investmentan investment in people, an investment in thefuture of your company, and an investment in the future of theMT industry.

The Idea

Begin all new screened MTs grads in theQA or proofreading department!

Wait. Dont dismiss this idea out of hand. At first, it mayseem to go against everything you believe about transcrip-tionand against everything youve been told. Let me tell youwhy this is a good idea and why it will work for you. Ill alsosuggest ways to sell your current, experienced MTs and, ifnecessary, your clients on the idea.

Look At the NumbersEven a very experienced MT has a learning curve when

starting with a new employer, and that first paycheck doesntdemonstrate earning potential. The skills of appropriatelyscreened new grads are much stronger than you may realize.However, their production is more seriously impacted by theexpected learning curve (new hardware, software, formats,quirky rules, and new dictators) than their more experiencedpeers.

Here is a typical production timeline for MT grads.

Their work may be flawless, but new MTs are excruciat-ingly slow. You may have to supplement their pay just sothey can make minimum wage. You have a negative return onthe lines produced, but you believe that production willimprove and that, over the long run, you will make backyour investment.

Unfortunately, the MTs themselves are not happy withthis arrangement. Their low earning capacity discouragesthem, may damage their self-esteem and self-confidence, andwill likely blind them from seeing that you are investing in

by Ellen Drake, CMT

16 PERSPECTIVES, Fall 2001

LLooookk wwiitthh ffaavvoorr uuppoonn aa bboolldd bbeeggiinnnniinngg..Chinese fortune cookie

The high cost of continued training and low productionprohibits many medical transcription (MT) companiesfrom hiring recent graduates of MT training programs.This creates a Catch 22 situation for inexperienced medicaltranscriptionists (MTs). They cant get a job without experi-ence and they cant get experience unless someone is willingto give them their first job. Its a Catch 22 for MT compa-nies as well. If they dont make a profit, they wont be aroundlong to hire experienced or inexperienced MTs.

In the past, mentoring MTs, independent contractors, andthe smallest companies have shouldered the burden of hiringnew MTs. These people, however, often cannot provide long-term employment opportunities, competitive pay, or necessarybenefits to retain the MTs they so unselfishly nurtured. Norcan they provide enough opportunities to the many new MTsneeded to fill ever-growing deficits.

At the 2001 Medical Transcription Industry Alliance(MTIA) annual meeting in Seattle, the need for increasingnumbers of qualified MTs was identified as a major concern.Many attendees readily admitted that what has been happen-ing and continues to happen is simply a re-shuffling of the cur-rent experienced MT pool. Companies lure MTs away fromtheir current employers with all the usual promisesbetterpay, better working conditions, better benefits, even betterdictation. Is this solving the problem of too few MTs tofill the 400,000+ FTE units revealed by the recent MTIA-sponsored Medical Transcription Market Analysis? Hardly. Ihope you will agree its time for a new look at an age oldproblem.

What if you could start a new MT at the same level ofproduction and quality that normally comes only after manymonths on the job? What if it came at little or no cost toyouor even with a net savings? And what if you couldachieve this with a greater chance of long-term loyalty froman employee who experiences early and lasting job satisfac-tion? Would you be willing to try a new approach, a newpathway, to production transcription?

I challenge you to keep an open mind. Avoid the tempta-tion to stick with the tried and true. Be willing to take alittle risk for the prospect of huge rewards. Isnt that what youdo when investing? Consider implementing this plan as an

125 lines/hour100 lines/hour80 lines/hour

50 lines/hour no improvement/termination

1 day 30 days 60 days 90 days

their career. On some level, they may blame you for thissituation and seek solace in the classified ads. If they pickup production quickly, they may see the light at the end ofthe tunnel. But many times, new grads cant shake the neg-ative associations built during the learning curve; just asproduction is showing promise, they quit to go elsewhere.

