#7 - Your Own Business (Part 2)

Still considering going it alone? I don't want to intentionally dissuade anyone, but here are a few more things to think about.

What happens when you want/need time off? What about an unexpected surge of work, and you've promised the client to have the reports back within a specified time period? Do you have a backup plan to have someone cover for you? Even if you're not planning to hire MTs to work for you, it's a good idea to have temporary help available for the unexpected (and be prepared to work the occasional all-nighter).

Business owners must also think about the opposite - not enough work. Perhaps you're a year or two into your business and lose a large client, regardless of the reason. A lot of your expenses are fixed and don't increase/decrease in relation to your revenue stream. Are you financially prepared? This is especially critical if you have employees expecting paychecks. Nothing sends an MT running in the opposite direction faster than not getting paid.

Until next time ...

#7 - Your Own Business (Part 1)

Having your own transcription business can be quite exciting. There's undoubtedly a sense of pride and accomplishment that comes with this achievement, but MTs considering this venture should weigh out all pros and cons.

The MTSO (Medical Transcription Service Owner) must wear many hats! Before the company can generate revenue, it needs clients. You must be ready and willing to knock on doors to solicit transcription business. It only takes one to get started, and if you do a great job, referrals from that one client are always a possibility. An advertising campaign can't hurt either, but this comes with a cost.

Before you solicit customers, you must know what you're going to charge them. This entails not just determining a per-line cost but the definition of your "line." Will you charge on a gross line or a character-counted line? If the latter, what methodology are you using to calculate that line? Is that method easily verifiable? Should a client challenge the line count you bill on, can your method support your invoice? Believe me - it must, or your business will probably be short lived.

Insurance is another must-have. Your clients are entrusting you with very, very confidential information, allowing you to take it to your office (be it commercial property or within your home). You must ensure the utmost in safeguards to protect that sensitive information, just as you must protect yourself in the event of a breach. Talk with your insurance representative and be sure you're covered. Don't make a policy decision based solely on price. Know the liability policy well and understand your protection.

#6 - Transcription Service (Part 4)

A final word on services ... for now.

One of the big advantages of working for a service is a pretty consistent flow of work. (Remember - you're probably getting paid on production, which means if there's nothing to type, you're earning nothing.) Depending on the size of the company and the number of customers they service, you may work simultaneously on 3 or more accounts. Then you should never run out of work, right? Well, not necessarily. There is a "seasonal" component in this industry, and although they're few and far between, there are times when incoming dictation will be slow. The week between Christmas and New Year's is definitely one of those times.

The key is to plan ahead. If you're working with a well-managed service, they should be tracking their volumes and be willing and able to share volume peaks and valleys with you (and even if they're not, track them yourself!). While work might be slow the week after Christmas or the weekend after Thanksgiving, it'll be coming in like crazy in the preceding weeks, and bonuses and overtime may be plenty. Some services will offer up to an additional $0.02/line as a bonus when accounts are behind. Take advantage of these opportunities and put away some of that extra cash to supplement the smaller paychecks.

Again - periods of low work are few and pretty short-lived, and the work certainly doesn't stop completely. There are peak times when MTs like to work, however, and if you're competing for jobs to transcribe during those peak times, well ...... be willing to work some evenings, and you'll never be without work. I recognize that many individuals work at home to be with their kids, and evening time is prime time with the family, but sometimes some sacrifices have to be made. Giving up a few evenings here and there is a small price to pay for having all the others free. You'll also earn the reputation within your service of being a team player, which can go a long way.

Enjoy the weekend!

#6 - Transcription Service (Part 3)

Payment methods of transcription services vary widely and are deserving of their own discussion. Almost always based on production, the typical method is a set amount for each line of transcription (i.e., $0.07 for each 65-character line). Brand new MTs can start at rates as low as $0.05, and seasoned MTs working shifts can command up to $0.12. Where the situation can get a little tricky is in defining the "line."

A "gross" line refers to each line on a page, regardless of how many words or characters it contains. If dictation happens to end after you've started a new line which has only one word, that still counts as a line. Not too many services pay on gross lines anymore ... for reasons I'm sure are obvious. Larger fonts and wider side margins have huge impacts.

The more common method in current times is a count of characters then divided by the number which defines a line, typically 65. In other words, all characters typed on a page are counted and divided by 65; the result is the number of "lines" the MT is paid for. This is a fair method, but when comparing service to service, be sure to know if blank spaces are included in the character count. Being paid on a 65-character line that doesn't include spaces is very different than one which does. It may not be visible, but your thumb still has to hit that space bar. Some services may pay on actual keystrokes, but that too can be unfair to the MT who has built up a library of macros or shortcuts, designed to display full words, sentences or even paragraphs with just a few keys.

