"We Have Met The Enemy And He Is Us"
Pogo Possum was the creation of comic strip author Walt Kelly, and this is probably his best-known quote. I personally have found it quite useful over the years to express my frustration, often at myself, at our tendency to be our own worst enemy. I had occasion to use it yet again today as I read through the latest edition of AHDI's member magazine Matrix. I can't link to it since it's available to AHDI members only, but I can tell you about one article in particular by author Kenneth W. Schafer, owner of Expert Medical Transcription in Miami, FL. The title of the piece is "Why Is My Paycheck Pitiful?" and it deals with the very timely issue of falling compensation for MTs. Schafer says he conducted an informal poll among other MT service owners about why working MTs aren't doing better financially, and some of the responses were what you'd expect: speech recognition technology, offshore outsourcing, and template-driven EMR systems. But there was one response that really illustrates that some of the downward financial pressure on MT compensation is self-inflicted.According to Schafer one MTSO told him that "she has MTs who will do a great job for low pay."
I'll let you think about that for a moment...
As Schafer points out, "as long as there are people who will work for a lower wage, why would any company pay them more money?" That's Business Ownership 101. It's the same reason why as a consumer I shop around for the best deal before I buy something; why would I pay more for something I can get for less?
As much as we'd like to blame "the suits" for falling MT wages, as long as skilled transcriptionists are willing to work for less than they are worth, MT service owners will be more than happy to accommodate them. Is it a scary thing to ask for a raise? It certainly can be for many of us. Is there a risk that asking for fair compensation could result in an employer saying "I pay what I pay, take it or leave it?" Of course--but is that the kind of employer you really want to work for?
If there is one message I believe working MTs desperately need to hear from their professional association, it is that you don't have to settle for less than you're worth. If enough MT practitioners take a stand against sub-par compensation, the industry will have no choice but to pay a fair wage or line count. As much as you the working MT need a job, MT service providers are just as dependent on you to provide the skilled labor necessary to fulfill their obligations to their clients. Settling for less than you're worth not only hurts you, it drags down compensation for the whole profession.
Business owners are going to run their businesses in a way that provides the highest return for the lowest investment; that's reality and it's not going to change. But as skilled workers, medical transcription professionals have more clout than they realize, especially if they'll stick together. I believe AHDI can and should provide more encouragement to working MTs in this regard; it's the very least we should expect from a professional association that exists to serve its hard-working member practitioners.
Jay Vance, CMT
AHDI Lounge Administrator/Moderator
Amen!
Jay, this is such a timely and compelling post. You are right to suggest that a professional association should be encouraging its members to advocate for themselves. I would respectfully suggest that this is the very heart of what AHDI has been messaging to MTs for quite some time. The problem is that most MTs hear the word "advocacy" and think "legislation." We continue to tell MTs to be advocates for themselves - through continuing education, credentialing, educating their superiors and clients about their skills and abilities, and having the right set of tools in their tool belts to negotiate and win with their employers. You are less likely to negotiate successfully for a raise or promotion if you come into an employer's office empty-handed.
When you go into your employer’s office to negotiate a salary increase, what arsenal of supportive documentation and resources do you take with you? I can promise you that you won't win favor with your employer simply by saying, "I'm worth more." Every human being on the planet thinks they're worth more than they are currently getting paid (likely because we tend to confuse worth, which can't be measured, with value, which is impacted by many economic factors).
You have to be prepared to show that employer WHY you think you're worth more than you are being paid or worth more than your colleagues around you are being paid. That means putting some powerful and persuasive evidence on the table that you bring measurable contributory value to that employer. And this is where AHDI has traditionally been positioned to assist the MT. We work to empower an MT in that negotiation to be able to say:
1. I'm worth more because I went through an AHDI approved school - which demonstrates that I have met industry-approved minimum standards for entry to practice. I have a more comprehensive, reliable foundation of knowledge than someone who went through an unregulated program or learned on the job.
