Wednesday, March 16, 2005

What are the prospects of progress in this type of job?

In the past nights, after work, I have been testing for my prospective employers.

Golly, I was not prepared for the difficult dictators. I even stopped applying to other companies to give time to these test files (while at the same time working in my present job editing).

This job is easy IF the dictator is clear and slow enough. Accent is not a problem. But recently with my test files, I have encountered dictators who won't even slow down on findings that really matter: (e.g., CV findings on a CVA patient; lab result of a Rheumatoid Arthritis suspect--I got the WBC count, not the Hgb and Hct if those were dictated, got the sed rate and ANA and RF). Some dictations, particularly SOAP in clinics, have sentences that make no sense, and which I could have researched on IF ONLY I knew what the case is all about (I wish all doctors doing SOAP will at least dictate the Working Diagnosis, so that by the time they dictate the medications, workup and plan, I can try to guess the mumbled words and come up with sentences that make sense and is related to the case.)

One thing I can say, the more I learn about how difficult this job is for MTs, the more I see how strong the net community built by MTs, and the more respect I develop for them (us). All the more reason for me to wonder why MTs salary (based on forums/chats I have witnessed) is going downhill. This is not at all an easy task! While some nurses (especially CNAs) may be doing back-breaking dirty tasks, we face the same dillemma of acquiring CTS, scoliosis/kyphosis, and poor eyesight, often at our own expense. If not for my present need to stay at home, I would have applied even for an NA position and slowly work my way up.

Furthermore, I believe that while MTs have the burden of making their transcriptions as close to error-free as possible for these to be considered quality documents, I also believe that doctors should produce quality documents in the form of their quality dictations as well. This whole quality assurance and proper documentation are intended to enhance quality medical service through continuity of care made possible by such quality documents (i.e., if a patient is attended to by different doctors--ER to admitting to attending primary care to specialists--proper documentation will make it easy for these doctors to manage the patient).

Ergo, don't MTs have a voice to make such demands from the doctors to provide us with quality dictations?

I used to work in a clinic where the nurses only had to ask me (assistant to the med director) to tell my fellow drs to make their handwriting more legible, so the nurses could properly log the cases in their ER/admissions logbook. I did, and everyone cooperated, so the nurses were happy. Needless to say, the ultimate beneficiary was the clinic and, indirectly, the patients.

I thinks MTs should also have this kind of feedback system with their clients (hospital QAM, by principles of quality assurance, can address such problems at the root cause by sending a notice to their doctors to improve their dictations, even to the point of sending the doctor who got more complaints from the MTS to a dictation workshop, to avoid erroneous documentations. If these are carried out, then the burden of errors will be on the MTs.) In true quality assurance, communication is important to come up with the least errors, and targeting the root cause is the best way to tackle problems.

I wonder if that is possible?

I can see now why individual MTs working on accounts of doctors within their vicinity have better work relations with the clients. If the client is a hard dictator, the MT has the right to demand a higher pay (because she uses more time and effort to transcribe) for a job well done. Either the client agrees to pay more, or make his dictations easier to transcribe.

But I don't see the same thing with MTs working for companies, especially when these MT companies are competing against each other, and trying very hard to please their clients by always promising at least 98% accuracy. Do they also have a means to address the problems of difficult dictators at the root cause? I have no idea...but I hope they do. I hope it is one of the issues tackled by AAMT. After all, MTs are part of the healthcare system, not mere typists.

Just a note about MT jobs in PI (you are aware that there are indeed some MT companies with offshore MTs): I have read a post in another forum where they say that MTs earn less than call center agents, and they (MTs) don't get it, when employers look for qualifications that are higher--allied health professions, typing speed of 45 wpm or more, and the rest is the same for both jobs (English proficiency, listening skills, computer skills).

I just might look for local clients sometime in the near future if the situation becomes so depressing, but then that would mean that I will not address issues on EMR (electronic medical records) handling, but purely just transcribing what the doctor dictates, then sending them copies (both hard and soft, as they desire); they will be responsible for filing and archiving their documents.

In any case, I will use this MT job to force me to study and to raise the money for USMLE. I hope I will make it, and if I do, I will remember the plight of many MTs.

I have read posts about MTs praying for the patients. Sometimes I have the same tendencies. In addition, I can't help asking whether the PCP did a previous workup for a differential diagnosis that I had in mind, or whether aside from referring to the ortho, did the PCP also refer the patient to the cardio?...things like that...

Well, I hope I will learn more about case management through these transcripts. It is like undergoing an apprenticeship. I hope that by the end of 2 or 3 years I will have studied enough to pass the USMLE, and learned enough insights from the specialists to add to my wisdom.

I honestly don't think that MTs will be regarded as that valuable in the coming years. Companies and clients will always use the competition to haggle for the price, and will use the VR technology to threaten the MTs and force them to bow down.

I think it is best to be on the client side -- be a doctor/health practitioner. There is no way one will run out of job in this profession.


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