Whether line counts include headers and footers is another consideration. A footer may consist of the patient's name, medical record number and a page number. The name and MR# are probably pulled in from a field that the MT did type - but only once. If the document is 5 pages long, that footer is going to appear 5 times. Some services will count footers in the total character count, but don't be surprised if they're not. Again - you've only typed them once, so to be paid once really is fair. If you're paid for every time they appear, say a quiet "thank you," even if only to yourself.

This same rule applies to headers, both those at the top of each page (similar to footers) and those used within the body of a report to designate a new paragraph (i.e., "History of Present Illness" or "Physical Examination"). Depending on the software being used, some companies may present you with a template that already includes these headings in the document. They may or may not be included in your character count because - you really didn't type them. If you are paid for them, whisper that "thank you" again. It's pointless, not to mention unprofessional, to argue that the service bills the client for those characters. You're not paid based on what the service charges ... that's between the service and their clients.

Until next time!

#6 - Transcription Service (Part 2)

Most medical transcription services require at least one year of transcription experience before they'll even consider testing a candidate. While some are willing to hire new graduates, those openings are often limited in number and can require the MT to work various shifts. Be prepared to take at least a transcription test consisting of a variety of medical documents, but written tests to determine a candidate's skills in grammar, punctuation, etc. are also common.

After successful completion of testing and acceptance of an offer comes equipment. Some services will provide equipment, others may require that MTs provide their own, and some will lease equipment to MTs for a monthly rental fee. The handling of equipment is often tied to the type of openings the service has - statutory (basically independent contractor) or employee. In addition to equipment, MTs who are actually employees of a service also receive employee benefits ranging from health insurance to paid time off (PTO) and 401(k) plans. They may also be reimbursed for internet expenses should internet connection be required to access voice files and transmit documents.

Methods of payment by services can run the gamut and will be touched on in a separate discussion.

Enjoy your day!

#6 - Transcription Service (Part 1)

In the late 1980s and early 1990s, transcription services were few, and of those, even fewer provided an opportunity to work from home. Telephone costs were still quite high, so those MTs who could work at home were limited geographically, being required to live close to the office (or at least within toll-free calling distance). Reduced phone rates and VoIP have certainly changed all that! The number of transcription services continues to grow, and experience MTs with a good work ethic have multiple options to choose from.

Working for a service means this: The service goes out and solicits business from hospitals, physician practices, etc. (all those business types previously discussed). The service then makes the work available to transcriptionists for processing. The MT transcribes the documents and returns them back to the service, not directly to the client, for processing. It's up to the service to properly format and deliver the documents according to their contract with the customer. All the MT needs to do is perform the work according to any guidelines provided by the service and do so in a timely manner. Sound easy enough?

Now what?

Fast forward 2-3 years when you finally have a few years of transcription experience - now what? If you have a great job, the choice is obvious; however, if you're working on site and still yearn to be at home, you have two options.

#5 - Teaching University Hospital

Teaching hospitals affiliated with universities differ from the previously discussed acute care hospitals in that they also serve as teaching facilities for new healthcare practitioners. Medical students and residents are assigned to attending physicians in rotations, and they quite frequently will be assigned the responsibility of dictating necessary documents. Dictating is a skill that must be learned and honed over time ... this is where they start!

Like hospitals, university facilities don't frequently allow their employees to work from home, so MT applicants should be prepared to work on site.

#4 - Acute Care Hospital

New transcriptionists often shy away from seeking work in a hospital. Why? Hospitals are least likely to allow their employees to work from home (although that number is on the rise), but this is the best training ground for the newbie MT. Depending on the size and location of the hospital, multiple specialties will be encountered. In addition, hospitals are required by regulatory bodies to maintain patient documentation, so MTs will also encounter a wide variety of report types.

Hospital settings also allow MTs access to patient records. If a healthcare professional is dictating the name of a drug that can't be deciphered, the MT has access to a chart that probably has the name of the drug written within.

Most importantly, however, the hospital setting allows the new transcription to work among fellow MTs. Stuck on a word? There's always another set of ears ready and willing to give a listen and help out.

