriptionists performing the service, just as pricing for many other services.

Think for a moment about what other services can be outsourced to foreign competitors? You can't outsource the guy who pumps your gas, the gal who reads your electric meter, the fellah who draws your blood, or the physician who examines you. These jobs all seem to fall into a category of site-dependent service providers.

MTs, then, are in a separate category of non-site-dependent service providers. We can probably be lumped together with anyone in the data processing or production business, say perhaps billers, generic transcriptionists, graphic artists, programmers, data input, etc. Our jobs are less protected simply because they can increasingly be performed anywhere (even boats and islands!) given new low cost communication technologies.

If we turned the situation around a little bit and imagined that MTs were flooding the country's borders and asking for work visas, we might see this a bit differently. Currently, as I understand it, immigration/visa policies are such that you can enter the country to work in an occupation that has high demand and low supply. None of us are crying too much when Mexican immigrants enter the country to staff our restaurants and pick our produce for less than minimum wage. If, however, those same immigrants wanted to staff our offices and mail rooms at higher salaries, I think we would hear a great public outcry. (To our shame, I don't hear that public outcry over the hiring of foreign nannies. Says a lot about the value we place on children and "women's work.")

In a true one world, global economy, on a level playing field, American MTs would have nothing to fear whatsoever; but the facts are that labor is cheaper in other countries, foreign competitors are hungrier than we are, and foreign workers are more motivated to settle for lower levels of compensation. American MTs cannot accept lower compensation because there will be no corresponding drop in the price of housing, eggs, milk, school clothes, tuition, electricity, and so forth. If we were willing to lower our rates to mere subsistence levels, who would want the job? Who would be willing to invest the cost of education and training to enter a profession from which you could expect only subsistence pay?

The actual production costs of paper, printers, computers, software, and dictation units could probably be minimized and result in some savings. However, many among us have already made those equipment purchases, taken the amortization, and now entered into a phase of our business where production costs are practically a moot point. The cost of our service is intrinsically tied to cost of living.

So, is this my call for tariffs and protectionism? I don't think so, not really. I'm probably best politically described as a libertarian and I abhor government regulation of business, including tariffs and import restrictions. I'm also a pragmatist and I know this isn't a fair world. I wholeheartedly support the ideas in Ayn Rand's "Atlas Shrugged," ideas that support a freely functioning and competitive market place, but I'm reminded that even Rand's John Galt and his cohorts found it necessary to protect themselves from their society (and by extension from the world) until such time as others accepted the principles upon which free trade and a free society are based; although, I'm not so arrogant as to believe that my conservative views are shared by others everywhere.

I think we can all agree, however, that for there to be a clear winner of a baseball game, it would be best if both teams played on the same diamond. Maybe the American worker has become greedy and lazy. Maybe my wanting to work a 40-hour work week, have a car in my garage, pay off a mortgage, send my kids to school, or finally take a real vacation is unreasonable. I think not. You'll notice we're not talking about working being exported to France, England, or Germany.

We're talking about work being exported to countries where the standards of living and the expectations of citizens for a better life are substantially lower than our own. We have, in discussing this issue in this newsgroup, tended not to lump ourselves in with the sweatshop scenarios, perhaps because we rightly view our work as much more than just production-type labor; yet, how is this different in any substantial way? Who among us would say it was okay for clothing manufacturers to produce their goods in South American countries where child workers toiled from dawn to dusk? Because we're talking about an educated adult sitting at a desk using a computer, is it different?

What a complex issue this is. I think that while your one world view is noble, it is not practical. This will be one world when workers in foreign countries performing comparable work can expect comparable compensation. For that matter, this will be one world when Asian girl-children aren't sold into slavery and prostitution rings. As a consumer, I don't want my health care dollars expended to support American or foreign corporations profiting from the most ill-paid workers. As an MT, I ask only that we play ball in the same ballpark.

Mitzi Ponce,,

In the Modem World, White-Collar Jobs Go Overseas

Washington Post Staff Writer
Tuesday, September 17 1996; Page A01
The Washington Post

At 7 one morning last week, records clerks at Mount Vernon Hospital in Fairfax County got an urgent request: Physician Stephanie Giorlando had just finished dictating a medical summary on a patient and needed a transcript of her comments. Unless her summary could be transcribed quickly, an elderly patient might have to spend another night in the hospital.