2. I am worth more because I am credentialed. Even though you may not require me to have it, I have required it of myself. That demonstrates that I am an achiever and am goal-oriented. It also demonstrates my commitment to education and standards. My credential tells you about my ability to meet standards established by the industry for my level of skill, and you can rely on me to apply those skills to benefit your company. And because I have it, I am qualified to assist others in your organization to achieve the credential for themselves - and that makes your employees a more marketable resource for your business.
3. I am worth more because my credential requires me to engage in ongoing continuing education. This means I am staying current with new trends and terminology in clinical medicine, documentation standards, technology, and regulatory compliance. That knowledge can be an asset to your company and to my coworkers as your organization grows.
4. I am worth more because I have invested in my profession and my industry through membership in my association and active engagement in the association's efforts on behalf of our sector. I can be an advocate for this company and our workforce through that involvement.
These are just a few things we hope to empower MTs to be able to say about themselves when the moment comes that an employer says, "Oh yeah? You think you're worth more money? Tell me why you think so." But they have to be blended with some supportive statements about your work history, the quality of your work product, the consistency and reliability of your work effort, and your loyalty to the organization that has employed you.
A friend reminded me not to long ago that the word "encourage" means "to put courage into." That is what I hope AHDI is and will always be about - putting courage into MTs to be achievers, advocates, and self-feeders.
Lea M. Sims, CMT, AHDI-F
Director of Professional Programs, AHDI
You are leaving out one huge issue. The company cannot pay the MT what it does not get from the client. Companies are being forced to bid much lower than ever before. They are having to compete with companies that can bid under 9 cents per line because they are using either some or all offshored labor and they really will work for a pittance. Your same Business 101 analogy would say that if more US employees demanded more money, the work would go offshore even faster as they will accept that meager pay without complaint.
You certainly bring up a valid point, that MTSOs are dealing with downward price pressure from the clients. In fact, in his article Schafer (an MTSO himself) brings up that very issue, that MTs have to realize that there are other factors at play when it comes to MT compensation. But I think we have to follow your scenario to the next step. The reality is that even offshore companies are hurting for qualified labor. As a result, the prices that offshore companies are charging now are significantly higher than they were even 5 years ago, and there's every reason to believe that trend is going to continue. Simply put, there is a WORLDWIDE shortage of qualified healthcare documentation professionals. So I don't believe it's accurate to say that if U.S. MTs demand fair compensation, the end result will INEVITABLY be more work going overseas and thus fewer jobs for U.S. MTs. Are there instances where this has happened? Of course. But there is not unlimited capacity overseas, so I don't think that's where the greatest challenge to MT compensation is coming from or will come from. The thing we should be most concerned about, in my opinion, is the push towards EMRs, with the marketing pitch being that EMRs will eliminate the need for transcription completely. That's where the primary battle front lies, I believe. And at this moment nobody knows what the final result will be, but AHDI and others in the industry are pushing hard for the recognition of narrative dictation and transcription as a crucial piece of process of accurately recording every patient's story.
How about we look at all sides of this issue? If we use the rationale that just standing up for more money, with good rationale, equals more money, why aren't the service owners doing that and why aren't they refusing to constantly lower their rates? One might suggest they've found that doesn't work.
At the same time, I think it's time to stop whining about how much less services are making. All one has to do is take a look across the internet to see that the publicly held services are constantly showing increased profits. If they are taking less money for the service they provide, those increases are coming from somewhere.
While I do agree that MTs shouldn't be willing to work for peanuts, it bothers me to always have that put at the feet of MTs without addressing the other side of things. And THAT is an area where a professional association could do some advocacy since there's a partnership between the two organizations.
Maybe some of our CDIA partners should be asked why they pay peanuts. Why is this the MTs issue when we have an organizational partnership with CDIA? This is a good topic for them to address here in this area.
