By Lori Boone

In the late 1950s, DeeAnn Guthner started her career as a medical transcriptionist (MT). She found a job at the Crippled Children’s Division at Oregon Health Science University as what was then-called a medical secretary. Her tasks included answering the telephone, filing and transcribing medical dictation. The woman she replaced was several months pregnant, which meant that DeeAnn had approximately six to eight weeks to learn how to transcribe. She was provided with a manual typewriter, a Dorland’s Dictionary, a foot pedal and a headset. At that time, there were no formal medical transcription training programs.

Since then, scores of sophisticated training programs have been created and are available online, through correspondence schools as well as at many community colleges throughout the country. More than 39,300 sites came up on Google when we typed in “medical transcription training programs” into its search engine. Today’s advanced technology, an aging population, high unemployment rates, a troubled economy and a severe labor shortage, have combined to make the medical transcription profession an option for employees and the focus of much attention for employers. For years, the medical transcription profession has provided meaningful employment for many and has become an ideal profession for mothers and others who wish to work from home. In fact, DeeAnn continues to work from home as an MT, earning a decent living while maintaining the freedom and flexibility that lets her spend more quality time with her grandchildren.

In 1978, the American Association for Medical Transcription (AAMT) was founded to support MT professionals. AAMT is stronger now than ever and continues to expand its services to this industry, supporting MTs throughout the country, and sustaining the certified medical transcriptionist (CMT) program. By the early 1990s, several MT training programs had been developed. At that time, hospitals and MT service organizations required candidates to have a minimum of five years of acute care experience before they could be considered for a MT position. This has recently been reduced to two years in an effort to attract a larger labor pool and keep up with the demand. However, this doesn’t do nearly enough to bridge the gap between being an MT student and gainful employment.

Current State of the Industry

The medical transcription profession is in dismal straights. The average age of today’s experienced MT is anywhere from 55 to 70+. The profession suffers from a serious labor shortage and smaller transcription services struggle daily with trying to keep up with turnaround times, the Health Insurance Portability and Accountability Act (HIPAA) regulations, massive dictation workloads and rapidly shifting technical challenges. Hospitals often face Joint Commission on Accreditation of Healthcare Organizations (JCAHO) challenges, as well as problems of impaired patient care and reimbursement, which have come about as a direct result of the labor shortage. Sending work offshore has applied a temporary band-aid to this dilemma, but also brings a whole new set of problems to the transcription table. These include English as a second language issues (including grammar, slang, names, etc.), extremely poor quality, HIPAA compliance concerns and lost U.S. jobs. This method may be very costly on the back end.

Who Is Affected?

• Small transcription services. Approximately 98 percent of today’s economy comes from small businesses. Small business drives the economy and without them, our financial backbone would not exist. Training costs are steep, and small services simply cannot compete with larger services in terms of capital resources and the ability to send work abroad at lower cost.
• Our economy. Every job sent offshore affects our local communities, as well as the national economy as a whole. The seasonally adjusted national unemployment rate for September 2002 was 5.6 percent. Before the terrorist attacks of Sept. 11, 2001, unemployment was at 4.9 percent, according to a recent Families USA report. In March 2002, the U.S. Department of Labor Bureau of Labor Statistics reported an unemployment rate of 6.9 percent in the District of Columbia alone.
• Patient care. It is heavily impaired with delayed reports and poor quality.
• Health care organizations. Health care delivery suffers from poor turnaround times, which impact the delivery of patient care, as well as slowing the reimbursement process. As a consequence, the entire system is affected.

What Is the Missing Link?

With the need for more MTs so obvious and training programs available, why is there such a startling labor shortage in the medical transcription profession? Is it simply a lack of awareness? It’s certainly not a lack of human resources. Nationwide there were 528,000 new unemployment claims during the last week of September 2001 alone. Some services have even attempted the use of prison labor to address the shortage issue. Now there’s a captive audience! What about the thousands recently laid off from the airline and hotel industries, many of whom could be retrained? What about pregnant teens, single mothers and women on welfare whose first language is English? With unemployment at an all time high, it doesn’t make sense that we have a severe shortage that practically parallels the national nursing shortage. In an industry as critical as health care, this is unacceptable.

What our profession needs is heightened industry, community and government awareness. We need a coalition of all health care professionals to participate in national reform that will create substantial new educational and employment opportunities throughout the country. We also need stronger partnerships between clients and vendors, schools and vendors, and between vendors, clients and their local communities.

Who Can Help?

• MTs. Seasoned MTs can be encouraged to make the crossover into teaching and providing quality assurance (QA) services. Find a service that provides educational opportunities and seek out work in these rewarding positions and give something back; pass on the baton. Find someone within your community to locate and mentor candidates. Go to your local community college and offer to teach a medical terminology course. We need more mentors to help more individuals advance their MT careers. Talk to your clients and others in your communities; begin to reach out to promote your profession.
• Schools can partner with transcription services, hospitals and clinics to create alliances that promote education through job fairs and word-of-mouth.
• Services can provide meaningful education and employment opportunities through internships/externships, as well as offer hands-on training and mentoring programs.
• Local, state and federal government agencies can help by providing financial assistance in the form of grants, scholarships, tuition reimbursement, cost of living assistance, etc.
• Health care organizations can also help by offering hands-on training and partnering with transcription services and school programs that provide training to newcomers.

Breaking In

How does one break into the MT profession? Finding a mentor whose coat tails you can grab onto, someone who can show you the ropes and make introductions, is a surefire way to gain real experience. I was fortunate enough to have a mother who took me by the hand and passed on the transcription torch to me. But not everyone who wants to get into the field knows someone who can provide the foundation for a successful career. You must get professional training to get in, period, whether you have a mentor or not.

The costs for today’s MT training programs range between $600 to $6,000 or more. A number of home-based programs are self-paced, but are advertised as taking three to 12 months to complete. Many community colleges offer two-year programs. Those who are seeking to enter the profession should do their homework carefully. Inquire about job placement, scholarship opportunities, success rates and whether or not the school or program offers someone to act as a mentor. This is absolutely necessary to succeed in this challenging work. You have to start somewhere, but remember that most services and health care organizations will not hire an inexperienced MT who doesn’t have proper training.

Are We Doing Our Part?

Some transcription services do offer training programs nationwide, and have partnered with community colleges and other trade schools to promote awareness and education with the goal of increasing our labor pool. If you own a transcription service, promote proper training and ongoing MT career development; get involved, hire more students. If you outsource your transcription, ask your vendor what programs they may have available to which you might be able to make a contribution. If you use in-house transcription employees, find out how to get involved in supporting an internship program through your local schools. Together, we can help rebuild our industry within a few short years. The key is creating a clear vision of what the future can hold.

At a time when jobs are sorely needed to boost the economy, the MT field is one place where health care organizations can make a real contribution. By using U.S.-based services that provide quality training and meaningful employment opportunities, health care providers can make a healthy, conscious contribution to stimulating the economy in their own communities and reviving the workforce, while ensuring that they can deliver timely and accurate medical documentation for patient care. Clients should ultimately decide where and how their transcription work gets done. By partnering with transcription vendors who are committed to replenishing the domestic labor pool and providing carefully thought out career development opportunities, health care providers can help educate and employ more U.S. citizens, ensure better patient care and have a strong voice in creating higher quality and a more cost-efficient health care delivery system.