The clerks went to work. Within minutes, Giorlando's recorded words were hurled across the globe over high-speed data lines to an office building in Bangalore, India, where a medical transcriptionist listened to the recording, typed up a transcript and shipped it back electronically to a proofreader in Virginia. The doctor got her paperwork by 11 a.m.

"It is incredible," said Denise Knauer, the hospital's manager of information word processing. "With most discharge summaries we have a standard 72-hour turnaround."

The Indian worker, who received on-the-job training to decipher American medical jargon, gets paid roughly one-tenth the $25,000 average salary of full-time medical transcriptionists in the United States. And while U.S. scribes typically have high-school level educations, most of the Indian transcriptionists have college degrees in the medical sciences.

Americans have known for years that U.S. companies are sending manufacturing jobs abroad to take advantage of lower costs and wages. Less publicized is that certain white-collar jobs are becoming globally mobile too, as employers use increasingly low-cost satellite and fiber-optic communications to link their U.S. headquarters to "back office" operations that used to be down the hall but now may be continents away.

No one knows how many jobs have gone abroad this way, though most analysts say the numbers remain relatively small. Still, it is big enough business that governments in Ireland, the Philippines, Jamaica, Barbados, St. Kitts, St. Lucia and other countries have formed special development corporations to vie for U.S. service jobs. At times they succeed in a big way. American Airlines' Caribbean Data Services, for instance, employs more than 1,100 people on Barbados to punch in data about airline tickets, making it the island's largest single private employer.

Most overseas information services jobs are low-skilled data-entry positions, in which people process credit card applications, direct-mail responses and insurance claims. Increasingly, however, the jobs being performed abroad over phone and computer lines are requiring more education and skills. The best-known example is the boom in offshore software production in Bangalore, as Fortune 500 companies realize they can hire an Indian PhD in computer science to write software code for $9,000 a year or less, then ship it back to the home office via phone or satellite links for packaging and sale.

"We originally attracted companies in the data-entry area," said Donville Inniff, business development officer for the Barbados Investment and Development Corp. "Now we run the whole gamut, including software development. We've been able to mesh our technology with the high literacy of our people. Our educational system is now slanted more toward the information technology area."

Exporting the work of creating medical transcripts is one of the more recent outgrowths. U.S. hospitals employ hundreds of workers in India, Barbados, the Philippines and Ireland through outside transcription companies.

Healthscribe Inc., based in Sterling, provides the links from Mount Vernon Hospital to nearly 100 transcriptionists at its Indian subsidiary, and back. It began as a software company, but moved into the medical transcripts business after its founders realized how inefficiently traditional U.S. transcription companies were moving data between doctors and transcriptionists.

Much of the industry remains "mired in the dark ages," according to Healthscribe founder Richard Burton. "Healthscribe has tried to redefine the business model. . . . India simply offers, in our view, the largest, highest-skilled English-speaking labor market in the world."

Most transcription services in this country still use 1980s-vintage word-processing programs. Some transcriptionists in this country, working at home, use computer communications. But others receive tape cassettes by courier and send paper transcripts, sometimes prepared on typewriters, back to the hospital the same way.

Enter companies such as Healthscribe, which has eight U.S. hospital clients to date, and Interlink Communications Ltd., a Chicago company that also is providing transcription services to hospitals by linking its software to workers in southern India.

"Labor is anywhere from 40 to 60 percent of costs" in the transcription business, said Raj Malhotra, president and founder of Interlink. "When you go overseas, obviously your labor costs are significantly lower and telecommunications costs are higher. So the challenge is to have sufficiently high volumes."

Burton and Malhotra both are adamant that they are not exporting jobs intended for Americans. They say there simply are not enough qualified U.S. workers to begin with, a point with which the U.S. Bureau of Labor Statistics agrees.

"There is more business than there are people to do it," Burton said. "And it will continue to grow 15 to 20 percent a year. The labor supply to do it [in this country] is not growing." He added that Healthscribe plans to add 150 jobs in the United States in the next year.

The two executives also dismiss images of a sweatshop environment that people associate with cheap offshore labor. Burton said his employees in Bangalore work in new, well-lit offices with Pentium-equipped computers. "We hire people at slightly more than the competitive wage base for administrative assistants in the Indian labor mark "We hire people at slightly more than the competitive wage base for administrative assistants in the Indian labor market. And they're paid for training," he said.

