Medical Transcription For Dummies^®

Introduction

You’ve probably heard that medical transcription is a flexible career that you can do from home. Perhaps you’re attracted to the idea of being part of the drama and intimate details of medical care, and medical transcription sounds like it would be very interesting work. Maybe you just want something, anything, you can do from home to earn a buck, and you’re wondering if medical transcription could be it.

Despite what some advertisements might lead you to believe, it’s not true that anyone willing to take a course can become a medical transcriptionist (MT) and earn big bucks working from home. It is true that it’s interesting, challenging, and often flexible work. Many MTs do work from home. You can prepare for and launch an MT career without ever stepping out your front door, if you want to. For some people, it’s a great career option, but it’s not the right choice for everyone.

About This Book

This isn’t a textbook about how to become an MT. You don’t need to read it cover to cover or even in order. Dip into the part you need, when you need it. Come back later and dip into a different section when you need that. Consider this a quick study guide, reusable reference, and career companion.

There’s a lot of information, and even more misinformation, available about working as a medical transcriptionist. This book is here to help you sort fact from fiction, so you can decide if you want to become an MT, and if so, how to go about it. It’s also designed to stand beside you and answer the questions that most commonly pop up after you get on the job.

Conventions Used in This Book

I don’t use many conventions in this book, but I do use a few:

When I define a new term, I italicize it. You can find the definition nearby (often in parentheses).

I use monofont for web and e-mail addresses. Note: When this book was printed, some web addresses may have needed to break across two lines of text. If that happened, rest assured that we haven’t added extra characters (such as hyphens) to indicate the break. So, when using one of these web addresses, just type in exactly what you see in this book, pretending as though the line break doesn’t exist.

What You’re Not to Read

The shaded boxes that appear here and there are sidebars. They include extra information that’s interesting or fun. The material in them isn’t essential to understanding the topic at hand, and you can bypass them without missing out on key concepts.

The Technical Stuff icon identifies extras included for people who like to know the details behind things. If you’re not one of them, it’s okay to zip right past.

Foolish Assumptions

I figure you’ve probably picked up this book for one of the following reasons:

You’re thinking about becoming an MT and you want to know what the job entails and how to get started.

You’re already an MT student and you picked up this book to help you get off to a flying start.

You’re a working MT who’s as obsessed with learning and growing as you’ve always been.

I also assume that you want to get straight to business and not waste time lollygagging around.

How This Book Is Organized

This book is broken into parts that parallel the journey to an MT career. It starts at the beginning with career exploration and moves on to identifying and mastering practical skills and then to landing and managing an MT job. The final part provides reference materials you can use to help you on the job.

Every chapter in Medical Transcription For Dummies is designed to be entirely self-contained. You can go through them in order or jump straight to whatever you need at the moment. This is one time when you can have something both ways.

Part I: So, You Want to Be a Medical Transcriptionist

Before diving into a career in medical transcription, you’ll want to know exactly what’s involved and what to expect. This part will give you the basis to decide if medical transcription is a realistic career option for you, and if so, how to get off to a running start. It starts with an inside look at what MTs do on a daily basis and what it really takes to break into the field. You’ll also survey the types of places MTs work and how much you can expect to earn. One of the most crucial foundations to a successful MT launch is getting the right training. This part identifies what that should include so you don’t spend good money on bad training.

Part II: Getting the Job Done: Medical Transcriptionist How-To

This is where you’ll meet and build the technical skills that lie at the heart of a successful medical transcription career. You can put yourself through medical terminology boot camp and study up on the mechanics of formatting medical reports following accepted standards. There’s also a chapter packed with tips for deciphering difficult dictation and tricks for coping with mumbly mouthed dictators. In medical transcription, time is (your) money. The chapters on effective referencing and speed-boosting techniques will help you lay in the skills so you can be fast and accurate.

Part III: Looking At the Types of Reports You’ll Transcribe

This part takes you on an in-depth tour of individual reports and how to transcribe them. Each member of the “Big Four” family of reports gets its own detailed chapter. You also step through another half-dozen report types you’re likely to encounter.

