HAS MTs DIVIDED
By Anne Miller
(Editor’s note: ADVANCE originally published Evelyn J. Graham’s article, “Can Industry Produc-tion Standards Work for Medical Transcription?” in its Feb. 1, 1999 issue. After this article appeared in print, ADVANCE created a bulletin board on its Web site to solicit our readers’ opinions on this topic. The original article and the bulletin board [titled, “MT Production Standards”] can still be accessed at www.advanceweb.com/hi.)
Mention the subject of production standards around any medical transcriptionist (MT), and you are sure to get a reaction. Some folks in the industry believe it is high time for some type of enforceable, nationwide standard to be implemented, if only to get everyone involved in medical transcription–MTs, medical transcription service owners, physicians who dictate, customers in need of MT services–“on the same page,” so to speak, with how the prices for such services should be determined. Others believe that national productivity standards could actually have a detrimental effect on MTs and MT service owners in the long run.
So who’s right? Should there be a national productivity standard for MTs, and if so, what should it be?
Isn’t There One Already?
There is one standard that exists in the medical transcription industry, relating to the definition of a line. In 1993, after two years of work groups, discussions and meetings, three of the industry’s largest professional associations–the American Association for Medical Transcription (AAMT), the Medical Transcription Industry Alliance (MTIA) and the American Health Information Management Association (AHIMA)–reached an agreement about a standard unit of measure for medical transcription work.
However, this standard was established only as a voluntary (and not an enforceable) unit of measure for MT work. “Leaders from the three professional organizations agreed that it was not the goal or intent to develop enforceable standards or to establish any kind of pricing structure,” said Molly Malone, executive director of MTIA.
According to the voluntary standard, the smallest unit of measure was proposed to be the character, which is defined as all letters, numbers, symbols and function keys necessary for the final appearance and content of a document, including the space bar, carriage return, underscore, bold, and all characters contained within a macro, headers and footers.
A line was said to equal 65 characters. Consistency in work measurement, it was agreed, could be achieved by counting characters the same way and converting the character count to a 65-character line.
MTIA and AHIMA still support this definition of a line. AAMT, however, withdrew its support of this 65-character line in 1998.
In an April 20, 1998 ADVANCE article (“AAMT No Longer Supports Quantity Definitions”), author Pat Forbis, CMT, AAMT’s associate executive director for professional affairs, wrote, “Unfortunately, one of the common challenges that MTs have been burdened with has been the manner in which some employers have misused, or even abused, the quantity definitions… some employers [have even] used [the 65-character line] as an excuse to change their method of measuring production, resulting in lower pay.”
Standards & MTs
If MTIA and AHIMA support the voluntary use of a 65-character line to calculate the price of transcription services, then what are the Industry Production Standards that Evelyn J. Graham recommended for MT service owners in the Feb. 1, 1999 issue of ADVANCE?
The National Association of Secretarial Services and Execu-tive Suite Network publishes the Industry Production Stan-dards (now in its fourth edition). These have been widely used for years by word processing business owners.
According to the Industry Production Standards, the following rules apply:
* One line equals 65 characters;
* The production standard for good quality medical dictation is 4.9 minutes of transcription for 1 minute of dictation (1:4.9 ratio);
* The production standard per hour is 10,840 characters per hour; and
* Basic service is defined as a 24-hour turnaround time, five days a week.
(For more specifics on the In-dustry Production Standards, please see the original article on ADVANCE’s Web site at www.advanceweb.com/hi.)
Issue Has MTs Divided
The issue of production standards for MTs is not one that will be easily re-solved, it seems. Many of our readers’ comments, which were culled from the ADVANCE bulletin board, have been reprinted here with some minor editing for clarity (see related article below.).
While many ADVANCE readers support the need for productivity standards for MTs, there is no agreement about what type of standard would be best. Many indicated that they were disinclined to adopt the Industry Production Standards for medical transcription, as the knowledge required to become an MT is so much more complex than that of a mere word processor.
And what do the leaders in the field seem to think? One thing is certain. “Read the online bulletin board comments from MTs–many harbor very strong feelings about this issue,” said MTIA’s Malone. “They blame MT professional associations for not championing this cause; and some feel the MT services are not paying them what they are worth.”
Indeed, the MT profession currently finds itself in a catch-22 situation–there is a great (and increasing) demand for MTs; but not enough people are being recruited into the profession to meet this demand. Some believe this may be because the average pay for MTs is not high–especially for the new MT, as it takes a lot of time and experience to become truly proficient.
But Stephanie Golden, who was an MT for 15 years and is currently vice president, director of national recruiting for MedQuist, a national MT service company with approximately 100 offices and 9,000 MT employees nationwide, disagrees. “Our MTs, on average, earn between $12 and $25 per hour. Some are making as much as $34 to $40 per hour,” she stated. “They receive approximately 50 percent of what we charge our clients–and remember, after the transcriptionists’ salaries are deducted, MedQuist still has to pay for its employees’ benefits, office space, telecom charges, management costs, etc.”
MedQuist offers its MT employees a benefits package that includes a 50 per- cent co-payment on health insurance costs, paid time off, participation in both a 401(k) plan and a stock-purchase op- tion, and worker’s compensation and unemployment insurance. In addition, MedQuist has recently implemented a new, nationwide bonus incentive program for MTs, and sponsors an MT of the month contest (with a $50 cash prize) in every office.
But, “It’s obvious that some of the smaller services are using our pricing structure to charge their clients without offering the same types of benefits to their MT employees,” Golden conceded. “It seems that the smaller a service is, the less likely it is to offer employees a benefits package.”
AAMT’s Forbis believes that a national industry standard would actually be detrimental to MTs everywhere. “Don’t get me wrong–I do believe MTs should receive a good day’s pay for a good day’s work; and I do believe it’s important and beneficial to track productivity,” she said. “However, I also believe production expectations must be limited to the environment in which the MT is working.”
Both Golden and Forbis agree: there are so many factors and variables that affect MTs that it would be impossible to take them all into account when designing a national standard. “There are equipment differences; equipment failures; word expanding software; different levels of work; different types of dictators; and so on,” Forbis noted. “If Company A is using much older, slower computers than Company B, would it be fair to hold both sets of MT employees accountable to the same expectation?”
“You’d have to create a multitude of different industry standards to come anywhere close to a true ‘apples to apples’ comparison of MT productivity,” added Golden. “A national standard just isn’t practical or realistic.”
So then, what should be done? “I think the only fair way to ad-dress this issue is to have every employer track productivity, but recognize and account for the fact that it is susceptible to change,” Forbis commented.
To illustrate her point, Forbis recounted the following story. “I had been an MT for years and was considered ex-tremely proficient in my field,” she related. One day, however, a physician handed her a tape containing a dictated bone marrow transplant–a brand-new procedure at the time.
“This dictation was full of unknown medical terminology, new references, new procedures, etc.,” Forbis recalled. “Normally, I would have breezed through a tape of that length in one hour or less–but this one took me all day to transcribe!”
It was the same type of situation when AIDS first hit the scene, Forbis added. “If the profession adopts industry-wide production standards, then the next time there’s a big change or breakthrough in medicine, I’m afraid every MT would suffer,” she remarked. “Productivity standards could, in effect, actually punish the MTs who strive to increase their knowledge and keep abreast of new developments.”
Again, ADVANCE wants to know: what do you think? The “MT Productivity Standards” bulletin board is still available on our Web site at www.advanceweb.com/hi. We invite you to check it out and submit your opinion on this topic. *
Anne Miller is an associate editor at ADVANCE.