If you suffer a net loss on lines produced during much ofthe transition phase, it may not be possible to sustain MTgrads on the satisfactory hourly wage for the required periodof time. But if you start appropriately screened grads in aproperly supervised QA department, they will earn as theylearn. These MTs-in-training may be paid $8 to $10 an hourcompared to the $12, $15, or even $20 an hour you may bepaying experienced MTs in the same position. You can moveproduction MTs out of QA and back into production (increas-ing revenue), never have an unfilled QA position, enjoy loweroverall cost of QA, and transition your grads from QA intoproduction transcription in 90 days with a production timelinethat looks like this.

Not only will you fill every production work station with aproducing MT with a high level of job satisfaction, but youhave developed an unlimited source of new staff and can growyour business.

Why This Idea Will WorkThere are numerous examples of individuals developing

their transcription skills by working in a QA capacity. Someexamples are dramatic. I once worked with a woman whosefirst position in an MT service was to print the MTs tran-scribed reports. She would make the edits and corrections theproofreader had marked on the draft hard copy. This was dur-ing the days of the MT/ST (magnetic tapeSelectric type-writer). She never listened to a word of dictation, yet thiswoman learned medical spelling, vocabulary, and phraseol-ogy and later became an excellent MT!

Another MT I know completed an intense 5-week ERtranscription course and worked on the production floor for ashort while before transferring to QA. After a couple of yearsin QA, having been exposed only to emergency room dicta-tion (and the few practice tapes from AAMT), she passed bothportions of the CMT exam! Was this because the exam is tooeasy? Certainly not. Ive taken the exam, and it is challeng-ing even to experienced MTs.

I myself learned by reading radiology reports over thephone to doctors offices. Years later, as an MT serviceowner, I found that my skills as an MT improved by per-forming QA checks. Not wanting to be challenged on correc-tions I made in MTs work, I made certain that I could justifyevery change, whether it was vocabulary, spelling, or style.Due to time constraints, I also made the corrections so that we

could send the work on to the client. I found that as I learnedto move around the document quicklydeleting, editing,moving blocks of copymy speed and skill as a transcrip-tionist improved as well. In addition, I was creating a spellingchecker for myself and other MTs (no good commercial onesbeing available in those days), and I documented every termI included. I corrected errors I had been making for years asI documented terms I thought I knew! Again, my transcriptionspeed and quality improved as I found it less necessary to lookup terms while working. The need for documentation hadburned them into my memory.

Benefits of This Strategy1. It will give new MTs additional ear training. By lis-

tening to the same physicians over and over, they will pick upthe repetitive phrases that are so important to recognize forimproved speed and accuracy. Recognition of such phrases iswhat allows experienced MTs to type ahead of the dictationby anticipating what comes next. They will also learn thespeech patterns of ESL physicians and other difficult dictators.

2. It will familiarize your new MTs with your companyshardware, software, and ways of doing things. Even experi-enced MTs suffer through a learning curve and lowered pro-duction when adapting to new systems. In a far less stressfulenvironment than that of being on production, your new MTswill become adept at using your companys hardware andsoftware. They will also quickly learn the formatting and stylepreferences specific to your company and its clients.

3. It will familiarize new MTs with all your accounts,formats, and special instructions. Changing accounts, adjust-ing to new formats, and remembering special instructions forindividual clients and dictators inhibit the production of evenexperienced MTs. After leaving the QA department, your newMTs will have no problems changing accounts and quicklyadapting to new formats and styles.

4. It will allow new MTs to learn the dictating habits ofdifficult doctors. New MTs, struggling to earn an adequateincome on production pay, are easily frustrated and demoral-ized by trying to repeatedly decipher difficult dictations. Thiscan be avoided when the new MT reviews the transcription ofhigh-quality, experienced MTs. Listening and listening againwhile reading accurate transcriptions will give the inexperi-enced MT a head start on the production floor.

5. It will give new MTs access to a data bank of reportsby difficult dictators and unlimited samples for style and for-matting preferences. Samples, samples, samples. Whether inQA or on production, nothing helps more when confronted bypoor dictation habits. Samples help prevent misapplying thestyle and formatting preferences of one client onto anotherclients work. In the QA department, staff members get usedto going from one client or dictator to another. If the new MTcreates and keeps a personalized notebook, it will proveinvaluable when that MT transfers into production. Of course,its very important to remove all identifying information fromprint samples and so-called normal reports.