Part IV: Employment Matters: Landing and Managing a Medical Transcriptionist Job

MT skills are useful only if you can put them to work! This part offers tips and advice to help you choose and land your first MT job — and the one after that. There’s a chapter explaining the technical details of outfitting a home office. If you opt to work as an independent contractor (IC), you’ll want to read the chapter on financial matters, for sure.

Part V: The Part of Tens

If you’re a fan of top ten lists, this is the part for you. It includes ten factors that contribute to MT success, busts ten common myths about medical transcription work, and introduces you to ten online resources that stand head and shoulders above the rest.

Part VI: Appendixes

Good references are among an MT’s best allies. The glossary, transcription examples, and sample reports in this part are here for you to turn to when you need a little help. They don’t eradicate the need for dedicated reference books, but they do provide a unique cross-section of material that zeroes in on the items experience shows you’re most likely to need.

Icons Used in This Book

As you go through this book, you’ll see the following cute little icons in the margins. Here’s what they mean:

The Tip icon points out a handy technique or shortcut that can save you time or help you avoid frustration down the road.

When you see the Remember icon, it’s pointing out a key concept you’ll want to file away in your brain for future use.

The Warning icon alerts you to potential pitfalls and things that can cause serious trouble. When you see it, pay extra-careful attention to the text nearby.

The Technical Stuff icon points out technical tidbits that are interesting but not absolutely necessary to understanding the topic at hand. If you want all the details you can get, read them. If you want just the basics, skip them.

Where to Go from Here

By all means, jump into this book anywhere you’d like. If you’re in an exploratory phase, Chapter 1 is the obvious place to begin, but you may also head on over to the Part of Tens and start by clearing up ten myths about medical transcription. If you want to take a gander at some actual medical reports, Appendix C has you covered.

If you’re burning to steep yourself in medical terminology as quickly as possible, the boot camp in Chapter 5 is specifically for you. If difficult dictators have you hog-tied, Chapter 7 will help you decipher what they are (in theory) saying. Working MTs and students near graduation may be particularly interested in the “faster, faster” productivity techniques in Chapter 9.

Thinking about going the independent contractor instead of employee route? Be sure to read Chapter 19 so you can get your financial ducks in a row and keep them there.

You also can read this book in the ordinary, straightforward manner: Start at the beginning and keep going until there are no pages left to turn.

Chapter 1

Just the Facts

In This Chapter

Looking below the surface to see what medical transcriptionists really do

Surveying employment options and paycheck possibilities

Identifying the skills medical transcriptionists need

Taking a peek at the reports you’ll transcribe

Charting a career in medical transcription

If you’re considering a career in medical transcription, there are some things you should know. The very first is that what medical transcriptionists (MTs) actually do all day is a whole lot more interesting and much more difficult than what most people think. Typing fast while listening to someone speak in tongues over headphones is just the tip of the iceberg.

Okay, the dictator isn’t really speaking in tongues, but it often sounds like she is, and the iceberg part is completely true. In this chapter, you’ll explore the 90 percent of medical transcription that most people never see because it’s out of sight, just like the largest part of an iceberg.

If you’ve heard that a lot of MTs work from home, you are, indeed, well informed. For many MTs, the daily commute is no farther than the walk from their breakfast table to their home office. Some MTs commute to their place of work, just like other employees, although these seem to be dwindling in number.

Medical transcription work has many attributes that attract people looking for a fresh career start. You can train and work from practically anywhere you can get an Internet connection, including your home. Nobody cares what you look like or how old you are; the only thing that matters is whether you can do the job well. Schedules often can be juggled so that you can work around other commitments.

It’s not all peaches and cream, however. Medical transcription can be high-stress work, and you aren’t likely to get rich doing it. It takes a particular set of personality traits and technical skills to survive and thrive in an MT career. This chapter introduces the world of medical transcription, so that you can decide if you want to become a part of it.

Getting the Skinny on the Medical Transcription Field

A medical transcriptionist’s job is to produce the clearest, most accurate healthcare documentation possible — and do it fast. Within the course of a day, a patient who comes into a hospital emergency room and is admitted with appendicitis will generate:

An emergency room (ER) report

Probably a CT scan or ultrasound of the abdomen

A consultation with a gastroenterologist and/or a surgeon

A complete preoperative history and physical examination

An operative report detailing the appendectomy

Potentially periodic progress notes

A discharge summary when sent home the next day

And all of them require transcription. That’s one patient, one hospital, one overnight stay. Multiply that by the number of patients who walk into hospitals each day, seven days a week.

