by Ellen Drake, CMT

Look with favor upon a bold beginning.

Chinese fortune cookie

he high cost of continued training and low production

prohibits many medical transcription (MT) companies
from hiring recent graduates of MT training programs.
This creates a Catch 22 situation for inexperienced medical
transcriptionists (MTs). They cant get a job without experience and they cant get experience unless someone is willing
to give them their first job. Its a Catch 22 for MT companies as well. If they dont make a profit, they wont be around
long to hire experienced or inexperienced MTs.
In the past, mentoring MTs, independent contractors, and
the smallest companies have shouldered the burden of hiring
new MTs. These people, however, often cannot provide longterm employment opportunities, competitive pay, or necessary
benefits to retain the MTs they so unselfishly nurtured. Nor
can they provide enough opportunities to the many new MTs
needed to fill ever-growing deficits.
At the 2001 Medical Transcription Industry Alliance
(MTIA) annual meeting in Seattle, the need for increasing
numbers of qualified MTs was identified as a major concern.
Many attendees readily admitted that what has been happening and continues to happen is simply a re-shuffling of the current experienced MT pool. Companies lure MTs away from
their current employers with all the usual promisesbetter
pay, better working conditions, better benefits, even better
dictation. Is this solving the problem of too few MTs to
fill the 400,000+ FTE units revealed by the recent MTIAsponsored Medical Transcription Market Analysis? Hardly. I
hope you will agree its time for a new look at an age old
problem.
What if you could start a new MT at the same level of
production and quality that normally comes only after many
months on the job? What if it came at little or no cost to
youor even with a net savings? And what if you could
achieve this with a greater chance of long-term loyalty from
an employee who experiences early and lasting job satisfaction? Would you be willing to try a new approach, a new
pathway, to production transcription?
I challenge you to keep an open mind. Avoid the temptation to stick with the tried and true. Be willing to take a
little risk for the prospect of huge rewards. Isnt that what you
do when investing? Consider implementing this plan as an

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PERSPECTIVES, Fall 2001

investmentan investment in people, an investment in the

future of your company, and an investment in the future of the
MT industry.
The Idea
Begin all new screened MTs grads in the
QA or proofreading department!
Wait. Dont dismiss this idea out of hand. At first, it may
seem to go against everything you believe about transcriptionand against everything youve been told. Let me tell you
why this is a good idea and why it will work for you. Ill also
suggest ways to sell your current, experienced MTs and, if
necessary, your clients on the idea.
Look At the Numbers
Even a very experienced MT has a learning curve when
starting with a new employer, and that first paycheck doesnt
demonstrate earning potential. The skills of appropriately
screened new grads are much stronger than you may realize.
However, their production is more seriously impacted by the
expected learning curve (new hardware, software, formats,
quirky rules, and new dictators) than their more experienced
peers.
Here is a typical production timeline for MT grads.
125 lines/hour
100 lines/hour
80 lines/hour
no improvement/termination

50 lines/hour
1 day

30 days

60 days

90 days

Their work may be flawless, but new MTs are excruciatingly slow. You may have to supplement their pay just so
they can make minimum wage. You have a negative return on
the lines produced, but you believe that production will
improve and that, over the long run, you will make back
your investment.
Unfortunately, the MTs themselves are not happy with
this arrangement. Their low earning capacity discourages
them, may damage their self-esteem and self-confidence, and
will likely blind them from seeing that you are investing in

their career. On some level, they may blame you for this
situation and seek solace in the classified ads. If they pick
up production quickly, they may see the light at the end of
the tunnel. But many times, new grads cant shake the negative associations built during the learning curve; just as
production is showing promise, they quit to go elsewhere.
If you suffer a net loss on lines produced during much of
the transition phase, it may not be possible to sustain MT
grads on the satisfactory hourly wage for the required period
of time. But if you start appropriately screened grads in a
properly supervised QA department, they will earn as they
learn. These MTs-in-training may be paid $8 to $10 an hour
compared to the $12, $15, or even $20 an hour you may be
paying experienced MTs in the same position. You can move
production MTs out of QA and back into production (increasing revenue), never have an unfilled QA position, enjoy lower
overall cost of QA, and transition your grads from QA into
production transcription in 90 days with a production timeline
that looks like this.
QA Dept