Again, valid points to consider. No doubt some MT services are in the same boat as some MTs in the sense that they're afraid to draw a line in the sand when it comes to pricing; they figure, "If we won't compete on price, someone else will." Or even worse, "If we don't compete on price we'll be replaced with an EMR." But clearly that trend can't be sustained forever. The question is, who's going to be the first to say "Enough!"? Let's get real; if it comes to the point where MTs can't make a decent living because the MTSOs keep taking contracts at lower and lower line rates in order to stay competitive, the whole shebang is going to collapse under its own weight and the entire MT industry as we know it will cease to exist. Is it possible that that's where it's all headed anyway, no matter what we do? Yes, it's possible. But I think it's too early to make that call, and I think we still have some cards to play before we fold and go home.
With regard to laying responsibility at the feet of MTs "without addressing the other side of things," I hear what you're saying. But the reality is we can only control what we can control. It is counterproductive for us to say, "Well, we'll change when THEY change." We need to do what's in our own best interests regardless of what anybody else does.
With all that said, I think we're all aware that the current economic situation is throwing a lot of folks for a loop. At the end of the day, a lot of people no doubt feel that working for something is better than having no work at all, and who am I to say otherwise when I'm not in that position at the moment? Far be it from me or anyone else to pass judgment on hard-working people who are just doing their best to survive in the hopes that things will get better soon. Sometimes harsh reality has a way of tempering our theoretically sound philosophical positions, huh?
Imagine if you go to your current employer and state that you will not work at their rate and demand more. What will be the outcome? With that said, what is an MT to do about increasing their rates? More education does not do it, credentialing only barely does in some cases. Advocating will not do it as we never mention the suppressed rates.
The reality is the only option the MT has is to produce more.
I don't think anyone knows what the outcome will be, which is why a lot of folks don't ever take that step, the fear of what MIGHT happen. As far as producing more, it may be that some MTs aren't taking advantage of every resource that's available in that regard. In fact, something else Schafer mentioned in his article was that one MTSO told him some of their MTs had never used a text expander! But the reality is that even the best MTs or editors can only produce so much; there is a limit to what the human mind and body can do. At what point do you say enough is enough? That's the question that every person has to answer for themselves. But my hope is that there will be someone who needs to hear that their skills are worthy of fair compensation and will have the courage to stand up for themselves. Again, if enough MTs did that in an organized fashion, the MT service providers would have to take notice.
So, are you in charge of organizing this demand more money movement Jay?
I am reminded of something I saw MTIA say way back when they first started foisting the VBC on the industry, "you smaller company's start charging by this method first and if it is successful then we larger companies will try it."
I think you should try this first, let us know how it went and just how long you kept that MT job and then maybe others will be more eager to give it a try. That lead by example theory goes a long way toward convincing people to grow some courage.
Great topic, Jay, and good comments. I would pass on to this list a conversation I had about 2 years ago with the CEO of a relatively large national service. He related to me that he had a group of his CMTs come to him and tell him they thought they should be paid more because of the their increased skills as CMTs. His response? "Give me higher quality than I demand from my other MTs and I will pay you more." They do and he does.
Long-time member and a past president of AHDI Betty Honkonen, CMT, AHDI-F, gave a session at ACE in my recent memory on "Negotiating your Worth." Other presentations have taken a look at defining your skills as an MT. Maybe it's time to take another look at some of those strategies. Everyone wants more money. Simply demanding more isn't going to change the picture. Can you prove you are worth it? Or have you already been one of the brave souls to speak up and with what results?
Really Jay? Do this in an organized fashion? Are you suggesting we UNIONIZE? Because otherwise, plain and simple, you run the risk of getting fired if you try to do this in an organized fashion without a union. Not sure about you, but there are a lot of MTs who sure as heck aren't going to risk losing their jobs for that.
Unionizing was only barely viable when you could limit the workforce. Now it is very easy to just move an account to an MTSO who will send it to another country without privacy laws. Unionizing or pushing the pay talk makes the process much easier. I think it is time for CDIA and AHDI to stop hiding around the antitrust act and have some open and frank conversations about compensation issues. This is close to the most critical issues for MTs struggling to decide whether to stay or leave the profession.
Oh yes, don't organize! You might get fired and lose that 3 cpl for editing that you are making, if you are actually getting any work! **shivers**