Hospitals aren’t the only prodigious producers of medical reports. Physician practices, specialty clinics, alternative health practitioners, managed care organizations, diagnostic facilities, and lots of other places all generate dictation every day.

These are the records that healthcare providers return to time and again when deciding what treatments a patient will receive immediately and in the future. They’re also legal documents. They may be used to determine whether someone is eligible to receive disability benefits and how much. In some cases, they’ll be pulled out when determining compensation for an injury or death that occurred as the result of someone else’s actions.

MT work is interesting, intellectually challenging, and a whole lot harder than people who’ve never done it can imagine. Many people spend good money on MT training, only to find that they don’t like doing medical transcription, and it doesn’t like them much either. Other people absolutely love it. The people who love it tend to share certain personality traits. Top among them are

A love of language and a passion for learning

The desire and ability to work independently and sometimes under pressure

A perfectionistic streak that makes attention to tiny details come naturally

Where the jobs are

MTs work in hospitals, physician practices, and other types of facilities. Many MTs are employed by medical transcription service organizations (MTSOs). An MTSO is a service bureau for medical transcription work. Many medical facilities that used to perform transcription in house now outsource it to MTSOs, making them a top source of MT employment.

It’s hard to say exactly how many people are currently doing MT work. The Bureau of Labor Statistics (BLS) estimates that nearly 79,000 MTs were on employer payrolls in 2010. There are actually a lot more than that, because BLS figures don’t include self-employed MTs, of which there are many. Self-employed MTs work as independent contractors (ICs), providing transcription services to one or more transcription clients.

How much they pay

MT earnings are hard to pin down for similar reasons: A lot of people aren’t counted. The BLS figures put the 2011 average annual wage for MTs across all industries at $34,050 and the hourly wage at $16.37. MTs working for medical and diagnostic laboratories or for general hospitals earn more than the average. Employees of business support services earn a bit less.

The BLS has the largest pool of pay data, but because it doesn’t include self-employed MTs, it’s a very incomplete picture. Figures available through Salary.com are more current, though less extensive. As of May 2012, Salary.com reported the average MT base salary to be $38,695.

Although MT pay is reported using hourly and annual figures, it’s usually calculated based on production. MTs typically earn a fixed amount for each line they transcribe. An MT making 8 cpl (cents per line) would earn $100 for transcribing 1250 lines (1250 × 0.08 = $100).

The number of lines a transcriptionist produces in any given day is affected by many factors. Some MTs have a target number of lines and work until they reach it; others work a set number of hours and transcribe as many lines as they can within that time. If you’re quick and have good dictation to work with, you can really crank out the reports and rack up your line count. On the downside, a string of really terrible dictators can slow your production and, thus, your earnings to a virtual standstill and make you feel like pulling your hair out.

To really dig into the details of MT job options and pay, head to Chapter 3.

What it takes to break in

You don’t need a license or certification to work as an MT, but formal training is an absolute must. Without it, no one will hire you. Even if you could miraculously wrangle your way in the door, to survive on the job, you’re going to need to tune up skills you already have and learn entirely new ones. There are two really good places to get MT training:

Community colleges: Community college programs come with the benefits of classmates, a fixed schedule to keep you on track, and face-to-face interaction with your instructors.

Online MT schools: Online programs free you to study on your own schedule, without leaving home. Online courses can be a great option for people with the self-discipline to study regularly and stay on track.

Either type of training will provide you all the skills needed to get out of the starting gate.

The quality of MT training programs varies greatly, and choosing a bad one can be an expensive and frustrating mistake. Chapter 4 provides additional information to help you choose wisely.

Studying to become an MT is guaranteed to be interesting, but it won’t be as quick as some advertisements may lead you to believe. Fast learners with plenty of time to devote to studying can complete an MT training program in about nine months. Most students require a bit longer. If you’ll be fitting studying in around a busy family life and/or a job, plan on a year or even two.