6. New MTs will learn terms they dont already know byhearing and seeing them in print in the work of your good

PERSPECTIVES, Fall 2001 17

QA Dept QA Dept QA Dept 125 lines/hour

1 day 30 days 60 days 90 days

MTs. While the new MTs are in the QA department, all thereviews they do should be with the audio dictation. Not onlywill they learn new terms they didnt have the opportunity tostudy while in school, they will learn the different ways dic-tators pronounce and mispronounce terms. If what they hearis not what is on the transcript, they should, of course, ask thesupervisor to listen and verify the term.

7. The additional medical knowledge, ear training, andfamiliarity they gain with company and production procedureswill ensure higher production when they do advance into pro-duction. This is a certainty. Once the new MTs advance to theproduction team, they will have avoided the problems withnew hardware and software, new formatting and style require-ments, and dictators theyre not used to, all of which impairthe performance of experienced MTs when changing jobs.

8. Keyboarding skills will improve. The new MT willlearn to edit and move quickly around the document usingshortcut key commands that many experienced MTs neverlearn. They will cut and paste, search and replace, deletewords and phrases in chunks rather than character by charac-ter, and scroll through a document by a paragraph or screenrather than by a line at a time. These essential keyboardingskills will translate to higher speed and better production whenthe MT advances to transcription.

9. It will do all the above while limiting the pressure toproduce. It is very difficult for a new MT to remain opti-mistic and have a good attitude about the job when under thegun to produce enough lines to make a living wage. Yes, itis necessary to accomplish a certain amount of work even inthe QA department, but generally, QA staff members are paidby the hour rather than production. Certainly, if a company isusing the plan described in this article, new MTs should bepaid by the hour. Knowing that they are making significantlymore than they would be making if immediately thrust into aproduction environment should ensure the loyalty and grati-tude of new MTs. The extra boost a stint in the QA depart-ment will give them when they do begin productiontranscription should be even more appreciated.

Elicit a Spirit of Cooperationand Contribution to a Cause

Acceptance of this idea by your current supervisors andMTs requires open-mindedness, cooperation, and a willing-ness to experiment. Therefore, your QA process must not bea punitive one. If experienced MTs feel they may lose moneyor respect based on the work of inexperienced MTs, youllnever sell this idea to them.

You will need to have at least one QA supervisor or expe-rienced MT-QA staffer who will be responsible for answeringquestions from the new MTs and reviewing their work. Thesupervisor should approve any edits or corrections beforesending the work to the client or back to the transcriptionistfor feedback. Your production MTs must be given the oppor-tunity to respond to any errors found in their work before theresults are engraved in stone.

Point out to your experienced MTs that these new MTscould be sitting next to them, asking questions and needingtheir help for things theyll learn instead in the QA depart-ment. Encourage a mentoring spirit in your experienced MTsand a desire to contribute to the growth of new MTs besidewhom they will one day be proud to work. Ask them toremember what it was like when they were inexperienced.Could such a plan have helped them be better MTs? If yourstaffing situation allows it, you may consider rotating evenyour experienced MTs through a stint in the QA department.Encourage a willingness to explore uncharted waters, toexperiment, and a desire to work toward the greater goodof the company and the profession.

It may take some time for MTs to accept this idea. Knowthat and be patient. Encourage them to be patient as well andto adopt a preferably positive wait and see attitude. Letthem know, however, that you are committed to giving theidea a good trial. Tell them that as the trial progresses, youwill appreciate any ideas they may have for improving theprocess. Listen to what they have to say but delay any imme-diate negative responses with a statement like, Ill considerwhat youve had to say and get back with you on this. Okay?

How to Institute This PlanExplain to newly hired MTs that they will begin their

career in the QA department. Share with them your philoso-phy and reasons for doing this. Reassure them that, althoughthey may feel their knowledge is limited, they will have excel-lent supervision and be working in an environment conduciveto learning. (And make sure thats the case!) Point out thattheyll make more money in this role than if thrust immedi-ately into production, and theyll make more money fasterwhen they do advance to production.