To some people in the industry, the overseas competition could be a plus for the profession in this country. If it "encourages us to do more education and apprenticeship programs, it's not a bad thing," said Catherine Baxter, executive director of the Medical Transcription Industry Alliance, a Houston-based trade association.

Healthscribe says it ensures quality by having proofreaders and doctors check the finished transcripts. In any case, it says, the Indian staff may be more highly qualified than an American one.

Another issue has arisen: confidentiality. Hospitals that use overseas medical transcriptionists also may have a more difficult time ensuring that patient records remain private. Burton said security of information was one reason Healthscribe opened its own facility in Bangalore, rather than contracting out the work.

Privacy advocates fear pharmaceutical companies, insurers, employers or others might gain access overseas to personal medical information.

"For all the talk about the confidentiality of patient records, you send that stuff to a country that has a thriving black market, you have no guarantee," said San Francisco transcription business owner George Heymont. "This is a job that should be kept in America."

Just as new technology has allowed jobs to flow overseas, it can also bring them back -- or eliminate them all together. As new generations of computer-literate doctors emerge, more will type reports directly into computerized records. Some U.S. transcriptionists are using software that speeds up the job by anticipating stock phrases and quickly spelling out long medical terms.

"It's like wearing roller skates," said Mary Morken, an independent transcriptionist from Virginia Beach. "This is going to help keep American workers in business in the face of cheap labor overseas."

Voice recognition technology is touted by software companies as a potential substitute for transcriptionists. But those in the industry say technology will never replace them entirely.

"There are just certain slang terms doctors use," Heymont said. "They like to talk in code. And doctors make up words all the time. You still have to have people who have the talent to do this kind of work."

@CAPTION: (Photo ran in an earlier edition) LaVinia D. Brown uses a computer to transcribe physicians' recorded dictation at Mount Vernon Hospital in Fairfax.

Copyright 1996 The Washington Post Company, permission to reprint> 9/96, from Alan Stancliff,
I am disturbed to hear that the president-elect of AAMT is involved in editing work of off-shore MTs who make $2,500 a year. I worder if AAMT members were aware of this when they voted for her? I would not be disturbed if I found out she were attempting to organize Indian MTs to get a similar wage to what we get here. Then she would be acting in the interest of American and Indian MTs.

This points out a signal weakness of AAMT. It attempts to represent the MT industry as a whole. But the MT industry is composed of MTs and service owners. We working MTs need an association that represents the interest of MTs on a world-wide basis and takes up the cudgels on OUR behalf.

Someone posted a note on this thread that said we who wanted Indian MTs to be paid what we are being paid are thinking of our own interests, and not the interests of foreign MTs. I would respond that we American MTs have interests in common with the off-shore MTs, and that these common interests need to be championed by an association called something like INTERNATIONAL ASSOCIATION FOR WORKING MEDICAL TRANSCRIPTIONISTS. Such an association would correctly advocate for us and recognize that the large services have interests that are different than ours.

What we need as MTs is power against the huge economic power of the corporations. We need this power because power takes a backward step only in the face of power. The only power we have is our potential unity, and ultimately our international unity and solidarity with world-wide MTs in the face of world-wide employers who would pit all of us against those of us who live in the meanest of circumstances. We need a union -- and one that will not fall into the trap of narrow xenophobia.

9/29/96, from Mitzi Ponce:
Ideas for American MTs competing in a world economy:

1. Educate the consumer regarding the nature of our training. Many MTs will spend as much or more time in formal training as others in the allied health professions, although we may not share in recognition of our formal training (to say nothing of continuing education). For instance, I recently prepared job descriptions for a local medical practice. I think we stack up pretty good as compared to the medical assistant who is required to have at least a one-year certificate, the radiology tech who is required to have at least a two- or three-year certificate, and the ultrasound tech who is required to have a one-year certificate.

2. As much as we may hate it, educate the consumer to *require* certification of some sort, either through college or technical school programs or through a certifying organization. I know the debate rages on about AAMT's CMT, but requiring certification of some sort by some governing/certifying body would serve several purposes. First, it would help eliminate the slipshod, start-up MT who offers to work directly for a physician, clinic, or hospital at $08/line and returns work so awful that the departmental secretary is required to spend hours cleaning it up or outsource the cleanup (true story). This scenario is a detriment to us all. Second, requiring certification would facilitate physicians' and administrators' view of the MT not as a typist but as an allied health professional deserving of respect and support, to say nothing of decent wages. Third, requiring certification would add to the foreign competitors' cost of doing business.

