After graduating from medical transcription school
what can I expect in my first job?
If you have successfully completed your medical transcription course through a local college, a private school or online correspondence course, congratulations! You are ready to embark on the quest of finding your first transcription job. That's a wonderful (and scary) position to be in.
Hopefully your schooling was accredited by the AHDI (Association for Healthcare Documentation Integrity [ahdionline.org] formerly known as AAMT (American Association of Medical Transcription). If your school has placement guidance, I hope you will take advantage of that. Even if there is no placement assistance, having graduated from an AHDI-accredited school will be one of your biggest helps in getting your first job.
1. Defining your career goals
It would be wonderful if you have taken the time or been guided to define your career goals and have asked yourself and been able to answer questions such as these:
1. What kind of a company do I want to work for?
A. A national company?
B. A regional company?
C. A local transcription company?
D. Or do I want to work for a small office or clinic in my city?
E. Or do I want to try to start my own business and get my own clients?
2. Am I okay with being hired as either an independent contractor (known as an IC) or an employee?
3. Do I need benefits?
A. Paid for by an employer?
B. Partly paid by me and partly paid for by an employer?
C. Or can I afford to get my own insurance?
4. Do I have the flexibility to work in an office or hospital for a while if I'm not finding an at-home job right away?
If you have already graduated, you won't be able to take early advantage of what I advise all potential students who contact me through this website....that is to ponder these questions BEFORE you ever start your schooling. And in addition to setting your goals, lay some groundwork toward those goals before training. But of course now that you've graduated, it's even more imperative that you define your goals, and then instead of laying groundwork for your first job, you will be actively hunting for your first MT job.
If you have not yet enrolled in school or have not yet graduated, you have the luxury of asking yourself the above questions and getting a better feel for what you want to do. Also check out my "desired qualities" page to see if you're temperamentally suited for the transcription career.
2. Laying the groundwork for your first job
Nowadays it is so hard to find a good national company to work for who will treat you well and from which you can make a good living, that I'm starting to recommend that the potential transcriptionist student start canvassing for a job--or at least check out the local job climate--before you even sign up for your school! That may sound strange, and years ago when I started my training it would have been considered strange indeed. But today I consider it groundwork that will pay off.
How do I do that?
Use the power of networking.
Start by going to any doctor office or other medical office that you, your family or friends use for your health care. This includes your general practitioner, family doctor, any specialists you use such as your pediatrician, diabetic doctor, foot doctor, physical therapist, massage therapist, etc.
Ask about their transcription. Be bold. It can't hurt. Talk to the physician/provider directly if you feel comfortable doing that. Otherwise ask the receptionists at the check-in/check-out area, or ask to speak to the office manager.
Once you have someone to talk to, ask them how their chart notes get into the chart. Don't be intimidated if they matter-of-factly tell you "Oh, we're a paperless office." This gives the impression that there is nothing to be typed, that the nurses, medical assistants, physicians are typing in the chart note information right in the exam room. That may be the case and if it is, hit them with question 2: Who types their physician referral/consultation letters? More than likely it is NOT the nurse, medical assistant or physician.
The answer you get will probably fall into these categories:
1. They contract with a national company to do their transcription.
2. They contract with a mid-sized to small local company.
3. They use at-home transcriptionists as independent contractors.
4. They have employee transcriptionists who work on-site or at home.
If they use at-home or on-site transcriptionists, ask if you can speak to one of them. Tell them you are going to be starting to school to become a transcriptionist and ask them if they would keep you in mind for the future.
This is where your predefined career goals might come into play. What if she asks you "Are you wanting to work at home or in the office?" "Are you planning on being an independent contractor or do you want to be an employee?" You'll sound a lot more professional if it's obvious you've already thought through those questions and can answer...even if you can only say, "Well, my preference would be..."
If they don't seem to warm to your questions, switch tactics. After all, you may sound like you're angling for their job! Instead of sounding like you want a full time or part time position, another way to get your foot in the door is to offer your services to fill in for vacation relief (or sick time). You might be surprised to know how many solo office transcriptionists have a very hard time taking time off because they can't find anybody to do their work while they're gone! I have known transcriptionists who made their living doing almost nothing but relief work.
Use the power of the transcriptionist's network
This advice applies if you are doing your ground work or if you have already graduated and are canvassing offices looking for your first job. If the offices/transcriptionists you contact don't have an opening right now, as them if they know of work elsewhere. The transcriptionists in a city often have their ear to the ground about what's going on with other offices and other transcriptionists. Maybe someone will soon be taking a maternity leave or their husband is being transferred to another city, or they plan to be off for an extended time recovering from surgery or taking care of a family member. Maybe they know their office or another office is planning on hiring some new doctors in the next 6 months to a year.
So use the power of their network for information that could benefit you either right then or when you have that graduation certificate in hand.
3. What help will the "newbie" get with their first job?
In other words: What if I don't measure up? Will I be fired?
Using the national companies as our example, it should make you feel better to know that ALL transcriptionists will be put on probation when they start out with a new company. That means you, with no experience, and me, with greater than 35 year's experience will both go through a probationary period. Granted, my probation may be shorter than yours, but we'll both have one. Depending on the company, and our level of experience or skill, that probationary period may be a week or two, or several months.
What happens in the probationary period?