MT employers expect even new MTs to arrive ready to hit the ground running, although you’ll continue to learn on the job. Absorb and practice as much as you possibly can while a student — you’ll be really glad you did later. While you’re at it, earn the highest GPA you possibly can. The higher your GPA, the easier it will be for you to land your first MT job.

Before you plunk down tuition and devote yourself to MT training (or decide not to), be sure to read Chapter 22. There’s quite a bit of MT fiction floating around, and Chapter 22 tackles it head-on.

Looking at What Goes into Good Transcription

A lot more goes into producing the neat, clear medical reports we all prefer to have in our health records than is apparent by reading them. MTs remove ambiguities, clean up jargon, and catch inadvertent errors that could prove catastrophic if they slipped by unnoticed. They take often messy input and turn it into a report that’s clear to everyone who reads it going forward, not just the person who originally dictated it. And they have to do it quickly, or else it’s cheerio, old chap — good luck in your next career!

To accomplish these feats, MTs apply skills that go far beyond listening well and typing fast. Truly understanding the language of medicine ranks at the top. It’s not just a matter of memorization, thank goodness! Memorizing even a fraction of the 120,000-plus terms in a standard 2,000-page medical dictionary would take a very, very long time. MTs don’t have to do that, because most medical terms are built from a set of reusable parts, combined and recombined to generate new meanings. MTs know the parts and how they work together. That makes the meaning of even unfamiliar terms instantly recognizable, and conveniently also possible to spell and pronounce. Without this knowledge, recognizing a term like choledocholithotomy the first time you heard it would be nearly impossible; with it, it’s a piece of cake. Chapter 5 provides a crash course on exactly how to do this.

Not all core MT skills are as fun as mastering medical lingo, but they’re necessary nonetheless. Not coincidentally, the better you are at them, the more successful your MT career will be. A solid MT

Has a well-stocked arsenal of tips and tricks for deciphering difficult dictators, whether they be mumblers, speed talkers, or people who haven’t mastered speaking English to the same degree that they’ve mastered practicing medicine

Is an expert on the nuances of formatting, punctuating, and capitalizing every aspect of medical reports according to industry standards

Knows how to quickly sleuth out details to confirm, rule out, or pin down a slippery word, phrase, medication dosage, facility name, or anything else

Is well versed in MT productivity tools and techniques, so they can transcribe as quickly and efficiently as possible

The MT uses all these skills to do one, not-so-simple thing: transcribe a healthcare provider’s spoken words into a neat, clear, and accurate medical report.

Anticipating What You’ll Transcribe

A lot of MT work involves transcribing a core set of reports nicknamed the Big Four. They’re so central that this book dedicates a chapter to each of them. They are

History and Physical examinations (H&P; Chapter 10)

Consultations (Chapter 11)

Operative reports (Chapter 12)

Discharge and death summaries (Chapter 13)

The Big Four make up a large share of MT work, but they’re accompanied by a huge constellation of other report types. For starters, an incredible variety of diagnostic procedures is used to probe the human body and pinpoint what’s gone awry, ranging from EEGs to echocardiograms and Doppler ultrasounds, to overnight sleep studies where the patient is wired up to more sensors than a crash-test dummy and every breath recorded and analyzed. All these diagnostic studies generate reports that need to be transcribed.

Another large batch of transcription work arrives in the form of routine office notes and progress reports. They come from checking up on Mr. Smith’s diabetes, diagnosing Mrs. Jones’s pregnancy with twins, and following up on Grandpa Bill’s long list of age-related ailments. These give you a true cross-section of the human condition and make you appreciate your own health.

MTs also transcribe special-purpose reports, such as psychiatric assessments, autopsy reports, and independent medical evaluations (IMEs), among others.

Making a Career of Medical Transcription

Somewhere between deciding you’re about ready to hit the job market and starting to polish up your résumé, you’re going to have to make a few key decisions, among them:

What type of medical transcription do you want to do? Some MTs are eager to dive in to a fast-paced acute care transcription environment; others find working for a small physician group or clinic more attractive. Becoming a specialist in a field like diagnostic radiology is an option, though it’s one that’s not widely available to entry-level MTs.