QA Dept

QA Dept

125 lines/hour

1 day

30 days

60 days

90 days

Not only will you fill every production work station with a
producing MT with a high level of job satisfaction, but you
have developed an unlimited source of new staff and can grow
your business.
Why This Idea Will Work
There are numerous examples of individuals developing
their transcription skills by working in a QA capacity. Some
examples are dramatic. I once worked with a woman whose
first position in an MT service was to print the MTs transcribed reports. She would make the edits and corrections the
proofreader had marked on the draft hard copy. This was during the days of the MT/ST (magnetic tapeSelectric typewriter). She never listened to a word of dictation, yet this
woman learned medical spelling, vocabulary, and phraseology and later became an excellent MT!
Another MT I know completed an intense 5-week ER
transcription course and worked on the production floor for a
short while before transferring to QA. After a couple of years
in QA, having been exposed only to emergency room dictation (and the few practice tapes from AAMT), she passed both
portions of the CMT exam! Was this because the exam is too
easy? Certainly not. Ive taken the exam, and it is challenging even to experienced MTs.
I myself learned by reading radiology reports over the
phone to doctors offices. Years later, as an MT service
owner, I found that my skills as an MT improved by performing QA checks. Not wanting to be challenged on corrections I made in MTs work, I made certain that I could justify
every 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 learned

to move around the document quicklydeleting, editing,
moving blocks of copymy speed and skill as a transcriptionist improved as well. In addition, I was creating a spelling
checker for myself and other MTs (no good commercial ones
being available in those days), and I documented every term
I included. I corrected errors I had been making for years as
I documented terms I thought I knew! Again, my transcription
speed and quality improved as I found it less necessary to look
up terms while working. The need for documentation had
burned them into my memory.
Benefits of This Strategy
1. It will give new MTs additional ear training. By listening to the same physicians over and over, they will pick up
the repetitive phrases that are so important to recognize for
improved speed and accuracy. Recognition of such phrases is
what allows experienced MTs to type ahead of the dictation
by anticipating what comes next. They will also learn the
speech patterns of ESL physicians and other difficult dictators.
2. It will familiarize your new MTs with your companys
hardware, software, and ways of doing things. Even experienced MTs suffer through a learning curve and lowered production when adapting to new systems. In a far less stressful
environment than that of being on production, your new MTs
will become adept at using your companys hardware and
software. They will also quickly learn the formatting and style
preferences specific to your company and its clients.
3. It will familiarize new MTs with all your accounts,
formats, and special instructions. Changing accounts, adjusting to new formats, and remembering special instructions for
individual clients and dictators inhibit the production of even
experienced MTs. After leaving the QA department, your new
MTs will have no problems changing accounts and quickly
adapting to new formats and styles.
4. It will allow new MTs to learn the dictating habits of
difficult doctors. New MTs, struggling to earn an adequate
income on production pay, are easily frustrated and demoralized by trying to repeatedly decipher difficult dictations. This
can be avoided when the new MT reviews the transcription of
high-quality, experienced MTs. Listening and listening again
while reading accurate transcriptions will give the inexperienced MT a head start on the production floor.
5. It will give new MTs access to a data bank of reports
by difficult dictators and unlimited samples for style and formatting preferences. Samples, samples, samples. Whether in
QA or on production, nothing helps more when confronted by
poor dictation habits. Samples help prevent misapplying the
style and formatting preferences of one client onto another
clients work. In the QA department, staff members get used
to going from one client or dictator to another. If the new MT
creates and keeps a personalized notebook, it will prove
invaluable when that MT transfers into production. Of course,
its very important to remove all identifying information from
print samples and so-called normal reports.
6. New MTs will learn terms they dont already know by
hearing and seeing them in print in the work of your good
PERSPECTIVES, Fall 2001