3. End the trend toward distancing ourselves from the people for whom we work. We should encourage our service owners and industry representatives to be on-site more often. I really like it when a physician is dictating remotely and says, "Hi, Mitzi. This is Dr. X. I'm dictating for patients seen..." I like knowing that the doc knows a person is at the other end of this increasingly impersonal process. I don't know if increasing our presence means we send out chatty newsletters to our clients ("Congratulations to M. Smith who just received his CMT!"), lobbying efforts, open houses, or some other PR effort, but if we don't toot our own horns, no one will. Again, in spite of the debate, AAMT may be the independent transcriptionist's greatest ally in this effort; services can promote themselves, the IC is at a bit of a disadvantage in the community.

4. Encourage the physician to be a partner in the process. If not through AAMT, then individual services or local organizations could invite physicans into the education process via seminars, articles, whatever.

5. Encourage highly visible internships and scholarship programs. Visit local schools on career days. Talk up the profession. Recruit.

6. Don't ever refer again to "working at home" or not having a "real job." I know I'm guilty of those. Instead, have "an office located in my home" or be a "flex-time employee." What we call ourselves will influence how others perceive us.

7. Write a letter to the editor of every magazine you read carrying one of those barely legitimate work-at-home ads. Say, maybe something along the lines of this multiple choice, fill in the blanks form:

Dear Editor:
Your recent _September 1996_ issue of _Big Name Magazine_ carried an advertisement on page _199_ for _Rip-You-Off Institute_. Amongst its offerings is a course in Medical Transcription. As a (professional) (certified) (proud) medical transcriptionist, I am (deeply concerned) (highly offended) by this advertisement. From my own experience and that of the thousands of competent MTs working in the United States, I can tell you that it is not possible to (train in only four months) (make $25,000 the first year). _Our Local Community College_ can educate an MT in two years who will then be able to (exceed the earnings potential claimed in this advertisement) (get a job in any local hospital) (work as an independent contractor) (enjoy the benefits of a real education). Further, after having checked with the (AAMT) (BBB) (hundreds of other MTs with whom I correspond), I can find nothing to recommend _Rip-You-Off Institute_ to the potential MT.

I realize that pulling this ad might be (directly opposed to your money-grubbing philosophy) (impossible) (contractually prohibited), so I would like to suggest instead that you run an article (profiling a successful MT service owner) (highlighting our profession as an excellent choice for young women) (discussing the new trend toward shipping our jobs offshore!) (profiling the growing role of men in our profession) (discussing the educational requirements for entering this rewarding profession) (comparing RYOI with several legitimate home training programs which don't make outrageous claims). I'm sure your readers would be interested in reading the facts about this exciting profession.

8. If you can't lick 'em, join 'em; if you won't join 'em, form a competing organization. I wasn't being flippant this weekend when I quoted Plato (Those who are too smart to engage in politics are punished by being governed by those who are dumber.); if you examine this quote it has many levels of meaning and poses either a highly satirical challenge or an interesting conundrum. Before disparaging AAMT (for the record, I am *not* a member), think about some other trite but true sayings: A house divided...Strength in numbers... If it seems on reflection that AAMT is really too self-serving or moribund to effectively represent the views of its membership or to promote its membership, then build a better organization.

9. Discuss these issues with folks in other professions. While, in perspective, this is just a minor incursion into our territory, tomorrow it could be a major incursion in a number of job categories (a few pop to mind: accounting, data management, programming). Buy American, encourage others to buy American, and encourage your friends, families, and acquaintances to ask from whom their doctors buy transcription services. Write letters to newspapers. Don't let offshore outsourcing be a hidden practice.

10. And, finally, give the physician good reason to prefer you over an offshore MT. Be better, be more correct, develop greater flexibility, be highly motivated, gain in professionalism, interface, network, or rant and rave if you must, but get noticed. Liken the situation to your physician's attorney outsourcing the typing of legal documents to an offshore company (wouldn't like that much, now would they?).