Do you want to work as an independent contractor or as an employee? MTs can find work as either an employee or as an IC. Both are very common, but they’re quite different propositions. The first is an employer-employee relationship; the other, a business-to-business (B2B) relationship. Each has pros and cons to consider:

• Employees are under the direct control of an employer. They have to do what the employer dictates, including working particular hours, working extra hours, or using specific methods. It’s the kind of arrangement that anyone who’s ever held even a part-time job is familiar with.

• Independent contractors, on the other hand, are self-employed. An IC is essentially running a business providing MT services. ICs have greater control over their work schedule and workload. They do, however, have to take on more taxes and don’t get to take advantage of employer-provided benefits. There’s a lot more to the IC picture, so if it’s on your list of possibilities, check out Chapter 19 for a detailed look at the financial ins and outs of working as an IC.

Once you start job shopping, you’ll quickly discover that one-stop job boards like CareerBuilder (www.careerbuilder.com) and Monster (www.monster.com) contain a bountiful supply of MT openings. Unfortunately, nearly all of them seek applicants with at least two years of experience, something that newly graduated MTs just don’t have. Fortunately, there are better places to look first anyway. In fact, your first (or your next) MT job may be as nearby as your training school’s list of connections. That’s one of the best places to start a fresh job search. Online MT communities and professional relationships are top resources, too. As with any other career, there’s no guarantee there will be a slew of employers waiting for you with open arms the minute you graduate. Some new graduates find employment right away; others really have to work at it.

MT employers routinely require applicants to pass a skills test as part of the application process. Just when you thought you were done with those pesky things, too! Pre-employment tests are an easy way for employers to weed out people who think they’re qualified but really aren’t. Take it as a piece of job security and further evidence that MT work is much more skilled than it appears on the surface. Your first test probably will be a little nerve-wracking, but if you know your stuff, you’ll pass with flying colors.

Once you’re on the job, you’ll discover something else about MT work that most people don’t know: At times, it’s really quite entertaining. When a doctor says something like “The patient came to see me today because she wants to get pregnant,” or “He denies a foul odor to his diarrhea,” how can you help but laugh?

MTs learn something new each and every day. It may be an interesting term, like furuncle, or running across HELLP syndrome or Christmas disease for the first time.

Medicine and technology are inextricably intertwined, and both evolve at an astounding rate. As an MT, you’ll need to evolve with them. It helps to be a passionate learner, as most MTs are.

Some of the largest changes right now involve the widely trumpeted arrival of speech recognition technology (SRT) and the federally mandated move to electronic health records (EHRs). Some people think these two things spell doom for the medical transcription field. Those are primarily the same people who focus on the top 10 percent of an iceberg and completely ignore the other 90 percent.

For example, speech recognition has come a long way, but MTs who clean up after it call it “speech wreck” for a reason. Only a computer can take “This is a 5-foot 6, 145-pound male” and turn it into “This is a 5-foot, 6,145-pound male,” or mindlessly record that a male patient underwent a radical hysterectomy. This is the kind of stuff that’s going to replace medical transcriptionists? What a terrifying prospect from the patient’s perspective! Medical malpractice attorneys and insurance providers must find it horrifying as well.

These particular boo-boos never made it into patient records, because MTs caught and corrected them first. But things like them occur all the time. Sometimes as many as 40 to 50 in a two-minute dictation. I couldn’t find a single MT who has ever seen an error-free SRT report. Not one, ever. Obviously, “speech wreck” won’t be replacing MTs any time soon. In fact, in some ways, it provides job security.

EHR is not likely to eliminate the need for MTs either. Healthcare providers need a way to include free-form opinions and discussion. Dictation provides it, and MTs are integral to making dictation work.

Things like new technologies and healthcare legislation impact how an MT carries out her job. The underlying mission, however, remains the same: to produce the most clear and accurate healthcare documentation possible, and do it fast! If you think that’s something you could learn to do, and want to do, then an MT career may be in your future. This book is here to help you decide if you and medical transcription are a good match. If the answer turns out to be yes, it’s also here to help you make it happen.