#3 - Outpatient Surgery Center

With more and more surgical procedures being done on an outpatient basis, many surgeons are setting up facilities where patients can have procedures without a visit to a hospital. Many of these facilities are state-of-the-art and approved by insurance carriers. Although medical language exposure could again be limited to the specialty of the surgeons (i.e., plastic surgery, genitourinary, orthopedics), working in this setting would better prepare the new transcriptionist to transcribe operative reports. Here is where those anatomy and physiology classes will really pay off!

MTs seem to have a love or hate relationship with ORs. Personally they're my favorite! The content is always interesting - sometimes downright fascinating - and they don't contain a lot of numbers to transcribe, as would other reports containing medicine dosages and lab values. It's certainly a personal preference .... for every MT I know that loves ORs, I know another who won't go near them!

#2 - Multispecialty Clinic

A step up from a priviate physician practice would be a multispecialty clinic. This would be a group of physicians from varying medical specialties in one setting. Sometimes the specialties are complimentary to each other (i.e., obstetrics and gynecology, pulmonary and cardiology), sometimes not. The group could even be an HMO (think Kaiser Permanente) where patients covered by a single insurance type can seek medical care for a variety of conditions. This setting would expose the new medical transcriptionist to a wider medical vocabulary than the single physician practice.

#1 - Physician office

A physician's private practice will probably be the easiest place for a newly trained transcriptionist to find work. Be aware that you may be required to also perform other duties (i.e., telephones, filing, billing, etc.). While this avenue does provide opportunity to gain transcription experience, your exposure to medical language will be limited to the physician's specialty (i.e., orthopedics, OB, urology, etc.). If your goal is to work from home independently, few transcription services would be willing to hire an MT with this type of background. Of course, you could negotiate an arrangement with the physician to transcribe at home ... ;-)

Where to work?

In the subsequent posts, I'll outline some of the places a medical transcriptionist can find work.

What are the education requirements?

At a minimum, a strong background in medical terminology is required of a medical transcriptionist, but a good understanding of anatomy and physiology will prove extremely beneficial to the MT just starting out. Proficiency in English, grammar and punctation is also recommended. Some healthcare providers are great dictators, some not so great. While some institutions demand "verbatim" transcription, meaning you type exactly what is heard, regardless of how incorrect it might be, while others permit - and encourage - grammatical editing.

Not surprisingly, US transcriptionists will frequently encounter foreign dictators, commonly referred to in the transcription world as ESLs (English as a second language). Some are difficult at first, but they can be mastered. The MT with a trained ear for various foreign accents will rarely, if ever, be out of work.

What exactly is medical transcription?

Medical transcription is the process of listening to physicians and other healthcare providers dictate medical reports and then typing what's heard, creating a document that will become a permanent part of a patient's medical record. Have you ever been in a physician's office or hospital and see sometime talking into a small hand-held machine? He/she is probably dictating someone's medical chart.

Accuracy of these documents is absolutely critical. Would you want to get copies of your own medical records 5 years from now and find out you were labeled with the wrong diagnosis? What if someone mistakenly typed the dosage of one of your medications wrong, and you ended up unconscious in a hospital in another city or state? The persons caring for you could obtain your medical records and administer that incorrect dose. Sadly, it happens.

Tax Season Fast Approaching

Working from home does bring some tax advantages. You will be permitted to deduct a percentage of your utilities, rent and insurance for the portion of space used for the home office. The percentage is calculated by either using actual square footage - if known - or number of rooms. If you live in a 2-bedroom apartment with a kitchen, living room and dining room and use one of those bedrooms as an office, you can deduct 20% of heat, electric, rent, etc. (1 room divided by 5 total = 0.20).

I tend to overlook (read: forget) mileage. Sure, if I have to take a lengthy drive somewhere for a special event or meeting, it's easy to remember to jot down the miles. But don't forget those short trips. Going to the post office to mail a work-related package counts, just as those trips to Staples or Office Depot for work-related supplies (also deductible). Everything counts!

Independent Contractor vs Statutory

My last post made mention of statutory employee. In the transcription world, there are typically three categories to choose from:

1) Company employee. This means your employer will provide equipment, and you will typically be entitled to company benefits; however, your employer will determine your schedule, even when working from home. You will probably be held to both an hourly schedule and be expected to maintain a production level.

2) Independent contractor. Here you are self-employed. You can either go out and round up your own clients, or you can work under contract with a service and transcribe for their clients. You will be paid on production, typically a rate for every line transcribed. You may have to submit an invoice to be paid, and no taxes will be withheld, so you'll be responsible for quarterly payments. At the end of the year, you'll receive a 1099 instead of a W-2 and have to complete a schedule C.