Again, I'm going to use a national company as my example here. After successfully testing and being hired, you will usually be assigned one or more client accounts. You will be given the client templates and the formatting they want for their reports. You may be given helpful lists of towns and schools in the area, area doctor names, etc. Your supervisor should let you know that all your reports will be "flagged" during your probation. This could mean you putting something manually in your report to force it to drop into the QA (quality assurance) area or it may be automated based on your MT number. However it gets there, the QA staff will be looking at all your reports. They will look to see if you are following the client rules for formatting and using the client templates correctly. They will be looking for errors in the content of the report and they will look for appropriate blanks versus too many blanks that indicate you need some mentoring. You should to get feedback on your reports during your probationary period so you can learn from your mistakes.
What are "appropriate" blanks?
Well, let's back that up a step. What are blanks, appropriate or not? The rule in the "real
world" of transcription is that if you have any doubts about what you heard (after listening
hard and/or doing some research on what you think it might be) you are to leave
a blank ______. Each company is different about how they like you to
leave those blanks and flag the report as not yet being complete (in other words not ready to send directly on to your client), but suffice
it to say the rule is the same no matter the mechanics of actually flagging
that report as having a blank (or several blanks).
Also the general rule is you are not "dinged"or your performance level is not lessened for leaving
blanks. They would prefer you to err on the side of caution rather than
submit a complete report with "iffy" terms in it that might be wrong.
During your probation ALL reports are flagged and go to QA. But after your probation is listed, a flagged report with a blank then goes to a QA person whose job it is to fix all the
blanks they can in the report. To make you feel better about your blanks,
often the QA person has to pass that report on to the client with some or all
of your blanks still in the report because even THEY (as supposed
"experts") can't figure it out.
And then there are the "appropriate blanks." These won't be because of your inexperience (or
incompetence), they will be blanks that even a VETERAN transcriptionist would have
left if they had done that same report. What would those be? Answer: Mainly
inconsistencies.
National companies are always working to lighten the load of their QA staff. If they see a trend in "appropriate blanks" that could be eliminated with some programming changes, they will usually implement those changes to minimize the number of reports that drop into the QA bin rather than going directly on the to the client.
A few years ago I found one of my biggest inconsistencies on my national reports was different ages
for the patient within the report. The dictator starts the report out saying
"This is a 19-year-old Caucasian male" and when they get down to the
Assessment or Impression they say "This is a 20-year-old Caucasian
male" Without access to the patient's birthdate, I would have to leave blanks anywhere the different ages are
mentioned in the report and give the reason as something like "inconsistency in age
dictated" and flag that report. If the QA staff also doesn't have access to the birthdate, they couldn't fix those blanks and would have to pass the report on to the client with blanks intact. Those kinds of blanks would NOT reflect negatively on you, the MT.
But most national companies are changing the demographic/header information made available to the MT and include the date of birth. Armed with that information the MT could just
correct the age inconsistencies and if there was nothing else wrong with the report, it could sail right through to the client.
Other inconsistency examples that can't be easily cleared up by programming changes: Say the dictator talks of a
"left ankle fracture" and then later refers to it as a "right ankle
fracture." You have to leave blanks on both because there is no way
to know WHICH is correct. Again, no dings for you and the QA person
wouldn't be able to tell either and would have to pass those blanks on to the
client.
Dates can be another area of inconsistency. Saying the patient lived in
Buffalo from 1979 to 1983 and then later saying they lived
in
Los Angeles
from 1982 to 1985 or something like that. Another common area of
inconsistency is things like number of siblings. One place they say they
have 2 sisters and 3 brothers and later they refer to their 3 sisters and 2
brothers!
You can see in the "real world" the dictators are not perfect! :o)
4. The routine QA review and the dreaded
"98% accuracy"
Okay, in which situations will you get "dinged?" ---note I didn't say fired -- I said dinged. Most of the larger
companies have a policy and goal of "98% or greater accuracy" in their final report product. This is what they promise their clients. And
most larger companies have a policy that each MT's accuracy will be
measured every few months (maybe once a quarter) with a sample review of your work by the QA
department.
When you come up on the list for review, they will select
about 10 to 20 of your reports (usually from one day) and listen to the spoken dictation
and compare it to your report and then give you a percentage of accuracy for
that group of reports. They have a list for "dinging" that goes
from worst to least errors. The following is a general outline of how a QA person might "grade" your reports. Each company's grading will vary but this gives you a general idea.
1. Worst errors are actual wrong words in a report, i.e., it is not the word
the dictator actually said. Those usually get a deduction of 1
point. Blanks are not dinged.
2. Next worst are the word is correct but the spelling is wrong.
I know the spellchecker should catch those, but if the word is not in the
system's dictionary, it will come up as a ? when the spellchecker is run.
You manually have the option to okay the word as correctly spelled...even
though it may be incorrect! Those might have a deduction of
1 or maybe 0.75 points.
3. Then you have the inconsistencies that you probably did. Like
it was a male patient and one time in the report you typed
"she." Or errors subject/verb disagreements (like he is, they are) Those get maybe 0.5 to -0.25 point deductions.
4. Then you get to the grammar/punctuation problems.
Don't worry, they DON'T ding you for commas as much as you might think.
:o) But they do look for missed periods at the end of a sentence, and
those "nonoptional commas" that change the meaning of
the sentence depending on their presence or absence. Those would get maybe 0.25 deduction.
Then they take your score for each report and average your score for all
the reports (the whole batch) and come up with your overall accuracy percentage.
Unfortunately your number is not totally objective. It will be subjective
to a slight degree because there is a human at the other end who has some
leeway...usually with the punctuation and grammar. So one QA person
might review your report and give you 100%, whereas if a different QA person
had that report, they would ding you for several punctuation errors and give you a 98%. But the QA reports are meant to be learning tools, not something to beat you over the head with.
Remember this:
They WANT you to succeed.
They have mechanisms built in to HELP you succeed.