Mitzi Ponce,,

8/96, Bev Hearn:
VDC Corp. announced on 08/12/96 that it will be working with Informatix Acquisition Corporation to develop a medical dictation and transcription service through a facility in Los Angeles using MTs in Noida, India, outside Delhi. "The medical transcription industry is primarily serviced by numerous small outfits utilizing basic transcription technology. Because labor rates in India are significantly lower than in the United States, Informatix believes that it will be able to offer its technologically superior dictation and transcription services at a lower cost than its competitors."
6/96, from Judy in Portland:
A little public pressure can go a long way. One of the simplest ways is to ask your doctor where his dictation goes, and tell everyone else to do the same.. Or how about some Letters to the Editor in response to the article on at home transcriptionists in USA Today (June 18) pointing out that that type of job is endangered. Letters to the Secretary of Labor. Letters to ? - Be creative, the job you save may be your own.
6/96, Peg Brundidge:
I couldn't agree more! I realize that this is something we may have to deal with, but if those of us IN the profession are just beginning to see this, you know doctors and others probably have no idea. They, on the other hand, may know and just not care, but I too say that it should at least be brought to light.

I, like many others, are struggling to "make my nitch" in this profession. I am not satisfied to just get a job. I also want to be very good at what I do. I take medical transcription very seriously, as I think anything having to do with the medical profession should be. I think it is bad enough to be sending our jobs out of the country, and for people of other countries to have to work in less than good conditions with less than adequate wages. It is bad enough when this work is being done regarding retail products, but when it comes to our medical and legal records and insurance billing, I think we're dealing with something else altogether.

I am not as informed as I would like to be about the companies that are doing overseas transcription. I want to learn about them, who and where they are, and what facilities they service. Then, with accurate and current information, I too think we should write public officials and perhaps even the facilities that are using these services just to inform them. What they ultimately end up doing about it is of course up to them, but at the least, they should know exactly who they are dealing with. I say let's educate ourselves to exactly what is going on and then begin to educate everyone else we come in contact with. I barely have a job and I DO want to save it!

6/96, from Judy in Portland:
Mary wrote: "US MT per week for 5000 lines: $280 with benefits ($7 an hour, lowest hospital pay) or $350 no benefits (7c a line). Overseas MT per week for 5000 lines: $15"

But labor rates are going up in Bangalore, so the computer industry is planning to move out to cheaper areas with new start up costs. Plus they have the cost of bringing in water and using generators and transporting them to the worksite. But I'll grant you it's still a LOT cheaper.

As an aside, I read an interesting statistic in Megatrends in Asia by Galbraith. They only have 1 phone line for every 100 people in India, and there are 4 million on the waiting list for a new phone line, some of whom have been on it for 5 years. They won't be doing home transcription any time soon.

Mary wrote, "My husband warned me that this can be a self-fulfilling prophecy: if we sound the alarm and tell everyone not to go into MT, we drive the companies overseas faster. So, as Barb Grow just wrote in her contribution for the paper on the future of MT for the AAMT Convention in July, we have some influence on the unknown future by how we talk about it today. If we have a great reputation as excellent producers, we will be harder to displace. However, the displacement might turn out to be a promotion!"

But if we don't "sound the alarm" to those doing the hiring, they will continue to hire services that send the transcription overseas without even knowing it. Just as the clothes we buy have labels - made in USA, wherever - companies should be required to state where any kind of work, transcription, computer programming, etc. is going to be done. Then the person doing the hiring can make a choice whether to go with that service and send work overseas or not. But right now I don't think anyone even questions where the work will be done, and they need to.

I don't think we should be telling people not to go into MT, just that work is being sent overseas and there are other changes currently going on with uncertain impact on the future but definite risks. Call it Informed Consent in employment. The more determined will still go into transcription and those that need more security will go elsewhere (if they can find anything more secure, and these days that's really a big IF).

6/17/96, from Prasanto, New Delhi:
Most Indian doctors use handwritten prescriptions and records here. The younger medicos, and several of those running pathological analysis labs, use computers for records. Let's see if I can track down an "MT" (out here, an MT is a management trainee!).

IBM recently developed a very sophisticated handwriting recognition system based on basic artificial intelligence techniques, for the sole purpose of reading and recognizing "the most challenging piece of handwriting on the planet", a doctor's prescription. That problem, at least, is universal! The system uses complex medical lexicons and heuristics to accurately interpret prescriptions.

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