The QA supervisor should probably spend no less than aday orienting them to company procedures, department pro-cedures, and an overview of production procedures. Givethem written, step-by-step instructions for all procedures.Make certain they have adequate references. Your pre-employment testing should have shown their ability to usereferences. If that is not part of pre-employment testing foryour company, be sure they know which reference to use andwhen and how to use it.

Be sure they know when to ask a question, that theyshould never guess, and that they can ask questions freelywithout reproach. The supervisor needs to have not only abun-dant patience but a nurturing and encouraging attitude. Sheshould also correct mistakes and criticize performance withoutdemeaning the new MT or sounding disparaging.

18 PERSPECTIVES, Fall 2001

What if you could start a new MT atthe same level of production and qualitythat normally comes only after manymonths on the job? What if it came atlittle or no cost to youor even with a netsavings?

If there are other experienced QA people in the depart-ment, new MTs should review the work of your more expe-rienced, higher quality MTs. This is true even if those MTsare transcribing the more difficult doctors and work types.This is the opposite of what you would do if the new MTswere put immediately into production where they should begiven the easier work types and easier dictators. Your newQA MTs can learn department procedures, software varia-tions, and formatting and style preferences while reviewingthe work of your best quality MTs. This will prevent newMTs having to learn too many things at once. It will alsoexpose them quickly to new knowledge and provide excellentear training opportunities.

Teach your new QA MTs how to access the same worktype and previous reports by the physician whose report theyare reviewing. However, they need to know that just becausesomething got through previously, it isnt necessarily cor-rect. Comparing several similar reports by the same dictatorwill often reveal discrepancies. Eventually, however, someonewill have figured out what the dictator was really saying. Ifthe QA specialist still questions a transcript, it should bemarked for the supervisor to listen to. The supervisor can usesuch occasions to assess and work on ear training skills.

After about a month, the new QA MTs should be verycomfortable with formats, style preferences, departmentalprocedures, any peculiarities in proprietary software, etc.Now they can advance to reviewing a variety of work typesand difficulty levels. They can be assigned a specific client toreview, with a different client each week. Do this for aboutanother month.

For the third and last month of QA review, the new MTsmight be placed on strictly fill-in-the-blanks type work.This would fine tune their ear training and give the supervi-sor a better sense of their critical thinking skills and problem-solving abilities.

At the end of three months, your new MTs should be ableto make the transition to production transcription with relativeease. They still may not have the transcription skill and judg-ment of a seasoned MT. They will, however, transcribe morework and with better quality than if they had been thrust intoproduction on day one. Within a day or two, or not more thana week at most, these MTs should be transcribing enough tomake them happy with their income and you happy with theircontribution to your companys overall production. They willhave a greater commitment to quality, be more receptive tothe QA process themselves, and will continue to grow inknowledge, editing skills, and speed because of the foundationprovided by their stint in the QA department. As well, youwill have a more loyal employee who understands thebehind-the-scenes factors that affect your companysmethod of operation, its policies and procedures.

Carefully considered and properly carried out, this plancan be a cost saving, comparatively painless, significantlymore effective way to bring recent MT program graduatesand inexperienced MTs into full, high quality production.

Authors Note: Portions of this article were contributedby Georgia Green, CMT. It is based on a presentation the twoof us made at the 2001 MTIA Annual Meeting in Seattle.

PERSPECTIVES, Fall 2001 19

After about a month, the new QA MTsshould be very comfortable with formats,style preferences, departmental procedures,any peculiarities in proprietary software,etc. Now they can advance to reviewing avariety of work types and difficulty levels.

Ellen Drake, CMT, of Peachtree City, Georgia, is coauthor of SaundersPharmaceutical Word Book and author of thenewly revised Sloanes Medical Word Book. Aformer English teacher and medical transcriptioninstructor, Ellen has also owned a home-basedmedical transcription service and has many yearsof experience transcribing all medical specialties.She is former Director of Education for HealthProfessions Institute and has contributed to manymedical transcriptioin education and referencebooks. E-mail: edrake@hpisum.com