17

What if you could start a new MT at

the same level of production and quality
that normally comes only after many
months on the job? What if it came at
little or no cost to youor even with a net
savings?
MTs. While the new MTs are in the QA department, all the
reviews they do should be with the audio dictation. Not only
will they learn new terms they didnt have the opportunity to
study while in school, they will learn the different ways dictators pronounce and mispronounce terms. If what they hear
is not what is on the transcript, they should, of course, ask the
supervisor to listen and verify the term.
7. The additional medical knowledge, ear training, and
familiarity they gain with company and production procedures
will ensure higher production when they do advance into production. This is a certainty. Once the new MTs advance to the
production team, they will have avoided the problems with
new hardware and software, new formatting and style requirements, and dictators theyre not used to, all of which impair
the performance of experienced MTs when changing jobs.
8. Keyboarding skills will improve. The new MT will
learn to edit and move quickly around the document using
shortcut key commands that many experienced MTs never
learn. They will cut and paste, search and replace, delete
words and phrases in chunks rather than character by character, and scroll through a document by a paragraph or screen
rather than by a line at a time. These essential keyboarding
skills will translate to higher speed and better production when
the MT advances to transcription.
9. It will do all the above while limiting the pressure to
produce. It is very difficult for a new MT to remain optimistic and have a good attitude about the job when under the
gun to produce enough lines to make a living wage. Yes, it
is necessary to accomplish a certain amount of work even in
the QA department, but generally, QA staff members are paid
by the hour rather than production. Certainly, if a company is
using the plan described in this article, new MTs should be
paid by the hour. Knowing that they are making significantly
more than they would be making if immediately thrust into a
production environment should ensure the loyalty and gratitude of new MTs. The extra boost a stint in the QA department will give them when they do begin production
transcription should be even more appreciated.
Elicit a Spirit of Cooperation
and Contribution to a Cause
Acceptance of this idea by your current supervisors and
MTs requires open-mindedness, cooperation, and a willingness to experiment. Therefore, your QA process must not be
a punitive one. If experienced MTs feel they may lose money
or respect based on the work of inexperienced MTs, youll
never sell this idea to them.

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PERSPECTIVES, Fall 2001

You will need to have at least one QA supervisor or experienced MT-QA staffer who will be responsible for answering
questions from the new MTs and reviewing their work. The
supervisor should approve any edits or corrections before
sending the work to the client or back to the transcriptionist
for feedback. Your production MTs must be given the opportunity to respond to any errors found in their work before the
results are engraved in stone.
Point out to your experienced MTs that these new MTs
could be sitting next to them, asking questions and needing
their help for things theyll learn instead in the QA department. Encourage a mentoring spirit in your experienced MTs
and a desire to contribute to the growth of new MTs beside
whom they will one day be proud to work. Ask them to
remember what it was like when they were inexperienced.
Could such a plan have helped them be better MTs? If your
staffing situation allows it, you may consider rotating even
your experienced MTs through a stint in the QA department.
Encourage a willingness to explore uncharted waters, to
experiment, and a desire to work toward the greater good
of the company and the profession.
It may take some time for MTs to accept this idea. Know
that and be patient. Encourage them to be patient as well and
to adopt a preferably positive wait and see attitude. Let
them know, however, that you are committed to giving the
idea a good trial. Tell them that as the trial progresses, you
will appreciate any ideas they may have for improving the
process. Listen to what they have to say but delay any immediate negative responses with a statement like, Ill consider
what youve had to say and get back with you on this. Okay?
How to Institute This Plan
Explain to newly hired MTs that they will begin their
career in the QA department. Share with them your philosophy and reasons for doing this. Reassure them that, although
they may feel their knowledge is limited, they will have excellent supervision and be working in an environment conducive
to learning. (And make sure thats the case!) Point out that
theyll make more money in this role than if thrust immediately into production, and theyll make more money faster
when they do advance to production.
The QA supervisor should probably spend no less than a
day orienting them to company procedures, department procedures, and an overview of production procedures. Give
them written, step-by-step instructions for all procedures.
Make certain they have adequate references. Your preemployment testing should have shown their ability to use
references. If that is not part of pre-employment testing for
your company, be sure they know which reference to use and
when and how to use it.
Be sure they know when to ask a question, that they
should never guess, and that they can ask questions freely
without reproach. The supervisor needs to have not only abundant patience but a nurturing and encouraging attitude. She
should also correct mistakes and criticize performance without
demeaning the new MT or sounding disparaging.