3) Statutory employee. This is the same as the independent contractor status with two exceptions. First, your Social Security will be withheld from your check, AND the company you contract with will pay their half (as an independent contractor, you'll pay "self-employment tax" which is essentially double Social Security - your portion as the "employee" and your portion as the "employer"). At the end of the year, you'll receive a W-2 instead of 1099, but the section for Statutory Employee should be checked so you're not hit with the SSI.

What's important to note here is that medical transcriptionists who function as statutory employees are earning a little more than their counterparts paid at the same production level but classified as independent contractors. Not having to pay the "employer" portion of the Social Security tax is really earning an additional 7.65%.

Licks & Wags .... Woofie

To employee or not to employee

I ran into equipment trouble today ... great way to start the week. As a company employee, my equipment is provided at no expense to me. When something breaks, I can pick up the phone or e-mail our support center and request a replacement. Years ago while working as a statutory employee under contract, I had to supply all my own equipment. True, it was a cash layout and I had to replace/repair things as they broke, but I was able to write off those expenses on my taxes and, more importantly, could run out immediately and have what I needed within hours as opposed to waiting.

Writing this reminds of the year a cassette recorder broke, and I had to go to the mall for a replacement ... the day after Thanksgiving ... not pretty.

Off-topic rant ...

Am I the only one who notices that when you visit a designated Web site to check on the status of a rebate, despite checking 2 weeks after the deadline, a record of your rebate cannot be found .... only to have the check coincidentally show up in your mailbox 3-4 days afterwards. I'm sure it's safe to assume that if I didn't check, the rebate would never show up.

That's bad enough, but NOW instead of the normal rebate check, I get a $30 debit card ... a debit card that cannot be used at an ATM to withdraw cash ... and now a debit card, I come to find, that has been denied at two different stores when I tried to use it. Oh ... and did I mention the monthly $3.00 maintenance fee for the debit card that doesn't work?

Woofie is growling and showing teeth ......

What do do?

Have you been searching the web for work-at-home opportunities? Don't be surprised when some carry a cost just to learn more about them. Sometimes we have to spend money in order to make money.

For companies sending you written materials, this isn't uncommmon - provided the price is reasonable and comes with a money-back guarantee. There is a cost involved with creating printed materials, along with packaging and shipping. I would be leery, however, of a company asking $79.95 for a downloadable file.

Always remember - if it sounds too good to be true, it probably is.

My Story

Before discussing the pros and cons of working from home, let me share a little about myself. I have a background in healthcare, and my main at-home profession is in the field of medical transcription. I’m a company employee working in management now, but when I first left my hospital job 16 years ago, I was earning a living soley by transcribing medical reports, being paid on production. I had been in a stressful full-time supervisory position and working part time for a local physician while also trying to complete my degree when I happened upon an advertisement seeking transcriptionists to work from home. I applied and was offered a contract as an independent contractor. I gave up the part-time job but maintained the full-time position while I acclimated myself to the new role.

Within 4-5 months, I was earning almost as much for the part-time transcription, working 15-18 hours per week, as I was at the full-time job (excluding benefits, of course) working 45 hours a per week). It became obvious that if I gave up my hospital job and just transcribed, I could probably double my income and work less hours, allowing me more time for classes.
Note must be made of a few critical points:

• I came into transcription with 5+ years of healthcare background. I did not learn to transcribe through one of the schools advertising in Soap Opera Digest and National Enquirer promising me $40,000 per year if a took their $2,000 18-month training course.
• I had no children and so had a quiet environment to work in.
• I do take pride in a strong work ethic, but as an independent contractor paid on production, if you don’t work, there’s no check.
• Finally, I’m a pretty fast typist.
  

I don’t mean to knock all at-home transcription courses, but some are rip-offs - consider where they’ve elected to advertise! There are a few credit-worthy courses available if you’re willing to put in the time. I’ll try to dig up some links in the near future.

Don’t forget to hug your pet today … Woofie

Greetings and welcome!

Caught up in the excitement and enthusiasm of a group of individuals I have much respect for, I begin my first blog. I didn’t have to go far to choose a topic. There is so much marketing and advertising geared these todays toward working from home - some good, some not so good. More and more companies are even sending their employees home to work from virtual offices - good for some folks, not so good for others.

I’m into my 17th year of working from home, so I think I’ve learned a thing or two along the way. Over the coming weeks and months, I’ll be sharing my experiences with you - some good, some not so good.

Licks and tail wags … Woofie