If there are other experienced QA people in the department, new MTs should review the work of your more experienced, higher quality MTs. This is true even if those MTs
are transcribing the more difficult doctors and work types.
This is the opposite of what you would do if the new MTs
were put immediately into production where they should be
given the easier work types and easier dictators. Your new
QA MTs can learn department procedures, software variations, and formatting and style preferences while reviewing
the work of your best quality MTs. This will prevent new
MTs having to learn too many things at once. It will also
expose them quickly to new knowledge and provide excellent
ear training opportunities.
Teach your new QA MTs how to access the same work
type and previous reports by the physician whose report they
are reviewing. However, they need to know that just because
something got through previously, it isnt necessarily correct. Comparing several similar reports by the same dictator
will often reveal discrepancies. Eventually, however, someone
will have figured out what the dictator was really saying. If
the QA specialist still questions a transcript, it should be
marked for the supervisor to listen to. The supervisor can use
such occasions to assess and work on ear training skills.
After about a month, the new QA MTs should be very
comfortable with formats, style preferences, departmental
procedures, any peculiarities in proprietary software, etc.
Now they can advance to reviewing a variety of work types
and difficulty levels. They can be assigned a specific client to
review, with a different client each week. Do this for about
another month.
For the third and last month of QA review, the new MTs
might be placed on strictly fill-in-the-blanks type work.
This would fine tune their ear training and give the supervisor a better sense of their critical thinking skills and problemsolving abilities.

After about a month, the new QA MTs

should be very comfortable with formats,
style preferences, departmental procedures,
any peculiarities in proprietary software,
etc. Now they can advance to reviewing a
variety of work types and difficulty levels.
At the end of three months, your new MTs should be able
to make the transition to production transcription with relative
ease. They still may not have the transcription skill and judgment of a seasoned MT. They will, however, transcribe more
work and with better quality than if they had been thrust into
production on day one. Within a day or two, or not more than
a week at most, these MTs should be transcribing enough to
make them happy with their income and you happy with their
contribution to your companys overall production. They will
have a greater commitment to quality, be more receptive to
the QA process themselves, and will continue to grow in
knowledge, editing skills, and speed because of the foundation
provided by their stint in the QA department. As well, you
will have a more loyal employee who understands the
behind-the-scenes factors that affect your companys
method of operation, its policies and procedures.
Carefully considered and properly carried out, this plan
can be a cost saving, comparatively painless, significantly
more effective way to bring recent MT program graduates
and inexperienced MTs into full, high quality production.
Authors Note: Portions of this article were contributed
by Georgia Green, CMT. It is based on a presentation the two
of us made at the 2001 MTIA Annual Meeting in Seattle.

Ellen Drake, CMT, of Peachtree City, Georgia, is coauthor of Saunders

Pharmaceutical Word Book and author of the
newly revised Sloanes Medical Word Book. A
former English teacher and medical transcription
instructor, Ellen has also owned a home-based
medical transcription service and has many years
of experience transcribing all medical specialties.
She is former Director of Education for Health
Professions Institute and has contributed to many
medical transcriptioin education and reference
books. E-mail: edrake@hpisum.com

PERSPECTIVES, Fall 2001

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